1592 Records downloaded - Mon Apr 16 12:15:47 UTC 2018
RECORD 1
TITLE
A Case of Nebulized Naloxone Use With Confirmatory Serum Naloxone
Concentrations
AUTHOR NAMES
Minhaj F.S.
Schult R.F.
Fields A.
Wiegand T.J.
AUTHOR ADDRESSES
(Minhaj F.S.; Schult R.F.; Fields A.; Wiegand T.J.) University of Rochester
Medical Center, Rochester, United States.
SOURCE
Annals of Pharmacotherapy (2018) 52:5 (495-496). Date of Publication: 1 May
2018
ISSN
1542-6270 (electronic)
1060-0280
BOOK PUBLISHER
SAGE Publications Inc., claims@sagepub.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug concentration, drug therapy, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
nebulization
EMTREE MEDICAL INDEX TERMS
adult
apnea
case report
clinical article
drug blood level
drug overdose
emergency ward
female
human
letter
multiple drug dose
oxygen saturation
priority journal
recurrent disease
respiration depression
suicide attempt
thinking impairment
young adult
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180195517
PUI
L621304730
DOI
10.1177/1060028017752428
FULL TEXT LINK
http://dx.doi.org/10.1177/1060028017752428
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 2
TITLE
ACMT and AACT position statement: preventing occupational fentanyl and
fentanyl analog exposure to emergency responders
AUTHOR NAMES
Moss M.J.
Warrick B.J.
Nelson L.S.
McKay C.A.
Dubé P.-A.
Gosselin S.
Palmer R.B.
Stolbach A.I.
AUTHOR ADDRESSES
(Moss M.J.) Emergency Medicine, VCU Medical Center, Richmond, United States.
(Warrick B.J.) Emergency Medicine, University of New Mexico, Albuquerque,
United States.
(Nelson L.S.) Department of Emergency Medicine, Rutgers New Jersey Medical
School, Newark, United States.
(McKay C.A.) Traumatology & Emergency Medicine, Hartford Hospital, Hartford,
United States.
(Dubé P.-A.) Institut national de santé publique du Québec, Québec, Canada.
(Gosselin S.) Centre Antipoison du Québec, Québec, Canada.
(Palmer R.B., Rpalmer@toxicologyassoc.com) Toxicology Associates, PLLC,
Littleton, United States.
(Stolbach A.I.) Johns Hopkins University School of Medicine, Baltimore,
United States.
CORRESPONDENCE ADDRESS
R.B. Palmer, PLLC 26 West Dry Creek Circle, Suite 325, Littleton, United
States. Email: Rpalmer@toxicologyassoc.com
SOURCE
Clinical Toxicology (2018) 56:4 (297-300). Date of Publication: 3 Apr 2018
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
fentanyl derivative (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy, prevention)
occupational exposure
prophylaxis
rescue personnel
EMTREE MEDICAL INDEX TERMS
eye
face
human
inhalation
letter
long term exposure
mucosa
nonhuman
occupational safety
protective equipment
respiration control
risk assessment
risk reduction
skin absorption
skin protection
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170653966
PUI
L618299148
DOI
10.1080/15563650.2017.1373782
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1373782
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 3
TITLE
Healthcare utilization and costs associated with treatment for opioid
dependence
AUTHOR NAMES
Shah A.
Duncan M.
Atreja N.
Tai K.S.
Gore M.
AUTHOR ADDRESSES
(Shah A., ankit.shah@alkermes.com; Duncan M.; Atreja N.; Gore M.) Alkermes,
Inc., Waltham, United States.
(Tai K.S.) Symlink, LLC, Portage, United States.
CORRESPONDENCE ADDRESS
A. Shah, Alkermes, Inc., 852 Winter Street, Waltham, United States. Email:
ankit.shah@alkermes.com
SOURCE
Journal of Medical Economics (2018) 21:4 (406-415). Date of Publication: 3
Apr 2018
ISSN
1941-837X (electronic)
1369-6998
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Objective: Opioid use disorder (OUD) can be managed with medication assisted
therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release
naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy
[NPT]). The objective of this study was to evaluate healthcare resource
utilization and costs associated with XR-NTX compared with alternative
treatments for opioid dependence. Methods: Adults with a diagnosis of opioid
dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between
January 1, 2011 and December 31, 2014 were identified in the Truven Health
MarketScan Commercial administrative claims database. Healthcare resource
utilization, costs (inpatient [IP], emergency department [ED], outpatient
[OP], and pharmacy) and adherence were evaluated for each cohort during
12-month baseline and follow-up periods. Results: A total of 29,235 patients
were included in the analysis; 1,041, 20,566, 745, and 6,883 received
XR-NTX, BUP, MET, and NPT, respectively. Patients in the XR-NTX cohort were
significantly younger and had more comorbidities compared with the other
cohorts. Patients in the XR-NTX group had the largest percentage decrease in
IP and ED utilization and costs from baseline to follow-up. OP and pharmacy
costs increased significantly from baseline to follow-up for all cohorts.
Overall, there was no significant change in total healthcare costs for the
XR-NTX group, whereas the costs increased significantly for other groups
(BUP = +43%, MET = +47.7%, NPT = +38.8%). Conclusions: Healthcare resource
utilization and costs increased from baseline to follow-up in BUP, MET, and
NPT patients, whereas patients receiving XR-NTX experienced no such
increase. This analysis suggests there may be economic value in the use of
XR-NTX for OUD.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy, pharmacoeconomics)
methadone (drug therapy, pharmacoeconomics)
naltrexone (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health care utilization
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
comorbidity
drug cost
emergency health service
female
follow up
hospital care
human
major clinical study
male
outpatient care
retrospective study
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180068830
PUI
L620513401
DOI
10.1080/13696998.2018.1427101
FULL TEXT LINK
http://dx.doi.org/10.1080/13696998.2018.1427101
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 4
TITLE
The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on
Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a
Single Health System
AUTHOR NAMES
Suffoletto B.
Lynch M.
Pacella C.B.
Yealy D.M.
Callaway C.W.
AUTHOR ADDRESSES
(Suffoletto B., suffbp@upmc.edu; Lynch M.; Pacella C.B.; Yealy D.M.;
Callaway C.W.) Department of Emergency Medicine, University of Pittsburgh
School of Medicine, Pittsburgh, United States.
CORRESPONDENCE ADDRESS
B. Suffoletto, Department of Emergency Medicine, University of Pittsburgh
School of Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue,
Pittsburgh, United States. Email: suffbp@upmc.edu
SOURCE
Journal of Pain (2018) 19:4 (430-438). Date of Publication: 1 Apr 2018
ISSN
1528-8447 (electronic)
1526-5900
BOOK PUBLISHER
Churchill Livingstone Inc.
ABSTRACT
Prescription drug monitoring programs (PDMPs) enable registered prescribers
to obtain real-time information on patients’ prescription history of
controlled medications. We sought to describe the effect of a state-mandated
PDMP on opioid prescribing by emergency medicine providers. We
retrospectively analyzed electronic medical records of 122,732 adult
patients discharged with an opioid prescription from 15 emergency
departments in a single health system in Pennsylvania from July 2015 to
March, 2017. We used an interrupted time series design to evaluate the
percentage of patients discharged each month with an opioid prescription
before and after state law-mandated PDMP use on August 25, 2016. From August
(pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate
decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2%
(95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017,
there was a mean decline of.46% (95% CI, −.38% to −.53%) in the percentage
of patients discharged with an opioid prescription. There was heterogeneity
in opioid prescribing across hospitals as well as according to patient
diagnosis. Perspective: This study examined the effect of a state-mandated
PDMP on opioid prescribing among emergency medicine providers from 15
different hospitals in a single health system. Findings support current PDMP
mandates in reducing opioid prescriptions, which could curb the prescription
opioid epidemic and may ultimately reduce abuse, misuse, and overdose death.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
monitoring
prescription
EMTREE MEDICAL INDEX TERMS
adult
clinical evaluation
clinical trial
death
diagnosis
drug overdose
electronic medical record
emergency ward
epidemic
female
human
male
multicenter study
Pennsylvania
retrospective study
time series analysis
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180025104
PUI
L620187615
DOI
10.1016/j.jpain.2017.11.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2017.11.010
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 5
TITLE
Naloxone nasal spray (Nyxoid(®)) in opioid overdose: a profile of its use in
the EU
AUTHOR NAMES
McKeage K.
Lyseng-Williamson K.A.
AUTHOR ADDRESSES
(McKeage K.; Lyseng-Williamson K.A., dtp@adis.com) Springer, Private Bag
65901, Mairangi Bay, Auckland, New Zealand.
CORRESPONDENCE ADDRESS
K.A. Lyseng-Williamson, Springer, Private Bag 65901, Mairangi Bay, Auckland,
New Zealand. Email: dtp@adis.com
SOURCE
Drugs and Therapy Perspectives (2018) 34:4 (150-156). Date of Publication: 1
Apr 2018
ISSN
1179-1977 (electronic)
1172-0360
BOOK PUBLISHER
Springer International Publishing
ABSTRACT
Naloxone is an opioid antagonist that reverses opioid-induced respiratory
depression. Concentrated naloxone 1.8 mg nasal spray (Nyxoid(®)) is approved
for the emergency treatment of opioid overdose in adults and adolescents
aged ≥ 14 years in non-medical and healthcare settings. It is well
tolerated, but may lead to opioid withdrawal syndrome in opioid-dependent
individuals. Naloxone nasal spray is rapidly absorbed and, relative to
reference intramuscular naloxone 0.4 mg, achieves generally similar early
exposure, but better maintenance of plasma levels, during the intermediate
period (15–120 min).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug therapy, intramuscular drug
administration, pharmacokinetics, pharmacology)
nose spray (drug therapy, pharmacokinetics, pharmacology)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
nyxoid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
article
dizziness (side effect)
drug efficacy
drug safety
drug tolerability
emergency care
headache (side effect)
human
hypertension (side effect)
hypotension (side effect)
pharmacodynamics
tachycardia (side effect)
vomiting (side effect)
withdrawal syndrome
DRUG TRADE NAMES
nyxoid
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180219043
PUI
L621337189
DOI
10.1007/s40267-018-0498-y
FULL TEXT LINK
http://dx.doi.org/10.1007/s40267-018-0498-y
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 6
TITLE
A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal
Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute
Renal Colic [Figure presented]
AUTHOR NAMES
Pathan S.A.
Mitra B.
Cameron P.A.
AUTHOR ADDRESSES
(Pathan S.A., sameer.pathan@monash.edu) Emergency Department, Hamad General
Hospital, Hamad Medical Corporation, Doha, Qatar.
(Pathan S.A., sameer.pathan@monash.edu; Mitra B.; Cameron P.A.) Department
of Epidemiology & Preventive Medicine, Monash University, Melbourne,
Australia.
(Pathan S.A., sameer.pathan@monash.edu; Mitra B.; Cameron P.A.) National
Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
(Mitra B.; Cameron P.A.) Emergency & Trauma Centre, The Alfred Hospital,
Melbourne, Australia.
CORRESPONDENCE ADDRESS
S.A. Pathan, PO BOX 50107, Mesaieed Post Office, Qatar. Email:
sameer.pathan@monash.edu
SOURCE
European Urology (2018) 73:4 (583-595). Date of Publication: 1 Apr 2018
ISSN
1873-7560 (electronic)
0302-2838
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Context: Renal colic is a common, acute presentation of urolithiasis that
requires immediate pain relief. European Association of Urology guidelines
recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the preferred
analgesia. However, the fear of NSAID adverse effects and the uncertainty
about superior analgesic effect have maintained the practice of advocating
intravenous opioids as the initial analgesia. Objective: The objective of
this systematic review and meta-analysis was to compare the safety and
efficacy of NSAIDs with opioids and paracetamol (acetaminophen) for the
management of acute renal colic. Evidence acquisition: Cochrane Central
Register of Controlled Trials, MEDLINE, EMBASE, World Health Organization
International Clinical Trials Registry Platform, Google Scholar, and the
reference list of retrieved articles were searched up to December 2016
without language restrictions. Two reviewers independently assessed eligible
studies using the Cochrane Collaboration tool for assessing and reporting
the risk of bias and abstracted data using predefined data fields. Evidence
synthesis: From 468 potentially relevant studies, 36 randomized controlled
trials (RCTs) including 4887 patients, published between 1982 and 2016, were
included in this systematic review. The treatment effect observed indicated
marginal benefit of NSAIDs over opioids in initial pain reduction at 30 min
(11 RCTs, n = 1985, mean difference [MD] –5.58, 95% confidence interval [CI]
–10.22 to –0.95; heterogeneity I(2) = 81%). In the subgroup analyses by the
route of administration, NSAIDs required fewer rescue treatments (seven
RCTs, n = 541, number needed to treat [NNT] 11, 95% CI 6–75) and had lower
vomiting rates compared with opioids (five RCTs, n = 531, NNT 5, 95% CI
4–8). Comparisons of NSAIDs with paracetamol showed no difference for both
drugs at 30 min (four RCTs, n = 1325, MD –5.67, 95% CI –17.52 to 6.18, p =
0.35; I(2) = 89%). Patients treated with NSAIDs required fewer rescue
treatments (two trials, n = 1145, risk ratio 0.56, 95% CI 0.42–0.74, p <
0.001; I(2) = 0%). Conclusions: NSAIDs were equivalent to opioids or
paracetamol in the relief of acute renal colic pain at 30 min. There was
less vomiting and fewer requirements for rescue analgesia with NSAIDs
compared with opioids. Patients treated with NSAIDs required less rescue
analgesia compared with paracetamol. Despite observed heterogeneity among
the included studies and the overall quality of evidence, the findings of a
lower need for rescue analgesia and fewer adverse events, in conjunction
with the practical advantages of ease of delivery, suggest that NSAIDs
should be the preferred analgesic option for patients presenting to the
emergency department with renal colic. Patient summary: In kidney
stone–related acute pain episodes in patients with adequate renal function,
treatment with nonsteroidal anti-inflammatory drugs offers effective and
most sustained pain relief, with fewer side effects, when compared with
opioids or paracetamol. Nonsteroidal anti-inflammatory drugs (NSAIDS)
provided effective and most sustained pain relief with fewer side effects.
The combined pragmatic benefits of ease of administration and lack of
analgesia abuse or addiction properties establish NSAIDS as the first-line
analgesia to treat acute renal colic pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nonsteroid antiinflammatory agent (adverse drug reaction, drug comparison,
drug therapy)
opiate (adverse drug reaction, drug comparison, drug therapy)
paracetamol (adverse drug reaction, drug comparison, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute disease (drug therapy, drug therapy)
kidney colic (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
anaphylaxis (side effect)
Cochrane Library
comparative effectiveness
drug efficacy
drug safety
Embase
gastrointestinal hemorrhage (side effect)
human
kidney failure (side effect)
Medline
meta analysis
priority journal
randomized controlled trial (topic)
review
systematic review
vomiting (side effect)
world health organization
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170823649
PUI
L619377025
DOI
10.1016/j.eururo.2017.11.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.eururo.2017.11.001
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 7
TITLE
Association between Electronic Medical Record Implementation of Default
Opioid Prescription Quantities and Prescribing Behavior in Two Emergency
Departments
AUTHOR NAMES
Delgado M.K.
Shofer F.S.
Patel M.S.
Halpern S.
Edwards C.
Meisel Z.F.
Perrone J.
AUTHOR ADDRESSES
(Delgado M.K., kit.delgado@uphs.upenn.edu; Shofer F.S.; Edwards C.; Meisel
Z.F.; Perrone J.) Center for Emergency Care Policy and Research, Department
of Emergency Medicine, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States.
(Delgado M.K., kit.delgado@uphs.upenn.edu; Halpern S.) Department of
Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States.
(Delgado M.K., kit.delgado@uphs.upenn.edu; Patel M.S.; Halpern S.) Center
for Health Incentives and Behavioral Economics, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States.
(Delgado M.K., kit.delgado@uphs.upenn.edu; Meisel Z.F.) Penn Injury Science
Center, University of Pennsylvania, Philadelphia, United States.
(Patel M.S.; Halpern S.) Department of Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, United States.
(Halpern S.) Department of Medical Ethics and Health Policy, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
M.K. Delgado, Center for Health Incentives and Behavioral Economics,
Perelman School of Medicine, University of Pennsylvania, Philadelphia,
United States. Email: kit.delgado@uphs.upenn.edu
SOURCE
Journal of General Internal Medicine (2018) 33:4 (409-411). Date of
Publication: 1 Apr 2018
ISSN
1525-1497 (electronic)
0884-8734
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
behavior
electronic medical record
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
article
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180036993
PUI
L620256780
DOI
10.1007/s11606-017-4286-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-017-4286-5
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 8
TITLE
Antagonists in the medical management of opioid use disorders: Historical
and existing treatment strategies
AUTHOR NAMES
Bisaga A.
Mannelli P.
Sullivan M.A.
Vosburg S.K.
Compton P.
Woody G.E.
Kosten T.R.
AUTHOR ADDRESSES
(Bisaga A., adam.bisaga@nyspi.columbia.edu; Sullivan M.A.) Department of
Psychiatry, Columbia University College of Physicians and Surgeons, New
York, United States.
(Mannelli P.) Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, United States.
(Sullivan M.A.) Alkermes Inc., Waltham, United States.
(Vosburg S.K.) Scientific Consultant, Edgewater, United States.
(Compton P.) Department of Family and Community Health, School of Nursing,
University of Pennsylvania, Philadelphia, United States.
(Woody G.E.) Department of Psychiatry, Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, United States.
(Kosten T.R.) Baylor College of Medicine, Houston, United States.
CORRESPONDENCE ADDRESS
A. Bisaga, Department of Psychiatry, Columbia University College of
Physicians and Surgeons, New York, United States. Email:
adam.bisaga@nyspi.columbia.edu
SOURCE
American Journal on Addictions (2018) 27:3 (177-187). Date of Publication: 1
Apr 2018
ISSN
1521-0391 (electronic)
1055-0496
BOOK PUBLISHER
Wiley Blackwell, info@wiley.com
ABSTRACT
Background and Objectives: Opioid use disorder (OUD) is a chronic condition
with potentially severe health and social consequences. Many who develop
moderate to severe OUD will repeatedly seek treatment or interact with
medical care via emergency department visits or hospitalizations. Thus,
there is an urgent need to develop feasible and effective approaches to help
persons with OUD achieve and maintain abstinence from opioids. Treatment
that includes one of the three FDA-approved medications is an evidence-based
strategy to manage OUD. The purpose of this review is to address practices
for managing persons with moderate to severe OUD with a focus on opioid
withdrawal and naltrexone-based relapse-prevention treatment. Methods:
Literature available on PubMed was used to review the evolution of treatment
strategies from the 1960s onward to manage opioid withdrawal and initiate
treatment with naltrexone. Results: Emerging practices for extended-release
naltrexone induction include the use of agonist tapers and adjuvant
medications. Clinical challenges frequently encountered when initiating this
therapy include managing withdrawal and ongoing opioid use during treatment.
Clinical factors may inform decisions regarding patient selection and length
of naltrexone treatment, such as recent opioid use and patient preferences.
Conclusions and Scientific Significance: Treatment strategies to manage
opioid withdrawal have evolved, but many patients with OUD do not receive
medication for the prevention of relapse. Clinical strategies for induction
onto extended-release naltrexone are now available and can be safely and
effectively implemented in specialty and select primary care settings. (©
2018 The Authors. The American Journal on Addictions Published by Wiley
Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry
(AAAP);27:177–187).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naltrexone (drug combination, drug therapy, pharmacokinetics)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine (drug combination)
clonidine (drug combination)
methadone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
disease severity
drug release
drug safety
drug withdrawal
human
long term care
low drug dose
patient preference
patient selection
phase 3 clinical trial (topic)
precursor
randomized controlled trial (topic)
review
treatment duration
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180232431
PUI
L621484222
DOI
10.1111/ajad.12711
FULL TEXT LINK
http://dx.doi.org/10.1111/ajad.12711
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 9
TITLE
Case 252: Acute hyperammonemic encephalopathy resulting from late-onset
ornithine transcarbamylase deficiency
AUTHOR NAMES
Hershman M.
Carmody R.
Udayasankar U.K.
AUTHOR ADDRESSES
(Hershman M.; Carmody R.; Udayasankar U.K., unniu@radiology.arizona.edu)
Department of Medical Imaging, University of Arizona College of Medicine,
1501 N Campbell Ave, Tucson, United States.
CORRESPONDENCE ADDRESS
U.K. Udayasankar, Department of Medical Imaging, University of Arizona
College of Medicine, 1501 N Campbell Ave, Tucson, United States. Email:
unniu@radiology.arizona.edu
SOURCE
Radiology (2018) 287:1 (353-359). Date of Publication: 1 Apr 2018
ISSN
1527-1315 (electronic)
0033-8419
BOOK PUBLISHER
Radiological Society of North America Inc., 820 Jorie Boulevard, Oak Brook,
United States.
EMTREE DRUG INDEX TERMS
ammonia (endogenous compound)
glucose (endogenous compound)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute brain disease (drug therapy, complication, diagnosis, drug therapy)
hyperammonemia (drug therapy, complication, diagnosis, drug therapy)
ornithine transcarbamylase deficiency (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
ammonia blood level
article
brain edema (diagnosis)
case report
cerebrospinal fluid analysis
clinical article
computer assisted tomography
emergency ward
female
Glasgow coma scale
glucose blood level
human
medical examination
muscle rigidity (diagnosis)
mydriasis (diagnosis)
neurologic examination
nuclear magnetic resonance
postoperative period
priority journal
scoring system
tremor (diagnosis)
young adult
CAS REGISTRY NUMBERS
ammonia (14798-03-9, 51847-23-5, 7664-41-7)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180214367
PUI
L621393879
DOI
10.1148/radiol.2018161834
FULL TEXT LINK
http://dx.doi.org/10.1148/radiol.2018161834
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 10
TITLE
Post opioid overdose outreach by public health and public safety agencies:
Exploration of emerging programs in Massachusetts
AUTHOR NAMES
Formica S.W.
Apsler R.
Wilkins L.
Ruiz S.
Reilly B.
Walley A.Y.
AUTHOR ADDRESSES
(Formica S.W., sformica@ssre.org; Apsler R.) Social Science Research and
Evaluation Inc., 21-C Cambridge Street, Burlington, United States.
(Apsler R.) Department of Psychiatry, Harvard Medical School, Harvard
University, 17 Quincy Street, Cambridge, United States.
(Wilkins L.; Ruiz S.; Reilly B.; Walley A.Y.) Massachusetts Department of
Public Health, Bureau of Substance Addiction Services, 250 Washington
Street, Boston, United States.
(Walley A.Y.) Clinical Addiction Research and Education Unit, Section of
General Internal Medicine, Boston University School of Medicine/Boston
Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, United States.
CORRESPONDENCE ADDRESS
S.W. Formica, Social Science Research and Evaluation Inc., 21-C Cambridge
Street, Burlington, United States. Email: sformica@ssre.org
SOURCE
International Journal of Drug Policy (2018) 54 (43-50). Date of Publication:
1 Apr 2018
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background: Opioid overdose is a significant public health problem.
Collaborative programs between local public health and public safety
agencies have emerged to connect overdose survivors and their personal
networks with harm reduction and addiction treatment services following a
non-fatal overdose event. This study explored the prevalence of these
programs in Massachusetts and the different ways they have been structured
and function. Methods: We sent an online screening questionnaire to police
and fire departments in all 351 communities in Massachusetts to find
instances in which they collaborated with a community-based public health
agency to implement a post-overdose outreach and support program. We
conducted telephone interviews with communities that implemented this type
of program and categorized programs based on their structure, outreach
approach, and other key characteristics. Results: Police and fire personnel
from 110 of the 351 communities in Massachusetts (31% response rate)
completed the screening survey. Among respondents, 21% (23/110) had
implemented a collaborative, community-based, post-overdose program with a
well-defined process to connect overdose survivors and their personal
networks with support services or addiction treatment services. Using data
from the interviews, we identified four types of programs: (1)
Multi-Disciplinary Team Visit, (2) Police Visit with Referrals, (3)
Clinician Outreach, and (4) Location-Based Outreach. Conclusions: This study
represents the first attempt to systematically document an emerging approach
intended to connect opioid overdose survivors and their personal networks
with harm reduction and addiction treatment services soon after a non-fatal
overdose event. These programs have the potential to increase engagement
with the social service and addiction treatment systems by those who are at
elevated risk for experiencing a fatal opioid overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
health program
public health service
EMTREE MEDICAL INDEX TERMS
article
community care
emergency health service
geographic distribution
health care survey
human
Massachusetts
online system
peer group
police
prevalence
priority journal
questionnaire
screening
social work
survivor
telephone interview
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180074280
PUI
L620516228
DOI
10.1016/j.drugpo.2018.01.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2018.01.001
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 11
TITLE
Examining the role of extracorporeal membrane oxygenation in patients
following suspected or confirmed suicide attempts: A case series
AUTHOR NAMES
Abbasi A.
Devers C.
Muratore C.S.
Harrington C.
Ventetuolo C.E.
AUTHOR ADDRESSES
(Abbasi A.; Harrington C.; Ventetuolo C.E., corey_ventetuolo@brown.edu)
Department of Medicine, Alpert Medical School of Brown University,
Providence, United States.
(Devers C.) Lifespan Hospital System, Providence, United States.
(Muratore C.S.) Department of Pediatric Surgery, Alpert Medical School of
Brown University, Providence, United States.
(Harrington C.) Department of Psychiatry, Alpert Medical School of Brown
University, Providence, United States.
(Ventetuolo C.E., corey_ventetuolo@brown.edu) Department of Health Services,
Policy and Practice, Brown School of Public Health, Providence, United
States.
CORRESPONDENCE ADDRESS
C.E. Ventetuolo, Division of Pulmonary, Critical Care & Sleep, Rhode Island
Hospital, 593 Eddy Street, POB Suite 224, Providence, United States. Email:
corey_ventetuolo@brown.edu
SOURCE
Journal of Critical Care (2018) 44 (445-449). Date of Publication: 1 Apr
2018
ISSN
1557-8615 (electronic)
0883-9441
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The decision to offer extracorporeal membrane oxygenation (ECMO) is based on
a risk/benefit assessment and the likelihood of a treatable underlying
condition or the feasibility of destination therapy (durable mechanical
support or thoracic organ transplantation) should heart-lung function fail
to improve. Patients who present following suspected suicide attempts who
fail medical therapy may pose a dilemma for clinicians. An assessment to
determine if a patient has a high likelihood of psychiatric recovery such
that bridging with ECMO or ultimately destination therapy could or should be
offered is not always feasible in the setting of critical illness. This case
series reviews our institution's experience with ECMO in the management of
five patients who presented following suspected or confirmed suicide
attempts. All five patients survived to hospital discharge. Two had
subsequent psychiatric admissions, one following a repeat suicide attempt. A
discussion of these cases demonstrates the effectiveness of ECMO in
supporting this group of patients in the short-term. The self-limited
natural history of many psychiatric episodes, poisonings and traumatic
injuries makes the use of ECMO a potentially reasonable support strategy.
However, careful consideration must be given to psychiatric history and
follow-up given the substantial commitment of resources, potential for
complications and for stranding patients on extracorporeal therapy without
definitive destination therapy.
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
methadone (drug therapy)
naloxone (drug therapy)
olanzapine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
extracorporeal membrane oxygenation device (adverse device effect)
extracorporeal oxygenation
suicide attempt (therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
adult respiratory distress syndrome (therapy)
alcohol abuse
alcohol intoxication (diagnosis)
anxiety disorder
article
Asperger syndrome
atelectasis (therapy)
bipolar disorder
bladder rupture (diagnosis, surgery)
bleeding (complication, therapy)
blood transfusion
bradycardia (diagnosis)
brain disease
cardiogenic shock (therapy)
case report
chest tube
clinical article
clinical effectiveness
computer assisted tomography
congestive heart failure
cyanosis
deep vein thrombosis (complication)
delirium (drug therapy)
depression (drug therapy)
disease association
disease course
disease exacerbation
drug abuse
drug dependence treatment
drug overdose
echocardiography
electrocardiogram
electronic medical record system
emergency ward
femoral neck fracture (diagnosis)
femur fracture (diagnosis, surgery)
fluid resuscitation
follow up
Haemophilus infection (complication)
heart contusion (diagnosis, surgery)
heart tamponade (diagnosis, surgery)
hematopneumothorax (diagnosis)
hospital admission
hospital discharge
hospitalization
human
hypotension (therapy)
hypoxemia (therapy)
insomnia
intoxication
jugular vein thrombosis (complication)
lung contusion (diagnosis)
male
medical history
mental hospital
methicillin resistant Staphylococcus aureus infection (complication)
multiple trauma (diagnosis)
muscle necrosis (complication, therapy)
obsessive compulsive disorder
panic
pelvis fracture (diagnosis, surgery)
pericardial effusion (diagnosis, surgery)
pericardiotomy
physiotherapy
pneumothorax (diagnosis)
psychiatric treatment
psychosocial rehabilitation
pulmonary aspiration (diagnosis)
pupil disease (drug therapy)
radius fracture (diagnosis)
respiratory failure (therapy)
respiratory tract disease (diagnosis)
resuscitation
rhabdomyolysis (complication, therapy)
rib fracture (diagnosis)
seizure
short course therapy
spine fracture (diagnosis)
staphylococcal pneumonia (complication)
substance abuse
thorax radiography
traumatology
unconsciousness
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Orthopedic Surgery (33)
Drug Literature Index (37)
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170844757
PUI
L619479557
DOI
10.1016/j.jcrc.2017.10.025
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jcrc.2017.10.025
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 12
TITLE
Multimodal analgesia decreases opioid consumption after shoulder
arthroplasty: a prospective cohort study
AUTHOR NAMES
McLaughlin D.C.
Cheah J.W.
Aleshi P.
Zhang A.L.
Ma C.B.
Feeley B.T.
AUTHOR ADDRESSES
(McLaughlin D.C.; Cheah J.W.; Zhang A.L.; Ma C.B.; Feeley B.T.,
Brian.Feeley@ucsf.edu) Department of Orthopaedic Surgery, University of
California, San Francisco, San Francisco, United States.
(Aleshi P.) Department of Anesthesiology, University of California, San
Francisco, San Francisco, United States.
CORRESPONDENCE ADDRESS
B.T. Feeley, Department of Orthopaedic Surgery, University of California,
San Francisco, 1500 Owens St, San Francisco, United States. Email:
Brian.Feeley@ucsf.edu
SOURCE
Journal of Shoulder and Elbow Surgery (2018) 27:4 (686-691). Date of
Publication: 1 Apr 2018
ISSN
1532-6500 (electronic)
1058-2746
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Background: Studies on perioperative pain control in shoulder arthroplasty
focus on regional anesthesia, with little research on other approaches.
Perioperative multimodal analgesia regimens decrease opioid intake and
opioid-related side effects in lower-extremity arthroplasty. In this study
we compare pain scores, opioid consumption, length of stay, and readmission
rates in postoperative shoulder arthroplasty patients treated with a
standard or multimodal analgesia regimen. Methods: A prospective cohort
analysis was performed at a single institution. Patients undergoing elective
shoulder arthroplasty were treated with either a standard opioid-based
regimen or a multimodal analgesia regimen perioperatively. Outcome measures
included inpatient pain scores, opioid use, length of stay, and 30- and
90-day emergency department visits and readmission rates. Results:
Seventy-five patients were included in each cohort. Patients treated with
the multimodal analgesia regimen had lower postoperative day 0 pain scores
(mean, 1.5 vs 2.2; P =.027). Opioid use in the multimodal cohort was lower
on all days: 47% lower on postoperative day 0, 37% on day 1, and 44% on day
2 (all P <.01). The length of inpatient stay was significantly shorter for
multimodal patients than for patients treated with the standard regimen
(1.44 days vs 1.91 days, P <.01). There was no difference in the rate of 30-
or 90-day emergency department visits or readmission. Conclusion: Patients
undergoing shoulder arthroplasty have decreased postoperative pain and
opioid consumption and shorter hospital stays when given a multimodal
analgesia regimen. There is no increase in short-term complications or
unplanned readmissions, indicating that this is a safe and effective means
to control postoperative pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
celecoxib (drug therapy)
gabapentin (drug therapy)
hydrocodone bitartrate plus paracetamol (drug combination, drug therapy)
hydromorphone (drug combination, drug therapy, intravenous drug
administration)
naproxen (drug therapy)
oxycodone (drug combination, drug therapy)
paracetamol (intravenous drug administration, oral drug administration)
ropivacaine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital readmission
postoperative pain (drug therapy, drug therapy, therapy)
shoulder arthroplasty
EMTREE MEDICAL INDEX TERMS
aged
analgesia
article
breakthrough pain (drug therapy)
cohort analysis
controlled study
emergency ward
female
human
length of stay
major clinical study
male
occupational therapy
physiotherapy
priority journal
prospective study
CAS REGISTRY NUMBERS
celecoxib (169590-42-5)
gabapentin (60142-96-3)
hydromorphone (466-99-9, 71-68-1)
naproxen (22204-53-1, 26159-34-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
ropivacaine (84057-95-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180010921
PUI
L620057271
DOI
10.1016/j.jse.2017.11.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jse.2017.11.015
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 13
TITLE
Vital Signs: Trends in Emergency Department Visits for Suspected Opioid
Overdoses - United States, July 2016-September 2017
AUTHOR NAMES
Vivolo-Kantor A.M.
Seth P.
Gladden R.M.
Mattson C.L.
Baldwin G.T.
Kite-Powell A.
Coletta M.A.
AUTHOR ADDRESSES
(Vivolo-Kantor A.M.; Seth P.; Gladden R.M.; Mattson C.L.; Baldwin G.T.;
Kite-Powell A.; Coletta M.A.)
SOURCE
MMWR. Morbidity and mortality weekly report (2018) 67:9 (279-285). Date of
Publication: 9 Mar 2018
ISSN
1545-861X (electronic)
ABSTRACT
INTRODUCTION: From 2015 to 2016, opioid overdose deaths increased 27.7%,
indicating a worsening of the opioid overdose epidemic and highlighting the
importance of rapid data collection, analysis, and dissemination.METHODS:
Emergency department (ED) syndromic and hospital billing data on
opioid-involved overdoses during July 2016-September 2017 were examined.
Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were
analyzed at the regional level and by demographic characteristics. To assess
trends based on urban development, data from 16 states were analyzed by
state and urbanization level.RESULTS: From July 2016 through September 2017,
a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions
in 45 states were suspected opioid-involved overdoses. This rate increased
on average by 5.6% per quarter. Rates increased across demographic groups
and all five U.S. regions, with largest increases in the Southwest, Midwest,
and West (approximately 7%-11% per quarter). In 16 states, 119,198 ED visits
(26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten
states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North
Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant
quarterly rate increases from third quarter 2016 to third quarter 2017, and
in one state (Kentucky), rates decreased significantly. The highest rate
increases occurred in large central metropolitan areas.CONCLUSIONS AND
IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: With continued increases in opioid
overdoses, availability of timely data are important to inform actions taken
by EDs and public health practitioners. Increases in opioid overdoses varied
by region and urbanization level, indicating a need for localized responses.
Educating ED physicians and staff members about appropriate services for
immediate care and treatment and implementing a post-overdose protocol that
includes naloxone provision and linking persons into treatment could assist
EDs with preventing overdose.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
utilization
EMTREE MEDICAL INDEX TERMS
adolescent
adult
drug overdose (epidemiology)
female
hospital emergency service
human
male
middle aged
trends
United States
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
29518069 (http://www.ncbi.nlm.nih.gov/pubmed/29518069)
PUI
L621211952
DOI
10.15585/mmwr.mm6709e1
FULL TEXT LINK
http://dx.doi.org/10.15585/mmwr.mm6709e1
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 14
TITLE
By default: The effect of prepopulated prescription quantities on opioid
prescribing in the emergency department
AUTHOR NAMES
Santistevan J.R.
Sharp B.R.
Hamedani A.G.
Fruhan S.
Lee A.W.
Patterson B.W.
AUTHOR ADDRESSES
(Santistevan J.R.; Sharp B.R., bsharp@medicine.wisc.edu; Hamedani A.G.; Lee
A.W.; Patterson B.W.) University of Wisconsin School of Medicine and Public
Health, BerbeeWalsh Department of Emergency Medicine, University Bay Office
Building, 800 University Bay Drive, Suite 310, Madison, United States.
(Fruhan S.) University of California San Francisco, Zuckerberg San Francisco
General Hospital, Department of Emergency Medicine, San Francisco, United
States.
(Fruhan S.) Kaiser Permanente Oakland Medical Center, Emergency Department,
Oakland, United States.
(Patterson B.W.) Health Innovation Program, University of Wisconsin-Madison,
Madison, United States.
CORRESPONDENCE ADDRESS
B.R. Sharp, University of Wisconsin School of Medicine and Public Health,
BerbeeWalsh Department of Emergency Medicine, University Bay Office
Building, 800 University Bay Drive, Suite 310, Madison, United States.
Email: bsharp@medicine.wisc.edu
SOURCE
Western Journal of Emergency Medicine (2018) 19:2 (392-397). Date of
Publication: 1 Mar 2018
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Opioid prescribing patterns have come under increasing
scrutiny with the recent rise in opioid prescriptions, opioid misuse and
abuse, and opioid-related adverse events. To date, there have been limited
studies on the effect of default tablet quantities as part of emergency
department (ED) electronic order entry. Our goal was to evaluate opioid
prescribing patterns before and after the removal of a default quantity of
20 tablets from ED electronic order entry. Methods: We performed a
retrospective observational study at a single academic, urban ED with 58,000
annual visits. We identified all adult patients (18 years or older) seen in
the ED and discharged home with prescriptions for tablet forms of
hydrocodone and oxycodone (including mixed formulations with acetaminophen).
We compared the quantity of tablets prescribed per opioid prescription 12
months before and 10 months after the electronic order-entry prescription
default quantity of 20 tablets was removed and replaced with no default
quantity. No specific messaging was given to providers, to avoid influencing
prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample
test of proportions, and Pearson's chi-squared tests where appropriate for
statistical analysis. Results: A total of 4, 104 adult patients received
discharge prescriptions for opioids in the pre-intervention period (151.6
prescriptions per 1,000 discharged adult patients), and 2, 464
postintervention (106.69 prescriptions per 1,000 discharged adult patients).
The median quantity of opioid tablets prescribed decreased from 20
(interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (p<0.0001) after
removal of the default quantity. While the most frequent quantity of tablets
received in both groups was 20 tablets, the proportion of patients who
received prescriptions on discharge that contained 20 tablets decreased from
0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24])
(p<0.001) after default quantity removal. Conclusion: Although the median
number of tablets differed significantly before and after the intervention,
the clinical significance of this is unclear. An observed wider distribution
of the quantity of tablets prescribed after removal of the default quantity
of 20 may reflect more appropriate prescribing patterns (i.e., less severe
indications receiving fewer tabs and more severe indications receiving
more). A default value of 20 tablets for opioid prescriptions may be an
example of the electronic medical record's ability to reduce practice
variability in medication orders actually counteracting optimal patient
care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
computerized provider order entry
hospital discharge
human
major clinical study
observational study
retrospective study
tablet
urban area
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180170983
PUI
L621148679
DOI
10.5811/westjem.2017.10.33798
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2017.10.33798
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 15
TITLE
Reducing opioid prescribing rates in emergency medicine
AUTHOR NAMES
Guarisco J.
Salup A.
AUTHOR ADDRESSES
(Guarisco J., jguarisco@ochsner.org) Department of Emergency Medicine,
Ochsner Clinic Foundation, New Orleans, United States.
(Guarisco J., jguarisco@ochsner.org) The University of Queensland School of
Medicine, Ochsner Clinical School, New Orleans, United States.
(Salup A.) Ochsner Clinic Foundation, New Orleans, United States.
CORRESPONDENCE ADDRESS
J. Guarisco, Department of Emergency Medicine, Ochsner Clinic Foundation,
1514 Jefferson Hwy, New Orleans, United States. Email: jguarisco@ochsner.org
SOURCE
Ochsner Journal (2018) 18:1 (42-45). Date of Publication: 1 Mar 2018
ISSN
1524-5012
BOOK PUBLISHER
Ochsner Clinic, kmcfadden@ochsner.org
ABSTRACT
Background: Pain management is one of the most common reasons patients visit
the emergency department. Understanding the contributions of emergency
medicine—and specifically Ochsner Health System’s emergency providers—to the
opioid crisis is important. Benchmark prescribing data indicated that
Ochsner Health System emergency medicine providers’ opioid prescription
rates were significantly higher than the national average in emergency
medicine. Methods: Data relevant to visit and opioid prescription counts
were extracted from the organization’s electronic health record system.
Opioid prescription rates were calculated for each provider. A data
transparency project was initiated in which provider opioid prescription
rates were unblinded and distributed among the provider group. Results:
Opioid prescription rates declined in aggregate for the emergency services
from 22% to 14% during the 1-year project timeline. Some physicians
demonstrated a 70% reduction in prescription rates. Importantly, patient
satisfaction scores were not negatively impacted by declining opioid
prescription rates. Conclusion: Provider performance transparency using
unblinded and transparent data analytics can efficiently and significantly
alter provider practice.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
prescription
EMTREE MEDICAL INDEX TERMS
article
benchmarking
electronic health record
emergency health service
emergency physician
emergency ward
health care facility
human
patient satisfaction
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180200145
PUI
L621326002
DOI
10.1043/TOJ-18-0004
FULL TEXT LINK
http://dx.doi.org/10.1043/TOJ-18-0004
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 16
TITLE
Effect of Automated Prescription Drug Monitoring Program Queries on
Emergency Department Opioid Prescribing
AUTHOR NAMES
Sun B.C.
Charlesworth C.J.
Lupulescu-Mann N.
Young J.I.
Kim H.
Hartung D.M.
Deyo R.A.
McConnell K.J.
AUTHOR ADDRESSES
(Sun B.C., sunb@ohsu.edu; McConnell K.J.) Center for Policy
Research–Emergency Medicine, Oregon Health & Science University, Portland,
United States.
(Deyo R.A.) Department of Family Medicine, Department of Emergency Medicine,
Oregon Health & Science University, Portland, United States.
(Charlesworth C.J.; Lupulescu-Mann N.; Young J.I.; Kim H.; McConnell K.J.)
Center for Health Systems Effectiveness, Oregon Health & Science University,
Portland, United States.
(Hartung D.M.) College of Pharmacy, Oregon Health & Science University,
Portland, United States.
(Deyo R.A.) Oregon Institute of Occupational Health Sciences, Oregon Health
& Science University, Portland, United States.
(Hartung D.M.) College of Pharmacy, Oregon State University, Portland,
United States.
CORRESPONDENCE ADDRESS
B.C. Sun, Center for Policy Research–Emergency Medicine, Oregon Health &
Science University, Portland, United States. Email: sunb@ohsu.edu
SOURCE
Annals of Emergency Medicine (2018) 71:3 (337-347.e6). Date of Publication:
1 Mar 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective: We assess whether an automated prescription drug monitoring
program intervention in emergency department (ED) settings is associated
with reductions in opioid prescribing and quantities. Methods: We performed
a retrospective cohort study of ED visits by Medicaid beneficiaries. We
assessed the staggered implementation (pre-post) of automated prescription
drug monitoring program queries at 86 EDs in Washington State from January
1, 2013, to September 30, 2015. The outcomes included any opioid prescribed
within 1 day of the index ED visit and total dispensed morphine milligram
equivalents. The exposure was the automated prescription drug monitoring
program query intervention. We assessed program effects stratified by
previous high-risk opioid use. We performed multiple sensitivity analyses,
including restriction to pain-related visits, restriction to visits with a
confirmed prescription drug monitoring program query, and assessment of 6
specific opioid high-risk indicators. Results: The study included 1,187,237
qualifying ED visits (898,162 preintervention; 289,075 postintervention).
Compared with the preintervention period, automated prescription drug
monitoring program queries were not significantly associated with reductions
in the proportion of visits with opioid prescribing (5.8 per 1,000
encounters; 95% confidence interval [CI] –0.11 to 11.8) or the amount of
prescribed morphine milligram equivalents (difference 2.66; 95% CI –0.15 to
5.48). There was no evidence of selective reduction in patients with
previous high-risk opioid use (1.2 per 1,000 encounters, 95% CI –9.5 to
12.0; morphine milligram equivalents 1.22, 95% CI –3.39 to 5.82). The lack
of a selective reduction in high-risk patients was robust to all sensitivity
analyses. Conclusion: An automated prescription drug monitoring program
query intervention was not associated with reductions in ED opioid
prescribing or quantities, even in patients with previous high-risk opioid
use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
butorphanol
codeine
dihydrocodeine
fentanyl
hydrocodone
hydromorphone
levacetylmethadol
levorphanol
methadone
morphine
oxycodone
oxymorphone
pentazocine
pethidine
tapentadol
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription drug monitoring program
EMTREE MEDICAL INDEX TERMS
adult
article
automation
cohort analysis
female
high risk patient
human
major clinical study
male
outcome assessment
priority journal
retrospective study
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
butorphanol (42408-82-2)
codeine (76-57-3)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
levacetylmethadol (34433-66-4)
levorphanol (125-72-4, 77-07-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tapentadol (175591-09-0, 175591-23-8)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170905854
PUI
L619965568
DOI
10.1016/j.annemergmed.2017.10.023
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.10.023
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 17
TITLE
Buprenorphine alone or with naloxone: Which is safer?
AUTHOR NAMES
Kelty E.
Cumming C.
Troeung L.
Hulse G.
AUTHOR ADDRESSES
(Kelty E., erin.kelty@uwa.edu.au; Hulse G.) Division of Psychiatry,
University of Western Australia, Sir Charles Gairdner Hospital, Nedlands,
Australia.
(Kelty E., erin.kelty@uwa.edu.au; Cumming C.; Troeung L.) School of
Population and Global Health, University of Western Australia, Crawley,
Australia.
(Cumming C.) National Drug Research Institute, Curtin University, Bentley,
Australia.
(Hulse G.) School of Medical and Health Sciences, Edith Cowan University,
Joondalup, Australia.
CORRESPONDENCE ADDRESS
E. Kelty, School of Population and Global Health, University of Western
Australia, Stirling Highway, Crawley, Australia. Email:
erin.kelty@uwa.edu.au
SOURCE
Journal of Psychopharmacology (2018) 32:3 (344-352). Date of Publication: 1
Mar 2018
ISSN
1461-7285 (electronic)
0269-8811
BOOK PUBLISHER
SAGE Publications Ltd, info@sagepub.co.uk
ABSTRACT
To address concerns regarding the intravenous diversion of buprenorphine, a
combined buprenorphine-naloxone (BUP-NLX) preparation was developed. The aim
of this study is to compare health outcomes in opioid dependent patients
treated with BUP and BUP-NLX. All patients treated with BUP and/or BUP-NLX
in Western Australia between 2001 and 2010 were included in the study (N =
3455). Patients were identified via State prescribing records and matched
against the State mortality, hospital, and emergency department records.
Rates of health events were examined and compared using Cox Proportional
Hazard Models and Generalized Estimating Equations. While on treatment there
was no significant difference between mortality rates in the two groups,
mortality rates following the cessation of treatment were significantly
higher in patients treated with BUP-NLX (adjusted hazard ratio: 1.59). Rates
of hospitalization were significantly elevated in BUP-NLX patients (adjusted
odds ratio: 1.17) compared with BUP treated patients; however, rates of
hospitalization with a skin/subcutaneous diagnosis were significantly lower
in BUP-NLX treated patients (adjusted odds ratio: 0.65). Off-treatment rates
of both all-cause hospital admissions (adjusted odds ratio: 1.53) and
hospital admissions with an opioid poisoning diagnosis (adjusted odds ratio:
1.59) were significantly elevated in BUP-NLX treated patients compared with
BUP treated patients. The addition of naloxone does not appear to improve
the safety profile of buprenorphine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug comparison, drug therapy, intravenous drug
administration)
buprenorphine plus naloxone (drug comparison, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
Australia
controlled study
drug efficacy
drug monitoring
drug safety
female
hospitalization
human
major clinical study
male
morbidity
mortality
priority journal
DRUG TRADE NAMES
suboxone
subutex
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180142647
PUI
L620902827
DOI
10.1177/0269881118756015
FULL TEXT LINK
http://dx.doi.org/10.1177/0269881118756015
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 18
TITLE
Features of prescription drug monitoring programs associated with reduced
rates of prescription opioid-related poisonings
AUTHOR NAMES
Pauly N.J.
Slavova S.
Delcher C.
Freeman P.R.
Talbert J.
AUTHOR ADDRESSES
(Pauly N.J., Nathan.Pauly@uky.edu; Freeman P.R.; Talbert J.) Institute for
Pharmaceutical Outcomes and Policy, University of Kentucky College of
Pharmacy, 789 South Limestone, Lexington, United States.
(Slavova S.) Department of Biostatistics, University of Kentucky College of
Public Health, 333 Waller Avenue, Suite 242, Lexington, United States.
(Delcher C.) Department of Health Outcomes and Policy, University of
Florida, 2004 Mowry Road, Suite 2237, P.O. Box 100177, Gainesville, United
States.
CORRESPONDENCE ADDRESS
N.J. Pauly, Institute for Pharmaceutical Outcomes and Policy, University of
Kentucky College of Pharmacy, 789 South Limestone, Lexington, United States.
Email: Nathan.Pauly@uky.edu
SOURCE
Drug and Alcohol Dependence (2018) 184 (26-32). Date of Publication: 1 Mar
2018
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background: The United States is in the midst of an opioid epidemic. In
addition to other system-level interventions, all states have responded
during the crisis by implementing prescription drug monitoring programs
(PDMPs). This study examines associations between specific administrative
features of PDMPs and changes in the risk of prescription opioid-related
poisoning (RxORP) over time. Methods: This longitudinal, observational study
utilized a ‘natural experiment’ design to assess associations between PDMP
features and risk of RxORP in a nationally-representative population of
privately-insured adults from 2004 to 2014. Administrative health claims
data were used to identify inpatient hospital admissions and emergency
department visits related to RxORP. Generalized estimating equation Poisson
regression models were used to examine associations between specific PDMP
features and changes in relative risk (RR) of RxORP over time. Results: In
adjusted analyses, states without PDMPs experienced an average annual
increase in the rate of RxORP of 9.51% over the study period, while states
with operational PDMPs experienced an average annual increase of 3.17%. The
increase in RR of RxORP over time in states with operational PDMPs was
significantly less than increases in states without PDMPs. States with
specific features, including those that monitored more schedules or required
more frequent data reporting, experienced stronger protective effects on the
RR of RxORP over time. Conclusion: This study examined associations between
specific PDMP features and RxORP rates in a nationally-representative
population of privately-insured adults. Results of this study may be used as
empirical evidence to guide PDMP best practices.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
prescription drug monitoring program
prescription opioid related poisoning
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
emergency ward
female
hospital admission
hospital patient
human
longitudinal study
major clinical study
male
observational study
patient identification
priority journal
private health insurance
risk factor
statistical analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180221253
PUI
L2000585585
DOI
10.1016/j.drugalcdep.2017.12.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2017.12.002
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 19
TITLE
Sheltering risks: Implementation of harm reduction in homeless shelters
during an overdose emergency
AUTHOR NAMES
Wallace B.
Barber K.
Pauly B.B.
AUTHOR ADDRESSES
(Wallace B., barclay@uvic.ca) School of Social Work, Canadian Institute for
Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria,
Canada.
(Barber K., kbarber@uvic.ca) Social Dimensions of Health, Canadian Institute
for Substance Use Research, University of Victoria, Box 1700 STN CSC,
Victoria, Canada.
(Pauly B.B., bpauly@uvic.ca) School of Nursing, Canadian Institute for
Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria,
Canada.
CORRESPONDENCE ADDRESS
B. Wallace, School of Social Work, Canadian Institute for Substance Use
Research, University of Victoria, Box 1700 STN CSC, Victoria, Canada. Email:
barclay@uvic.ca
SOURCE
International Journal of Drug Policy (2018) 53 (83-89). Date of Publication:
1 Mar 2018
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background The current opioid overdose crisis in North America is
heightening awareness of the need for and the challenges of implementing
harm reduction, notably within complex and diverse settings such as homeless
shelters. In this paper, we explore the implementation of harm reduction in
homeless shelters during an emerging overdose emergency. Methods The
objective of this qualitative study was to identify and understand
micro-environment level factors within emergency shelters responding to
homelessness and substance use, and the macro-level influences that produce
and sustain structural vulnerabilities. We conducted eight focus groups with
a total of 49 participants during an emerging overdose emergency. These
included shelter residents (n = 23), shelter staff (n = 13), and harm
reduction workers (n = 13). Results The findings illustrate the challenges
of implementing an overdose response when substance use is prohibited
onsite, without an expectation of abstinence, and where harm reduction
services are limited to the distribution of supplies. In this context, harm
reduction is partially implemented and incomplete. Shelters can be a site of
risks and trauma for residents and staff due to experiencing, witnessing,
and responding to overdoses. Conclusion The current overdose crisis
heightens the challenges of implementing harm reduction, particularly within
complex and diverse settings such as homeless shelters. When harm reduction
is limited to the distribution of supplies such as clean equipment and
naloxone, important principles of engagement and the development of trust
necessary to the provision of services are overlooked with negative
implications for service users.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
emergency shelter
harm reduction
health care planning
homelessness
substance use
EMTREE MEDICAL INDEX TERMS
adult
alcohol intoxication
article
clinical article
controlled study
coping behavior
drug withdrawal
emergency care
female
human
information processing
male
microenvironment
primary health care
priority journal
psychotrauma
public policy
qualitative research
risk assessment
risk factor
smoking habit
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180003317
PUI
L619964426
DOI
10.1016/j.drugpo.2017.12.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2017.12.011
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 20
TITLE
Opioid medication use in patients with gastrointestinal diagnoses vs
unexplained gastrointestinal symptoms in the US Veterans Health
Administration
AUTHOR NAMES
Sayuk G.S.
Kanuri N.
Gyawali C.P.
Gott B.M.
Nix B.D.
Rosenheck R.A.
AUTHOR ADDRESSES
(Sayuk G.S., gsayuk@wustl.edu; Kanuri N.; Gyawali C.P.; Nix B.D.) Division
of Gastroenterology, Washington University School of Medicine, St. Louis,
United States.
(Sayuk G.S., gsayuk@wustl.edu; Gott B.M.) Department of Psychiatry,
Washington University School of Medicine, St. Louis, United States.
(Sayuk G.S., gsayuk@wustl.edu) Gastroenterology Section, John Cochran
Veterans Affairs Medical Center, St. Louis, United States.
(Rosenheck R.A.) Department of Veterans Affairs, New England Mental Illness
Research, Education, and Clinical Center, West Haven, United States.
(Rosenheck R.A.) Department of Psychiatry, Yale School of Medicine, New
Haven, United States.
CORRESPONDENCE ADDRESS
G.S. Sayuk, Division of Gastroenterology, Washington University School of
Medicine, St. Louis, United States. Email: gsayuk@wustl.edu
SOURCE
Alimentary Pharmacology and Therapeutics (2018) 47:6 (784-791). Date of
Publication: 1 Mar 2018
ISSN
1365-2036 (electronic)
0269-2813
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Background: While opioid prescriptions have increased alarmingly in the
United States (US), their use for unexplained chronic gastrointestinal (GI)
pain (eg, irritable bowel syndrome) carries an especially high risk for
adverse effects and questionable benefit. Aim: To compare opioid use among
US veterans with structural GI diagnoses (SGID) and those with unexplained
GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have
no accepted role. Methods: Veterans Health Administration (VHA)
administrative data from fiscal year 2012 were used to identify veterans
with diagnostic codes recorded for SGID and FGID. This cohort study examined
VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during
the year and number of prescriptions filled. Bivariate and multiple logistic
regression analyses adjusted for potential confounding factors
(demographics, medical diagnoses, social factors) and identified potential
mediators (service use, psychiatric comorbidity) of opioid use in these
groups. Results: A greater proportion of veterans with FGID received an
opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to
only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In
multivariate logistic regression, personality disorders and drug abuse (OR
1.23 for each group), recent homelessness (OR 1.22), psychotropic medication
fills (OR 1.55) and emergency department encounters (OR 1.21) were
independently associated with opioid prescription use. Conclusions: Despite
the potential for adverse consequences, opioids more often are prescribed
for veterans with chronic, unexplained GI symptoms compared to those with
structural diagnoses. Psychiatric comorbidities and frequent healthcare
encounters mediate some of the opioid use risk.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
gastrointestinal symptom (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
bipolar disorder
cohort analysis
comorbidity
controlled study
depression
drug abuse
dyspepsia (drug therapy)
emergency ward
fibromyalgia
functional disease (drug therapy)
gastroesophageal reflux (drug therapy)
health care utilization
homelessness
human
inflammatory bowel disease (drug therapy)
irritable colon (drug therapy)
major clinical study
personality disorder
prescription
prevalence
priority journal
risk assessment
risk factor
United States
veteran
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180039989
PUI
L620281884
DOI
10.1111/apt.14503
FULL TEXT LINK
http://dx.doi.org/10.1111/apt.14503
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 21
TITLE
A Practical Approach to Neonatal Opiate Withdrawal Syndrome
AUTHOR NAMES
Devlin L.A.
Davis J.M.
AUTHOR ADDRESSES
(Devlin L.A., Lori.devlinphinney@louisville.edu) Department of Pediatrics,
University of Louisville, School of Medicine, 601 South Floyd Street,
Louisville, United States.
(Davis J.M.) Department of Pediatrics, Floating Hospital at Tufts Medical
Center, Tufts Clinical, Translational Science Institute, Tufts University,
Boston, United States.
CORRESPONDENCE ADDRESS
L.A. Devlin, Department of Pediatrics, University of Louisville, School of
Medicine, 601 South Floyd Street, Louisville, United States. Email:
Lori.devlinphinney@louisville.edu
SOURCE
American Journal of Perinatology (2018) 35:4 (324-330). Date of Publication:
1 Mar 2018
ISSN
1098-8785 (electronic)
0735-1631
BOOK PUBLISHER
Thieme Medical Publishers, Inc., custserv@thieme.com
ABSTRACT
Perinatal opioid misuse and neonatal opioid withdrawal syndrome (NOWS) are a
significant public health problem that has grown exponentially over the past
decade. In the United States, a woman seeks emergency room care for
prescription opioid misuse every 3 minutes and approximately every 25
minutes, a child is born with signs of drug withdrawal. The economic impact
of perinatal opioid misuse is significant with annual hospital charges for
NOWS in 2012 as $1.5 billion dollars. Perinatal opioid misuse is a complex,
multifaceted problem that demands a multidisciplinary cross specialty
approach. This article will review the current state of NOWS and provide
medical practitioners with a practical guide to enhance evidence based
practice.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
anticonvulsive agent
antidepressant agent
benzodiazepine
buprenorphine
catechol methyltransferase (endogenous compound)
gabapentin
methadone
mu opiate receptor (endogenous compound)
mu opiate receptor agonist
nicotine
opiate receptor (endogenous compound)
psychotropic agent
rifampicin
serotonin uptake inhibitor
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neonatal opioid withdrawal syndrome
opiate addiction
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
autoregulation
body weight gain
cohort analysis
drug dependence
drug misuse
drug seeking behavior
emergency ward
epigenetics
evidence based practice
heredity
hospital charge
human
incidence
laboratory test
medicaid
medical care
neonatal stress
newborn
nutrition education
perinatal care
pharmacogenomics
physician
prenatal care
prescription
priority journal
promoter region
public health
review
screening test
single nucleotide polymorphism
substance use
United States
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
catechol methyltransferase (9012-25-3)
gabapentin (60142-96-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nicotine (54-11-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
rifampicin (13292-46-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170790348
PUI
L619181244
DOI
10.1055/s-0037-1608630
FULL TEXT LINK
http://dx.doi.org/10.1055/s-0037-1608630
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 22
TITLE
Patient narratives in Yelp reviews offer insight into opioid experiences and
the challenges of pain management
AUTHOR NAMES
Graves R.L.
Goldshear J.
Perrone J.
Ungar L.
Klinger E.
Meisel Z.F.
Merchant R.M.
AUTHOR ADDRESSES
(Graves R.L., gravesrach@gmail.com; Goldshear J.; Ungar L.; Klinger E.;
Merchant R.M.) Penn Medicine Center for Digital Health, University of
Pennsylvania, 3400 Civic Center Blvd, Philadelphia, United States.
(Graves R.L., gravesrach@gmail.com; Perrone J.; Meisel Z.F.; Merchant R.M.)
Department of Emergency Medicine, Perelman School of Medicine, University of
Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, United
States.
(Ungar L.) Computer and Information Science, University of Pennsylvania,
Levine Hall, 3330 Walnut Street, Philadelphia, United States.
CORRESPONDENCE ADDRESS
R.L. Graves, Penn Medicine Center for Digital Health, University of
Pennsylvania, 3400 Civic Center Blvd, Philadelphia, United States. Email:
gravesrach@gmail.com
SOURCE
Pain Management (2018) 8:2 (95-104). Date of Publication: 1 Mar 2018
ISSN
1758-1877 (electronic)
1758-1869
BOOK PUBLISHER
Future Medicine Ltd., info@futuremedicine.com
ABSTRACT
Aim: To characterize Yelp reviews about pain management and opioids.
Methods: We manually coded and applied natural language processing to 836
Yelp reviews of US hospitals mentioning an opioid medication. Results: Yelp
reviews by patients and caregivers describing experiences with pain
management and opioids had lower ratings compared with other reviews.
Negative descriptions of pain management and opioid-related experiences were
more commonly described than positive experiences, and the number of themes
they reflected was more diverse. Conclusion: Yelp reviews offer insights
into pain management and opioid use that are not assessed by traditional
surveys. As a free, highly utilized source of unstructured narratives, Yelp
may allow ongoing assessment of policies related to pain management and
opioid use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
article
backache (drug therapy)
caregiver
decision making
dizziness (side effect)
drug efficacy
drug hypersensitivity (side effect)
emergency ward
eye pain (drug therapy)
flank pain (drug therapy)
gastrointestinal symptom (side effect)
genital pain (drug therapy)
headache (side effect)
hospital
human
infection (drug therapy)
mental disease (side effect)
musculoskeletal pain (drug therapy)
narrative
natural language processing
nausea (side effect)
online system
otalgia (drug therapy)
pain assessment
patient
patient satisfaction
personal experience
postoperative pain (drug therapy)
priority journal
retrospective study
skin pain (drug therapy)
social media
sore throat (drug therapy)
thorax pain (drug therapy, side effect)
tooth pain (drug therapy)
United States
vomiting (side effect)
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180169220
PUI
L621112735
DOI
10.2217/pmt-2017-0050
FULL TEXT LINK
http://dx.doi.org/10.2217/pmt-2017-0050
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 23
TITLE
What Role Has Emergency Medicine Played in the Opioid Epidemic: Partner in
Crime or Canary in the Coal Mine?: March 2018 Annals of Emergency Medicine
Journal Club
AUTHOR NAMES
Barrett T.W.
Bellew S.D.
AUTHOR ADDRESSES
(Barrett T.W.; Bellew S.D.) Vanderbilt University Medical Center, Nashville,
United States.
SOURCE
Annals of Emergency Medicine (2018) 71:3 (416-418). Date of Publication: 1
Mar 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
article
chronic pain
epidemiology
human
medical student
medicare
methodology
postoperative pain
primary medical care
priority journal
protocol compliance
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180119685
PUI
L620756077
DOI
10.1016/j.annemergmed.2018.01.033
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2018.01.033
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 24
TITLE
Associations between pharmacotherapy for opioid dependence and clinical and
criminal justice outcomes among adults with co-occurring serious mental
illness
AUTHOR NAMES
Robertson A.G.
Easter M.M.
Lin H.-J.
Frisman L.K.
Swanson J.W.
Swartz M.S.
AUTHOR ADDRESSES
(Robertson A.G., allison.gilbert@duke.edu; Easter M.M.; Swanson J.W.; Swartz
M.S.) Department of Psychiatry & Behavioral Sciences, Duke University School
of Medicine, United States.
(Lin H.-J.; Frisman L.K.) Connecticut Department of Mental Health and
Addiction Services, University of Connecticut School of Social Work, United
States.
CORRESPONDENCE ADDRESS
A.G. Robertson, DUMC Box 3071, Durham, United States. Email:
allison.gilbert@duke.edu
SOURCE
Journal of Substance Abuse Treatment (2018) 86 (17-25). Date of Publication:
1 Mar 2018
ISSN
1873-6483 (electronic)
0740-5472
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Adults suffering from a serious mental illness (SMI) and a substance use
disorder are at especially high risk for poor clinical outcomes and also
arrest and incarceration. Pharmacotherapies for treating opioid dependence
could be a particularly important mode of treatment for opioid-dependent
adults with SMI to lower their risk for overdose, high-cost
hospitalizations, repeated emergency department visits, and incarceration,
given relapse rates are very high following detoxification in the absence of
one of the three FDA-approved pharmacotherapies. This study estimates the
effects of methadone, buprenorphine, and oral naltrexone on clinical and
justice-related outcomes in a sample of justice-involved adults with SMI,
opioid dependence, and criminal justice involvement. Administrative data
were merged from several public agencies in Connecticut for 8736 adults 18
years of age or older with schizophrenia spectrum disorder, bipolar
disorder, or major depression; co-occurring moderate to severe opioid
dependence; and who also had at least one night in jail during 2002–2009.
Longitudinal multivariable regression models estimated the effect of
opioid-dependence pharmacotherapy as compared to outpatient substance abuse
treatment without opioid-dependence pharmacotherapy on inpatient substance
abuse or mental health treatment, emergency department visits, criminal
convictions, and incarcerations, analyzing instances of each outcome 12
months before and after an index treatment episode. Several baseline
differences between the study groups (opioid-dependence pharmacotherapy
group versus outpatient treatment without opioid-dependence pharmacotherapy)
were adjusted for in the regression models. All three opioid-dependence
pharmacotherapies were associated with reductions in inpatient substance
abuse treatment, and among the oral naltrexone subgroup, also reductions in
inpatient mental health treatment, as well as improved adherence to SMI
medications. Overall, the opioid-dependence pharmacotherapy group had higher
rates of arrest and incarceration in the follow-up period than the
comparison group; but those using oral naltrexone had lower rates of arrest
(including felonies). The analysis of observational administrative data
provides useful population-level estimates but also has important
limitations that preclude conclusive causal inferences. Large reductions in
crisis-driven service utilization associated with opioid-dependence
pharmacotherapy in this study suggest that evidence-based medications for
treating opioid dependence can be used successfully in adults with SMI and
should be considered more systematically during assessments of treatment
needs for this population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (oral drug administration)
methadone (oral drug administration)
naltrexone (oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
criminal justice
mental disease
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
article
bipolar disorder
comorbidity
Connecticut
controlled study
felony
female
health care utilization
hospitalization
human
major clinical study
major depression
male
medication compliance
priority journal
recidivism
schizophrenia
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170885849
PUI
L619775522
DOI
10.1016/j.jsat.2017.12.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jsat.2017.12.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 25
TITLE
Combatting Opioid Overdoses in Ohio: Emergency Department Physicians’
Prescribing Patterns and Perceptions of Naloxone
AUTHOR NAMES
Penm J.
MacKinnon N.J.
Lyons M.S.
Tolle E.
Sneed G.T.
AUTHOR ADDRESSES
(Penm J., Jonathan.Penm@sydney.edu.au) Faculty of Pharmacy, The University
of Sydney, Sydney, Australia.
(MacKinnon N.J., RxDeanMac@uc.edu; Sneed G.T., Gregory.Sneed@uc.edu) College
of Pharmacy, University of Cincinnati, Cincinnati, United States.
(Lyons M.S., lyonsme@ucmail.uc.edu) College of Medicine, University of
Cincinnati, Cincinnati, United States.
(Tolle E., e-tolle.1@onu.edu) Institute for Wellness and Education,
Woodstock, United States.
(Tolle E., e-tolle.1@onu.edu) Physician’s Pharmacy, Austell, United States.
CORRESPONDENCE ADDRESS
G.T. Sneed, College of Pharmacy, University of Cincinnati, Cincinnati,
United States. Email: Gregory.Sneed@uc.edu
SOURCE
Journal of General Internal Medicine (2018) (1-2). Date of Publication: 28
Feb 2018
ISSN
1525-1497 (electronic)
0884-8734
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
Ohio
perception
physician
prescription
EMTREE MEDICAL INDEX TERMS
article
drug overdose
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180148821
PUI
L620934537
DOI
10.1007/s11606-018-4353-6
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-018-4353-6
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 26
TITLE
Impact of opioid use on health care utilization and survival in patients
with newly diagnosed stage IV malignancies
AUTHOR NAMES
Zylla D.
Steele G.
Shapiro A.
Richter S.
Gupta P.
AUTHOR ADDRESSES
(Zylla D., dylan.zylla@parknicollet.com; Steele G.; Shapiro A.; Richter S.)
Frauenshuh Cancer Center, Park Nicollet Oncology Research and HealthPartners
Institute, 3800 Park Nicollet Blvd, Minneapolis, United States.
(Zylla D., dylan.zylla@parknicollet.com; Steele G.; Shapiro A.)
HealthPartners Institute, Minneapolis, United States.
(Richter S.) Professional Data Analysts, Inc., Minneapolis, United States.
(Gupta P.) Hematology/Oncology Section, Department of Medicine, Minneapolis
VA Health Care System, Minneapolis, United States.
CORRESPONDENCE ADDRESS
D. Zylla, Frauenshuh Cancer Center, Park Nicollet Oncology Research and
HealthPartners Institute, 3800 Park Nicollet Blvd, Minneapolis, United
States. Email: dylan.zylla@parknicollet.com
SOURCE
Supportive Care in Cancer (2018) (1-8). Date of Publication: 2 Feb 2018
ISSN
1433-7339 (electronic)
0941-4355
BOOK PUBLISHER
Springer Verlag, service@springer.de
ABSTRACT
Purpose: Patients with advanced cancers frequently experience pain. Opioids
are commonly prescribed to treat cancer-related pain, but their use might be
associated with undesirable consequences including adverse effects and tumor
progression, resulting in increased heath care utilization and shorter
survival. We examined these possibilities in a large cohort of patients
diagnosed with ten common advanced malignancies. Methods: We identified 1386
newly diagnosed patients with stage IV non-hematologic malignancies from
2005 to 2013 and ascertained opioid utilization within 90 days of starting
anti-cancer treatment using electronic medical record and tumor registry
data. Opioid utilization was stratified into low opioid (LO; < 5 mg oral
morphine equivalents (OME)/day) and high opioid (HO; ≥ 5 mg OME/day). Health
care utilization included tallies of emergency room, urgent care, and
inpatient visits. The association of opioid use, tumor type prognosis, age,
and gender with overall survival was analyzed in univariate and multivariate
models. Results: HO use patients (n = 624) had greater health care
utilization compared to LO use patients (n = 762; p < 0.05). HO use patients
also had shorter survival (median survival, 5.5 vs 12.4 months; p < 0.0001).
On multivariate analysis, HO use remained associated with shorter overall
survival (HR 1.4; 95% CI, 1.3–1.6; p < 0.0001) after adjusting for age,
gender, and prognostic group. Conclusions: In advanced cancer patients, HO
use is associated with greater health care utilization and shorter survival.
Prospective studies using opioid-sparing approaches are indicated, to
confirm these retrospective findings and to evaluate if these undesirable
effects associated with opioid use can be mitigated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
advanced cancer
cancer staging
cancer survival
health care utilization
overall survival
EMTREE MEDICAL INDEX TERMS
adult
article
cancer model
cancer patient
cancer prognosis
cancer therapy
cohort analysis
controlled study
diagnosis
electronic medical record
emergency ward
female
gender
hospital patient
human
major clinical study
male
median survival time
multivariate analysis
prognosis
prospective study
register
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180256795
PUI
L621591039
DOI
10.1007/s00520-018-4062-z
FULL TEXT LINK
http://dx.doi.org/10.1007/s00520-018-4062-z
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 27
TITLE
ECMO used successfully in a near fatal case of opioid-induced acute
respiratory distress syndrome
AUTHOR NAMES
Greenberg K.
Kohl B.
AUTHOR ADDRESSES
(Greenberg K., karen_greenberg@teamhealth.com) Drexel Neurosciences
Institute, Drexel University College of Medicine, 219 North Broad St 7th
Floor, Philadelphia, United States.
(Kohl B., benjaminkohl@ariahealth.org) Aria Jefferson Health System,
Torresdale campus, 10800 Knights Road, Philadephia, United States.
CORRESPONDENCE ADDRESS
K. Greenberg, Drexel Neurosciences Institute, Drexel University College of
Medicine, 219 North Broad St 7th Floor, Philadelphia, United States. Email:
karen_greenberg@teamhealth.com
SOURCE
American Journal of Emergency Medicine (2018) 36:2 (343.e5-343.e6). Date of
Publication: 1 Feb 2018
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Acute Respiratory Distress Syndrome (ARDS) was first recognized during the
1960s. It is a distinct type of hypoxemic respiratory failure characterized
by acute abnormality of both lungs. Extracorporeal membrane oxygenation
(ECMO) is being increasingly used for patients with severe ARDS refractory
to otherwise conventional management. A 29 year old male arrived with
Emergency Medical Services (EMS) status post presumed heroin overdose. He
was administered Naloxone 2 mg intravenously prior to arrival in the
emergency department. The patient arrived in severe respiratory distress
with a pulse oximetry level of 50% and was immediately intubated. The
patient's pulse oximetry level remained in the seventies despite intubation
and aggressive ventilator management. The Intensive Care Unit team in
conjunction with cardiothoracic surgery initiated venovenous ECMO therapy in
the emergency department itself. The patient was transferred to a tertiary
center for venoarterial ECMO that was continued for 6 more days. After an
extensive hospitalization, the patient was ultimately transferred to an
acute medical rehabilitation center. With the current opioid crisis,
emergency physicians and providers need to be aware that opioids can induce
severe ARDS refractory to mechanical ventilation. ECMO as a treatment option
can be used safely and successfully as described in this unique patient case
report.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug toxicity)
EMTREE DRUG INDEX TERMS
alprazolam (drug toxicity)
bicarbonate (endogenous compound)
cocaine (drug toxicity)
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adult respiratory distress syndrome (diagnosis, therapy)
extracorporeal oxygenation
EMTREE MEDICAL INDEX TERMS
adult
arterial gas
article
bicarbonate blood level
case report
clinical article
drug abuse
emergency health service
emergency ward
hepatitis C
human
intubation
leukocyte count
male
positive end expiratory pressure
priority journal
pulse oximetry
thorax radiography
unconsciousness
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
bicarbonate (144-55-8, 71-52-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Clinical and Experimental Biochemistry (29)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170820836
PUI
L619361662
DOI
10.1016/j.ajem.2017.11.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.11.020
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 28
TITLE
Perception and Practice Among Emergency Medicine Health Care Providers
Regarding Discharging Patients After Opioid Administration
AUTHOR NAMES
Surmaitis R.M.
Amaducci A.
Henry K.
Jong M.
Kiernan E.A.
Kincaid H.
Houck L.J.
Sabbatini S.J.
Greenberg M.R.
Katz K.D.
AUTHOR ADDRESSES
(Surmaitis R.M.; Amaducci A.; Henry K.; Jong M.; Kiernan E.A.; Kincaid H.;
Houck L.J.; Sabbatini S.J.; Greenberg M.R., mrgdo@ptd.net; Katz K.D.)
Department of Emergency Medicine, Lehigh Valley Hospital and Health
Network/USF MCOM, Allentown, United States.
CORRESPONDENCE ADDRESS
M.R. Greenberg, Department of Emergency Medicine, Lehigh Valley Hospital and
Health Network, LVH-M-5th floor EM Residency Suite, 2545 Schoenersville
Road, Bethlehem, United States. Email: mrgdo@ptd.net
SOURCE
Clinical Therapeutics (2018) 40:2 (214-223.e5). Date of Publication: 1 Feb
2018
ISSN
1879-114X (electronic)
0149-2918
BOOK PUBLISHER
Excerpta Medica Inc.
ABSTRACT
Purpose: This study aimed to determine the current attitudes, perceptions,
and practices of emergency medicine providers and nurses (RNs) regarding the
discharge of adult patients from the emergency department (ED) after
administration of opioid analgesics. Methods: A cross-sectional survey was
administered at 3 hospital sites with a combined annual ED census of
>180,000 visits per year. All 59 attending emergency physicians (EPs), 233
RNs, and 23 advanced practice clinicians (APCs) who worked at these sites
were eligible to participate. Findings: Thirty-five EPs (59.3%), 88 RNs
(37.8%), and 14 APCs (60.9%) completed the survey for an overall response
rate of 51.75%. Most respondents were female (95 [69.9%]). The factor ranked
most important to consider when discharging a patient from the ED after
administration of opioids was the patient's functional status and vital
signs (median, 2.00; interquartile range, 2.00–3.50). More RNs (84 [96.6%])
than EPs (29 [82.9%]) reported that developing an ED policy or guideline for
safe discharge after administration of opioids is important to clinical
practice (P = 0.02). Only 8 physicians (23.5%) reported that they did not
prescribe intramuscular morphine, and 15 (42.9%) reported that they did not
prescribe intramuscular hydromorphone. EPs (7 [20.0%]) and RNs (3 [3.4%])
differed in regard to whether they were aware if any patients to whom they
administered an opioid had experienced an adverse drug-related event (P =
0.01). Most EPs (24 [68.6%]) and RNs (54 [61.4%]) believed that the decision
for patient discharge should be left to both the emergency medicine provider
and the RN. Implications: Most study participants believed that developing a
policy or guideline for safe discharge after administration opioids in the
ED is important to clinical practice. Only a few physicians reported that
they did not prescribe intramuscular hydromorphone or morphine. Most
participants believed the discharge decision after administration of opioids
in the ED should be primarily determined by both the emergency medicine
provider and the RN.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (oral drug administration)
EMTREE DRUG INDEX TERMS
fentanyl (intravenous drug administration)
hydromorphone (intramuscular drug administration, intravenous drug
administration)
morphine (intramuscular drug administration, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
health care personnel
health care practice
hospital discharge
perception
EMTREE MEDICAL INDEX TERMS
adult
advanced practice clinician
adverse event
article
clinical practice
cross-sectional study
emergency physician
emergency ward
female
functional status
health personnel attitude
hospital policy
human
male
medical decision making
nurse
paramedical personnel
questionnaire
treatment response
vital sign
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180037693
PUI
L620272411
DOI
10.1016/j.clinthera.2018.01.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.clinthera.2018.01.001
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 29
TITLE
Antidote Availability in Saudi Arabia Hospitals in the Riyadh Province
AUTHOR NAMES
AlTamimi A.
Malhis N.K.
Khojah N.M.
Manea S.A.
AlTamimi A.
AlShammary S.A.
AUTHOR ADDRESSES
(AlTamimi A.; Malhis N.K.; Khojah N.M.) Pediatric Emergency, King Fahad
Medical City, Riyadh, Saudi Arabia.
(Manea S.A.; AlTamimi A., aaltamimi@kfmc.med.sa) Pharmacy Department, King
Fahad Medical City, Riyadh, Saudi Arabia.
(AlShammary S.A.) Palliative Care, King Fahad Medical City, Riyadh, Saudi
Arabia.
CORRESPONDENCE ADDRESS
A. AlTamimi, Pharmacy Department, King Fahad Medical City, Riyadh, Saudi
Arabia. Email: aaltamimi@kfmc.med.sa
SOURCE
Basic and Clinical Pharmacology and Toxicology (2018) 122:2 (288-292). Date
of Publication: 1 Feb 2018
ISSN
1742-7843 (electronic)
1742-7835
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Inadequate antidote stocking is a global problem in hospitals. Insufficient
supplies and delays in the administration of antidotes could lead to death
and additional potentially negative clinical consequences. Our objective was
to determine the availability of antidotes in hospitals listed on the Saudi
Ministry of Health website in the Riyadh Province and to evaluate the
leading poison in Saudi Arabia. A cross-sectional study was conducted using
questionnaires. The questionnaires were distributed to pharmacist directors
and emergency room-treating physicians in 17 public hospitals throughout the
Riyadh Province. None (0/17) of the pharmacies contained the 24 recommended
essential antidotes by the expert consensus guidelines for stocking of
antidotes in hospitals. Polyvalent scorpion antivenom, atropine sulphate,
calcium gluconate, flumazenil and naloxone hydrochloride were stocked in
94.12% (16/17) of hospitals. 66.67% of patients presented with osmolality,
and 55.56% of referral patients with opiates, barbiturates, acetaminophen
and salicylate. Our findings have important implications for healthcare
institutions and pharmaceutical practices. National practice guidelines are
needed to assist pharmacists in selecting appropriate antidotes based on the
local pattern of poisoning incidents. Therefore, further study in the
Kingdom of Saudi Arabia needs to be completed to fully evaluate the
availability of antidotes throughout the country.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy, pharmacokinetics, pharmacology)
amyl nitrite (drug therapy, pharmacokinetics, pharmacology)
atropine (drug therapy, pharmacokinetics, pharmacology)
barbituric acid derivative (drug therapy, pharmacokinetics, pharmacology)
bicarbonate (drug therapy, pharmacokinetics, pharmacology)
bivalent snake antivenom (drug therapy, pharmacokinetics, pharmacology)
calcium chloride (drug therapy, pharmacokinetics, pharmacology)
edetate calcium disodium (drug therapy, pharmacokinetics, pharmacology)
flumazenil (drug therapy, pharmacokinetics, pharmacology)
gluconate calcium (drug therapy, pharmacokinetics, pharmacology)
hydroxocobalamin hydrochloride (drug therapy, pharmacokinetics,
pharmacology)
naloxone (drug therapy, pharmacokinetics, pharmacology)
paracetamol (drug therapy, pharmacokinetics, pharmacology)
polyvalent scorpion antivenom (drug therapy, pharmacokinetics, pharmacology)
polyvalent snake antivenom (drug therapy, pharmacokinetics, pharmacology)
salicylic acid (drug therapy, pharmacokinetics, pharmacology)
scorpion venom antiserum (drug therapy, pharmacokinetics, pharmacology)
sodium nitrite (drug therapy, pharmacokinetics, pharmacology)
sodium thiosulfate (drug therapy, pharmacokinetics, pharmacology)
unclassified drug
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug bioavailability
EMTREE MEDICAL INDEX TERMS
article
cross-sectional study
descriptive research
emergency ward
human
intoxication (drug therapy)
multicenter study
osmolality
physician
priority journal
public hospital
questionnaire
Saudi Arabia
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
amyl nitrite (463-04-7)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
edetate calcium disodium (62-33-9)
flumazenil (78755-81-4)
gluconate calcium (299-28-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170751643
PUI
L618952978
DOI
10.1111/bcpt.12897
FULL TEXT LINK
http://dx.doi.org/10.1111/bcpt.12897
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 30
TITLE
Death from Kratom toxicity and the possible role of intralipid
AUTHOR NAMES
Aggarwal G.
Robertson E.
McKinlay J.
Walter E.
AUTHOR ADDRESSES
(Aggarwal G.; Robertson E.; McKinlay J.; Walter E., ewalter@nhs.net)
Department of Intensive Care, Royal Surrey County Hospital, Guildford,
United Kingdom.
CORRESPONDENCE ADDRESS
E. Walter, Department of Intensive Care, Royal Surrey County Hospital,
Egerton Road, Guildford, Surrey, United Kingdom. Email: ewalter@nhs.net
SOURCE
Journal of the Intensive Care Society (2018) 19:1 (61-63). Date of
Publication: 1 Feb 2018
ISSN
1751-1437
BOOK PUBLISHER
SAGE Publications Inc., claims@sagepub.com
ABSTRACT
We present the case of a 26-year-old man who was brought into our emergency
department in cardiorespiratory arrest, having taken Kratom 24 h previously.
Despite multi-organ support, he deteriorated and died from cardiorespiratory
failure and hypoxic brain damage 12 h later. Lipid emulsion was given, with
significant temporary improvement in the cardiorespiratory failure. Kratom
is derived from Mitragyna speciosa, a tropical deciduous and evergreen tree
in the coffee family, and is native to Southeast Asia, and its leaves are
used as a legal high in some parts of the world. Here, we review the
pharmacochemistry of the drug, and wish to highlight that the effects of
Kratom may not be as benign as are commonly reported, and the possible role
of intralipid in managing the Kratom toxicity in this case.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
intralipid
EMTREE DRUG INDEX TERMS
bicarbonate
lipid emulsion
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
death
Kratom toxicity
toxicity
EMTREE MEDICAL INDEX TERMS
adult
arterial oxygen tension
article
body temperature
brain damage
brain hernia
cardiopulmonary insufficiency
cardiovascular disease
case report
clinical article
electric activity
emergency ward
heart ventricle arrhythmia
hemodiafiltration
human
hypoxia
male
mean arterial pressure
metabolic acidosis
neurosurgery
noradrenalin brain level
pressor response
respiratory failure
toxicity testing
warming
x-ray computed tomography
young adult
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
intralipid (68890-65-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180097005
PUI
L620638561
DOI
10.1177/1751143717712652
FULL TEXT LINK
http://dx.doi.org/10.1177/1751143717712652
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 31
TITLE
Initial Pain Management in Pediatric Acute Pancreatitis: Opioid Versus
Non-opioid
AUTHOR NAMES
Grover A.S.
Mitchell P.D.
Manzi S.F.
Fox V.L.
AUTHOR ADDRESSES
(Grover A.S., amit.grover@childrens.harvard.edu; Fox V.L.) Division of
Gastroenterology, Hepatology and Nutrition, Division of Genetics and
Genomics, Clinical Pharmacogenomics Service, Boston Children's Hospital,
Harvard Medical School, Hunnewell Ground. 300 Longwood Avenue, Boston,
United States.
(Mitchell P.D.) Institutional Centers for Clinical and Translational
Research, Division of Genetics and Genomics, Clinical Pharmacogenomics
Service, Boston Children's Hospital, Harvard Medical School, Boston, United
States.
(Manzi S.F.) Department of Pharmacy, Division of Genetics and Genomics,
Clinical Pharmacogenomics Service, Boston Children's Hospital, Harvard
Medical School, Boston, United States.
CORRESPONDENCE ADDRESS
A.S. Grover, Division of Gastroenterology, Hepatology and Nutrition,
Division of Genetics and Genomics, Clinical Pharmacogenomics Service, Boston
Children's Hospital, Harvard Medical School, Hunnewell Ground. 300 Longwood
Avenue, Boston, United States. Email: amit.grover@childrens.harvard.edu
SOURCE
Journal of Pediatric Gastroenterology and Nutrition (2018) 66:2 (295-298).
Date of Publication: 1 Feb 2018
ISSN
1536-4801 (electronic)
0277-2116
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Nearly all patients with acute pancreatitis (AP) experience some degree of
abdominal pain that is severe enough to prompt medical evaluation and
necessitate analgesia. Effective analgesia is a priority in caring for such
patients. Despite its importance, strategies for pain management in AP have
been poorly studied, particularly in the field of pediatrics. Presently, no
published data examine the management of pain because of AP in children at
the time of initial presentation. Management approaches are often
extrapolated from adult practice and based on anecdotal experience in the
absence of objective data. The aim of our study was to examine the initial
provision of analgesia to children who presented to a pediatric emergency
department with AP.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
aluminum magnesium hydroxide (drug combination, drug therapy, topical drug
administration)
diphenhydramine (drug combination, drug therapy)
fentanyl (drug therapy)
gabapentin (drug therapy)
hydromorphone (drug therapy)
ibuprofen (drug therapy)
ketorolac (drug therapy)
morphine (drug therapy)
mylanta (drug therapy)
oxycodone (drug therapy)
oxycodone plus paracetamol (drug therapy)
paracetamol (drug therapy)
simethicone (drug therapy)
sucralfate (drug therapy)
sumatriptan (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (drug therapy, drug therapy)
acute pancreatitis
analgesia
child health care
EMTREE MEDICAL INDEX TERMS
article
emergency ward
female
human
major clinical study
male
priority journal
retrospective study
CAS REGISTRY NUMBERS
aluminum magnesium hydroxide (37317-08-1, 39366-43-3)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
gabapentin (60142-96-3)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
mylanta (39322-42-4, 51810-72-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
simethicone (53663-76-6, 8050-81-5)
sucralfate (54182-58-0)
sumatriptan (103628-46-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Gastroenterology (48)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180078006
PUI
L620565035
DOI
10.1097/MPG.0000000000001809
FULL TEXT LINK
http://dx.doi.org/10.1097/MPG.0000000000001809
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 32
TITLE
All-Cause and Drug-Related Medical Events Associated with Overuse of
Gabapentin and/or Opioid Medications: A Retrospective Cohort Analysis of a
Commercially Insured US Population
AUTHOR NAMES
Peckham A.M.
Fairman K.A.
Sclar D.A.
AUTHOR ADDRESSES
(Peckham A.M., apeckh@midwestern.edu; Fairman K.A.; Sclar D.A.) Department
of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale,
19555 N. 59th Avenue, Glendale, United States.
CORRESPONDENCE ADDRESS
A.M. Peckham, Department of Pharmacy Practice, Midwestern University College
of Pharmacy-Glendale, 19555 N. 59th Avenue, Glendale, United States. Email:
apeckh@midwestern.edu
SOURCE
Drug Safety (2018) 41:2 (213-228). Date of Publication: 1 Feb 2018
ISSN
1179-1942 (electronic)
0114-5916
BOOK PUBLISHER
Springer International Publishing
ABSTRACT
Introduction: Overuse of gabapentin and/or opioids occurs in a small
percentage of patients at > 3-fold labeled dosages. Gabapentin may
potentiate opioid effects. Objective: The aim was to assess patient harm,
defined as use of inpatient hospital (IPH) or emergency department (ED)
services, associated with overuse of gabapentin with or without concomitant
overuse of opioids. Data source: Data were sourced from the Truven Health
MarketScan(®) Commercial Claims and Encounters database, for the years
2013–2015. Eligibility criteria: The eligibility criteria were two or more
claims (billed encounters) and ≥120 days of treatment with gabapentin and/or
opioids. Methods: Cohort identification was based on daily-dosage thresholds
of 50 morphine-milligram equivalents and 3600 mg of gabapentin in a 12-month
follow-up: (1) no overuse; (2) mild overuse (two or more claims or two or
fewer calendar quarters over threshold); and (3) sustained overuse (three or
more over-threshold calendar quarters). IPH and ED use were measured for
6 months after the first overuse date (cohorts 2 and 3) or a randomly
assigned date (cohort 1). Logistic regression analyses controlled for
pre-treatment IPH/ED utilization, indication, addiction diagnosis,
concomitant sedative/hypnotic use, and demographics. Results: All-cause and
drug-related IPH/ED utilization increased monotonically with degree of
overuse, particularly of more than one medication. Sustained overuse of
gabapentin multiplied odds of all-cause IPH by 1.366 [95% confidence
interval (CI) 1.055–1.769], drug-related IPH by 1.440 (95% CI 1.010–2.053),
and IPH/ED for altered mental status (e.g., euphoria, anxiety) by 1.864 (95%
CI 1.324–2.624). Sustained overuse of both medications quadrupled odds of
all-cause IPH, drug-related IPH, and IPH/ED for altered mental status or
respiratory depression. Conclusion: Despite modest effects of gabapentin
overuse alone, overuse of gabapentin with opioids may increase risk of harm
and health-service utilization, supporting calls to make gabapentin a
controlled substance in the USA.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
gabapentin (adverse drug reaction, drug toxicity)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
benzodiazepine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug abuse
health care utilization
EMTREE MEDICAL INDEX TERMS
addiction (side effect)
adult
anxiety
article
ataxia (side effect)
blurred vision (side effect)
catatonia (side effect)
chorea (side effect)
cohort analysis
controlled study
convulsion (side effect)
drug overdose
drug utilization
dystonia (side effect)
emergency health service
emergency ward
euphoria
extrapyramidal symptom (side effect)
faintness (side effect)
female
follow up
food and drug administration
health care facility
heart palpitation (side effect)
hospital care
human
insomnia (side effect)
major clinical study
male
middle aged
motor dysfunction (side effect)
nystagmus (side effect)
opiate addiction
patient harm
priority journal
public health
respiration depression (side effect)
retrospective study
slurred speech (side effect)
somnolence (side effect)
tachycardia (side effect)
tremor (side effect)
United States
weakness (side effect)
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
gabapentin (60142-96-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170683804
PUI
L618503207
DOI
10.1007/s40264-017-0595-1
FULL TEXT LINK
http://dx.doi.org/10.1007/s40264-017-0595-1
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 33
TITLE
Healthcare utilization in adults with opioid dependence receiving extended
release naltrexone compared to treatment as usual
AUTHOR NAMES
Soares W.E.
Wilson D.
Rathlev N.
Lee J.D.
Gordon M.
Nunes E.V.
O'Brien C.P.
Friedmann P.D.
AUTHOR ADDRESSES
(Soares W.E., William.soaresMD@baystatehealth.org) Department of Emergency
Medicine, Baystate Medical Center, 759 Chestnut St., Springfield, United
States.
(Wilson D., donna.wilson@baystatehealth.org; Rathlev N.,
Niels.rathlev@baystatehealth.org; Friedmann P.D.,
Peter.friedmannmd@baystatehealth.org) Baystate Medical Center, 759 Chestnut
St., Springfield, United States.
(Lee J.D., joshua.lee@nyumc.org) Department of Population Health, New York
University, 227 E. 30th St., New York, United States.
(Gordon M., mgordon@friendsresearch.org) Friends Research Institute, 1040
Park Avenue, Baltimore, United States.
(Nunes E.V., Nunesed@nyspi.columbia.edu) Columbia University Medical Center,
617 West End Avenue, New York, United States.
(O'Brien C.P., obrien@mail.med.upenn.edu) Department of Psychiatry,
University of Pennsylvania, Department of Behavior Health, Philadelphia
Veterans Affairs Medical Center, Philadelphia, United States.
CORRESPONDENCE ADDRESS
W.E. Soares, Department of Emergency Medicine, Baystate Medical Center, 759
Chestnut St., Springfield, United States. Email:
William.soaresMD@baystatehealth.org
SOURCE
Journal of Substance Abuse Treatment (2018) 85 (66-69). Date of Publication:
1 Feb 2018
ISSN
1873-6483 (electronic)
0740-5472
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Background Opioid use disorders have reached epidemic proportions, with
overdose now the leading cause of accidental death in the United States.
Extended release naltrexone (XR-NTX) has emerged as a medication treatment
that reduces opioid use and craving. However, the effect of XR-NTX therapy
on acute healthcare utilization, including emergency department visits and
inpatient hospitalizations, remains uncertain. The objective of the current
study is to evaluate hospital-based healthcare resource utilization in
adults involved in the criminal justice system with a history of opioid use
disorder randomized to XR-NTX therapy compared with treatment as usual (TAU)
during a 6-month treatment phase and 12 months post-treatment follow up.
Methods This retrospective exploratory analysis uses data collected in a
published randomized trial. Comparisons of the number of emergency
department visits and hospital admissions (for drug detox, psychiatric care
and other medical reasons) were performed using chi square tests for any
admission and negative binomial models for number of admissions. Results Of
the 308 participants randomized, 96% had utilization data (76% complete 6
months, 67% complete follow up). No significant differences were seen in
overall healthcare utilization (IRR = 0.88, 95%CI 0.63–1.23, p = 0.45), or
substance use-related drug detox hospitalizations (IRR = 0.83, 95%CI
0.32–2.16, p = 0.71). Despite having more participants report chronic
medical problems at baseline (43% vs. 32%, p = 0.05), those receiving XR-NTX
generally experienced equivalent or lower rates of healthcare utilization
compared to TAU. The XR-NTX group had significantly lower medical/surgical
related hospital admissions (IRR = 0.55, 95%CI 0.30–1.00, p = 0.05) during
the course of the entire study. Conclusions XR-NTX did not significantly
increase rates of healthcare utilization compared to TAU. Provider concerns
regarding healthcare utilization should not preclude the consideration of
XR-NTX as therapy for opioid use disorders.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug comparison, drug therapy)
methadone (drug comparison, drug therapy)
naltrexone (drug comparison, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care utilization
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
criminal justice
drug detoxification
emergency ward
exploratory research
female
follow up
hospital admission
human
major clinical study
male
mental health care
priority journal
retrospective study
substance use
treatment duration
treatment outcome
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170394091
PUI
L616540453
DOI
10.1016/j.jsat.2017.05.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jsat.2017.05.009
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 34
TITLE
Trends in opioid prescribing before and after implementation of an emergency
department opioid prescribing policy
AUTHOR NAMES
Beaudoin F.L.
Janicki A.
Zhai W.
Choo E.K.
AUTHOR ADDRESSES
(Beaudoin F.L., Francesca_Beaudoin@brown.edu; Janicki A.; Choo E.K.) The
Department of Emergency Medicine, Alpert Medical School of Brown University,
Providence, United States.
(Janicki A.) The Department of Emergency Medicine, University of Pittsburg,
Pittsburg, United States.
(Zhai W.) The Department of Biostatistics, Brown University, Providence,
United States.
(Choo E.K.) The Department of Emergency Medicine, Oregon Health and Science
University, Portland, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, 593 Eddy Street, Claverick 2, Providence, United States.
Email: Francesca_Beaudoin@brown.edu
SOURCE
American Journal of Emergency Medicine (2018) 36:2 (329-331). Date of
Publication: 1 Feb 2018
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health care planning
health care policy
prescription
EMTREE MEDICAL INDEX TERMS
clinical practice
emergency care
human
inappropriate prescribing
letter
morbidity
mortality
practice guideline
priority journal
trend study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170544563
PUI
L617559845
DOI
10.1016/j.ajem.2017.07.068
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.07.068
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 35
TITLE
A randomized controlled trial comparing two vaso-occlusive episode (VOE)
protocols in sickle cell disease (SCD)
AUTHOR NAMES
Tanabe P.
Silva S.
Bosworth H.B.
Crawford R.
Paice J.A.
Richardson L.D.
Miller C.N.
Glassberg J.
AUTHOR ADDRESSES
(Tanabe P., paula.tanabe@duke.edu; Silva S.) Duke University School of
Nursing and Medicine, United States.
(Bosworth H.B.) Departments of Population Health Sciences, Medicine,
Psychiatry, and School of Nursing, United States.
(Bosworth H.B.) Duke University, Center for Health Services Research in
Primary Care Durham VAMC, United States.
(Crawford R.) Division of Hematology, Department of Medicine, Duke
University School of Medicine, United States.
(Paice J.A.) Division of Hematology-Oncology, Northwestern University;
Feinberg School of Medicine, United States.
(Richardson L.D.) Population Health Science & Policy, Icahn School of
Medicine at Mount Sinai, United States.
(Miller C.N.) Department of Emergency Medicine, University Hospitals
Cleveland Medical Center, Case Western Reserve University School of
Medicine, United States.
(Glassberg J.) Hematology and Medical Oncology of The Mount Sinai
Comprehensive Sickle Cell Program, Icahn School of Medicine at Mount Sinai,
United States.
CORRESPONDENCE ADDRESS
P. Tanabe, Duke University School of Nursing and Medicine, United States.
Email: paula.tanabe@duke.edu
SOURCE
American Journal of Hematology (2018) 93:2 (159-168). Date of Publication: 1
Feb 2018
ISSN
1096-8652 (electronic)
0361-8609
BOOK PUBLISHER
Wiley-Liss Inc., info@wiley.com
ABSTRACT
Limited evidence guides opioid dosing strategies for acute Sickle Cell (SCD)
pain. We compared two National Heart, Lung and Blood (NHBLI) recommended
opioid dosing strategies (weight-based vs. patient-specific) for ED
treatment of acute vaso-occlusive episodes (VOE). A prospective randomized
controlled trial (RCT) was conducted in two ED's. Adults ≥ 21 years of age
with SCD disease were eligible. Among the 155 eligible patients, 106
consented and 52 had eligible visits. Patients were pre-enrolled in the
outpatient setting and randomized to one of two opioid dosing strategies for
a future ED visit. ED providers accessed protocols through the electronic
medical record. Change in pain score (0-100 mm VAS) from arrival to ED
disposition, as well as side effects were assessed. 52 patients (median age
was 27 years, 42% were female, and 89% black) had one or more ED visits for
a VOE (total of 126 ED study visits, up to 5 visits/patient were included).
Participants randomized to the patient-specific protocol experienced a mean
reduction in pain score that was 16.6 points greater than patients
randomized to the weight-based group (mean difference 95% CI = 11.3 to 21.9,
P = 0.03). Naloxone was not required for either protocol and nausea and/or
vomiting was observed less often in the patient-specific protocol (25.8% vs
59.4%, P = 0.0001). The hospital admission rate for VOE was lower for
patients in the patient-specific protocol (40.3% vs 57.8% P = 0.05). NHLBI
guideline-based analgesia with patient-specific opioid dosing resulted in
greater improvements in the pain experience compared to a weight-based
strategy, without increased side effects.
EMTREE DRUG INDEX TERMS
hydromorphone (adverse drug reaction, clinical trial, drug therapy,
subcutaneous drug administration)
morphine sulfate (adverse drug reaction, clinical trial, drug therapy,
intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, complication, drug therapy)
sickle cell anemia
sickle cell crisis (drug therapy, complication, drug therapy)
vasoocclusive crisis (drug therapy, complication, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
Black person
blood pressure
breathing rate
controlled study
electronic medical record
emergency ward
female
heart rate
hospital admission
hospital discharge
human
major clinical study
male
multicenter study
nausea and vomiting (side effect)
open study
oxygen saturation
patient compliance
phase 3 clinical trial
priority journal
prospective study
randomized controlled trial
sedation
side effect (side effect)
visual analog scale
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
Adverse Reactions Titles (38)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT02222246)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180022099
PUI
L620159424
DOI
10.1002/ajh.24948
FULL TEXT LINK
http://dx.doi.org/10.1002/ajh.24948
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 36
TITLE
An emergency response to the opioid overdose crisis in Canada: a regulated
opioid distribution program
AUTHOR NAMES
Tyndall M.
AUTHOR ADDRESSES
(Tyndall M., mark.tyndall@bccdc.ca) BC Centre for Disease Control,
Vancouver, Canada.
(Tyndall M., mark.tyndall@bccdc.ca) School of Population and Public Health,
University of British Columbia, Vancouver, Canada.
SOURCE
CMAJ (2018) 190:2 (E35-E36). Date of Publication: 15 Jan 2018
ISSN
1488-2329 (electronic)
0820-3946
BOOK PUBLISHER
Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, Canada.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Canada
emergency
EMTREE MEDICAL INDEX TERMS
drug overdose
human
note
pharmacokinetics
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180259711
PUI
L621599295
DOI
10.1503/cmaj.171060
FULL TEXT LINK
http://dx.doi.org/10.1503/cmaj.171060
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 37
TITLE
An emergency response to the opioid overdose crisis in Canada: a regulated
opioid distribution program
AUTHOR NAMES
Tyndall M.
AUTHOR ADDRESSES
(Tyndall M., mark.tyndall@bccdc.ca) BC Centre for Disease Control,
Vancouver, Canada.
(Tyndall M., mark.tyndall@bccdc.ca) School of Population and Public Health,
University of British Columbia, Vancouver, Canada.
SOURCE
CMAJ (2018) 190:2 (E35-E36). Date of Publication: 15 Jan 2018
ISSN
1488-2329 (electronic)
0820-3946
BOOK PUBLISHER
Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, Canada.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Canada
emergency
EMTREE MEDICAL INDEX TERMS
drug overdose
human
note
pharmacokinetics
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180237732
PUI
L621507614
DOI
10.1503/cmaj.171060
FULL TEXT LINK
http://dx.doi.org/10.1503/cmaj.171060
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 38
TITLE
Self-identification of nonpharmaceutical fentanyl exposure following heroin
overdose
AUTHOR NAMES
Griswold M.K.
Chai P.R.
Krotulski A.J.
Friscia M.
Chapman B.
Boyer E.W.
Logan B.K.
Babu K.M.
AUTHOR ADDRESSES
(Griswold M.K.; Chapman B.; Babu K.M., kavita.babu@umassmemorial.org)
Division of Medical Toxicology, Department of Emergency Medicine, University
of Massachusetts Medical School, Worcester, United States.
(Chai P.R.; Boyer E.W.) Division of Medical Toxicology, Department of
Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School,
Boston, United States.
(Krotulski A.J.; Friscia M.; Logan B.K.) The Center for Forensic Science
Research and Education (CFSRE), Willow Grove, United States.
(Logan B.K.) NMS Labs, Willow Grove, United States.
CORRESPONDENCE ADDRESS
K.M. Babu, University of Massachusetts Medical School, 55 Lake Ave N.,
Worcester, United States. Email: kavita.babu@umassmemorial.org
SOURCE
Clinical Toxicology (2018) 56:1 (37-42). Date of Publication: 2 Jan 2018
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Objective: To compare user self-identification of nonpharmaceutical fentanyl
exposure with confirmatory urine drug testing in emergency department (ED)
patients presenting after heroin overdose. Methods: This was a
cross-sectional study of adult ED patients who presented after a heroin
overdose requiring naloxone administration. Participants provided verbal
consent after which they were asked a series of questions regarding their
knowledge, attitudes and beliefs toward heroin and nonpharmaceutical
fentanyl. Participants also provided urine samples, which were analyzed
using liquid chromatography coupled to quadrupole time-of-flight mass
spectrometry to identify the presence of fentanyl, heroin metabolites, other
clandestine opioids, common pharmaceuticals and drugs of abuse. Results:
Thirty participants were enrolled in the study period. Ten participants
(33%) had never required naloxone for an overdose in the past, 20
participants (67%) reported recent abstinence, and 12 participants (40%)
reported concomitant cocaine use. Naloxone was detected in all urine drug
screens. Heroin or its metabolites were detected in almost all samples
(93.3%), as were fentanyl (96.7%) and its metabolite, norfentanyl (93.3%).
Acetylfentanyl was identified in nine samples (30%) while U-47700 was
present in two samples (6.7%). Sixteen participants self-identified fentanyl
in their heroin (sensitivity 55%); participants were inconsistent in their
qualitative ability to identify fentanyl in heroin. Conclusions: Heroin
users presenting to the ED after heroin overdose requiring naloxone are
unable to accurately identify the presence of nonpharmaceutical fentanyl in
heroin. Additionally, cutting edge drug testing methodologies identified
fentanyl exposures in 96.7% of our patients, as well as unexpected
clandestine opioids (like acetylfentanyl and U-47700).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
fentanyl (drug analysis)
EMTREE DRUG INDEX TERMS
acetylfentanyl (drug analysis)
cocaine
drug metabolite (drug analysis)
naloxone (drug therapy)
norfentanyl (drug analysis)
u 47700 (drug analysis)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug exposure
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
clinical article
cocaine dependence
controlled study
cross-sectional study
drug screening
drug urine level
drug withdrawal
emergency ward
female
human
liquid chromatography
male
specimen handling
time of flight mass spectrometry
urine sampling
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170494650
MEDLINE PMID
28681615 (http://www.ncbi.nlm.nih.gov/pubmed/28681615)
PUI
L617262859
DOI
10.1080/15563650.2017.1339889
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1339889
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 39
TITLE
Going beyond prescription pain relievers to understand the opioid epidemic:
the role of illicit fentanyl, new psychoactive substances, and street heroin
AUTHOR NAMES
Pergolizzi J.V.
LeQuang J.A.
Taylor R.
Raffa R.B.
AUTHOR ADDRESSES
(Pergolizzi J.V.; LeQuang J.A.; Taylor R.) NEMA Research, Inc, Naples,
United States.
(Raffa R.B., robert.raffa@temple.edu) Department of Pharmacology &
Toxicology, University of Arizona College of Pharmacy, Tucson, United
States.
(Raffa R.B., robert.raffa@temple.edu) Department of Pharmaceutical Sciences,
Temple University School of Pharmacy, Philadelphia, United States.
()
CORRESPONDENCE ADDRESS
R.B. Raffa, 3825 E Diablo Canyon Place, Tucson, United States. Email:
robert.raffa@temple.edu
SOURCE
Postgraduate Medicine (2018) 130:1 (1-8). Date of Publication: 2 Jan 2018
ISSN
1941-9260 (electronic)
0032-5481
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia, United
States.
ABSTRACT
The opioid epidemic is associated with morbidity and mortality, and it has
taken a vast toll on American society. While prescription opioid abuse is
part of the opioid problem, it is by no means the entirety of it. Opioid
abuse appears to have entered a technology-driven new world of clandestine
labs all over the globe and many new synthetic analog, counterfeit, and
adulterated drugs that arrive via the internet faster than the Drug
Enforcement Administration (DEA) can catalog and outlaw them. To deal with
opioid abuse, it must be recognized that it is more–far more–than a subset
of chronic pain patients who become addicted. Indeed, to reduce the opioid
epidemic to this population is to misunderstand it. The opioid epidemic
involves illicit opioids, counterfeit opioids, new psychoactive substances,
diverted opioids, and prescription opioids. The objective of this narrative
review is to consider the roles of all substances that contribute to the
opioid epidemic in America.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
fentanyl
narcotic analgesic agent
psychotropic agent
EMTREE DRUG INDEX TERMS
benzodiazepine
counterfeit drug
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
prescription
EMTREE MEDICAL INDEX TERMS
behavior
chronic pain
community care
drug dependence
drug industry
emergency ward
epidemic
government
health care survey
health insurance
human
medical literature
medical profession
meta analysis
mortality
oncology
pharmaceutical care
public health
review
systematic review
technology
world health organization
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170849142
MEDLINE PMID
29190175 (http://www.ncbi.nlm.nih.gov/pubmed/29190175)
PUI
L619499343
DOI
10.1080/00325481.2018.1407618
FULL TEXT LINK
http://dx.doi.org/10.1080/00325481.2018.1407618
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 40
TITLE
Rate of patients at elevated risk of opioid overdose visiting the emergency
department
AUTHOR NAMES
Pedigo J.R.
Seifert C.F.
AUTHOR ADDRESSES
(Pedigo J.R.; Seifert C.F., charles.seifert@ttuhsc.edu) Department of
Pharmacy Practice, Texas Tech University Health Sciences Center School of
Pharmacy, University Medical Center, Lubbock, United States.
CORRESPONDENCE ADDRESS
C.F. Seifert, School of Pharmacy, Texas Tech University Health Sciences
Center, 3601 4th Street, STOP 8162, Lubbock, United States. Email:
charles.seifert@ttuhsc.edu
SOURCE
American Journal of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Objective: To determine the rate of patients visiting the emergency
department who are at risk of opioid overdose. Methods: The electronic
records of a 412 bed tertiary care county teaching hospital were searched
for emergency department (ED) visits from January 1, 2013 to October 31,
2016 to find patients on at least 100 mg morphine equivalents (MME) of oral
opioid therapy, or an opioid in combination with a benzodiazepine. Records
were also searched for patients with a positive urinalysis for opioids when
no opioid was present on their home medication list. Medication
reconciliations were searched for patients at risk of opioid overdose who
were subsequently discharged on naloxone. Results: An analysis of 2521
patients visiting the ED was performed, and the overall rate of risk of
opioid overdose increased from 25.84% to 47.41% (p < 0.0001) in patients
meeting inclusion criteria from 2013 to 2016. For patients on opioids, the
rate of patients on 100 MME daily or greater increased from 9.72% to 28.24%
(p < 0.0001) from 2013 to 2016. The rate of patients on opioid therapy in
combination with benzodiazepine therapy did not change significantly from
2013 to 2016. When comparing patients at risk of opioid overdose to total
emergency department visits, we found the rate of at risk patients increased
significantly from 0.12% to 0.56% (p < 0.0001) from 2013 to 2016.
Conclusions: The rate of patients visiting the emergency department at risk
of opioid overdose increased significantly from 2013 to 2016. Naloxone was
not routinely prescribed to this patient cohort.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
risk assessment
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
controlled clinical trial
controlled study
drug combination
drug overdose
drug therapy
female
human
information processing
major clinical study
male
medication therapy management
teaching hospital
tertiary health care
urinalysis
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180229014
PUI
L2000609142
DOI
10.1016/j.ajem.2018.03.055
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2018.03.055
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 41
TITLE
Designer drugs: Review and implications for emergency management
AUTHOR NAMES
Pourmand A.
Mazer-Amirshahi M.
Chistov S.
Li A.
Park M.
AUTHOR ADDRESSES
(Pourmand A., pourmand@gwu.edu; Chistov S.; Li A.; Park M.) Emergency
Medicine Department, George Washington University, Washington, United
States.
(Mazer-Amirshahi M.) Emergency Medicine Department, MedStar Washington
Hospital Center, Washington, United States.
CORRESPONDENCE ADDRESS
A. Pourmand, Department of Emergency Medicine, Medical Center, George
Washington University, 2120 L St. NW, Washington, United States. Email:
pourmand@gwu.edu
SOURCE
Human and Experimental Toxicology (2018) 37:1 (94-101). Date of Publication:
1 Jan 2018
ISSN
1477-0903 (electronic)
0960-3271
BOOK PUBLISHER
SAGE Publications Ltd, info@sagepub.co.uk
ABSTRACT
In the past 10 years, “designer drugs” such as synthetic cannabinoids and
cathinones have emerged and come into widespread use, resulting in more
overdose cases involving these new drugs in the United States. Emergency
departments regularly treat a diverse array of drug intoxications, and
providers must be cognizant of novel drugs of abuse and the associated
clinical presentations in order to provide the most appropriate care. This
review aims to describe the epidemiology, mechanism of action, clinical
presentation, and treatment of intoxication for both the common and newest
drugs of abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
designer drug (drug toxicity)
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
benzodiazepine derivative (drug therapy)
butyrophenone derivative (drug therapy)
cannabinoid (drug toxicity)
cathinone (drug toxicity)
dextromethorphan (drug toxicity)
infusion fluid (drug therapy)
ketamine (drug toxicity)
naloxone (drug therapy)
opiate (drug toxicity)
phencyclidine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
EMTREE MEDICAL INDEX TERMS
anxiety disorder (drug therapy)
bradycardia (drug therapy)
catatonia (drug therapy)
clinical feature
drug abuse
drug intoxication (drug therapy, epidemiology)
emergency ward
human
hypertension (drug therapy)
hypotension (drug therapy)
Mitragyna
Mitragyna speciosa
priority journal
respiration depression (drug therapy)
restlessness (drug therapy)
review
Salvia divinorum
sedation
substance abuse
symptom
tachycardia (drug therapy)
treatment outcome
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
dextromethorphan (125-69-9, 125-71-3)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phencyclidine (77-10-1, 956-90-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170853811
PUI
L619528605
DOI
10.1177/0960327117698542
FULL TEXT LINK
http://dx.doi.org/10.1177/0960327117698542
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 42
TITLE
Safety of a Brief Emergency Department Observation Protocol for Patients
With Presumed Fentanyl Overdose
AUTHOR NAMES
Scheuermeyer F.X.
DeWitt C.
Christenson J.
Grunau B.
Kestler A.
Grafstein E.
Buxton J.
Barbic D.
Milanovic S.
Torkjari R.
Sahota I.
Innes G.
AUTHOR ADDRESSES
(Scheuermeyer F.X., frank.scheuermeyer@gmail.com; DeWitt C.; Christenson J.;
Grunau B.; Kestler A.; Grafstein E.; Barbic D.; Milanovic S.; Torkjari R.;
Sahota I.) Department of Emergency Medicine, St Paul's Hospital and the
University of British Columbia, Vancouver, Canada
(Buxton J.) British Columbia Center for Disease Control, Vancouver, Canada
(Innes G.) Department of Emergency Medicine, Rockyview Hospital and the
University of Calgary, Calgary, Canada
CORRESPONDENCE ADDRESS
F.X. Scheuermeyer, Department of Emergency Medicine, St Paul's Hospital and
the University of British Columbia, Vancouver, Canada Email:
frank.scheuermeyer@gmail.com
SOURCE
Annals of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective: Fentanyl overdoses are increasing and few data guide
emergency department (ED) management. We evaluate the safety of an ED
protocol for patients with presumed fentanyl overdose. Methods: At an urban
ED, we used administrative data and explicit chart review to identify and
describe consecutive patients with uncomplicated presumed fentanyl overdose
(no concurrent acute medical issues) from September to December 2016. We
linked regional ED and provincial vital statistics databases to ascertain
admissions, revisits, and mortality. Primary outcome was a composite of
admission and death within 24 hours. Other outcomes included treatment with
additional ED naloxone, development of a new medical issue while in the ED,
and length of stay. A prespecified subgroup analysis assessed low-risk
patients with normal triage vital signs. Results: There were 1,009
uncomplicated presumed fentanyl overdose, mainly by injection. Median age
was 34 years, 85% were men, and 82% received out-of-hospital naloxone. One
patient was hospitalized and one discharged patient died within 24 hours
(combined outcome 0.2%; 95% confidence interval [CI] 0.04% to 0.8%). Sixteen
patients received additional ED naloxone (1.6%; 95% CI 1.0% to 2.6%), none
developed a new medical issue (0%; 95% CI 0% to 0.5%), and median length of
stay was 173 minutes (interquartile range 101 to 267). For 752 low-risk
patients, no patients were admitted or developed a new issue, and one died
postdischarge; 3 (0.4%; 95% CI 0.01% to 1.3%) received ED naloxone.
Conclusion: In our cohort of ED patients with uncomplicated presumed
fentanyl overdose-typically after injection-deterioration, admission,
mortality, and postdischarge complications appear low; the majority can be
discharged after brief observation. Patients with normal triage vital signs
are unlikely to require ED naloxone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
complication
death
deterioration
drug overdose
drug therapy
emergency health service
female
human
injection
length of stay
low risk patient
major clinical study
male
medical record review
mortality
pharmacokinetics
risk assessment
vital sign
vital statistics
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180173811
PUI
L621164249
DOI
10.1016/j.annemergmed.2018.01.054
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2018.01.054
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 43
TITLE
Analysis of the clinical effects of using naloxone hydrochloride in
emergency treatments of acute alcoholism
AUTHOR NAMES
Gou W.
Peng L.
Yang Q.
Cao L.
AUTHOR ADDRESSES
(Gou W.) Department of Neurology, The Seventh People’s Hospital of Chengdu,
Chengdu, China.
(Gou W.) Department of Geriatrics, The Seventh People’s Hospital of Chengdu,
Chengdu, China.
(Peng L.) Department of Neurology, The Institutional Hospital of Chengdu
Military Command, Chengdu, China.
(Yang Q.; Cao L.) Department of Endocrinology, The Seventh People’s Hospital
of Chengdu, Chengdu, China.
CORRESPONDENCE ADDRESS
W. Gou, Department of Neurology, The Seventh People’s Hospital of Chengdu,
China.
SOURCE
Biomedical Research (India) (2018) 29:2 (330-333). Date of Publication: 2018
ISSN
0970-938X
BOOK PUBLISHER
Scientific Publishers of India
ABSTRACT
Objective: This study aimed to analyse the clinical effects of using
naloxone hydrochloride in emergency treatments of acute alcoholism. Methods:
A total of 146 patients admitted between August 2015 and August 2017 in the
hospital where the author works were divided into control (n=73) and test
(n=73) groups using the odd–even method. Routine and naloxene hydrochloride
treatments were administered to the control and test groups, respectively.
The clinical effects on the two groups were then compared. Results: The
overall response rate of the test group was significantly higher (P<0.05)
than that of the control group. The test group significantly outperformed
the control group in terms of onset, symptom remission, and symptom
disappearance times. The two groups were also compared in terms of
limb-movement recovery time, the time when GCS rating reaches eight points,
and the duration of hospitalization. Similarly, the test group again showed
a significantly higher (P<0.05) performance than the control group.
Furthermore, the test and control groups were compared in terms of negative
response rate, wherein no significant difference (P<0.05) was observed.
Conclusions: The use of naloxone hydrochloride in the emergency treatment of
acute alcoholism was reliable, effective, and safe. The compound can
significantly alleviate the patients’ clinical symptoms and shorten the
recovery time. Therefore, further clinical application of naloxone
hydrochloride should be promoted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism (drug therapy, drug therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug effect
drug efficacy
drug response
drug safety
Glasgow coma scale
hospital admission
hospitalization
human
limb movement
major clinical study
reliability
remission
symptom
time factor
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180203224
PUI
L621278915
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 44
TITLE
Naloxone access for Emergency Medical Technicians: An evaluation of a
training program in rural communities
AUTHOR NAMES
Zhang X.
Marchand C.
Sullivan B.
Klass E.M.
Wagner K.D.
AUTHOR ADDRESSES
(Zhang X.; Wagner K.D., karlawagner@unr.edu) School of Community Health
Sciences, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno,
United States.
(Marchand C.; Klass E.M.) Office of Statewide Initiatives, University of
Nevada, Reno School of Medicine, 411 West Second Street, Reno, United
States.
(Sullivan B.) Nevada State Health Division, Emergency Medical Systems, 4126
Technology Way, Suite 201, Carson City, United States.
CORRESPONDENCE ADDRESS
K.D. Wagner, School of Community Health Sciences, University of Nevada,
Reno, 1664 N. Virginia St. MC 0274, Reno, United States. Email:
karlawagner@unr.edu
SOURCE
Addictive Behaviors (2018). Date of Publication: 2018
ISSN
1873-6327 (electronic)
0306-4603
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
Introduction: Opioid-related overdose death rates in rural communities in
the United States are much higher than their urban counterparts. However,
basic life support (BLS) personnel, who are more common in rural areas, have
much lower rates of naloxone administration than other levels of emergency
medical services (EMS). Training and equipping basic level Emergency Medical
Technician (EMTs) to administer naloxone for an opioid overdose could yield
positive outcomes. Methods: Following a legislative change that allowed EMTs
to administer naloxone in one rural state, we evaluated an EMT training
program by examining EMTs' opioid overdose knowledge and attitudes before
and after the training. Results: One-hundred-seventeen rural EMTs
participated the training. They demonstrated statistically significant
improvements on almost all of the knowledge questions after the training
(p's = 0.0469 to <0.0001). The opioid overdose competency and concern scales
showed statistically significant improvement (p < 0.0001) and reduction (p <
0.0001), respectively. Furthermore, statistically significant changes in
knowledge and opinions of state law regarding naloxone administration were
observed. Significantly more EMTs supported the idea of expanding naloxone
to people at risk for overdose (p = 0.0026) after the training. Conclusions:
At a time when states are passing legislation to expand first responders'
access to naloxone, this study provides evidence about authorizing EMTs to
administer naloxone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
rescue personnel
rural population
training
EMTREE MEDICAL INDEX TERMS
adult
article
controlled clinical trial
controlled study
drug overdose
female
human
law
male
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180201129
PUI
L2000561785
DOI
10.1016/j.addbeh.2018.03.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.addbeh.2018.03.004
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 45
TITLE
The impact of opioid medications on subsequent fractures in discharged
emergency department patients with peripheral vertigo
AUTHOR NAMES
Grewal K.
Austin P.C.
Kapral M.K.
Lu H.
Atzema C.L.
AUTHOR ADDRESSES
(Grewal K., keerat.grewal@mail.utoronto.ca; Atzema C.L.) Department of
Medicine, Division of Emergency Medicine, University of Toronto, Institute
for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Canada.
(Austin P.C.; Atzema C.L.) Sunnybrook Health Sciences Centre, University of
Toronto, Faculty of Medicine, Toronto, Canada.
(Kapral M.K.) University Health Network, University of Toronto, Toronto,
Canada.
(Austin P.C.; Kapral M.K.) Institute of Health Policy, Management, and
Evaluation, University of Toronto, Toronto, Canada.
(Austin P.C.; Kapral M.K.; Lu H.; Atzema C.L.) Institute for Clinical
Evaluative Sciences, Toronto, Canada.
CORRESPONDENCE ADDRESS
K. Grewal, Department of Medicine, Division of Emergency Medicine,
University of Toronto, Institute for Clinical Evaluative Sciences, 2075
Bayview Avenue, Toronto, Canada. Email: keerat.grewal@mail.utoronto.ca
SOURCE
Canadian Journal of Emergency Medicine (2018) 20:1 (28-35). Date of
Publication: 1 Jan 2018
ISSN
1481-8043 (electronic)
1481-8035
BOOK PUBLISHER
Cambridge University Press, info@bcdecker.com
ABSTRACT
Background Vertigo is common in the emergency department (ED). Most
aetiologies are peripheral and do not require hospitalization, but many
patients still fear falling. Some patients may be taking opioid analgesic
medications (for other reasons); the risk of falls leading to fractures
among patients with vertigo could be potentiated by the simultaneous use of
opioids. Objectives To examine the risk of fractures in discharged ED
patients with peripheral vertigo who were being prescribed opioids during
the same time period. Methods Linked administrative databases from Ontario
were used to compare discharged ED patients aged ≥65 with peripheral vertigo
to patients with urinary tract infection (UTI) from 2006 to 2011. We used
Cox regression analysis with an interaction term to estimate the modifying
effect of an opioid prescription on the hazard of fracture within 90 days.
Results There were 13,012 patients with a peripheral vertigo syndrome and
76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI
cohort had access to a filled opioid prescription. Compared to vertigo
patients who did not fill an opioid prescription, the adjusted hazard of
fracture among vertigo patients who did fill a prescription was 3.59 (95% CI
1.97-6.13). Among UTI patients who filled an opioid prescription the hazard
ratio was 1.68 (95% CI 1.43-1.97) compared to UTI patients who did not.
Conclusions Patients discharged from the ED with peripheral vertigo who were
also being prescribed opioids had a higher hazard of subsequent fracture
compared to those who were not, and the effect was much greater than among
UTI patients. These results suggest that in the acutely vertiginous older
patient, opioid analgesic medications should be modified, where possible.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fracture
urinary tract infection
vertigo
EMTREE MEDICAL INDEX TERMS
aged
article
cohort analysis
comorbidity
disease classification
emergency ward
female
health care facility
hospital admission
hospital discharge
hospitalization
human
major clinical study
male
outcome assessment
prescription
retrospective study
sensitivity analysis
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Public Health, Social Medicine and Epidemiology (17)
Urology and Nephrology (28)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20180044826
PUI
L620315328
DOI
10.1017/cem.2017.37
FULL TEXT LINK
http://dx.doi.org/10.1017/cem.2017.37
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 46
TITLE
Emergency Department Contribution to the Prescription Opioid Epidemic
AUTHOR NAMES
Axeen S.
Seabury S.A.
Menchine M.
AUTHOR ADDRESSES
(Axeen S., axeen@usc.edu; Menchine M.) Department of Emergency Medicine
(Seabury S.A.) Department of Ophthalmology, Keck School of Medicine
(Axeen S., axeen@usc.edu; Seabury S.A.) Leonard D. Schaeffer Center for
Health Policy and Economics, University of Southern California, Los Angeles,
CA
CORRESPONDENCE ADDRESS
S. Axeen, Department of Emergency Medicine Email: axeen@usc.edu
SOURCE
Annals of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective: We characterize the relative contribution of emergency
departments (EDs) to national opioid prescribing, estimate trends in opioid
prescribing by site of care (ED, office-based, and inpatient), and examine
whether higher-risk opioid users receive a disproportionate quantity of
their opioids from ED settings. Methods: This was a retrospective analysis
of the nationally representative Medical Expenditure Panel Survey from 1996
to 2012. Individuals younger than 18 years and with malignancy diagnoses
were excluded. All prescriptions were standardized through conversion to
milligrams of morphine equivalents. Reported estimates are adjusted with
multivariable regression analysis. Results: From 1996 to 2012, 47,081
patient-years (survey-weighted population of 483,654,902 patient-years)
surveyed by the Medical Expenditure Panel Survey received at least 1 opioid
prescription. During the same period, we observed a 471% increase in the
total quantity of opioids (measured by total milligrams of morphine
equivalents) prescribed in the United States. The proportion of opioids from
office-based prescriptions was high and increased throughout the study
period (71% of the total in 1996 to 83% in 2012). The amount of opioids
originating from the ED was modest and declined throughout the study period
(7.4% in 1996 versus 4.4% in 2012). For people in the top 5% of opioid
consumption, ED prescriptions accounted for only 2.4% of their total
milligrams of morphine equivalents compared with 87.8% from office visits.
Conclusion: Between 1996 and 2012, opioid prescribing for noncancer patients
in the United States significantly increased. The majority of this growth
was attributable to office visits and refills of previously prescribed
opioids. The relative contribution of EDs to the prescription opioid problem
was modest and declining. Thus, further efforts to reduce the quantity of
opioids prescribed may have limited effect in the ED and should focus on
office-based settings. EDs could instead focus on developing and
disseminating tools to help providers identify high-risk individuals and
refer them to treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
epidemic
prescription
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
article
body weight
diagnosis
female
hospital patient
human
major clinical study
male
malignant neoplasm
opiate addiction
regression analysis
retrospective study
risk assessment
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180060554
PUI
L620396538
DOI
10.1016/j.annemergmed.2017.12.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.12.007
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 47
TITLE
Emergency physicians' attitudes and perceived barriers to the implementation
of take-home naloxone programs in Canadian emergency departments
AUTHOR NAMES
Lacroix L.
Thurgur L.
Orkin A.M.
Perry J.J.
Stiell I.G.
AUTHOR ADDRESSES
(Lacroix L., llacroix@qmed.ca; Thurgur L.; Perry J.J.; Stiell I.G.)
Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue,
Ottawa, Canada.
(Perry J.J.; Stiell I.G.) Ottawa Hospital, Research Institute, University of
Ottawa, Ottawa, Canada.
(Orkin A.M.) Schwartz/Reisman Emergency Medicine Institute, Mount Sinai,
Toronto, Canada.
(Orkin A.M.) Dalla Lana School of Public Health, Department of Family and
Community Medicine, University of Toronto, Toronto, Canada.
CORRESPONDENCE ADDRESS
L. Lacroix, Department of Emergency Medicine, University of Ottawa, 1053
Carling Avenue, Ottawa, Canada. Email: llacroix@qmed.ca
SOURCE
Canadian Journal of Emergency Medicine (2018) 20:1 (46-52). Date of
Publication: 1 Jan 2018
ISSN
1481-8043 (electronic)
1481-8035
BOOK PUBLISHER
Cambridge University Press, info@bcdecker.com
ABSTRACT
Objectives Rates of opioid-related deaths have reached the level of national
public health crisis in Canada. Community-based opioid overdose education
and naloxone distribution (OEND) programs distribute naloxone to people at
risk, and the emergency department (ED) may be an underutilized setting to
deliver naloxone to these people. The goal of this study was to identify
Canadian emergency physicians' attitudes and perceived barriers to the
implementation of take-home naloxone programs. Methods This was an anonymous
Web-based survey of members of the Canadian Association of Emergency
Physicians. Survey questions were developed by the research team and piloted
for face validity and clarity. Two reminder emails were sent to
non-responders at 2-week intervals. Respondent demographics were collected,
and Likert scales were used to assess attitudes and barriers to the
prescription of naloxone from the ED. Results A total of 459 physicians
responded. The majority of respondents were male (64%), worked in urban
tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes
to OEND were strongly positive; 86% identified a willingness to prescribe
naloxone from the ED. Perceived barriers included support for patient
education (57%), access to follow-up (44%), and inadequate time (37%). In
addition to people at risk of overdose, 77% of respondents identified that
friends and family members may also benefit. Conclusions Canadian emergency
physicians are willing to distribute take-home naloxone, but thoughtful
systems are required to facilitate opioid OEND implementation. These data
will inform the development of these programs, with emphasis on
multidisciplinary training and education.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
benzodiazepine
diamorphine
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
physician attitude
EMTREE MEDICAL INDEX TERMS
article
clinical practice
emergency ward
female
follow up
health care access
health care planning
health program
heroin dependence
human
male
opiate addiction
patient education
prescription
questionnaire
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20180044834
PUI
L620315501
DOI
10.1017/cem.2017.390
FULL TEXT LINK
http://dx.doi.org/10.1017/cem.2017.390
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 48
TITLE
Emergency Department Provider Perspectives on Benzodiazepine–Opioid
Coprescribing: A Qualitative Study
AUTHOR NAMES
Kim H.S.
McCarthy D.M.
Hoppe J.A.
Mark Courtney D.
Lambert B.L.
AUTHOR ADDRESSES
(Kim H.S., howard.kim@northwestern.edu; McCarthy D.M.; Mark Courtney D.)
Department of Emergency Medicine, Northwestern University Feinberg School of
Medicine, Chicago, United States.
(Hoppe J.A.) Department of Emergency Medicine, University of Colorado School
of Medicine, Aurora, United States.
(Hoppe J.A.) Rocky Mountain Poison & Drug Center, Denver, United States.
(Lambert B.L.) Department of Communication Studies, Northwestern University
Feinberg School of Medicine, Chicago, United States.
(Lambert B.L.) Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, United States.
CORRESPONDENCE ADDRESS
H.S. Kim, Department of Emergency Medicine, Northwestern University Feinberg
School of Medicine, Chicago, United States. Email:
howard.kim@northwestern.edu
SOURCE
Academic Emergency Medicine (2018) 25:1 (15-24). Date of Publication: 1 Jan
2018
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e.,
“coprescribed”) in many clinical settings, despite guidelines advising
against this practice and mounting evidence that concomitant use of both
medications increases overdose risk. This study sought to characterize the
contexts in which benzodiazepine–opioid coprescribing occurs and providers’
reasons for coprescribing. Methods: We conducted focus groups with emergency
department (ED) providers (resident and attending physicians, advanced
practice providers, and pharmacists) from three hospitals using
semistructured interviews to elicit perspectives on benzodiazepine–opioid
coprescribing. Discussions were audio-recorded and transcribed. We performed
qualitative content analysis of the resulting transcripts using a consensual
qualitative research approach, aiming to identify priority categories that
describe the phenomenon of benzodiazepine–opioid coprescribing. Results:
Participants acknowledged coprescribing rarely and reluctantly and often
provided specific discharge instructions when coprescribing. The decision to
coprescribe is multifactorial, often isolated to specific clinical and
situational contexts (e.g., low back pain, failed solitary opioid therapy)
and strongly influenced by a provider's beliefs about the efficacy of
combination therapy. The decision to coprescribe is further influenced by a
self-imposed pressure to escalate care or avoid hospital admission. When
considering potential interventions to reduce the incidence of
coprescribing, participants opposed computerized alerts but were supportive
of a pharmacist-assisted intervention. Many providers found the process of
participating in peer discussions on prescribing habits to be beneficial.
Conclusions: In this qualitative study of ED providers, we found that
benzodiazepine–opioid coprescribing occurs in specific clinical and
situational contexts, such as the treatment of low back pain or failed
solitary opioid therapy. The decision to coprescribe is strongly influenced
by a provider's beliefs and by self-imposed pressure to escalate care or
avoid admission.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
cyclobenzaprine (drug therapy)
diazepam (drug therapy)
muscle relaxant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health behavior
health care personnel
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
audio recording
awareness
backache
clinical article
clinical practice
Colorado
combination drug therapy
computerized provider order entry
content analysis
decision making
dependent personality disorder
drug efficacy
drug mechanism
drug safety
female
hospital discharge
human
Illinois
incidence
information processing
intractable pain
low back pain (drug therapy)
male
multicenter study
patient care
patient guidance
patient satisfaction
personal experience
pharmacist
physician
practice guideline
priority journal
qualitative analysis
qualitative research
residency education
resident
semi structured interview
vital sign
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
cyclobenzaprine (303-53-7, 6202-23-9)
diazepam (439-14-5)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170683096
PUI
L618499622
DOI
10.1111/acem.13273
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13273
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 49
TITLE
Reduction of Parenteral Opioid Use in Community Emergency Departments
Following Implementation of Treatment Guidelines
AUTHOR NAMES
Ghobadi A.
Van Winkle P.J.
Menchine M.
Chen Q.
Huang B.Z.
Sharp A.L.
AUTHOR ADDRESSES
(Ghobadi A., ali.x.ghobadi@gmail.com) Department of Emergency Medicine
Orange County Anaheim Medical Center Kaiser Permanente Southern California
AnaheimCA
(Van Winkle P.J.) Department of Pediatrics Orange County Anaheim Medical
Center Kaiser Permanente Southern California AnaheimCA
(Menchine M.) Department of Emergency Medicine Keck School of Medicine
University of Southern California Los Angeles, CA
(Chen Q.; Huang B.Z.; Sharp A.L.) Department of Research and Evaluation
Kaiser Permanente Southern California Pasadena, CA
(Sharp A.L.) Department of Emergency Medicine Los Angeles Medical Center
Kaiser Permanente Southern California Los AngelesCA
CORRESPONDENCE ADDRESS
A. Ghobadi, Department of Emergency Medicine Orange County Anaheim Medical
Center Kaiser Permanente Southern California AnaheimCA Email:
ali.x.ghobadi@gmail.com
SOURCE
Academic Emergency Medicine (2018). Date of Publication: 2018
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Opioid prescribing guidelines are commonly seen as part of the
solution to America's opioid epidemic. However, the effectiveness of
specific treatment guidelines on altering opioid prescribing in the
emergency department (ED) is unclear. We examined provider ordering patterns
before and after implementation of opioid use guidelines for ED patients
overall and the specific subsets of ED patients with either chronic opioid
use or fracture. Methods: We conducted a pre-post interrupted time series
analysis of adult (≥18 years old) ED encounters in 14 integrated community
EDs before (2013) and after (2014) the implementation of opioid prescribing
guidelines. We compared opioid use pre- and postintervention using segmented
logistic regression for primary and secondary analyses. The primary outcome
was parenteral opioid use in the ED, with additional subgroup analysis of
chronic pain and fracture cohorts. We also examined ED oral opioid use and
discharge prescribing. Results: There were 508,337 pre- and 531,620
postintervention encounters. The intervention was associated with an initial
reduction in the odds of parenteral opioids ordered (odds ratio [OR] = 0.89,
95% CI = 0.87-0.91) and a decrease in the monthly trend compared to the
preintervention period (OR = 0.99, 95% CI = 0.99-0.99). The immediate
reduction in parenteral opioid use was significantly larger in the cohort of
patients with chronic pain (OR = 0.81, 95% CI = 0.72-0.91), whereas the
fracture cohort showed no change (OR = 1.10, 95% CI = 0.97-1.25).
Conclusion: The use of an opioid ordering guideline was associated with
significant reduction in parenteral opioid use in the ED and as intended
subgroup comparisons suggest that acute fractures were not affected and
chronic pain visits were associated with larger decreases in opioid use.
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
practice guideline
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain
cohort analysis
controlled study
disease course
female
fracture
human
male
outcome assessment
prescription
secondary analysis
time series analysis
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180252117
PUI
L621574616
DOI
10.1111/acem.13395
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13395
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 50
TITLE
Effect of a Data-driven Intervention on Opioid Prescribing Intensity Among
Emergency Department Providers: A Randomized Controlled Trial
AUTHOR NAMES
Michael S.S.
Babu K.M.
Androski C.
Reznek M.A.
AUTHOR ADDRESSES
(Michael S.S., sean.michael@ucdenver.edu; Babu K.M.; Reznek M.A.) Department
of Emergency Medicine Worcester, MA
(Androski C.) University of Massachusetts Medical School Worcester, MA
(Michael S.S., sean.michael@ucdenver.edu) Department of Emergency Medicine
University of Colorado School of Medicine Aurora, CO
CORRESPONDENCE ADDRESS
S.S. Michael, Department of Emergency Medicine University of Colorado School
of Medicine Aurora, CO Email: sean.michael@ucdenver.edu
SOURCE
Academic Emergency Medicine (2018). Date of Publication: 2018
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Little is known about accuracy of provider self-perception of
opioid prescribing. We hypothesized that an intervention asking emergency
department (ED) providers to self-identify their opioid prescribing
practices compared to group norms-and subsequently providing them with their
actual prescribing data-would alter future prescribing compared to controls.
Methods: This was a prospective, multicenter randomized trial in which all
attending physicians, residents, and advanced practice providers at four EDs
were randomly assigned either to no intervention or to a brief data-driven
intervention during which providers were: 1) asked to self-identify and
explicitly report to research staff their perceived opioid prescribing in
comparison to their peers and 2) then given their actual data with peer
group norms for comparison. Our primary outcome was the change in each
provider's proportion of patients discharged with an opioid prescription at
6 and 12 months. Secondary outcomes were opioid prescriptions per hundred
total prescriptions and normalized morphine milligram equivalents
prescribed. Our primary comparison stratified intervention providers by
those who underestimated their prescribing and those who did not
underestimate their prescribing, both compared to controls. Results: Among
109 total participants, 51 were randomized to the intervention, 65% of whom
underestimated their opioid prescribing. Intervention participants who
underestimated their baseline prescribing had larger-magnitude decreases
than controls (Hodges-Lehmann difference = -2.1 prescriptions per hundred
patients at 6 months [95% confidence interval (CI) = -3.9 to -0.5] and -2.2
per hundred at 12 months [95% CI = -4.8 to -0.01]). Intervention
participants who did not underestimate their prescribing had similar changes
to controls. Conclusions: Self-perception of prescribing was frequently
inaccurate. Providing clinicians with their actual opioid prescribing data
after querying their self-perception reduced future prescribing among
providers who underestimated their baseline prescribing. Our findings
suggest that guideline and policy interventions should directly address the
potential barrier of inaccurate provider self-awareness.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
awareness
controlled study
drug therapy
female
human
major clinical study
male
multicenter study
outcome assessment
peer group
perception
practice guideline
prospective study
randomized controlled trial
resident
staff
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180241311
PUI
L621518109
DOI
10.1111/acem.13400
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13400
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 51
TITLE
Emergency Department Treatment of Opioid Addiction: An Opportunity to Lead
AUTHOR NAMES
Martin A.
Mitchell A.
Wakeman S.
White B.
Raja A.
AUTHOR ADDRESSES
(Martin A., amartin24@mgh.harvard.edu; White B.; Raja A.) Massachusetts
General Hospital Emergency Department
(Mitchell A.) Harvard Medical School and Harvard Kennedy School Boston, MA
(Wakeman S.) Massachusetts General Hospital Substance Use Disorders
Initiative
SOURCE
Academic Emergency Medicine (2018). Date of Publication: 2018
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180105073
PUI
L620668768
DOI
10.1111/acem.13367
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13367
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 52
TITLE
Opioid-Induced "Likeability" and "Feeling Good" Are Not Associated With
Return Visits to an ED Among Migraine Patients Administered IV Hydromorphone
AUTHOR NAMES
Friedman B.W.
Latev A.
Campbell C.
White D.
AUTHOR ADDRESSES
(Friedman B.W., bwfriedmanmd@gmail.com; Latev A.; Campbell C.; White D.)
Department of Emergency Medicine, Albert Einstein College of
MedicineMontefiore Health SystemBronx, NY USA
CORRESPONDENCE ADDRESS
B.W. Friedman, Department of Emergency Medicine, Albert Einstein College of
MedicineMontefiore Health SystemBronx, NY USA. Email: bwfriedmanmd@gmail.com
SOURCE
Headache (2018). Date of Publication: 2018
ISSN
1526-4610 (electronic)
0017-8748
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Background: Parenteral opioids are used in more than 50% of emergency
department (ED) visits for migraine. Use of opioids for migraine has been
associated with subsequent ED visits, perhaps because of opioid-induced
euphoria. In this study, we quantify the extent to which nontherapeutic
effects of opioids influence migraine outcomes. We hypothesized that
"feeling good" and medication likeability would in fact be associated with
receipt of opioids (rather than relief of migraine pain) and that receipt of
opioids (rather than relief of migraine pain) would be associated with
return visits to the ED. Methods: During an ED-based clinical trial,
migraine patients were randomized to receive hydromorphone 1 mg or
prochlorperazine 10 mg+diphenhydramine 25 mg IV. Thirty minutes after
medication administration, we asked, (1) How much did you like the
medication you received? and (2) How good did the medication make you feel?
Participants were asked to provide answers on a 0-10 scale. We also
determined 0-10 pain scores at baseline and 1 hour and number of return
visits for headache during the subsequent month. Results: Sixty-three
patients received prochlorperazine and 64 hydromorphone. Prochlorperazine
pain scores improved by 6.8 (SD: 2.6), hydromorphone by 4.7 (SD: 3.3) (95%CI
for difference of 2.1: 1.0, 3.2). On the 0-10 likeability scale,
prochlorperazine patients reported a mean of 7.2 (SD: 2.8), hydromorphone
6.9 (SD: 2.9) (95% CI for difference of 0.3: -0.7, 1.3). On the 0-10 feeling
good scale, prochlorperazine patients reported a mean of 7.5 (SD: 2.3),
hydromorphone 6.8 (SD: 2.8) (95%CI: for difference of 0.7: -0.2, 1.6). In
the hydromorphone group, 8/57 (14%, 95%CI: 7, 26%) returned to the ED vs
5/63 (8%, 95%CI: 3,18%) in the prochlorperazine group. In regression
modeling, feeling good was independently associated with pain relief (P<.01)
but not with medication received (P=.67) or return visits (P=.12).
Similarly, medication likeability was independently associated with pain
relief (P<.01) but not medication received (P=.12) or return visits (P=.16).
Conclusion: We did not detect an association between hydromorphone and
medication likeability, feeling good, or return visits to the ED. Headache
relief was associated with medication likeability and feeling good.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
diphenhydramine
hydromorphone
prochlorperazine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
euphoria
migraine
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
controlled study
drug therapy
emergency ward
female
human
major clinical study
male
randomized controlled trial
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180174093
PUI
L621165463
DOI
10.1111/head.13292
FULL TEXT LINK
http://dx.doi.org/10.1111/head.13292
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 53
TITLE
An enhanced recovery program for bariatric surgical patients significantly
reduces perioperative opioid consumption and postoperative nausea
AUTHOR NAMES
King A.B.
Spann M.D.
Jablonski P.
Wanderer J.P.
Sandberg W.S.
McEvoy M.D.
AUTHOR ADDRESSES
(King A.B.; Jablonski P., patrick.m.jablonski@vanderbilt.edu; Wanderer J.P.;
McEvoy M.D.) Department of Anesthesiology, Vanderbilt University Medical
Center, Nashville, United States.
(Spann M.D.) Department of Surgical Science, Vanderbilt University Medical
Center, Nashville, United States.
(Sandberg W.S.) Vanderbilt University School of Medicine, Nashville, United
States.
CORRESPONDENCE ADDRESS
P. Jablonski, Department of Anesthesiology, Vanderbilt University Medical
Center, 1211 21st Avenue South, #708, Nashville, United States. Email:
patrick.m.jablonski@vanderbilt.edu
SOURCE
Surgery for Obesity and Related Diseases (2018). Date of Publication: 2018
ISSN
1878-7533 (electronic)
1550-7289
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Background: Patients frequently remain in the hospital after bariatric
surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced
recovery after surgery (ERAS) concepts address these perioperative
complications and therefore improve length of stay for bariatric surgery
patients. Objectives: To determine if ERAS concepts increase the proportion
of patients discharged on postoperative day 1. Secondary objectives included
mean length of stay, perioperative opioid use, emergency department visits,
and readmissions. Setting: A large metropolitan university tertiary
hospital. Methods: A quantitative before and after study was conducted for
patients undergoing bariatric surgical patients. Data were collected
surrounding length of stay, perioperative opioid consumption, antiemetic
therapy requirements postoperatively, multimodal analgesia compliance,
emergency department visits, and hospital readmission rates. Wilcoxon
rank-sum and χ(2) test were used to compare continuous and categorical
variables, respectively. A secondary analysis was performed using Aligned
Rank Transformation and Cochran-Mantel-Haenszel χ(2) tests to account for an
increase in sleeve gastrectomies in the intervention group. Results: The 2
groups had clinically similar baseline characteristics. Comparison group (N
= 366) and ERAS group (N = 715) patients underwent a primary bariatric
surgery procedure. There was an increase in the number of patients
undergoing a laparoscopic sleeve gastrectomy in the intervention group.
After accounting for this increase, the percentage of patients discharged on
postoperative day 1 was unchanged (79.8% non-ERAS versus 83.1% ERAS, P
=.52). ERAS length of stay was statistically significantly lower for gastric
bypass (P<.001) and robotic gastric bypass (P =.01). Perioperative opioid
consumption was reduced (41.0 versus 16.2 morphine equivalents, P<0.001),
and fewer ERAS patients required postoperative antiemetics (68.8% versus
46.2%, P<.001). Emergency department visits at 7 days were reduced (6.0%
versus 3.2%, P =.04), but hospital readmission rates were unchanged.
Conclusions: Implementing ERAS did not reduce the percentage of patients
discharged on postoperative day 1 in a bariatric surgery program with
historically low length of stay, but it led to significant reductions in
perioperative opioid use, decreases in postoperative nausea, and early
emergency room visits.
EMTREE DRUG INDEX TERMS
antiemetic agent
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
convalescence
laparoscopic sleeve gastrectomy
length of stay
opiate addiction
postoperative nausea
surgical patient
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
chi square test
controlled study
drug therapy
emergency ward
female
gastric bypass surgery
hospital readmission
human
major clinical study
male
secondary analysis
surgery
tertiary care center
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180201122
PUI
L2000552007
DOI
10.1016/j.soard.2018.02.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.soard.2018.02.010
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 54
TITLE
Lactate gap as a tool in identifying ethylene glycol poisoning
AUTHOR NAMES
Sagar A.S.
Jimenez C.A.
McKelvy B.J.
AUTHOR ADDRESSES
(Sagar A.S.; McKelvy B.J.) Department of Pulmonary, Critical Care and Sleep
Medicine, University of Texas Health Science Center at Houston, Houston,
United States.
(Jimenez C.A., cajimenez@mdanderson.org) Department of Pulmonary Medicine,
MD Anderson Cancer Center, Houston, United States.
CORRESPONDENCE ADDRESS
C.A. Jimenez, Department of Pulmonary Medicine, MD Anderson Cancer Center,
Houston, United States. Email: cajimenez@mdanderson.org
SOURCE
BMJ Case Reports (2018) 2018 Article Number: 224243. Date of Publication:
2018
ISSN
1757-790X (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis,
with the presence of an osmolar gap and the right clinical context
suggesting to the diagnosis. Rapid recognition and early treatment is
crucial. Unfortunately, ethylene glycol levels are not readily available and
must be performed at a reference laboratory. We present a case where
recognising the significance of the 'lactate gap' assisted in identifying
ethylene glycol poisoning.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ethylene glycol (drug toxicity)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy)
alcohol (endogenous compound)
lactic acid (endogenous compound)
naloxone
opiate (drug therapy)
paracetamol
salicylic acid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical assessment tool
drug intoxication
lactate gap
EMTREE MEDICAL INDEX TERMS
acidosis (drug therapy)
adult
alcohol intoxication (diagnosis)
arterial oxygen saturation
article
artificial ventilation
backache (drug therapy)
blood pressure measurement
brain scintiscanning
case report
clinical article
dialysis
differential diagnosis
dizziness
emergency ward
extubation
fatigue
follow up
Glasgow coma scale
heart rate measurement
hospital discharge
human
hypertension
ketoacidosis (diagnosis)
lactate blood level
lactic acidosis (diagnosis)
leukocytosis (diagnosis)
male
mental disease
metabolic acidosis (diagnosis, therapy)
methanol poisoning (diagnosis)
outcome assessment
priority journal
speech disorder
tachycardia
treatment response
walking difficulty
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
alcohol (64-17-5)
ethylene glycol (107-21-1)
lactic acid (113-21-3, 50-21-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180185040
PUI
L621181352
DOI
10.1136/bcr-2018-224243
FULL TEXT LINK
http://dx.doi.org/10.1136/bcr-2018-224243
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 55
TITLE
Opportunities for Prevention and Intervention of Opioid Overdose in the
Emergency Department
AUTHOR NAMES
Houry D.E.
Haegerich T.M.
Vivolo-Kantor A.
AUTHOR ADDRESSES
(Houry D.E., dhoury@cdc.gov; Haegerich T.M.; Vivolo-Kantor A.) Centers for
Disease Control and Prevention, Atlanta, GA
CORRESPONDENCE ADDRESS
D.E. Houry, Centers for Disease Control and Prevention, Atlanta, GA Email:
dhoury@cdc.gov
SOURCE
Annals of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
EMTREE MEDICAL INDEX TERMS
article
drug overdose
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180165855
PUI
L621086052
DOI
10.1016/j.annemergmed.2018.01.052
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2018.01.052
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 56
TITLE
Associations of Early Opioid Use with Patient-reported Outcomes and Health
Care Utilization among Older Adults with Low Back Pain
AUTHOR NAMES
Gold L.S.
Hansen R.N.
Avins A.L.
Bauer Z.
Comstock B.A.
Deyo R.A.
Heagerty P.J.
Rundell S.D.
Suri P.
Turner J.A.
Jarvik J.G.
AUTHOR ADDRESSES
(Gold L.S., goldl@uw.edu; Bauer Z.; Rundell S.D.; Jarvik J.G.) Department of
Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center,
University of Washington, Box 359455, Seattle, United States.
(Hansen R.N.) Pharmaceutical Outcomes Research and Policy Program Department
of Pharmacy, United States.
(Hansen R.N.; Jarvik J.G.) Department of Health Services, United States.
(Comstock B.A.; Heagerty P.J.) Department of Biostatistics, School of Public
Health, United States.
(Rundell S.D.; Suri P.; Turner J.A.) Department of Rehabilitation Medicine,
United States.
(Turner J.A.) Department of Psychiatry and Behavioral Sciences, United
States.
(Jarvik J.G.) Department of Neurological Surgery, University of Washington,
United States.
(Suri P.) Veteran's Administration Puget Sound Health Care System, Seattle,
United States.
(Avins A.L.) Division of Research, Northern California Kaiser-Permanente,
San Francisco, United States.
(Deyo R.A.) Departments of Family Medicine, Oregon Institute of Occupational
Health Sciences, Oregon Health and Science University, Portland, United
States.
CORRESPONDENCE ADDRESS
L.S. Gold, Department of Radiology, Comparative Effectiveness, Cost, and
Outcomes Research Center, University of Washington, Box 359455, Seattle,
United States. Email: goldl@uw.edu
SOURCE
Clinical Journal of Pain (2018) 34:4 (297-305) Article Number: 0557. Date of
Publication: 2018
ISSN
1536-5409 (electronic)
0749-8047
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objectives: The objective of this study was to compare outcomes and health
care utilization of older patients who did versus did not fill opioid
prescriptions within 90 days of initiating care for low back pain. Materials
and Methods: For patients ≥65 years with new back pain visits, we used
propensity scores to match those who filled no opioid prescriptions to those
who filled ≥2 opioid prescriptions within 90 days (and the first opioid
prescription within 30 d) of the index visit. Over 24 months, we examined
patient-reported outcomes, health care utilization, and subsequent opioid
prescription fills. Results: Among 1954 patients eligible for matching, 238
(12%) filled ≥2 opioid prescriptions within 90 days; 200 of these were
matched to controls. Patients with versus without early opioid prescriptions
had similar patient-reported outcomes but were more likely to have filled ≥1
opioid prescription 18 to 24 months after the index visit (odds ratio [95%
confidence interval]=2.4 [1.5-3.9]) and to have had ≥1 visit to the
emergency department in the subsequent 24 months (OR, 1.6; 95% confidence
interval, 1.0-2.5). Discussion: Among older patients with new back pain
visits, filling ≥2 opioid prescriptions within 90 days of the visit was
associated with similar back pain-related outcomes but increased likelihood
of filling opioid prescriptions 18 to 24 months later compared with matched
patients who did not fill early opioid prescriptions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
morphine (drug therapy)
muscle relaxant agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
health care utilization
low back pain (drug therapy, drug therapy)
patient-reported outcome
EMTREE MEDICAL INDEX TERMS
aged
article
Brief Pain Inventory
cohort analysis
emergency care
female
hospitalization
human
longitudinal study
major clinical study
male
numeric rating scale
pain intensity
prescription
priority journal
propensity score
quality of life
Roland Morris disability questionnaire
treatment duration
visual analog scale
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Gerontology and Geriatrics (20)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180239458
PUI
L621512490
DOI
10.1097/AJP.0000000000000557
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0000000000000557
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 57
TITLE
Addressing the high rate of opioid prescriptions for dental pain in the
emergency department
AUTHOR NAMES
Patel N.A.
Afshar S.
AUTHOR ADDRESSES
(Patel N.A., nisarg_patel@hms.harvard.edu) Harvard School of Dental
Medicine, 188 Longwood Ave, Boston, United States.
(Afshar S., salim.afshar@childrens.harvard.edu) Department of Plastic and
Oral Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, United
States.
CORRESPONDENCE ADDRESS
S. Afshar, Department of Plastic & Oral Surgery, 300 Longwood Avenue,
Hunnewell, 1st Floor, Boston, United States. Email:
salim.afshar@childrens.harvard.edu
SOURCE
American Journal of Emergency Medicine (2018) 36:1 (138-139). Date of
Publication: 1 Jan 2018
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent
antibiotic agent
bupivacaine
controlled substance
non prescription drug
nonsteroid antiinflammatory agent
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
tooth pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
clinical evaluation
consultation
drug abuse
drug bioavailability
drug megadose
drug safety
drug use
emergency ward
evidence based practice
health care quality
human
letter
local anesthesia
long term care
managed care
medically uninsured
morbidity
mortality rate
mouth examination
nerve block
online analysis
opiate addiction
practice guideline
priority journal
staff training
time to treatment
tooth extraction
videorecording
CAS REGISTRY NUMBERS
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5, 38396-39-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170505675
PUI
L617318849
DOI
10.1016/j.ajem.2017.07.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.07.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 58
TITLE
Looking Ahead: The Role of Emergency Physicians in the Opioid Epidemic
AUTHOR NAMES
Lynch M.J.
Yealy D.M.
AUTHOR ADDRESSES
(Lynch M.J.; Yealy D.M., yealydm@upmc.edu) University of Pittsburgh and
UPMC, Pittsburgh, PA
CORRESPONDENCE ADDRESS
D.M. Yealy, University of Pittsburgh and UPMC, Pittsburgh, PA Email:
yealydm@upmc.edu
SOURCE
Annals of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
epidemic
EMTREE MEDICAL INDEX TERMS
article
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180114002
PUI
L620728368
DOI
10.1016/j.annemergmed.2018.01.051
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2018.01.051
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 59
TITLE
Opioid doses and acute care utilization outcomes for adults with sickle cell
disease: ED versus acute care unit
AUTHOR NAMES
Molokie R.E.
Montminy C.
Dionisio C.
Farooqui M.A.
Gowhari M.
Yao Y.
Suarez M.L.
Ezenwa M.O.
Schlaeger J.M.
Wang Z.J.
Wilkie D.J.
AUTHOR ADDRESSES
(Molokie R.E., remolokie@uic.edu; Gowhari M., mgowhal@uic.edu) University of
Illinois at Chicago, College of Medicine, Department of Hematology/Oncology,
820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, United States.
(Molokie R.E., remolokie@uic.edu) Jesse Brown Veterans Administration
Medical Center, 820 S. Damen Avenue, MP 111, Chicago, United States.
(Molokie R.E., remolokie@uic.edu; Wang Z.J., zjwang@uic.edu) University of
Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical
Sciences, 833 S. Wood Street, Chicago, United States.
(Montminy C., ccalip2@uic.edu) University of Illinois Hospital and Health
Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, United
States.
(Dionisio C., coridion@iu.edu) Riley Hospital for Children at Indiana
University Health Department of Psychiatry, 705 Riley Hospital Drive,
Indianapolis, United States.
(Farooqui M.A.) Saint George's University, University Centre, Grenada.
(Yao Y., yyao@uic.edu; Suarez M.L., mlsuarez@uic.edu; Ezenwa M.O.,
moezenwa@uic.edu; Wilkie D.J., diwilkie@uic.edu) University of Illinois at
Chicago, College of Nursing, Department of Biobehavioral Health Science, 845
S. Damen Avenue, (M/C 802), Chicago, United States.
(Yao Y., yyao@uic.edu; Ezenwa M.O., moezenwa@uic.edu; Wilkie D.J.,
diwilkie@uic.edu) University of Florida, College of Nursing, Department of
Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville,
United States.
(Schlaeger J.M., jschlaeg@uic.edu) University of Illinois at Chicago,
College of Nursing, Department of Women, Children and Family Health Science,
845 S. Damen Avenue, (M/C 802), Chicago, United States.
CORRESPONDENCE ADDRESS
R.E. Molokie, University of Illinois at Chicago, College of Medicine,
Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C
712), Chicago, United States. Email: remolokie@uic.edu
SOURCE
American Journal of Emergency Medicine (2018) 36:1 (88-92). Date of
Publication: 1 Jan 2018
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Background Acute care units (ACUs) with focused sickle cell disease (SCD)
care have been shown to effectively address pain and limit hospitalizations
compared to emergency departments (ED), the reason for differences in
admission rates is understudied. Our aim was compare effects of usual care
for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings,
hospital admission rates and lengths of stay. Methods In a retrospective,
comparative cohort, single academic tertiary center study, 148 adults with
sickle cell pain received care in the ED, ACU or both. From the medical
records we documented opioid doses, unit discharge pain ratings, hospital
admission rates, and lengths of stay. Findings Pain on admission to the ED
averaged 8.7 ± 1.5 and to the ACU averaged 8.0 ± 1.6. The average pain on
discharge from the ED was 6.4 ± 3.0 and for the ACU was 4.5 ± 2.5. 70% of
the 144 ED visits resulted in hospital admissions as compared to 37% of the
73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths
of stay. Significant differences between ED and ACU in first opioid dose and
hourly opioid dose were noted. Conclusions Applying guidelines for higher
dosing of opioids for acute painful episodes in adults with SCD in ACU was
associated with improved pain outcomes and decreased hospitalizations,
compared to ED. Adoption of this approach for SCD pain in ED may result in
improved outcomes, including a decrease in hospital admissions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
hydromorphone (drug therapy)
morphine (drug therapy)
morphine sulfate (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute care unit
emergency care
emergency ward
health care utilization
pain (drug therapy, drug therapy)
patient care
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain (drug therapy)
cohort analysis
comparative study
controlled study
female
hospital admission
hospital discharge
human
intensive care unit
length of stay
major clinical study
male
medical documentation
medical record
outcome assessment
pain assessment
pain intensity
pain severity
priority journal
recommended drug dose
retrospective study
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170578445
MEDLINE PMID
28802541 (http://www.ncbi.nlm.nih.gov/pubmed/28802541)
PUI
L617757035
DOI
10.1016/j.ajem.2017.07.037
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.07.037
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 60
TITLE
Emergency Department Visits Involving Opioid Overdoses, U.S., 2010–2014
AUTHOR NAMES
Guy G.P.
Pasalic E.
Zhang K.
AUTHOR ADDRESSES
(Guy G.P., irm2@cdc.gov; Pasalic E.; Zhang K.) Division of Unintentional
Injury Prevention, National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention, Atlanta, United States.
CORRESPONDENCE ADDRESS
G.P. Guy, Division of Unintentional Injury Prevention, Centers for Disease
Control and Prevention, 4770 Buford Highway, NE, MS F-62, Atlanta, United
States. Email: irm2@cdc.gov
SOURCE
American Journal of Preventive Medicine (2018) 54:1 (e37-e39). Date of
Publication: 1 Jan 2018
ISSN
1873-2607 (electronic)
0749-3797
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (disease management)
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
aged
article
emergency ward
female
health care cost
human
major clinical study
male
medicaid
medically uninsured
medicare
middle aged
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170796514
PUI
L619210617
DOI
10.1016/j.amepre.2017.09.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amepre.2017.09.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 61
TITLE
Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A
case report
AUTHOR NAMES
Johnson S.
McCracken J.
Baidoun F.
AUTHOR ADDRESSES
(Johnson S., Sjohns30@hfhs.org; McCracken J., Jmccrac3@hfhs.org; Baidoun F.,
Fbaidou1@hfhs.org) Henry Ford Wyandotte Hospital, 2333 Biddle Ave,
Wyandotte, United States.
CORRESPONDENCE ADDRESS
S. Johnson, Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte,
United States. Email: Sjohns30@hfhs.org
SOURCE
International Journal of Surgery Case Reports (2018) 42 (227-232). Date of
Publication: 2018
ISSN
2210-2612
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
Introduction Abdominal visceral injuries after cardiopulmonary resuscitation
(CPR) are infrequent though can be significant complications of CPR
requiring invasive interventions. We present a case of a gastric perforation
as a result of bystander CPR. This resulted in tension pneumoperitoneum
necessitating abdominal decompression prior to laparotomy and repair.
Presentation of case 37-year-old female complained of abdominal pain and
distension after return of spontaneous circulation from successful CPR
following a drug overdose and cardiopulmonary arrest. Abdominal imaging
showed significant amounts of free intraperitoneal air causing compression
of the abdominal visceral organs. Patient underwent exploratory laparotomy.
Prior to induction of general anesthesia with potential cardiovascular
collapse from the tension pneumoperitoneum, the abdomen was decompressed
with a spring-loaded insufflation (Veress) needle while the patient was
awake. Upon exploration, there were two three-centimeter gastric
perforations that were primarily repaired with omental patch. The patient
had an uneventful recovery and discharged home on postoperative day four.
Conclusion The Veress needle, usually used for insufflating the abdomen
during laparoscopy, can also be an effective tool to decompress the abdomen
when presented with tension pneumoperitoneum. Abdominal visceral injuries
are rare following CPR but do occur and will likely require an invasive
intervention. Surviving cardiac arrest as a young person and living without
deficits outweighs the risk of a surgical correction for a visceral injury.
While resuscitation measures are critical for survival, medical personnel
need to be aware of potential complications from resuscitative efforts and
potential management strategies.
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pneumoperitoneum (complication, surgery)
resuscitation
tension pneumoperitoneum (complication, surgery)
EMTREE MEDICAL INDEX TERMS
abdominal distension
abdominal pain
abdominal surgery
abdominal tenderness
adult
article
cardiopulmonary arrest (therapy)
case report
clinical article
computer assisted tomography
drug overdose
dyspnea
emergency health service
female
general anesthesia
human
laparoscopy
laparotomy
medical history
needle
pneumomediastinum
pneumopericardium
priority journal
return of spontaneous circulation
shock
stomach perforation
thorax radiography
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Gastroenterology (48)
Toxicology (52)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180002864
PUI
L619988174
DOI
10.1016/j.ijscr.2017.12.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijscr.2017.12.014
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 62
TITLE
Is Low-Dose Ketamine an Effective Alternative to Opioids for the Treatment
of Acute Pain in the Emergency Department?
AUTHOR NAMES
Gottlieb M.
Ryan K.W.
Binkley C.
AUTHOR ADDRESSES
(Gottlieb M.; Ryan K.W.; Binkley C.) Department of Emergency Medicine, Rush
University Medical Center, Chicago, United States.
SOURCE
Annals of Emergency Medicine (2018). Date of Publication: 2018
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
pain
EMTREE MEDICAL INDEX TERMS
article
human
low drug dose
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180228655
PUI
L2000598160
DOI
10.1016/j.annemergmed.2017.10.028
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.10.028
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 63
TITLE
Predictors of Gabapentin Overuse With or Without Concomitant Opioids in a
Commercially Insured U.S. Population
AUTHOR NAMES
Peckham A.M.
Evoy K.E.
Covvey J.R.
Ochs L.
Fairman K.A.
Sclar D.A.
AUTHOR ADDRESSES
(Peckham A.M., apeckh@midwestern.edu; Fairman K.A.; Sclar D.A.) Department
of Pharmacy Practice College of Pharmacy-Glendale Midwestern University
Glendale, Arizona
(Evoy K.E.) College of Pharmacy The University of Texas at Austin San
Antonio, Texas
(Evoy K.E.) School of Medicine UT Health Science Center San Antonio San
Antonio, Texas
(Evoy K.E.) Southeast Clinic University Health System San Antonio, Texas
(Evoy K.E.) UT Health Science Center San Antonio Pharmacotherapy Education
and Research Center San Antonio, Texas
(Covvey J.R.) Division of Pharmaceutical, Administrative and Social Sciences
Duquesne University School of Pharmacy Pittsburgh, Pennsylvania
(Ochs L.) Department of Pharmacy Practice University of New England College
of Pharmacy Portland, Maine
CORRESPONDENCE ADDRESS
A.M. Peckham, Department of Pharmacy Practice College of Pharmacy-Glendale
Midwestern University Glendale, Arizona Email: apeckh@midwestern.edu
SOURCE
Pharmacotherapy (2018). Date of Publication: 2018
ISSN
1875-9114 (electronic)
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc.
ABSTRACT
Objective: Research suggests the medical consequences of gabapentin overuse
depend on whether gabapentin is abused alone or with opioids to potentiate
an opioid "high." The objective of this study was to assess predictors of
gabapentin overuse with or without concomitant opioids. Methods: Data were
obtained from the Truven Health MarketScan(®) Commercial Claims and
Encounters database for 2013 through 2015. Eligibility criteria were
gabapentin utilization, with or without opioids, for 120 days or longer
throughout a 12-month observation period. Cohort identification was based on
patterns of overuse exceeding thresholds of 3600 mg of gabapentin and/or 50
morphine-mg equivalents of opioids; sustained overuse was defined as three
or more quarters exceeding threshold. Diagnostic predictors were measured in
the 6 months pretreatment in inpatient (IP) or emergency department (ED)
settings. Indications were measured in IP, ED, or ambulatory settings.
Logistic regression analyses adjusted for age, sex, indication, use of
benzodiazepine or z-hypnotics (i.e., zaleplon, zolpidem, eszopiclone) during
gabapentin treatment, pretreatment ED/IP use, and pretreatment diagnoses of
anxiety or depression. Results: Criteria for sustained overuse were met by
2.0% of 44,148 patients treated with gabapentin without opioids and by 11.7%
of 15,335 patients treated with concomitant gabapentin-opioid. The top three
predictors of sustained overuse for gabapentin-only patients were insomnia
(7.0%), euphoria (4.5%), and bipolar disorder (4.5%), and were
detoxification (35.6%), altered mental status (26.3%), and addiction (21.6%)
for gabapentin-opioid patients. In adjusted analyses, concomitant opioid use
multiplied the odds of sustained misuse by 6.32 (95% confidence interval
[CI] = 5.80-6.89) and the interaction of addiction with opioid use by 1.88
(95% CI = 1.32-2.66). Among gabapentin-only patients, sustained misuse was
predicted by a history of anxiety (odds ratio = 1.56, 95% CI = 1.02-2.38)
but not by a history of addiction. Conclusions: The likelihood of gabapentin
overuse alone is low but significantly increases with concomitant opioid
use, especially when coupled with a history of addiction. History of
addiction does not appear to increase risk of gabapentin misuse among those
with gabapentin alone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
gabapentin
opiate
prescription drug
EMTREE DRUG INDEX TERMS
benzodiazepine
eszopiclone
zaleplon
zolpidem
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction
drug abuse
substance abuse
EMTREE MEDICAL INDEX TERMS
adult
anxiety
article
bipolar disorder
detoxification
diagnosis
drug overdose
drug therapy
emergency ward
euphoria
female
hospital patient
human
insomnia
major clinical study
male
mental health
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180226124
PUI
L621445859
DOI
10.1002/phar.2096
FULL TEXT LINK
http://dx.doi.org/10.1002/phar.2096
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 64
TITLE
Creating opioid dependence in the emergency department
AUTHOR NAMES
Upadhye S.
AUTHOR ADDRESSES
(Upadhye S., suneel_upadhye@hotmail.com) Division of Emergency Medicine,
McMaster University, Hamilton General Hospital, Barton St. East, Hamilton,
Canada.
CORRESPONDENCE ADDRESS
S. Upadhye, Division of Emergency Medicine, McMaster University, Hamilton
General Hospital, Barton St. East, Hamilton, Canada. Email:
suneel_upadhye@hotmail.com
SOURCE
Canadian Journal of Emergency Medicine (2018) 20:1 (100-103). Date of
Publication: 1 Jan 2018
ISSN
1481-8043 (electronic)
1481-8035
BOOK PUBLISHER
Cambridge University Press, info@bcdecker.com
ABSTRACT
Clinical question What is the risk of creating opioid dependence from an ED
opioid prescription? Article chosen Barnett ML, Olenski AR, Jena AB.
Opioid-prescribing patterns of emergency physicians and risk of long-term
use. N Engl J Med 2017;376:663-73, doi:10.1056/NEJMsa1610524. Objective This
study examined the risk of creating long-term opioid dependence from a
prescription written in an opioid-naive patient in the ED.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
article
drug screening
drug use
emergency ward
female
human
major clinical study
male
multiple choice test
observational study
policy
primary medical care
public health
retrospective study
risk assessment
total quality management
very elderly
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180044832
PUI
L620315476
DOI
10.1017/cem.2017.370
FULL TEXT LINK
http://dx.doi.org/10.1017/cem.2017.370
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 65
TITLE
Recurrent Ethylene Glycol Poisoning with Elevated Lactate Levels to Obtain
Opioid Medications
AUTHOR NAMES
Zuckerman M.
Vo T.
AUTHOR ADDRESSES
(Zuckerman M.) Department of Emergency Medicine, University of Colorado
School of Medicine, Aurora, United States.
(Vo T.) Denver Health and Hospital Authority, Department of Emergency
Medicine, Denver, United States.
CORRESPONDENCE ADDRESS
M. Zuckerman, Department of Emergency Medicine, University of Colorado
School of Medicine, Leprino Building, B215, 12401 East 17th Avenue, Aurora,
United States.
SOURCE
Journal of Emergency Medicine (2018). Date of Publication: 2018
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background: Malingering is when a patient feigns illness for secondary gain.
While most patients with malingering manufacture or exaggerate symptoms,
some patients may induce illness. Previous reports of malingering patients
inducing illness include sepsis, kidney pain, migraine, and chest pain.
However, acute poisoning as a manifestation of malingering appears to be
rare. Case Report: We describe the case of a 39-year-old man who presented
to the emergency department complaining of diffuse body pain. The patient
reported multiple admission at outside hospitals for “lactate” and said, “it
feels like it is happening again because of how my body feels.” Laboratory
findings were concerning for serum lactate of >20.0 mmol/L and ethylene
glycol (EG) level of 19 mg/dL. A chart review found that the man had been
admitted for elevated serum lactate 8 times to area hospitals in several
years, often in the setting of EG poisoning. During these episodes he
required intravenous fluids and frequent intravenous pain medications. When
confronted about concern regarding the recurrent fallacious lactate levels
in the setting of factitious EG ingestion, the patient often became
combative and left against medical advice. The primary metabolite of EG,
glycolic acid, can interfere with lactate assays, causing a false elevation.
Our patient apparently recognized this and took advantage of it to be
admitted and receive intravenous opioids. This is the only case known to us
of malingering via EG ingestion. Why Should an Emergency Physician be Aware
of This?: Emergency physicians should be aware that metabolites of EG may
interfere with serum lactate assay. In addition, they should be aware of
possible malingering-related poisoning and plausible association with
requests for intravenous opioid pain medications. This represents a risk to
the patient and others if undiagnosed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ethylene glycol
lactic acid
opiate
EMTREE DRUG INDEX TERMS
glycolic acid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
factitious disease
intoxication
malingering
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical article
drug combination
emergency physician
emergency ward
human
human tissue
ingestion
lactate blood level
liquid
male
medical record review
metabolite
multicenter study
pain
risk assessment
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180247871
PUI
L2000625168
DOI
10.1016/j.jemermed.2018.01.044
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2018.01.044
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 66
TITLE
Opioid drugs and stercoral perforation of the colon: Case report and review
of literature
AUTHOR NAMES
Poitras R.
Warren D.
Oyogoa S.
AUTHOR ADDRESSES
(Poitras R., reneelexiepoitras@gmail.com; Warren D.) Avalon University
School of Medicine, Youngstown, United States.
(Oyogoa S.) Department of General Surgery, Raleigh General Hospital,
Beckley, United States.
CORRESPONDENCE ADDRESS
R. Poitras, Avalon University School of Medicine, Youngstown, United States.
Email: reneelexiepoitras@gmail.com
SOURCE
International Journal of Surgery Case Reports (2018) 42 (94-97). Date of
Publication: 2018
ISSN
2210-2612
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
Introduction Stercoral perforation of the colon is a rare pathology, which
is believed to be caused by an increased intraluminal pressure created by a
fecaloma. Opioid induced constipation is a rare and often unsuspected cause
of colonic perforation. Presentation of case We report the case of a
58-year-old woman, who presented to the emergency department (ED) with
severe hypotension, abdominal pain and gastrointestinal bleeding. She was
found to have a diffusely tender and distended abdomen. Her history was
positive for long-term suboxone use and chronic constipation. Abdominopelvic
computed tomography (CT) scan revealed a bowel perforation, ascites and
fecal impaction. Emergency laparotomy revealed extensive stool in the
peritoneal cavity as well as hemoperitoneum. There was a fecal bolus with
perforation located in the sigmoid colon. On postoperative day (POD) six, a
second abdominopelvic CT scan was performed and results revealed the
necessity of a second exploratory laparotomy. She had multiple loculated
abscesses within the small bowel and other areas, which were opened and
washed out. Discussion Due to the inflating use of drugs in the opioid
class, the recognition of this pathology has become increasingly important.
The action of the drug on the mu-opioid receptors, any patients taking
opioid medications are at risk for constipation progressing to stercoral
perforation and should be monitored closely. Conclusion Patients presenting
with chronic constipation, fecal impaction on imaging and clinical signs of
peritonitis or sepsis, should consider stercoral perforation in their
differential diagnosis since early detection is key to reduce mortality
rates in these cases.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (adverse drug reaction)
EMTREE DRUG INDEX TERMS
metronidazole
piperacillin plus tazobactam
vancomycin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
colon perforation (diagnosis, surgery)
stercoral perforation of the colon (diagnosis, surgery)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
article
case report
chronic constipation
chronic pain (side effect)
clinical article
computer assisted tomography
constipation (side effect)
differential diagnosis
emergency
emergency surgery
emergency ward
female
gastrointestinal hemorrhage
human
hypotension
laparotomy
middle aged
priority journal
reoperation
CAS REGISTRY NUMBERS
metronidazole (39322-38-8, 443-48-1)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170872611
PUI
L619593806
DOI
10.1016/j.ijscr.2017.11.060
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijscr.2017.11.060
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 67
TITLE
Fentanyl and the evolving opioid epidemic: What strategies should policy
makers consider?
AUTHOR NAMES
Barry C.L.
AUTHOR ADDRESSES
(Barry C.L., cbarry@jhu.edu) Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
CORRESPONDENCE ADDRESS
C.L. Barry, Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, United States. Email:
cbarry@jhu.edu
SOURCE
Psychiatric Services (2018) 69:1 (100-103). Date of Publication: 1 Jan 2018
ISSN
1557-9700 (electronic)
1075-2730
BOOK PUBLISHER
American Psychiatric Association
ABSTRACT
Major policy efforts are being aimed at combating the epidemic of opioid
addiction and overdose deaths. In response to the epidemic, the medical
community and policy makers have attempted to intervene; to date, these
varied approaches have done little to reverse the increase in mortality
related to opioid overdose. One factor that has complicated efforts to
control overdose deaths has been the emergence of a public health crisis
related to illicit fentanyl. The rise in fentanyl-related overdose deaths
means that new approaches are needed to combat the opioid epidemic,
including adoption of harm reduction strategies. Specific strategies that
should be considered as part of efforts to combat the opioid crisis include
safe drug consumption sites, anonymous drug-checking services, updated
naloxone distribution policies, harm reduction–oriented policing, expansion
of evidence-based pharmacological treatments in criminal justice and
emergency department settings, and stigma-reduction messaging emphasizing
the risks of fentanyl.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl
opiate
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
health care policy
EMTREE MEDICAL INDEX TERMS
drug legislation
drug use
evidence based practice
harm reduction
human
review
risk factor
stigma
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180012703
PUI
L620072771
DOI
10.1176/appi.ps.201700235
FULL TEXT LINK
http://dx.doi.org/10.1176/appi.ps.201700235
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 68
TITLE
ACMT 2018 Annual Scientific Meeting Abstracts
AUTHOR ADDRESSES
SOURCE
Journal of Medical Toxicology (2018) 14:1. Date of Publication: 2018
CONFERENCE NAME
15th Annual Scientific Meeting of the American College of Medical
Toxicology, ACMT 2018
CONFERENCE LOCATION
Washington, DC, United States
CONFERENCE DATE
2018-04-06 to 2018-04-08
ISSN
1937-6995
BOOK PUBLISHER
Springer New York LLC
ABSTRACT
The proceedings contain 174 papers. The topics discussed include: novel
illicit opioids masquerading as counterfeit pharmaceuticals on the drug
market; a recipe for disaster? quantification of opiates in homemade poppy
seed tea; national trends and characteristics of severe pediatric opioid
exposures reported to US poison centers, 2013-2016; the effect of mandatory
patient prescription history review on opioid prescriptions in the emergency
department; the predictive value of opioid co-ingestion for acetaminophen-
induced hepatotoxicity; serotonin toxicity in massive loperamide ingestion;
severe treatment-refractory cardiotoxicity secondary to chronic loperamide
use; emergency department patients' perceptions of the efficacy and safety
of opioid analgesics; wearable biosensors to evaluate recurrent opioid
toxicity after naloxone administration; high willingness to use rapid
fentanyl test strips among young adults who use drugs; a click away from
overdose: an exposure to furanylfentanyl purchased on the darkweb; pulmonary
complications of opioid overdose treated with naloxone; and factors
associated with naloxone administration in an urban fire EMS system.
EMTREE DRUG INDEX TERMS
fentanyl
loperamide
naloxone
opiate
paracetamol
unclassified drug
EMTREE MEDICAL INDEX TERMS
adult
adverse drug reaction
biosensor
cardiotoxicity
child
conference review
disaster
drug efficacy
drug overdose
drug therapy
emergency ward
human
ingestion
liver toxicity
lung complication
market
perception
pharmacokinetics
poison center
poppy seed
predictive value
prescription
serotonin syndrome
side effect
tea
test strip
young adult
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
loperamide (34552-83-5, 53179-11-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
LANGUAGE OF ARTICLE
English
PUI
L621476648
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 69
TITLE
Emergency legal authority and the opioid crisis
AUTHOR NAMES
Rutkow L.
Vernick J.S.
AUTHOR ADDRESSES
(Rutkow L.; Vernick J.S.) Department of Health Policy and Management, Center
for Injury Research and Policy, Johns Hopkins Bloomberg School of Public
Health, Baltimore, United States.
CORRESPONDENCE ADDRESS
L. Rutkow, Department of Health Policy and Management, Center for Injury
Research and Policy, Johns Hopkins Bloomberg School of Public Health,
Baltimore, United States.
SOURCE
New England Journal of Medicine (2017) 377:26 (2512-2514). Date of
Publication: 28 Dec 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
authority
emergency
legal aspect
opiate addiction
EMTREE MEDICAL INDEX TERMS
awareness
disease severity
drug monitoring
evidence based medicine
food and drug administration
government
health care personnel
health education
human
law enforcement
medicaid
medical practice
mortality
prescription
priority journal
public health problem
public policy
review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180022528
MEDLINE PMID
29140760 (http://www.ncbi.nlm.nih.gov/pubmed/29140760)
PUI
L620082544
DOI
10.1056/NEJMp1710862
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMp1710862
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 70
TITLE
Emergency department opioid misuse diagnoses increasing in adolescents and
young adults
AUTHOR NAMES
Abbasi J.
AUTHOR ADDRESSES
(Abbasi J.)
SOURCE
JAMA - Journal of the American Medical Association (2017) 318:24
(2416-2417). Date of Publication: 26 Dec 2017
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS
ibuprofen (drug therapy)
morphine (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse (diagnosis)
emergency ward
opiate addiction (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult education
analgesia
blood analysis
comorbidity
coronary care unit
data base
disease association
drug abuse
hospital admission
hospital patient
hospitalization
human
morbidity
mortality
national health organization
outpatient
pain (drug therapy)
pediatrics
postoperative pain (drug therapy)
prescription
priority journal
public health
short survey
surgical patient
teleconsultation
United States
urinalysis
CAS REGISTRY NUMBERS
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
morphine (52-26-6, 57-27-2)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180018723
MEDLINE PMID
29214309 (http://www.ncbi.nlm.nih.gov/pubmed/29214309)
PUI
L620134475
DOI
10.1001/jama.2017.16586
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2017.16586
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 71
TITLE
Emergency medical services naloxone administration: Many unknowns and
opportunities
AUTHOR NAMES
Oliva E.M.
Bounthavong M.
AUTHOR ADDRESSES
(Oliva E.M.) VA Program Evaluation and Resource Center, Office of Mental
Health and Suicide Prevention, VA Center for Innovation to Implementation,
795 Willow Road (152 MPD), Menlo Park, United States.
(Bounthavong M.) VHA Pharmacy Benefits Management Services, Academic
Detailing Service, Seattle, United States.
CORRESPONDENCE ADDRESS
E.M. Oliva, VA Program Evaluation and Resource Center, Office of Mental
Health and Suicide Prevention, VA Center for Innovation to Implementation,
795 Willow Road (152 MPD), Menlo Park, United States.
SOURCE
Annals of Internal Medicine (2017) 167:12 (890-891). Date of Publication: 19
Dec 2017
ISSN
1539-3704 (electronic)
0003-4819
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
drug overdose (drug therapy, drug therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
breathing
consciousness
drug information
editorial
emergency ward
food and drug administration
health care
health care facility
health care quality
human
opiate addiction (drug therapy)
outpatient department
patient education
patient monitoring
patient safety
practice guideline
prescription
priority journal
professional knowledge
public health
rescue personnel
respiration depression
scope of practice
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170893179
PUI
L619899141
DOI
10.7326/M17-2963
FULL TEXT LINK
http://dx.doi.org/10.7326/M17-2963
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 72
TITLE
Underlying factors in drug overdose deaths
AUTHOR NAMES
Dowell D.
Noonan R.K.
Houry D.
AUTHOR ADDRESSES
(Dowell D., ddowell@cdc.gov) National Center for Injury Prevention and
Control, US Centers for Disease Control and Prevention, Atlanta, United
States.
(Noonan R.K.) National Center for Injury Prevention and Control, US Centers
for Disease Control and Prevention, Atlanta, United States.
(Houry D.) National Center for Injury Prevention and Control, US Centers for
Disease Control and Prevention, Atlanta, United States.
(Dowell D., ddowell@cdc.gov) National Center for Injury Prevention and
Control, US Centers for Disease Control and Prevention, 4770 Buford Hwy NE,
MS F-62, Atlanta, United States.
CORRESPONDENCE ADDRESS
D. Dowell, National Center for Injury Prevention and Control, US Centers for
Disease Control and Prevention, Atlanta, United States. Email:
ddowell@cdc.gov
SOURCE
JAMA - Journal of the American Medical Association (2017) 318:23
(2295-2296). Date of Publication: 19 Dec 2017
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS
buprenorphine
diamorphine
fentanyl
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cause of death
drug overdose
EMTREE MEDICAL INDEX TERMS
emergency ward
health care cost
health service
human
opiate addiction
priority journal
probability
risk reduction
short survey
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180018955
MEDLINE PMID
29049472 (http://www.ncbi.nlm.nih.gov/pubmed/29049472)
PUI
L620134691
DOI
10.1001/jama.2017.15971
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2017.15971
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 73
TITLE
The Effects of Kentucky's Comprehensive Opioid Legislation on Patients
Presenting with Prescription Opioid or Heroin Abuse to One Urban Emergency
Department
AUTHOR NAMES
Faryar K.A.
Freeman C.L.
Persaud A.K.
Furmanek S.P.
Guinn B.E.
Mattingly W.A.
Wiemken T.L.
Buckner K.A.
Huecker M.R.
AUTHOR ADDRESSES
(Faryar K.A.; Freeman C.L.; Huecker M.R.) Department of Emergency Medicine,
University of Louisville School of Medicine, Louisville, United States.
(Persaud A.K.; Furmanek S.P.; Guinn B.E.; Mattingly W.A.; Wiemken T.L.;
Buckner K.A.) Division of Infectious Diseases Clinical Research Support
Program, University of Louisville School of Medicine, Louisville, United
States.
CORRESPONDENCE ADDRESS
K.A. Faryar, Department of Emergency Medicine, University of Cincinnati,
College of Medicine, 231 Albert Sabin Way, Cincinnati, United States.
SOURCE
Journal of Emergency Medicine (2017) 53:6 (805-814). Date of Publication: 1
Dec 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Prescription opioid abuse has increased to epidemic proportions
in the United States. Kentucky, along with other states, passed
comprehensive legislation to monitor and curb opioid prescribing. Objectives
This paper characterizes patients who presented to the emergency department
(ED) after abusing prescription opioids and heroin prior to and after the
passage of House Bill 1 (HB1) in April 2012. Methods Based on a
retrospective review of ED visits from 2009–2014 in one urban adult
facility, patients were included if the chief complaint or diagnosis was
directly related to prescription opioid or heroin abuse. The primary outcome
is the number and type of substance abused by each ED patient. Results From
2009–2014, 2945 patients presented to the ED after prescription opioid or
heroin abuse. The number of prescription opioid patients decreased from 215
(of 276 patients) in 2009 to 203 (of 697 patients) in 2014; 77.9% of
patients abused opioids in 2009, vs. 29% in 2014 (a 63% decrease). The
number of heroin patients increased from 61 in 2009 to 494 in 2014; 22% of
patients in 2009 abused heroin, vs. 71% in 2014 (a 221% increase). Both
piecewise regression and autoregressive integrated moving average trend
models showed an increased trend in patient heroin abuse beginning in
2011–2012. Conclusions Our facility experienced a decrease in the number of
patients who abused prescription opioids and an increase in the number of
patients who abused heroin over the study period. The transition seemed to
occur just prior to, or concurrent with, enforcement of statewide opioid
legislation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heroin dependence
law
opiate addiction
prescription
EMTREE MEDICAL INDEX TERMS
adult
aged
article
controlled study
emergency ward
female
human
Kentucky
major clinical study
male
middle aged
outcome assessment
priority journal
retrospective study
trend study
urban area
young adult
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Arthritis and Rheumatism (31)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170792984
PUI
L619197848
DOI
10.1016/j.jemermed.2017.08.066
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2017.08.066
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 74
TITLE
Macroeconomic conditions and opioid abuse
AUTHOR NAMES
Hollingsworth A.
Ruhm C.J.
Simon K.
AUTHOR ADDRESSES
(Hollingsworth A.; Simon K., simonkos@indiana.edu) School of Public and
Environmental Affairs, Indiana University, United States.
(Ruhm C.J.) Public Policy and Economics, Frank Batten School of Leadership
and Public Policy, University of Virginia, United States.
(Ruhm C.J.; Simon K., simonkos@indiana.edu) NBER, United States.
CORRESPONDENCE ADDRESS
K. Simon, School of Public and Environmental Affairs, Indiana University,
United States. Email: simonkos@indiana.edu
SOURCE
Journal of Health Economics (2017) 56 (222-233). Date of Publication: 1 Dec
2017
ISSN
1879-1646 (electronic)
0167-6296
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
We examine how deaths and emergency department (ED) visits related to use of
opioid analgesics (opioids) and other drugs vary with macroeconomic
conditions. As the county unemployment rate increases by one percentage
point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid
overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic
shocks also increase the overall drug death rate, but this increase is
driven by rising opioid deaths. Our findings hold when performing a
state-level analysis, rather than county-level; are primarily driven by
adverse events among whites; and are stable across time periods.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
macroeconomic condition
opiate addiction
socioeconomics
EMTREE MEDICAL INDEX TERMS
article
Black person
Caucasian
death
drug overdose
emergency ward
Hispanic
human
mortality rate
unemployment
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170791407
PUI
L619123401
DOI
10.1016/j.jhealeco.2017.07.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jhealeco.2017.07.009
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 75
TITLE
Pulmonary hemorrhage in acute heroin overdose: a report of two cases
AUTHOR NAMES
Riccardello G.J.
Maldjian P.D.
AUTHOR ADDRESSES
(Riccardello G.J., riccargj@njms.rutgers.edu; Maldjian P.D.) Department of
Radiology, New Jersey Medical School, Rutgers University, 150 Bergen Street,
Newark, United States.
CORRESPONDENCE ADDRESS
G.J. Riccardello, Department of Radiology, New Jersey Medical School,
Rutgers University, 150 Bergen Street, Newark, United States. Email:
riccargj@njms.rutgers.edu
SOURCE
Emergency Radiology (2017) 24:6 (709-712). Date of Publication: 1 Dec 2017
ISSN
1438-1435 (electronic)
1070-3004
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Diffuse alveolar hemorrhage (DAH) is a clinical syndrome characterized by
pulmonary hemorrhage, respiratory failure, and high early mortality rates.
DAH typically appears on chest radiographs as bilateral parenchymal
consolidations. To our knowledge, pulmonary hemorrhage associated with
heroin overdose has not been reported. We report the clinical and
radiographic findings in two cases of acute DAH following heroin overdose.
We speculate that an adulterating agent may be the underlying etiology in
these cases. While pulmonary edema as a consequence of heroin overdose is
well-documented and usually first suspected when consolidations are present
on a chest radiograph in a patient with a history of recent heroin use, we
believe that DAH should also be considered in the proper clinical context.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
EMTREE DRUG INDEX TERMS
creatine kinase (endogenous compound)
creatinine
furosemide
hemoglobin (endogenous compound)
naloxone
nitrogen (endogenous compound)
oxygen
prednisone
salbutamol (inhalational drug administration)
urea (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
lung hemorrhage
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical article
coughing
dyspnea
emergency ward
follow up
heart rate
hemoptysis
human
hypoxemia
intubation
laboratory test
leukocyte count
lung congestion
lung edema
lung lavage
male
mental health
muscle cramp
non rebreathing valve
oxygen saturation
physical examination
pneumonia
priority journal
rhabdomyolysis
tachypnea
thorax radiography
urea nitrogen blood level
venous congestion
young adult
CAS REGISTRY NUMBERS
creatine kinase (9001-15-4)
creatinine (19230-81-0, 60-27-5)
diamorphine (1502-95-0, 561-27-3)
furosemide (54-31-9)
hemoglobin (9008-02-0)
naloxone (357-08-4, 465-65-6)
nitrogen (7727-37-9)
oxygen (7782-44-7)
prednisone (53-03-2)
salbutamol (18559-94-9, 35763-26-9)
urea (57-13-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170479034
PUI
L617172472
DOI
10.1007/s10140-017-1531-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s10140-017-1531-5
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 76
TITLE
An increase in per-patient naloxone requirements in an opioid epidemic
AUTHOR NAMES
Birmingham L.E.
Nielson J.A.
AUTHOR ADDRESSES
(Birmingham L.E., birminghaml@summeahealth.org) Summa Health System - Akron
City Campus, Department of Emergency Medicine, Akron, United States.
(Birmingham L.E., birminghaml@summeahealth.org) Kent State University,
College of Public Health, Kent, United States.
(Nielson J.A.) Northeastern Ohio Medical University, Rootstown, United
States.
(Nielson J.A.) Western Reserve Hospital, Cuyahoga Falls, United States.
CORRESPONDENCE ADDRESS
L.E. Birmingham, 55 Arch St. Suite 2D, Akron, United States. Email:
birminghaml@summeahealth.org
SOURCE
American Journal of Emergency Medicine (2017) 35:12 (1958-1959). Date of
Publication: 1 Dec 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
carfentanil
fentanyl
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
automation
consciousness level
disease course
drug cost
emergency physician
emergency ward
heroin dependence (diagnosis, drug therapy)
human
letter
priority journal
treatment outcome
CAS REGISTRY NUMBERS
carfentanil (59708-52-0)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170438725
PUI
L616853883
DOI
10.1016/j.ajem.2017.05.033
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.05.033
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 77
TITLE
ACMT and AACT Position Statement: Preventing Occupational Fentanyl and
Fentanyl Analog Exposure to Emergency Responders
AUTHOR NAMES
Moss M.J.
Warrick B.J.
Nelson L.S.
McKay C.A.
Dubé P.-A.
Gosselin S.
Palmer R.B.
Stolbach A.I.
AUTHOR ADDRESSES
(Moss M.J.) Oregon Poison Center, Portland, United States.
(Warrick B.J.) University of New Mexico, Albuquerque, United States.
(Nelson L.S.) Rutgers New Jersey Medical School, Newark, United States.
(McKay C.A.) University of Connecticut School of Medicine, Farmington,
United States.
(Dubé P.-A.) Institut national de santé publique du Québec, Quebec City,
Canada.
(Gosselin S.) McGill University Health Center, Montreal, Canada.
(Palmer R.B.) University of Colorado School of Medicine, Aurora, United
States.
(Stolbach A.I., positionstatements@acmt.net) Johns Hopkins University,
Baltimore, United States.
CORRESPONDENCE ADDRESS
A.I. Stolbach, Johns Hopkins University, Baltimore, United States. Email:
positionstatements@acmt.net
SOURCE
Journal of Medical Toxicology (2017) 13:4 (347-351). Date of Publication: 1
Dec 2017
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
fentanyl derivative (drug toxicity)
EMTREE DRUG INDEX TERMS
alfentanil (drug toxicity)
carfentanil (drug toxicity)
naloxone (drug toxicity)
narcotic analgesic agent (drug toxicity)
remifentanil (drug toxicity)
sufentanil (drug toxicity)
xylazine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug exposure
occupational health
occupational medicine
rescue personnel
EMTREE MEDICAL INDEX TERMS
anxiety
article
body surface
disease control
dizziness
drug bioavailability
drug intoxication
emergency health service
evaporation
eye protection
human
hypoventilation
laser transdermal delivery device
law
lipophilicity
literature
medical care
mortality
mucosa
nonhuman
occupational exposure
occupational toxicology
oxygenation
respiration depression
skin absorption
toxicology
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
carfentanil (59708-52-0)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
remifentanil (132539-07-2)
sufentanil (56030-54-7)
xylazine (23076-35-9, 7361-61-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Occupational Health and Industrial Medicine (35)
Environmental Health and Pollution Control (46)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170603830
PUI
L618004013
DOI
10.1007/s13181-017-0628-2
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-017-0628-2
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 78
TITLE
A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and
Clandestine Opioids in Oral Fluid After Reported Heroin Overdose
AUTHOR NAMES
Griswold M.K.
Chai P.R.
Krotulski A.J.
Friscia M.
Chapman B.P.
Varma N.
Boyer E.W.
Logan B.K.
Babu K.M.
AUTHOR ADDRESSES
(Griswold M.K.; Chapman B.P.; Babu K.M., kavitambabu@gmail.com) Division of
Medical Toxicology, Department of Emergency Medicine, University of
Massachusetts Medical School, Worcester, United States.
(Chai P.R.; Boyer E.W.) Division of Medical Toxicology, Department of
Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School,
Boston, United States.
(Krotulski A.J.; Friscia M.; Logan B.K.) Center for Forensic Science
Research and Education, Fredric Rieders Family Foundation, Willow Grove,
United States.
(Varma N.) Department of Quantitative Health Sciences, University of
Massachusetts Medical School, Worcester, United States.
CORRESPONDENCE ADDRESS
K.M. Babu, Division of Medical Toxicology, Department of Emergency Medicine,
University of Massachusetts Medical School, Worcester, United States. Email:
kavitambabu@gmail.com
SOURCE
Journal of Medical Toxicology (2017) 13:4 (287-292). Date of Publication: 1
Dec 2017
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Introduction: The adulteration of heroin with non-pharmaceutical fentanyl
and other high-potency opioids is one of the factors contributing to
striking increases in overdose deaths. To fully understand the magnitude of
this problem, accurate detection methods for fentanyl and other novel opioid
adulterant exposures are urgently required. The objective of this work was
to compare the detection of fentanyl in oral fluid and urine specimens using
liquid chromatography quadrupole time-of-flight mass spectrometry
(LC-QTOF-MS) in a population of heroin users presenting to the Emergency
Department after overdose. Methods: This was a prospective observational
study of adult Emergency Department patients who presented after a reported
heroin overdose requiring naloxone administration. Participants provided
paired oral fluid and urine specimens, which were prepared, extracted, and
analyzed using a dual LC-QTOF-MS workflow for the identification of
traditional and emerging drugs of abuse. Analytical instrumentation included
SCIEX TripleTOF® 5600+ and Waters Xevo® G2-S QTOF systems. Results: Thirty
participants (N = 30) were enrolled during the study period. Twenty-nine
participants had fentanyl detected in their urine, while 27 had fentanyl
identified in their oral fluid (overall agreement 93.3%, positive percent
agreement 93.1%). Cohen’s Kappa (k) was calculated and demonstrated
moderately, significant agreement (k = 0.47; p value 0.002) in fentanyl
detection between oral fluid and urine using this LC-QTOF-MS methodology.
Additional novel opioids and metabolites, including norfentanyl,
acetylfentanyl, and U-47700, were detected during this study. Conclusion: In
this study of individuals presenting to the ED after reported heroin
overdose, a strikingly high proportion had a detectable fentanyl exposure.
Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing
for fentanyl detection indicates a role for oral fluid testing in
surveillance for nonpharmaceutical fentanyl. Additionally, the use of
LC-QTOF-MS allowed for the detection of other clandestine opioids
(acetylfentanyl and U-47700) in oral fluid.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
fentanyl (drug toxicity)
narcotic analgesic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fluid intake
liquid chromatography-mass spectrometry
matrix assisted laser desorption ionization time of flight mass spectrometry
EMTREE MEDICAL INDEX TERMS
analytical parameters
article
clinical assessment
clinical evaluation
clinical practice
comparative study
drug screening
emergency ward
injury
library score
limit of detection
liquid liquid extraction
methodology
prescription
prospective study
qualitative analysis
research
retention time
scoring system
toxicology
urinalysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Clinical and Experimental Biochemistry (29)
Environmental Health and Pollution Control (46)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170741492
PUI
L618892010
DOI
10.1007/s13181-017-0632-6
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-017-0632-6
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 79
TITLE
3 new initiatives target opioid crisis: The opioid crisis is still getting
worse—so what’s being done about it?
AUTHOR NAMES
Edlin M.
AUTHOR ADDRESSES
(Edlin M.) Sonoma, United States.
CORRESPONDENCE ADDRESS
M. Edlin, Sonoma, United States.
SOURCE
Drug Topics (2017) 161:12. Date of Publication: 1 Dec 2017
ISSN
1937-8157 (electronic)
0012-6616
BOOK PUBLISHER
Advanstar Communications Inc., info@advanstar.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
medicare
pharmacy technician
EMTREE MEDICAL INDEX TERMS
drug megadose
emergency ward
health care delivery
human
note
outcome assessment
pharmacy
pharmacy benefit manager
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170877277
PUI
L619724435
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 80
TITLE
Comparative Effectiveness of Patient-Controlled Analgesia for Treating Acute
Pain in the Emergency Department
AUTHOR NAMES
Bijur P.E.
Mills A.M.
Chang A.K.
White D.
Restivo A.
Persaud S.
Schechter C.B.
Gallagher E.J.
Birnbaum A.J.
AUTHOR ADDRESSES
(Bijur P.E., polly.bijur@einstein.yu.edu; Chang A.K.; White D.; Restivo A.;
Persaud S.; Gallagher E.J.; Birnbaum A.J.) Department of Emergency Medicine,
Albert Einstein College of Medicine, Bronx, United States.
(Schechter C.B.) Department of Family and Social Medicine, Albert Einstein
College of Medicine, Bronx, United States.
(Mills A.M.) Department of Emergency Medicine, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
P.E. Bijur, Department of Emergency Medicine, Albert Einstein College of
Medicine, Bronx, United States. Email: polly.bijur@einstein.yu.edu
SOURCE
Annals of Emergency Medicine (2017) 70:6 (809-818.e2). Date of Publication:
1 Dec 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective We assess the effectiveness of patient-controlled analgesia
in the emergency department (ED). We hypothesized that decline in pain
intensity from 30 to 120 minutes after initial intravenous opioid
administration is greater in patients receiving morphine by
patient-controlled analgesia compared with usual care and would differ by a
clinically significant amount. Method This was a pragmatic randomized
controlled trial of patient-controlled analgesia and usual care (opioid and
dose at physician's discretion) in 4 EDs. Entry criteria included age 18 to
65 years and acute pain requiring intravenous opioids. The primary outcome
was decline in numeric rating scale pain score 30 to 120 minutes
postbaseline. Secondary outcomes included satisfaction, time to analgesia,
adverse events, and patient-controlled analgesia pump-related problems. We
used a mixed-effects linear model to compare rate of decline in pain (slope)
between groups. A clinically significant difference between groups was
defined as a difference in slopes equivalent to 1.3 numeric rating scale
units. Results Six hundred thirty-six patients were enrolled. The rate of
decline in pain from 30 to 120 minutes was greater for patients receiving
patient-controlled analgesia than usual care (difference=1.0 numeric rating
scale unit; 95% confidence interval [CI] 0.6 to 1.5; P<.001) but did not
reach the threshold for clinical significance. More patients receiving
patient-controlled analgesia were satisfied with pain management
(difference=9.3%; 95% CI 3.3% to 15.1%). Median time to initial analgesia
was 15 minutes longer for patient-controlled analgesia than usual care (95%
CI 11.4 to 18.6 minutes). There were 7 adverse events in the
patient-controlled analgesia group and 1 in the usual care group
(difference=2.0%; 95% CI 0.04% to 3.9%), and 11 pump-programming errors.
Conclusion The findings of this study do not favor patient-controlled
analgesia over usual ED care for acute pain management.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, clinical trial, drug therapy)
morphine (adverse drug reaction, clinical trial, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
comparative effectiveness
emergency ward
pain (drug therapy, disease management, drug therapy)
patient controlled analgesia
EMTREE MEDICAL INDEX TERMS
adult
adverse event (side effect)
aged
analgesia
article
assisted ventilation
breast feeding
controlled study
female
health insurance
human
loading drug dose
major clinical study
male
Monte Carlo method
multicenter study
nausea (side effect)
numeric rating scale
outcome assessment
patient satisfaction
priority journal
pruritus (side effect)
randomized controlled trial
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170415697
MEDLINE PMID
28601270 (http://www.ncbi.nlm.nih.gov/pubmed/28601270)
PUI
L616692779
DOI
10.1016/j.annemergmed.2017.03.064
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.03.064
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 81
TITLE
Case 37-2017: A 36-year-old man with unintentional opioid overdose
AUTHOR NAMES
Raja A.S.
Miller E.S.
Flores E.J.
Wakeman S.E.
Eng G.
AUTHOR ADDRESSES
(Raja A.S.; Miller E.S.) Departments of Emergency Medicine Massachusetts
General Hospital, Boston, United States.
(Flores E.J.) Departments of Radiology, Massachusetts General Hospital,
Boston, United States.
(Wakeman S.E.) Departments of Medicine, Massachusetts General Hospital,
Boston, United States.
(Eng G.) Departments of Pathology, Massachusetts General Hospital, Boston,
United States.
(Raja A.S.; Miller E.S.) Departments of Emergency Medicine Harvard Medical
School, Boston, United States.
(Raja A.S.; Flores E.J.) Departments of Radiology Harvard Medical School,
Boston, United States.
(Wakeman S.E.) Departments of Medicine, Harvard Medical School, Boston,
United States.
(Eng G.) Departments of Pathology, Harvard Medical School, Boston, United
States.
SOURCE
New England Journal of Medicine (2017) 377:22 (2181-2188). Date of
Publication: 30 Nov 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
ABSTRACT
Dr. Alister M. Martin (Emergency Medicine): A 36-year-old man with
opioid-use disorder was seen in the emergency department of this hospital
during the winter because of opioid overdose. Approximately 4 years before
this evaluation, the patient had undergone an unspecified hand surgery.
Immediately after the procedure, hydromorphone was administered. After the
patient was discharged home, he initially sought out more prescription
opioids and then switched to intravenous heroin because he found it to be
less expensive and more easily obtained. During the next 3 years, he
injected 1 to 2 g of heroin each day. One year before this evaluation, after
the patient lost his job, he attempted to quit using heroin. He began to
take methadone, which helped to reduce withdrawal symptoms and cravings, but
he stopped taking it after 10 days because he was concerned that weaning off
methadone after a period of maintenance treatment would be associated with
unacceptable adverse effects. He then resumed heroin use. Six months before
this evaluation, the patient again stopped using heroin and was admitted to
an inpatient, medically supervised detoxification program for management of
withdrawal symptoms. After 2 weeks, he was discharged home. Approximately 2
months before this evaluation, the patient was released from jail and was
admitted to a structured residential rehabilitation program, in which he
participated in work therapy, attended regular Narcotics Anonymous meetings,
and underwent random, intermittent urine toxicology screenings. He continued
in this program and abstained from opioid use until 3 days before this
evaluation, when he resumed intravenous heroin use. He obtained the drug,
which he believed to be mixed with fentanyl, from a single dealer and began
to inject 0.5 g at a time using clean needles and cotton filters. On the day
of this evaluation, the patient injected 0.5 g at 10 a.m., followed by
another 0.5 g at approximately 1:30 p.m.; he remembered subsequently walking
around a park and placing a phone call to a friend to arrange a meeting.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intranasal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, complication, diagnosis, drug therapy)
opioid overdose (drug therapy, complication, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical article
clinical feature
consciousness level
cyanosis (complication, diagnosis, therapy)
differential diagnosis
drug effect
Glasgow coma scale
heroin dependence (diagnosis)
human
male
opiate addiction (diagnosis)
positive end expiratory pressure
prescription
priority journal
thorax radiography
winter
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170889862
MEDLINE PMID
29171813 (http://www.ncbi.nlm.nih.gov/pubmed/29171813)
PUI
L619742126
DOI
10.1056/NEJMcpc1710563
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMcpc1710563
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 82
TITLE
Intraosseous administration of antidotes–a systematic review
AUTHOR NAMES
Elliott A.
Dubé P.-A.
Cossette-Côté A.
Patakfalvi L.
Villeneuve E.
Morris M.
Gosselin S.
AUTHOR ADDRESSES
(Elliott A.; Dubé P.-A., pierre-andre.dube@inspq.qc.ca) Department of
Environmental Health and Toxicology, Institut National de Santé Publique du
Québec, Québec, Canada.
(Dubé P.-A., pierre-andre.dube@inspq.qc.ca) Faculty of Pharmacy, Université
Laval, Canada.
(Cossette-Côté A.) Department of Pharmacy, Centre Intégré de Santé et de
Services Sociaux du Bas-Saint-Laurent, Hôpital de Rimouski, Rimouski,
Canada.
(Patakfalvi L.) Department of Family Medicine & Hospital Medicine, McGill
University, Montreal, Canada.
(Villeneuve E.) Department of Pharmacy, McGill University Health Centre,
Montréal, Canada.
(Morris M.) Schulich Library of Physical Sciences, Life Sciences and
Engineering, McGill University, Montreal, Canada.
(Gosselin S.) Department of Medicine and Emergency Medicine, McGill
University Health Centre, Montréal, Canada.
(Gosselin S.) Centre antipoison du Québec, Province of Alberta Drug
Information Service, Canada.
CORRESPONDENCE ADDRESS
P.-A. Dubé, Department of Environmental Health and Toxicology, Institut
national de santé publique du Québec, 945 Wolfe Avenue, Québec, Canada.
Email: pierre-andre.dube@inspq.qc.ca
SOURCE
Clinical Toxicology (2017) 55:10 (1025-1054). Date of Publication: 26 Nov
2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Context: Intraosseous (IO) access is an established route of administration
in resuscitation situations. Patients with serious poisoning presenting to
the emergency department may require urgent antidote therapy. However,
intravenous (IV) access is not always readily available. Objective: This
study reviews the current evidence for IO administration of antidotes that
could be used in poisoning. The primary outcome was mortality as a surrogate
of efficacy. Secondary outcomes included hemodynamic variables,
electrocardiographic variables, neurological status, pharmacokinetics
outcomes, and adverse effects as defined by each article. Methods: A medical
librarian created a systematic search strategy for Medline, subsequently
translated to Embase, BIOSIS, PubMed, Web of Science, Cochrane, Database of
Abstracts of Reviews of Effects (DARE), and the CENTRAL clinical trial
register, all of which we searched from inception to 30 June 2016.
Interventions included IO administration of selected antidotes. Articles
included volunteer studies, poisoning, or other resuscitation contexts such
as cardiac arrest, burns, dehydration, seizure, hemorrhagic shock, or
undifferentiated shock. We considered all human studies and animal
experiments to the exception of in vitro studies. Two reviewers
independently selected studies, and a third adjudicated in case of
disagreement. Three reviewers extracted all relevant data. Three reviewers
evaluated the risk of bias and quality of the articles using specific scales
according to each type of study design. Results: A total of 47 publications
(46 articles and one abstract) met our inclusion criteria and described IO
administration of 13 different antidotes. These included one case series and
21 case reports describing 26 patients, and 25 animal experiments. Of those,
seven human case reports and four animal experiments specifically reported
the use of antidotes in poisoning. Human case reports suggested favorable
outcomes with IO use of atropine, diazepam, hydroxocobalamin, insulin, lipid
emulsion, methylene blue, phentolamine, prothrombin complex concentrate, and
sodium bicarbonate. Clinical outcomes varied according to the antidote used.
The only reported adverse event was ventricular tachycardia following IO
naloxone. Regarding the animal experiments, IO administration of lipid
emulsion and of hydroxocobalamin showed improved survival in
bupivacaine-poisoned rats and in cyanide-intoxicated swine, respectively.
Animal data also suggested an equivalent bio-availability between IO and IV
administration for atropine, calcium chloride, dextrose 50%, diazepam,
methylene blue, pralidoxime, and sodium bicarbonate. Adverse effect
reporting of fat emboli after IO administration of sodium bicarbonate, for
example, was conflicting due to the significant heterogeneity in the timing
of lung examination across studies. Conclusion: The evidence supporting the
use of IO route for the administration of antidotes in a context of
poisoning is scarce. The majority of the evidence consists of case reports
and animal experiments. Common antidotes such as acetylcysteine, fomepizole,
and digoxin-specific antibody fragments have not been studied or reported
with the use of the IO route. Despite the low-quality evidence available, IO
access is a potential option for antidotal treatments in toxicological
resuscitation when IV access is unavailable.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug administration, intraosseous drug administration)
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
atropine (intraosseous drug administration, intravenous drug administration)
bicarbonate (intraosseous drug administration, intravenous drug
administration)
calcium chloride (intraosseous drug administration, intravenous drug
administration)
diazepam (intraosseous drug administration, intravenous drug administration)
digoxin antibody
glucose (intraosseous drug administration, intravenous drug administration)
hydroxocobalamin (intraosseous drug administration)
insulin (intraosseous drug administration)
lipid emulsion (intraosseous drug administration)
methylene blue (intraosseous drug administration, intravenous drug
administration)
naloxone (intraosseous drug administration)
phentolamine (intraosseous drug administration)
pralidoxime (intraosseous drug administration, intravenous drug
administration)
prothrombin complex (intraosseous drug administration)
EMTREE MEDICAL INDEX TERMS
bibliographic database
bone growth
bone injury
burn
clinical outcome
dehydration
drug bioavailability
drug efficacy
drug potency
electrocardiography
emergency ward
fat embolism
heart arrest
heart ventricle tachycardia
hemorrhagic shock
human
in vitro study
intoxication
lung examination
meta analysis
mortality
nonhuman
outcome assessment
quality control
resuscitation
review
risk factor
seizure
systematic review
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
insulin (9004-10-8)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
phentolamine (50-60-2, 73-05-2)
pralidoxime (6735-59-7)
prothrombin complex (37224-63-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170858253
MEDLINE PMID
28644688 (http://www.ncbi.nlm.nih.gov/pubmed/28644688)
PUI
L619547466
DOI
10.1080/15563650.2017.1337122
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1337122
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 83
TITLE
Impact of a chronic pain management pathway on opioid administration and
prescribing in an Emergency Department
AUTHOR NAMES
Pace C.
Shah S.
Zhang A.X.
Zosel A.E.
AUTHOR ADDRESSES
(Pace C., cpace@mcw.edu) Department of Emergency Medicine, Medical College
of Wisconsin, Milwaukee, WI, USA
(Shah S.; Zhang A.X.) Medical College of Wisconsin, Milwaukee, WI, USA
(Zosel A.E.) Wisconsin Poison Center, Department of Emergency Medicine,
Section of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI,
USA
CORRESPONDENCE ADDRESS
C. Pace, Department of Emergency Medicine, Medical College of Wisconsin,
Milwaukee, WI, USA Email: cpace@mcw.edu
SOURCE
Clinical Toxicology (2017) (1-7). Date of Publication: 22 Nov 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Context: Prescription opioid abuse and misuse is a significant public health
crisis. In 2012, an opioid prescribing pathway for patients with chronic
pain presenting to the Emergency Department (ED) was implemented. The
objective of this study is to determine the impact of the pathway for
administration of opioids in the ED as well as the prescribing of opioids
for home use after discharge. Methods: Retrospective pre- and
post-intervention time series study of consecutive patients presenting to
the ED with acute and chronic pain complaints before and after
implementation of the pathway. For the purposes of this study, we included
patients with chronic abdominal or back pain – defined as pain present for
greater than three months – and acute pain as acute long bone fracture.
Results: Before pathway implementation, there was no statistically
significant difference in the mean morphine equivalent (MEQ) dose
administered for chronic or acute pain patients. After pathway
implementation, there was a decrease in IV/IM morphine administered to
patients with chronic pain (p = .0200) but not to patients with acute pain
(p = .0820). Overall, MEQs administered did not change in either group. In
the acute pain group, no significant differences were found in the number of
patients who received opioid prescriptions upon discharge (p = .7749).
However, in the chronic pain group, the number of patients who received
opioid prescriptions upon discharge decreased with statistical significance
(p = .0017). Conclusions: After the implementation of a chronic pain
management pathway in an ED, there is a decrease noted in opioids
administered to patients with chronic pain both in the ED and prescriptions
on discharge. In patients presenting with acute pain, there was no change in
administration or prescription of opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain
analgesia
backache
chronic pain
emergency medicine
emergency ward
fracture
long bone
opiate addiction
prescription
EMTREE MEDICAL INDEX TERMS
adult
controlled study
disease course
drug therapy
human
lumbar region
retrospective study
statistical significance
time series analysis
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170826689
PUI
L619388599
DOI
10.1080/15563650.2017.1401081
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1401081
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 84
TITLE
Opioid vs nonopioid acute pain management in the emergency department
AUTHOR NAMES
Kyriacou D.N.
AUTHOR ADDRESSES
(Kyriacou D.N., demetrios.kyriacou@jamanetwork.org) Chicago, United States.
(Kyriacou D.N., demetrios.kyriacou@jamanetwork.org) Department of Emergency
Medicine, Northwestern University Feinberg School of Medicine, Chicago,
United States.
CORRESPONDENCE ADDRESS
D.N. Kyriacou, Northwestern University Feinberg School of Medicine,
Department of Emergency Medicine, 211 E Ontario St, Ste 200, Chicago, United
States. Email: demetrios.kyriacou@jamanetwork.org
SOURCE
JAMA - Journal of the American Medical Association (2017) 318:17
(1655-1656). Date of Publication: 7 Nov 2017
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
opiate
EMTREE DRUG INDEX TERMS
ibuprofen
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
EMTREE MEDICAL INDEX TERMS
drug efficacy
drug overdose
drug use
editorial
health care personnel
human
medical care
patient risk
priority journal
United States
CAS REGISTRY NUMBERS
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170823828
MEDLINE PMID
29114813 (http://www.ncbi.nlm.nih.gov/pubmed/29114813)
PUI
L619378127
DOI
10.1001/jama.2017.16725
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2017.16725
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 85
TITLE
Effect of a single dose of oral opioid and nonopioid analgesics on acute
extremity pain in the emergency department: A randomized clinical trial
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Esses D.
Barnaby D.P.
Baer J.
AUTHOR ADDRESSES
(Chang A.K., achang3@yahoo.com) Department of Emergency Medicine, Albany
Medical College, Albany, United States.
(Bijur P.E.; Esses D.; Barnaby D.P.; Baer J.) Department of Emergency
Medicine, Albert Einstein College of Medicine, Montefiore Medical Center,
Bronx, United States.
(Chang A.K., achang3@yahoo.com) Department of Emergency Medicine, Albany
Medical College, 16 New Scotland Ave, MC-139, Albany, United States.
SOURCE
JAMA - Journal of the American Medical Association (2017) 318:17
(1661-1667). Date of Publication: 7 Nov 2017
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
ABSTRACT
IMPORTANCE: The choice of analgesic to treat acute pain in the emergency
department (ED) lacks a clear evidence base. The combination of ibuprofen
and acetaminophen (paracetamol) may represent a viable nonopioid
alternative. OBJECTIVES: To compare the efficacy of 4 oral analgesics.
DESIGN, SETTINGS, AND PARTICIPANTS: Randomized clinical trial conducted at 2
urban EDs in the Bronx, New York, that included 416 patients aged 21 to 64
years with moderate to severe acute extremity pain enrolled from July 2015
to August 2016. INTERVENTIONS: Participants (104 per each combination
analgesic group) received 400 mg of ibuprofen and 1000 mg of acetaminophen;
5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300
mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. MAIN
OUTCOMES AND MEASURES: The primary outcome was the between-group difference
in decline in pain 2 hours after ingestion. Pain intensity was assessed
using an 11-point numerical rating scale (NRS), in which 0 indicates no pain
and 10 indicates the worst possible pain. The predefined minimum clinically
important difference was 1.3 on the NRS. Analysis of variance was used to
test the overall between-group difference at P = .05 and 99.2% CIs adjusted
for multiple pairwise comparisons. RESULTS: Of 416 patients randomized, 411
were analyzed (mean [SD] age, 37 [12] years; 199 [48%] women; 247 [60%]
Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the
mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen
and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and
acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and
acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and
acetaminophen group (P = .053). The largest difference in decline in the NRS
pain score from baseline to 2 hours was between the oxycodone and
acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2%
CI, −0.1 to 1.8), which was less than the minimum clinically important
difference in NRS pain score of 1.3. Adverse events were not assessed.
CONCLUSIONS AND RELEVANCE: For patients presenting to the ED with acute
extremity pain, there were no statistically significant or clinically
important differences in pain reduction at 2 hours among single-dose
treatment with ibuprofen and acetaminophen or with 3 different opioid and
acetaminophen combination analgesics. Further research to assess adverse
events and other dosing may be warranted. TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT02455518.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (clinical trial, drug combination, drug comparison, drug therapy,
oral drug administration)
hydrocodone (clinical trial, drug combination, drug comparison, drug
therapy, oral drug administration)
ibuprofen (clinical trial, drug combination, drug comparison, drug therapy,
oral drug administration)
oxycodone (clinical trial, drug combination, drug comparison, drug therapy,
oral drug administration)
paracetamol (clinical trial, drug combination, drug therapy, oral drug
administration)
EMTREE DRUG INDEX TERMS
opiate (clinical trial, drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
limb pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical effectiveness
combination drug therapy
controlled study
double blind procedure
drug efficacy
female
human
major clinical study
male
minimal clinically important difference
numeric rating scale
outcome assessment
pain intensity
priority journal
randomized controlled trial
single drug dose
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT02455518)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170823831
MEDLINE PMID
29114833 (http://www.ncbi.nlm.nih.gov/pubmed/29114833)
PUI
L619378130
DOI
10.1001/jama.2017.16190
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2017.16190
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 86
TITLE
The opioid crisis in the USA: a public health emergency
AUTHOR NAMES
The Lancet
AUTHOR ADDRESSES
(The Lancet)
SOURCE
The Lancet (2017) 390:10107 (2016). Date of Publication: 4 Nov 2017
ISSN
1474-547X (electronic)
0140-6736
BOOK PUBLISHER
Lancet Publishing Group, cususerv@lancet.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS
death
drug abuse
drug dependence
drug intoxication
editorial
emergency
epidemic
evidence based practice
harm reduction
human
priority journal
public health
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170773726
PUI
L619087391
DOI
10.1016/S0140-6736(17)32808-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0140-6736(17)32808-8
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 87
TITLE
Use of Prophylactic Ondansetron with Intravenous Opioids in Emergency
Department Patients: A Prospective Observational Pilot Study
AUTHOR NAMES
Culver M.A.
Richards E.C.
Jarrell D.H.
Edwards C.J.
AUTHOR ADDRESSES
(Culver M.A.; Richards E.C.) Department of Pharmacy, Banner University
Medical Center Phoenix, Phoenix, United States.
(Jarrell D.H.; Edwards C.J.) Department of Pharmacy, Banner University
Medical Center Tucson, Tucson, United States.
CORRESPONDENCE ADDRESS
M.A. Culver, Banner University Medical Center Phoenix, Department of
Pharmacy, 1111 East McDowell Road, Phoenix, United States.
SOURCE
Journal of Emergency Medicine (2017) 53:5 (629-634). Date of Publication: 1
Nov 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background The current literature suggests that the prophylactic use of
antiemetics is ineffective at preventing nausea or vomiting caused by
opioids in the emergency department (ED). While there is no data evaluating
ondansetron's efficacy for preventing opioid-induced nausea and vomiting,
this practice remains common despite a lack of supporting evidence.
Objectives This study aimed to identify if prophylactic ondansetron
administered with intravenous (IV) opioids prevents opioid-induced nausea or
vomiting. Methods This prospective observational study was conducted in the
ED at two academic medical institutions. Patients were eligible for
enrollment if they were prescribed an IV opioid with or without IV
ondansetron and absence of baseline nausea. Patients' level of nausea was
evaluated at baseline, 5 min, and 30 min after an IV opioid was administered
and then observed for 2 hours. Results One hundred thirty-three patients
were enrolled, with 90% of patients presenting with a chief complaint of
pain. Sixty-four (48.1%) patients received an IV opioid alone and 69 (51.9%)
patients received both IV ondansetron and an IV opioid. Twenty-three (17.3%)
patients developed nausea caused by opioid administration. One (0.75%)
patient had an emetic event and 3 (2.3%) patients required rescue
antiemetics during their observation period. Rate of nausea was similar
between treatment groups 5 min after the opioid was administered (p =
0.153). There was no statistical difference in emesis, rescue medication
requirements, or nausea severity between treatment groups. Conclusion Our
trial found that ondansetron did not appear to be effective at preventing
opioid-induced nausea or vomiting. These findings and previous literature
suggest prophylactic ondansetron should not be given to ED patients who are
receiving IV opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ondansetron (drug combination, drug therapy, intravenous drug
administration)
opiate (adverse drug reaction, drug combination, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction, drug combination, drug therapy, intravenous
drug administration)
hydromorphone (adverse drug reaction, drug combination, drug therapy,
intravenous drug administration)
morphine (adverse drug reaction, drug combination, drug therapy, intravenous
drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
nausea (drug therapy, side effect, drug therapy, prevention, side effect)
vomiting (drug therapy, side effect, drug therapy, prevention, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adult
arm pain (drug therapy)
article
backache (drug therapy)
controlled study
disease severity
drug efficacy
drug safety
female
headache (drug therapy)
human
incidence
leg pain (drug therapy)
loading drug dose
major clinical study
male
neck pain (drug therapy)
observational study
pelvic pain (drug therapy)
pilot study
priority journal
prospective study
sore throat (drug therapy)
thorax pain (drug therapy)
tooth pain (drug therapy)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170706372
PUI
L618671488
DOI
10.1016/j.jemermed.2017.06.040
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2017.06.040
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 88
TITLE
Acupuncture's Role in Solving the Opioid Epidemic: Evidence,
Cost-Effectiveness, and Care Availability for Acupuncture as a Primary,
Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017
AUTHOR NAMES
Fan A.Y.
Miller D.W.
Bolash B.
Bauer M.
McDonald J.
Faggert S.
He H.
Li Y.M.
Matecki A.
Camardella L.
Koppelman M.H.
Stone J.A.M.
Meade L.
Pang J.
AUTHOR ADDRESSES
(Fan A.Y.) The American TCM Association, Vienna, United States.
(Miller D.W., eastwestkiddoc@hotmail.com; Faggert S.; He H.; Camardella L.;
Stone J.A.M.; Meade L.) The American Society of Acupuncturists, Chicago,
United States.
(Miller D.W., eastwestkiddoc@hotmail.com; Bolash B.; Bauer M.; McDonald J.;
Camardella L.; Koppelman M.H.; Meade L.) The Joint Acupuncture Opioid Task
Force, La Verne, United States.
(Miller D.W., eastwestkiddoc@hotmail.com) Pacific College of Oriental
Medicine, Chicago, United States.
(Bauer M.) The Acupuncture Now Foundation, La Verne, United States.
(McDonald J.; Koppelman M.H.) The Acupuncture Evidence Project, Providence,
United States.
(Faggert S.) The Acupuncture Society of Virginia, Vienna, United States.
(He H.) The National Federation of Chinese TCM Organizations, New York,
United States.
(He H.; Matecki A.) The American Alliance for Professional Acupuncture
Safety, Greenwich, United States.
(Li Y.M.) The American Traditional Chinese Medicine Society, New York,
United States.
(Matecki A.) Highland Hospital, Alameda Health System, Oakland, United
States.
(Stone J.A.M.) Indiana University, School of Medicine, Indianapolis, United
States.
(Pang J.) University of California, San Diego School of Medicine, San Diego,
United States.
CORRESPONDENCE ADDRESS
D.W. Miller, University of California, San Diego School of Medicine, San
Diego, United States. Email: eastwestkiddoc@hotmail.com
SOURCE
Journal of Integrative Medicine (2017) 15:6 (411-425). Date of Publication:
1 Nov 2017
ISSN
2095-4964
BOOK PUBLISHER
Elsevier (Singapore) Pte Ltd, 3 Killiney Road, 08-01, Winsland House I,
Singapore, Singapore.
ABSTRACT
The United States (U.S.) is facing a national opioid epidemic, and medical
systems are in need of non-pharmacologic strategies that can be employed to
decrease the public's opioid dependence. Acupuncture has emerged as a
powerful, evidence-based, safe, cost-effective, and available treatment
modality suitable to meeting this need. Acupuncture has been shown to be
effective for the management of numerous types of pain conditions, and
mechanisms of action for acupuncture have been described and are
understandable from biomedical, physiologic perspectives. Further,
acupuncture's cost-effectiveness can dramatically decrease health care
expenditures, both from the standpoint of treating acute pain and through
avoiding addiction to opioids that requires costly care, destroys quality of
life, and can lead to fatal overdose. Numerous federal regulatory agencies
have advised or mandated that healthcare systems and providers offer
non-pharmacologic treatment options for pain. Acupuncture stands out as the
most evidence-based, immediately available choice to fulfil these calls.
Acupuncture can safely, easily, and cost-effectively be incorporated into
hospital settings as diverse as the emergency department, labor and delivery
suites, and neonatal intensive care units to treat a variety of commonly
seen pain conditions. Acupuncture is already being successfully and
meaningfully utilized by the Veterans Administration and various branches of
the U.S. Military, in some studies demonstrably decreasing the volume of
opioids prescribed when included in care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacoeconomics)
EMTREE DRUG INDEX TERMS
endorphin (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acupuncture
analgesia
cost effectiveness analysis
EMTREE MEDICAL INDEX TERMS
article
chronic pain
drug bioavailability
emergency ward
evidence based practice
feasibility study
food and drug administration
health care cost
health care system
human
neonatal intensive care unit
nerve cell plasticity
nonhuman
opiate addiction
pain
patient safety
priority journal
quality of life
CAS REGISTRY NUMBERS
endorphin (60118-07-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170790540
PUI
L619181696
DOI
10.1016/S2095-4964(17)60378-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S2095-4964(17)60378-9
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 89
TITLE
Alternative Viewpoint: Predictors of Response in Emergency Department
Patients Receiving Intravenous Opioids for Severe Pain
AUTHOR NAMES
Priano J.
Faley B.
AUTHOR ADDRESSES
(Priano J., jimpriano@gmail.com) Emergency Medicine, Florida Hospital,
Orlando, United States.
(Faley B.) Medical Affairs, Pharmacy Alliance, Pacira Pharmaceuticals Inc.,
San Diego, United States.
CORRESPONDENCE ADDRESS
J. Priano, Emergency Medicine, Florida Hospital, Orlando, United States.
Email: jimpriano@gmail.com
SOURCE
Pharmacotherapy (2017) 37:11 (e118-e119). Date of Publication: 1 Nov 2017
ISSN
1875-9114 (electronic)
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
hydromorphone (drug comparison, drug therapy, intravenous drug
administration)
morphine (drug comparison, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
article
disease severity
drug efficacy
emergency ward
prediction
treatment response
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170756068
PUI
L618987014
DOI
10.1002/phar.2030
FULL TEXT LINK
http://dx.doi.org/10.1002/phar.2030
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 90
TITLE
Methadone gastrobezoar in a psychiatric patient presented in coma
AUTHOR NAMES
Gavala A.
Manou D.
Psalida V.
Nystatzaki M.
Mavrogiannis C.
Alevizopoulos G.
Myrianthefs P.
AUTHOR ADDRESSES
(Gavala A.; Psalida V.; Myrianthefs P., pmiriant@nurs.uoa.gr) Department of
Intensive Care Unit, Kaliftaki, Nea Kifissia, Greece.
(Manou D.; Mavrogiannis C.) Department of Gastrenterology, Agioi Anargyroi
General Hospital, Kaliftaki, Nea Kifissia, Greece.
(Nystatzaki M.; Alevizopoulos G.) Department of Psychiatry, Agioi Anargyroi
General Hospital, Kaliftaki, Nea Kifissia, Greece.
(Mavrogiannis C.; Alevizopoulos G.; Myrianthefs P., pmiriant@nurs.uoa.gr)
Faculty of Nursing, School of Health Sciences, National and Kapodistrian
University of Athens, Greece.
CORRESPONDENCE ADDRESS
P. Myrianthefs, Department of Intensive Care Unit, Kaliftaki, Nea Kifissia,
Greece. Email: pmiriant@nurs.uoa.gr
SOURCE
Indian Journal of Critical Care Medicine (2017) 21:11 (796-798). Date of
Publication: 1 Nov 2017
ISSN
1998-359X (electronic)
0972-5229
BOOK PUBLISHER
Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai, India.
ABSTRACT
A 43-year-old psychiatric patient was transferred in coma and hypercapnic
respiratory failure at the emergency department. He was intubated for airway
protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray
revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by
gastroscopy; one large in the stomach fundus and a smaller one in the
pylorus. Gastric lavage through the gastroscope and administration of
gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets
retrieved from the stomach identified as methadone and toxicological tests
of the gastric fluid confirmed the presence of methadone as the only organic
chemical compound. The patient was extubated on the 7(th) day and released
from the ICU on the 10(th) day under psychiatric consultation having normal
vital signs. Methadone gastric bezoar may lead to persistent intoxication,
respiratory failure, and coma requiring ICU care. Diagnosis may be difficult
and a high index of suspicion is needed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug therapy)
EMTREE DRUG INDEX TERMS
activated carbon
alprazolam
erythromycin (intravenous drug administration)
flumazenil (intravenous drug administration)
fondaparinux (drug therapy, subcutaneous drug administration)
lactulose
meglumine diatrizoate
metoclopramide
naloxone (intravenous drug administration)
olanzapine
omeprazole (drug therapy, intravenous drug administration)
quetiapine
sultamicillin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bezoar
coma
mental patient
EMTREE MEDICAL INDEX TERMS
abdominal radiography
abnormal laboratory result
adult
article
case report
clinical article
computer assisted tomography
deep vein thrombosis (drug therapy, prevention)
depression
drug dependence (drug therapy)
gastroscope
gastroscopy
human
hypercapnia
intensive care unit
intubation
male
neuroimaging
respiratory failure
schizophrenia
stomach erosion
stomach juice
stomach lavage
stress ulcer (drug therapy, prevention)
suicide attempt
tablet
toxicology
treatment response
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alprazolam (28981-97-7)
erythromycin (114-07-8, 70536-18-4)
flumazenil (78755-81-4)
fondaparinux (104993-28-4, 114870-03-0)
lactulose (4618-18-2)
meglumine diatrizoate (131-49-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
omeprazole (73590-58-6, 95510-70-6)
quetiapine (111974-72-2)
sultamicillin (58694-35-2, 76497-13-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170821272
PUI
L619363281
DOI
10.4103/ijccm.IJCCM_17_17
FULL TEXT LINK
http://dx.doi.org/10.4103/ijccm.IJCCM_17_17
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 91
TITLE
Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary
resuscitation by trained paramedics and medics inside the hospital
AUTHOR NAMES
Garg R.
Ahmed S.M.
Kapoor M.C.
Chakra Rao S.S.C.
Mishra B.B.
Kalandoor M.V.
Singh B.
Divatia J.V.
AUTHOR ADDRESSES
(Garg R.) Department of Onco-Anaesthesiology and Palliative Medicine, Dr
BRAIRCH, All India Institute of Medical Sciences, India.
(Ahmed S.M., sma99@rediffmail.com) Department of Anaesthesiology and
Critical Care, J N Medical College, Aligarh Muslim University, Aligarh,
India.
(Kapoor M.C.) Department of Anesthesia, Max Smart Super Specialty Hospital,
New Delhi, India.
(Chakra Rao S.S.C.) Department of Anaesthesiology, Care Emergency Hospital,
Kakinada, India.
(Mishra B.B.) Department of Anaesthesiology, Indian College of
Anaesthesiologists, Bhubaneswar, India.
(Kalandoor M.V.) Department of Anaesthesiology, Government General Hospital,
Kasaragod, India.
(Singh B.) Department of Anaesthesiology and Intensive Care, GB Pant
Institute of Postgraduate Medical Education and Research, India.
(Divatia J.V.) Department of Anaesthesia, Critical Care and Pain, Tata
Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
CORRESPONDENCE ADDRESS
S.M. Ahmed, Department of Anaesthesiology and Critical Care, J N Medical
College, Aligarh Muslim University, Aligarh, India. Email:
sma99@rediffmail.com
SOURCE
Indian Journal of Anaesthesia (2017) 61:11 (883-894). Date of Publication: 1
Nov 2017
ISSN
0019-5049
BOOK PUBLISHER
Indian Society of Anaesthetists, Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata, India.
ABSTRACT
The cardiopulmonary resuscitation (CPR) guideline of comprehensive
cardiopulmonary life support (CCLS) for management of the patient with
cardiopulmonary arrest in adults provides an algorithmic step-wise approach
for optimal outcome of the patient inside the hospital by trained medics and
paramedics. This guideline has been developed considering the infrastructure
of healthcare delivery system in India. This is based on evidence in the
international and national literature. In the absence of data from the
Indian population, the extrapolation has been made from international data,
discussed with Indian experts and modified accordingly to ensure their
applicability in India. The CCLS guideline emphasise the need to recognise
patients at risk for cardiac arrest and their timely management before a
cardiac arrest occurs. The basic components of CPR include chest
compressions for blood circulation; airway maintenance to ensure airway
patency; lung ventilation to enable oxygenation and defibrillation to
convert a pathologic ‘shockable’ cardiac rhythm to one capable to
maintaining effective blood circulation. CCLS emphasises incorporation of
airway management, drugs, and identification of the cause of arrest and its
correction, while chest compression and ventilation are ongoing. It also
emphasises the value of organised team approach and optimal
post-resuscitation care.
EMTREE DRUG INDEX TERMS
amiodarone (intravenous drug administration)
antiarrhythmic agent
atropine
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary arrest (diagnosis, therapy)
comprehensive cardiopulmonary life support
resuscitation
EMTREE MEDICAL INDEX TERMS
airway patency
artery catheterization
article
Bag mask ventilation
bibliographic database
circulation
coding algorithm
defibrillation
electric activity
electrocardiography
emergency ward
endotracheal tube
health care delivery
heart arrest
heart rhythm
heart ventricle tachycardia
human
implantable cardiac monitor
implantable cardioverter defibrillator
lung ventilation
out of hospital cardiac arrest
outcome assessment
outpatient department
peripheral venous catheter
quality control
respiration control
return of spontaneous circulation
CAS REGISTRY NUMBERS
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
epinephrine (51-43-4, 55-31-2, 6912-68-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170819521
PUI
L619351912
DOI
10.4103/ija.IJA_664_17
FULL TEXT LINK
http://dx.doi.org/10.4103/ija.IJA_664_17
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 92
TITLE
Response to Letter to the EditorThe Contribution of the Emergency Department
to Opioid Pain Reliever Misuse and Diversion: A Critical Review
AUTHOR NAMES
Lyapustina T.
Castillo R.
Omaki E.
Shields W.
McDonald E.
Rothman R.
Gielen A.
AUTHOR ADDRESSES
(Lyapustina T., lyapustina@uchc.edu) University of Connecticut Health
Center, Farmington, United States.
(Lyapustina T., lyapustina@uchc.edu) Johns Hopkins School of Medicine,
Baltimore, United States.
(Castillo R.; Omaki E.; Shields W.; McDonald E.; Gielen A.) Department of
Health Policy and Management, Johns Hopkins Bloomberg School of Public
Health, Baltimore, United States.
(Rothman R.) Division of Emergency Medicine, Johns Hopkins Medicine,
Baltimore, United States.
SOURCE
Pain Practice (2017) 17:8 (1123). Date of Publication: 1 Nov 2017
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse (epidemiology)
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
epidemic
human
letter
prescription
public health
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170783324
PUI
L619142476
DOI
10.1111/papr.12598
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12598
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 93
TITLE
Controversies and carfentanil: We have much to learn about the present state
of opioid poisoning
AUTHOR NAMES
Cole J.B.
Nelson L.S.
AUTHOR ADDRESSES
(Cole J.B., jon.cole@hcmed.org) Minnesota Poison Control System, Department
of Emergency Medicine, Hennepin County Medical Center, University of
Minnesota Medical School, Minneapolis, United States.
(Nelson L.S.) Department of Emergency Medicine, Division of Medical
Toxicology, Rutgers New Jersey Medical School, New Jersey Poison Information
& Education System, Newark, United States.
CORRESPONDENCE ADDRESS
J.B. Cole, 701 Park Ave, Mail Code: RL.240, Minneapolis, United States.
Email: jon.cole@hcmed.org
SOURCE
American Journal of Emergency Medicine (2017) 35:11 (1743-1745). Date of
Publication: 1 Nov 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carfentanil (drug dose, pharmacology)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
drug exposure
drug legislation
drug safety
emergency health service
human
law enforcement
note
priority journal
CAS REGISTRY NUMBERS
carfentanil (59708-52-0)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170609845
PUI
L618030887
DOI
10.1016/j.ajem.2017.08.045
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.08.045
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 94
TITLE
Rates and Risk Factors for Opioid Dependence and Overdose after Urological
Surgery
AUTHOR NAMES
Shah A.S.
Blackwell R.H.
Kuo P.C.
Gupta G.N.
AUTHOR ADDRESSES
(Shah A.S., arshah@lumc.edu; Blackwell R.H.; Gupta G.N.) Department of
Urology, Loyola University Medical Center, Maywood, United States.
(Kuo P.C.; Gupta G.N.) Department of Surgery, Loyola University Medical
Center, Maywood, United States.
(Blackwell R.H.; Kuo P.C.; Gupta G.N.) One:MAP Division of Clinical
Informatics and Analytics, Loyola University Medical Center, Maywood, United
States.
CORRESPONDENCE ADDRESS
A.S. Shah, Department of Urology, Loyola University Medical Center, 2160
South First Ave., Fahey Center, Room 241, Maywood, United States. Email:
arshah@lumc.edu
SOURCE
Journal of Urology (2017) 198:5 (1130-1136). Date of Publication: 1 Nov 2017
ISSN
1527-3792 (electronic)
0022-5347
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Purpose Effective pain management is a critical component of the
perioperative process with opioids representing a mainstay of therapy. The
opioid epidemic is a growing concern in the United States. The goal of this
study was to quantify the risk of opioid dependence or overdose among
patients undergoing urological surgery and to identify risk factors of
opioid dependence or overdose. Materials and Methods We retrospectively
reviewed data on urological surgery from 2007 to 2011. Data sources included
the HCUP (Healthcare Cost and Utilization Project) inpatient, ambulatory
surgery and emergency department data sets. Outcomes of postoperative opioid
dependence and overdose were identified by previously validated ICD-9 codes.
Multivariable logistic regression adjusted for surgical procedure was
performed to identify predictors of opioid dependence or overdose following
urological surgery. Results Overall 675,527 patients underwent urological
surgery, of whom 0.09% were diagnosed with opioid dependence or overdose.
Patients in whom opioid dependence or overdose developed were younger
(median age 51 vs 62 years), carried nonprivate insurance (69.6% vs 66%),
underwent an inpatient procedure (81.0% vs 42.4%) and had a longer length of
stay (median 3 vs 0 days) and a history of depression (14.4% vs 3.4%) or
chronic obstructive pulmonary disease (20.3% vs 8.9%, all p <0.001). On
adjusted multivariable analysis these factors remained independent risk
factors for opioid dependence or overdose. Conclusions Postoperative opioid
dependence or overdose affects 1 of 1,111 urological surgery patients. Risk
factors for opioid dependence or overdose included younger age, inpatient
surgery and increasing hospitalization duration, baseline depression,
tobacco use and chronic obstructive pulmonary disease as well as insurance
provider, including Medicaid, Medicare (age less than 65 years) and
noninsured status.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
opiate addiction
patient risk
urologic surgery
EMTREE MEDICAL INDEX TERMS
adult
African American
aged
ambulatory surgery
article
Asian
bladder sphincter prosthesis
California
Caucasian
Charlson Comorbidity Index
chronic obstructive lung disease
comorbidity
depression
emergency ward
hernioplasty
Hispanic
hospital discharge
hospital patient
household income
human
ICD-9
inflatable penis prosthesis
length of stay
liver disease
major clinical study
male
male genital system surgery
medicaid
medically uninsured
medicare
nephroureterectomy
orchiectomy
partial nephrectomy
patient selection
pelvis surgery
peptic ulcer
percutaneous nephrolithotomy
postoperative complication
priority journal
private health insurance
prostatectomy
race
retrospective study
risk factor
surgical patient
tobacco use
transurethral electrovaporization
transurethral resection
ureteral stenting
ureteroscopy
urethrotomy
very elderly
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170671518
PUI
L618426044
DOI
10.1016/j.juro.2017.05.037
FULL TEXT LINK
http://dx.doi.org/10.1016/j.juro.2017.05.037
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 95
TITLE
The Contribution of the Emergency Department To Opioid Pain Reliever Misuse
And Diversion: A Critical Review
AUTHOR NAMES
Lyapustina T.
Castillo R.
Omaki E.
Shields W.
McDonald E.
Rothman R.
Gielen A.
AUTHOR ADDRESSES
(Lyapustina T., lyapustina@uchc.edu) University of Connecticut Health
Center, Farmington, United States.
(Lyapustina T., lyapustina@uchc.edu) Johns Hopkins School of Medicine,
Baltimore, United States.
(Castillo R.; Omaki E.; Shields W.) Department of Health Policy and
Management, Johns Hopkins Bloomberg School of Public Health, Baltimore,
United States.
(McDonald E.; Gielen A.) Department of Health, Behavior and Society, Johns
Hopkins Bloomberg School of Public Health, Baltimore, United States.
(Rothman R.) Division of Emergency Medicine, Johns Hopkins Medicine,
Baltimore, United States.
CORRESPONDENCE ADDRESS
T. Lyapustina, University of Connecticut Health Center, Farmington, United
States. Email: lyapustina@uchc.edu
SOURCE
Pain Practice (2017) 17:8 (1097-1104). Date of Publication: 1 Nov 2017
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Prescription opioid pain reliever (OPR) misuse and diversion is an important
and growing public health problem in the United States that is responsible
for significant morbidity and mortality. Emergency physicians are among the
top prescribers of OPRs, yet the relative contribution of emergency
department (ED) OPR prescriptions to the overall opioid abuse epidemic
remains unclear. This study critically reviews seven peer-reviewed studies
that specifically identified the ED as a source of OPRs. Of the OPRs
prescribed in the ED, approximately 10% are associated with indicators of
inappropriate prescribing, and approximately 42% may ultimately be misused;
of the OPRs that are diverted, approximately 10% originate from an ED
prescription. Among patients who suffer an OPR-related death, approximately
1.8% of the OPR pills given to the decedents will have come from the ED. In
addition to the need for more research, the existing literature suggests an
urgent need for interventions in the ED to reduce OPR misuse and diversion.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
benzodiazepine
hydrocodone
methadone
morphine
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
emergency ward
pain
prescription drug diversion
EMTREE MEDICAL INDEX TERMS
anesthesiologist
death
drug abuse
drug dose regimen
drug release
drug surveillance program
family medicine
human
inappropriate prescribing
internist
neurologist
prescription
psychiatrist
rehabilitation medicine
review
sex difference
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170269297
PUI
L615331429
DOI
10.1111/papr.12568
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12568
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 96
TITLE
Sedation and analgesia for procedures in the pediatric emergency room
ORIGINAL (NON-ENGLISH) TITLE
Sedação e analgesia para procedimentos no pronto-socorro de pediatria
AUTHOR NAMES
Ramalho C.E.
Bretas P.M.C.
Schvartsman C.
Reis A.G.
AUTHOR ADDRESSES
(Ramalho C.E.; Bretas P.M.C.; Reis A.G., ameliareis30@gmail.com)
Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das
Clínicas, Instituto da Criança, São Paulo, Brazil.
(Ramalho C.E.; Bretas P.M.C.; Schvartsman C.; Reis A.G.,
ameliareis30@gmail.com) Universidade de São Paulo (USP), Faculdade de
Medicina, Departamento de Pediatria, São Paulo, Brazil.
(Schvartsman C.) Faculdade Israelita de Ciências da Saúde Albert Einstein,
São Paulo, Brazil.
CORRESPONDENCE ADDRESS
A.G. Reis, Universidade de São Paulo (USP), Faculdade de Medicina, Hospital
das Clínicas, Instituto da Criança, São Paulo, Brazil. Email:
ameliareis30@gmail.com
SOURCE
Jornal de Pediatria (2017) 93 Supplement 1 (2-18). Date of Publication: 1
Nov 2017
ISSN
0021-7557
BOOK PUBLISHER
Elsevier Editora Ltda
ABSTRACT
Objective Children and adolescents often require sedation and analgesia in
emergency situations. With the emergence of new therapeutic options, the
obsolescence of others, and recent discoveries regarding already known
drugs, it became necessary to review the literature in this area. Data
sources Non-systematic review in the PubMed database of studies published up
to December 2016, including original articles, review articles, systematic
reviews, and meta-analyses. References from textbooks, publications from
regulatory agencies, and articles cited in reviews and meta-analyses through
active search were also included. Data synthesis Based on current
literature, the concepts of sedation and analgesia, the necessary care with
the patient before, during, and after sedoanalgesia, and indications related
to the appropriate choice of drugs according to the procedure to be
performed and their safety profiles are presented. Conclusions The use of
sedoanalgesia protocols in procedures in the pediatric emergency room should
guide the professional in the choice of medication, the appropriate
material, and in the evaluation of discharge criteria, thus assuring quality
in care.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
dexmedetomidine (adverse drug reaction)
etomidate (adverse drug reaction)
fentanyl (adverse drug reaction)
flumazenil (adverse drug reaction)
ketamine (adverse drug reaction, drug combination)
midazolam (adverse drug reaction)
morphine (adverse drug reaction)
naloxone (adverse drug reaction)
narcotic analgesic agent
propofol (adverse drug reaction, drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pediatric emergency medicine
sedation
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
anxiety disorder (side effect)
apnea (side effect)
arthralgia (side effect)
bradycardia (side effect)
child
clinical assessment
convulsion (side effect)
drug contraindication
drug indication
emergency health service
fatty liver (side effect)
fever (side effect)
gastrointestinal symptom (side effect)
health care quality
heart arrest (side effect)
human
hyperlipidemia (side effect)
hypersalivation (side effect)
hypertension (side effect)
hypotension (side effect)
hypoventilation (side effect)
infusion related reaction (side effect)
larynx spasm (side effect)
lung edema (side effect)
metabolic acidosis (side effect)
myalgia (side effect)
myoclonus (side effect)
nausea (side effect)
paradoxical drug reaction (side effect)
rating scale
respiration depression (side effect)
restlessness (side effect)
review
rhabdomyolysis (side effect)
shivering (side effect)
sinus arrhythmia (side effect)
tachycardia (side effect)
visual analog scale
vomiting (side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
dexmedetomidine (113775-47-6)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English, Portuguese
LANGUAGE OF SUMMARY
English, Portuguese
EMBASE ACCESSION NUMBER
20170703315
MEDLINE PMID
28945987 (http://www.ncbi.nlm.nih.gov/pubmed/28945987)
PUI
L618649908
DOI
10.1016/j.jped.2017.07.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jped.2017.07.009
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 97
TITLE
In Response: The Contribution of the Emergency Department to Opioid Pain
Reliever Misuse and Diversion: A Critical Review
AUTHOR NAMES
Mazer-Amirshahi M.
Motov S.
Nelson L.
AUTHOR ADDRESSES
(Mazer-Amirshahi M., maryannmazer@gmail.com) Department of Emergency
Medicine, MedStar Washington Hospital Center, Washington, United States.
(Mazer-Amirshahi M., maryannmazer@gmail.com) Georgetown University School of
Medicine, Washington, United States.
(Motov S.) Department of Emergency Medicine, Maimonides Medical Center,
Brooklyn, United States.
(Nelson L.) Department of Emergency Medicine, Rutgers New Jersey School of
Medicine, Newark, United States.
SOURCE
Pain Practice (2017) 17:8 (1122). Date of Publication: 1 Nov 2017
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
drug misuse
emergency ward
prescription drug diversion
EMTREE MEDICAL INDEX TERMS
analgesic agent abuse
chronic pain
disability
drug monitoring
emergency medicine
evidence based medicine
human
letter
patient risk
prescription
public health problem
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170391749
PUI
L616523223
DOI
10.1111/papr.12590
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12590
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 98
TITLE
The opioid crisis: A case for shifting from tertiary to primary prevention
AUTHOR NAMES
Gravel J.
AUTHOR ADDRESSES
(Gravel J., gravel.jon@gmail.com) Department of Family and Community
Medicine, Faculty of Medicine, University of Toronto, Ontario, Toronto,
Canada.
CORRESPONDENCE ADDRESS
J. Gravel, Department of Family and Community Medicine, Faculty of Medicine,
University of Toronto, Ontario, Toronto, Canada. Email: gravel.jon@gmail.com
SOURCE
Canadian Journal of Emergency Medicine (2017) 19:6 (503). Date of
Publication: 1 Nov 2017
ISSN
1481-8043 (electronic)
1481-8035
BOOK PUBLISHER
Cambridge University Press, info@bcdecker.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
primary prevention
tertiary prevention
EMTREE MEDICAL INDEX TERMS
chronic pain
disease exacerbation
drug intoxication
drug overdose
emergency ward
human
letter
prescription
risk assessment
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180066823
PUI
L620503491
DOI
10.1017/cem.2017.388
FULL TEXT LINK
http://dx.doi.org/10.1017/cem.2017.388
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 99
TITLE
Trump declares opioid public health emergency but no extra money
AUTHOR NAMES
Roehr B.
AUTHOR ADDRESSES
(Roehr B.) Washington, DC
SOURCE
BMJ (Clinical research ed.) (2017) 359 (j4998). Date of Publication: 27 Oct
2017
ISSN
1756-1833 (electronic)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
financial management
EMTREE MEDICAL INDEX TERMS
economics
emergency
human
opiate addiction (therapy)
public health
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
29079683 (http://www.ncbi.nlm.nih.gov/pubmed/29079683)
PUI
L619685355
DOI
10.1136/bmj.j4998
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.j4998
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 100
TITLE
Reframing the opioid epidemic as a national emergency
AUTHOR NAMES
Gostin L.O.
Hodge J.G.
Noe S.A.
AUTHOR ADDRESSES
(Gostin L.O., gostin@law.georgetown.edu) O'Neill Institute for National and
Global Health Law, Georgetown University Law Center, Washington, United
States.
(Hodge J.G.) Center for Public Health Law and Policy, Sandra Day o'Connor
College of Law, Arizona State University, Phoenix, United States.
(Noe S.A.) University of Pennsylvania Law School, Philadelphia, United
States.
(Gostin L.O., gostin@law.georgetown.edu) Georgetown University Law Center,
600 New Jersey Ave, NW, McDonough 568, Washington, United States.
CORRESPONDENCE ADDRESS
L.O. Gostin, Georgetown University Law Center, 600 New Jersey Ave, NW,
McDonough 568, Washington, United States. Email: gostin@law.Georgetown.edu
SOURCE
JAMA - Journal of the American Medical Association (2017) 318:16
(1539-1540). Date of Publication: 24 Oct 2017
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
health care planning
opiate addiction
EMTREE MEDICAL INDEX TERMS
authority
chronic pain
criminal justice
drug abuse
drug dependence
drug misuse
health care cost
human
life expectancy
mortality rate
note
priority journal
public health service
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170786031
MEDLINE PMID
28832871 (http://www.ncbi.nlm.nih.gov/pubmed/28832871)
PUI
L619152659
DOI
10.1001/jama.2017.13358
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2017.13358
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 101
TITLE
In response to: “Loperamide metabolite-induced cardiomyopathy and QTc
prolongation”
AUTHOR NAMES
Eggleston W.
Marraffa J.M.
Nacca N.
AUTHOR ADDRESSES
(Eggleston W., williamdeggleston@gmail.com; Nacca N.) Department of
Emergency Medicine, SUNY Upstate Medical University, Syracuse, United
States.
(Marraffa J.M.) Upstate New York Poison Center, Syracuse, United States.
CORRESPONDENCE ADDRESS
W. Eggleston, Department of Emergency Medicine, SUNY Upstate Medical
University, Syracuse, United States. Email: williamdeggleston@gmail.com
SOURCE
Clinical Toxicology (2017) 55:9 (1023). Date of Publication: 21 Oct 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
loperamide
EMTREE DRUG INDEX TERMS
desmethylloperamide
haloperidol
naloxone
olanzapine
oxycodone
trazodone
unclassified drug
venlafaxine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiomyopathy
EMTREE MEDICAL INDEX TERMS
blood level
drug blood level
electrocardiogram
emergency ward
human
letter
prescription
QT prolongation
takotsubo cardiomyopathy
CAS REGISTRY NUMBERS
haloperidol (52-86-8, 1511-16-6)
loperamide (34552-83-5, 53179-11-6)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
oxycodone (124-90-3, 76-42-6)
trazodone (19794-93-5, 25332-39-2)
venlafaxine (93413-69-5, 99300-78-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170439149
PUI
L616863786
DOI
10.1080/15563650.2017.1334917
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1334917
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 102
TITLE
Reviewing opioid use, monitoring, and legislature: Nursing perspectives
AUTHOR NAMES
Jukiewicz D.A.
Alhofaian A.
Thompson Z.
Gary F.A.
AUTHOR ADDRESSES
(Jukiewicz D.A., daj47@case.edu; Alhofaian A.; Thompson Z.; Gary F.A.) Case
Western Reserve University, Frances Payne Bolton School of Nursing, 10900
Euclid Ave., Cleveland, United States.
CORRESPONDENCE ADDRESS
D.A. Jukiewicz, Case Western Reserve University, Frances Payne Bolton School
of Nursing, 10900 Euclid Ave., Cleveland, United States. Email:
daj47@case.edu
SOURCE
International Journal of Nursing Sciences (2017) 4:4 (430-436). Date of
Publication: 10 Oct 2017
ISSN
2352-0132
BOOK PUBLISHER
Chinese Nursing Association, mahongying@hotmail.com
ABSTRACT
The phenomena of prescription opioid misuse and abuse have a complicated
history of contributing factors including policies, practices, and
prescribing leading to contemporary phenomena. Some factors implicated in
the opioid drug abuse problem include inefficient prescribing and improper
use, lack of knowledge related to interpretation and assessment of pain
levels, and decreased oversight and regulation from government and policy
agents. Nurses, often frontline providers, need to be knowledgeable and
embrace the guidelines, and necessary implications associated with both
prescribing and administration of opioids. Additionally, all providers
including physicians, physician assistants, nurse practitioners, and bedside
nurses must have a firm understanding of the improper use and abuse of
opioids. The examination and review of opioid policies at the state and
federal level has revealed inconsistency with regulations, policies, and
guidelines that have lead to the current situation. The use of an
interdisciplinary team with nurses and various other practitioners is a good
strategy to help reduce this problem.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
analgesia
decision making
drug abuse
drug surveillance program
emergency ward
health care personnel
human
note
nurse practitioner
psychologic assessment
public health
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170804818
PUI
L619266805
DOI
10.1016/j.ijnss.2017.09.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijnss.2017.09.001
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 103
TITLE
Evaluation of Emergency Department Management of Opioid-Tolerant Cancer
Patients With Acute Pain
AUTHOR NAMES
Patel P.M.
Goodman L.F.
Knepel S.A.
Miller C.C.
Azimi A.
Phillips G.
Gustin J.L.
Hartman A.
AUTHOR ADDRESSES
(Patel P.M.; Goodman L.F., lauren.goodman@osumc.edu; Knepel S.A.; Miller
C.C.; Azimi A.; Gustin J.L.; Hartman A.) Division of Palliative Medicine,
The Ohio State University Wexner Medical Center, Columbus, United States.
(Goodman L.F., lauren.goodman@osumc.edu) Division of Pulmonary, Allergy,
Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical
Center, Columbus, United States.
(Phillips G.) The Ohio State University Center for Biostatistics, Columbus,
United States.
(Hartman A.) Department of Pharmacy, The Ohio State University Wexner
Medical Center, Columbus, United States.
CORRESPONDENCE ADDRESS
L.F. Goodman, Division of Pulmonary, Allergy, Critical Care, and Sleep
Medicine, The Ohio State University Wexner Medical Center (LFG), Columbus,
United States. Email: lauren.goodman@osumc.edu
SOURCE
Journal of Pain and Symptom Management (2017) 54:4 (501-507). Date of
Publication: 1 Oct 2017
ISSN
1873-6513 (electronic)
0885-3924
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Context There are no previously published studies examining opioid doses
administered to opioid-tolerant cancer patients during emergency department
(ED) encounters. Objectives To determine if opioid-tolerant cancer patients
presenting with acute pain exacerbations receive adequate initial doses of
as needed (PRN) opioids during ED encounters based on home oral morphine
equivalent (OME) use. Methods We performed a retrospective cohort study of
opioid-tolerant cancer patients who received opioids in our ED over a
two-year period. The percentage of patients who received an adequate initial
dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was
evaluated. Logistic regression was used to establish the relationship
between 24-hour ambulatory OME and initial ED OME to assess whether higher
home usage was associated with higher likelihood of being undertreated.
Results Out of 216 patients, 61.1% of patients received an adequate initial
PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home,
77.4% received an adequate initial dose; however, only 3.2% of patients
taking >400 OMEs per day at home received an adequate dose. Patients with
ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an
adequate initial dose of PRN opioid in the ED compared to patients with
ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00–0.02, P < 0.001).
Conclusions Patients with daily home use less than 200 OMEs generally
received adequate initial PRN opioid doses during their ED visit. However,
patients with higher home opioid usage were at increased likelihood of being
undertreated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy, transdermal drug administration)
hydrocodone (drug therapy, oral drug administration)
hydromorphone (drug therapy, oral drug administration)
morphine (drug therapy, oral drug administration)
oxycodone (drug therapy, oral drug administration)
oxymorphone (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy, drug therapy)
cancer patient
drug tolerability
emergency care
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
aged
article
breast cancer
cohort analysis
controlled study
disease exacerbation
female
home care
human
logistic regression analysis
lung cancer
major clinical study
male
prostate cancer
retrospective study
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
EMBASE CLASSIFICATIONS
Cancer (16)
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170663658
PUI
L618363239
DOI
10.1016/j.jpainsymman.2017.07.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpainsymman.2017.07.013
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 104
TITLE
Toxicological Emergencies in the Resuscitation Area of a Pediatric Emergency
Department: A 12-Month Review
AUTHOR NAMES
Beauchamp G.A.
Kerrey B.T.
Mittiga M.R.
Rinderknecht A.S.
Yin S.
AUTHOR ADDRESSES
(Beauchamp G.A., beauchamp.gillian@gmail.com) Department of Emergency
Medicine, University of Cincinnati, Cincinnati, United States.
(Kerrey B.T.; Mittiga M.R.; Rinderknecht A.S.; Yin S.) Division of Emergency
Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, United
States.
(Beauchamp G.A., beauchamp.gillian@gmail.com) Oregon Poison Center, 3181 SW
Sam Jackson Park Rd, Portland, United States.
CORRESPONDENCE ADDRESS
G.A. Beauchamp, Oregon Poison Center, 3181 SW Sam Jackson Park Rd, Portland,
United States. Email: beauchamp.gillian@gmail.com
SOURCE
Pediatric Emergency Care (2017) 33:10 (670-674). Date of Publication: 1 Oct
2017
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objective: Few studies of children with toxicological emergencies describe
those undergoing acute resuscitation, and most describe exposures to single
agents. We describe a 12-month sample of patients evaluated in the
resuscitation area of a pediatric emergency department (ED) for a
toxicological emergency. Methods: We conducted a retrospective chart review
of patients in a high-volume, academic pediatric ED. We identified patients
evaluated in the ED resuscitation area for toxicological exposure and
conducted structured chart reviews to collect relevant data. For all
variables of interest, we calculated standard descriptive statistics.
Results: Of 2999 patients evaluated in the resuscitation area through 12
months (March 2009 to April 2010), we identified 80 (2.7%) whose primary ED
diagnosis was toxicological. The mean age was 11.4 years. Eighty-six percent
of patients were triaged to the resuscitation area for significantly altered
mental status. The most frequent single exposures were ethanol (25%),
clonidine (10%), and acetaminophen (5%). At least 1 laboratory test was
performed for almost all patients (97%). Interventions performed in the
resuscitation area included intravenous access placement (97%), activated
charcoal (20%), naloxone (19%), and endotracheal intubation (12%).
Eighty-two percent of patients were admitted to the hospital; 37% to the
intensive care unit. No patients studied in this sample died and most
received only supportive care. Conclusions: In a high-volume pediatric ED,
toxicological emergencies requiring acute resuscitation were rare. Ethanol
and clonidine were the most frequent single exposures. Most patients
received diagnostic testing and were admitted. Further studies are needed to
describe regional differences in pediatric toxicological emergencies.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug toxicity)
activated carbon (drug therapy)
alcohol (drug toxicity)
amphetamine derivative (drug toxicity)
analgesic agent (drug toxicity)
anticonvulsive agent (drug toxicity)
benzodiazepine derivative (drug therapy, drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (endogenous compound)
calcium channel blocking agent (drug toxicity)
carbon dioxide (endogenous compound)
clonidine (drug toxicity)
cosmetic (drug toxicity)
diphenhydramine (drug toxicity)
domestic chemical (drug toxicity)
ethylene glycol (drug toxicity)
gabapentin (drug toxicity)
hydrocarbon (drug toxicity)
insulin (drug toxicity)
naloxone (drug therapy)
neuroleptic agent (drug therapy, drug toxicity)
nonsteroid antiinflammatory agent (drug toxicity)
opiate (drug toxicity)
paracetamol (drug toxicity)
phencyclidine (drug toxicity)
pregabalin (drug toxicity)
tetrahydrocannabinol (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
xenobiotic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
intoxication (drug therapy, drug therapy)
pediatric emergency medicine
resuscitation
toxicological emergency
EMTREE MEDICAL INDEX TERMS
acidosis
adolescent
adult
alcohol intoxication
article
child
computer assisted tomography
delirium (drug therapy)
digestive tube
drug exposure
electrocardiogram
emergency health service
emergency patient
emergency ward
endotracheal intubation
female
Foley balloon catheter
foreign body
high volume hospital
hospital admission
human
infant
intensive care unit
laboratory test
life support equipment
major clinical study
male
medical record review
mental disease
nasogastric tube
newborn
orogastric tube
oxygen therapy
palliative therapy
pediatric hospital
poison center
retrospective study
sinus arrhythmia
sinus bradycardia
thorax radiography
vascular access
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
bicarbonate (144-55-8, 71-52-3)
carbon dioxide (124-38-9, 58561-67-4)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
diphenhydramine (147-24-0, 58-73-1)
ethylene glycol (107-21-1)
gabapentin (60142-96-3)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
phencyclidine (77-10-1, 956-90-1)
pregabalin (148553-50-8)
tetrahydrocannabinol (1972-08-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160686840
PUI
L612327188
DOI
10.1097/PEC.0000000000000858
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000858
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 105
TITLE
Emergency department attending physician variation in opioid prescribing in
low acuity back pain
AUTHOR NAMES
Hoppe J.A.
McStay C.
Sun B.C.
Capp R.
AUTHOR ADDRESSES
(Hoppe J.A., Jason.hoppe@ucdenver.edu; McStay C.; Capp R.) University of
Colorado, School of Medicine, Department of Emergency Medicine, 12401 E.
17th Avenue, Aurora, United States.
(Sun B.C.) Oregon Health and Science University, Department of Emergency
Medicine, Portland, United States.
CORRESPONDENCE ADDRESS
J.A. Hoppe, University of Colorado, School of Medicine, Department of
Emergency Medicine, 12401 E. 17th Avenue, Aurora, United States. Email:
Jason.hoppe@ucdenver.edu
SOURCE
Western Journal of Emergency Medicine (2017) 18:6 (1135-1142). Date of
Publication: 1 Oct 2017
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Despite treatment guidelines suggesting alternatives, as well
as evidence of a lack of benefit and evidence of poor long-term outcomes,
opioid analgesics are commonly prescribed for back pain from the emergency
department (ED). Variability in opioid prescribing suggests a lack of
consensus and an opportunity to standardize and improve care. We evaluated
the variation in attending emergency physician (EP) opioid prescribing for
patients with uncomplicated, low acuity back pain (LABP). Methods: This
retrospective study evaluated the provider-specific proportion of LABP
patients discharged from an urban academic ED over a seven-month period with
a prescription for opioids. LABP was strictly defined as (1) back pain chief
complaint, (2) discharged from ED with no interventions, and (3) predefined
discharge diagnosis of back pain. We excluded providers if they had less
than 25 LABP patients in the study period. The primary outcome was the
physician-specific proportion of LABP patients discharged with an opioid
analgesic prescription. We performed a descriptive analysis and then risk
standardized prescribing proportion by adjusting for patient and clinical
characteristics using hierarchical logistic regression. Results: During the
seven-month study period, 23 EPs treated and discharged at least 25 LABP
patients and were included. Eight (34.8%) were female, and six (26.1%) were
junior attendings (< 5 years after residency graduation). There were 943
LABP patients included in the analysis. Provider-specific proportions ranged
from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-fold
variation in prescribing proportions. There was a six-fold variation in the
adjusted, risk-standardized prescribing proportion with a range from 12.0%
to 78.2% [mean 50.4% (SD +/-16.4)]. Conclusion: We found large variability
in opioid prescribing practices for LABP that persisted after adjustment for
patient and clinical characteristics. Our findings support the need to
further standardize and improve adherence to treatment guidelines and
evidence suggesting alternatives to opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
hydrocodone (drug therapy)
oxycodone (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
emergency ward
low acuity back pain (drug therapy, drug therapy)
low back pain (drug therapy, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
clinical evaluation
cohort analysis
consensus
controlled study
descriptive research
female
hospital admission
hospital discharge
hospital patient
human
major clinical study
male
outcome assessment
practice guideline
primary medical care
retrospective study
treatment duration
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Orthopedic Surgery (33)
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170865975
MEDLINE PMID
29085548 (http://www.ncbi.nlm.nih.gov/pubmed/29085548)
PUI
L619591706
DOI
10.5811/westjem.2017.7.33306
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2017.7.33306
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 106
TITLE
Why are some people who have received overdose education and naloxone
reticent to call Emergency Medical Services in the event of overdose?
AUTHOR NAMES
Koester S.
Mueller S.R.
Raville L.
Langegger S.
Binswanger I.A.
AUTHOR ADDRESSES
(Koester S., steve.koester@ucdenver.edu) Department of Anthropology,
University of Colorado Denver, Denver, United States.
(Koester S., steve.koester@ucdenver.edu; Mueller S.R.,
shane.mueller@ucdenver.edu) Department of Health and Behavioral Sciences,
University of Colorado Denver, Denver, United States.
(Mueller S.R., shane.mueller@ucdenver.edu; Binswanger I.A.,
Ingrid.binswanger@ucdenver.edu) Division of General Internal Medicine,
University of Colorado School of Medicine, 12631 E. 17th Ave. B-180 Aurora,
, United States.
(Mueller S.R., shane.mueller@ucdenver.edu; Binswanger I.A.,
Ingrid.binswanger@ucdenver.edu) Institute for Health Research, Kaiser
Permanente Colorado, Denver, United States.
(Raville L., lisa.harm.reduction@gmail.com) Harm Reduction Action Center,
231 E Colfax Ave, Denver, United States.
(Langegger S., sig.langegger@aiu.ac.jp) Faculty of International Liberal
Arts, Akita International University, Japan.
CORRESPONDENCE ADDRESS
S. Koester, Department of Anthropology, University of Colorado Denver,
Denver, United States. Email: steve.koester@ucdenver.edu
SOURCE
International Journal of Drug Policy (2017) 48 (115-124). Date of
Publication: 1 Oct 2017
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background Overdose Education and Naloxone Distribution (OEND) training for
persons who inject drugs (PWID) underlines the importance of summoning
emergency medical services (EMS). To encourage PWID to do so, Colorado
enacted a Good Samaritan law providing limited immunity from prosecution for
possession of a controlled substance and/or drug paraphernalia to the
overdose victim and the witnesses who in good faith provide emergency
assistance. This paper examines the law's influence by describing OEND
trained PWIDs’ experience reversing overdoses and their decision about
calling for EMS support. Methods Findings from two complementary studies, a
qualitative study based on semi-structured interviews with OEND trained PWID
who had reversed one or more overdoses, and an on-going fieldwork-based
project examining PWIDs’ self-identified health concerns were triangulated
to describe and explain participants’ decision to call for EMS. Results In
most overdose reversals described, no EMS call was made. Participants
reported several reasons for not doing so. Most frequent was the fear that
despite the Good Samaritan law, a police response would result in arrest of
the victim and/or witness for outstanding warrants, or sentence violations.
Fears were based on individual and collective experience, and reinforced by
the city of Denver's aggressive approach to managing homelessness through
increased enforcement of misdemeanors and the imposition of more recent
ordinances, including a camping ban, to control space. The city's homeless
crisis was reflected as well in the concern expressed by housed PWID that an
EMS intervention would jeopardize their public housing. Conclusion Results
suggest that the immunity provided by the Good Samaritan law does not
address PWIDs’ fear that their current legal status as well as the victim's
will result in arrest and incarceration. As currently conceived, the Good
Samaritan law does not provide immunity for PWIDs’ already enmeshed in the
criminal justice system, or PWID fearful of losing their housing.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
emergency health service
health education
health program
miscellaneous named groups
Overdose Education and Naloxone Distribution training
persons who inject drug
EMTREE MEDICAL INDEX TERMS
article
conceptual framework
criminal justice system
ethnography
fear
Good Samaritan law
homelessness
housing
human
incarceration
law
law enforcement
legal aspect
personal experience
police arrest
priority journal
qualitative research
semi structured interview
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170521648
PUI
L617421067
DOI
10.1016/j.drugpo.2017.06.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2017.06.008
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 107
TITLE
Adverse cardiac events associated with incident opioid drug use among older
adults with COPD
AUTHOR NAMES
Vozoris N.T.
Wang X.
Austin P.C.
Lee D.S.
Stephenson A.L.
O’Donnell D.E.
Gill S.S.
Rochon P.A.
AUTHOR ADDRESSES
(Vozoris N.T., nick.vozoris@utoronto.ca; Stephenson A.L.) Division of
Respirology, Department of Medicine, St. Michael’s Hospital, 30 Bond Street,
Toronto, Canada.
(Vozoris N.T., nick.vozoris@utoronto.ca; Stephenson A.L.) Keenan Research
Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital,
Toronto, Canada.
(Vozoris N.T., nick.vozoris@utoronto.ca; Lee D.S.; Stephenson A.L.; Rochon
P.A.) Department of Medicine, University of Toronto, Toronto, Canada.
(Wang X.; Austin P.C.; Lee D.S.; Gill S.S.; Rochon P.A.) Institute for
Clinical Evaluative Sciences, Toronto, Canada.
(Austin P.C.; Lee D.S.; Stephenson A.L.; Rochon P.A.) Institute of Health
Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
(O’Donnell D.E.; Gill S.S.) Department of Medicine, Queen’s University,
Kingston, Canada.
(Rochon P.A.) Women’s College Research Institute, Women’s College Hospital,
Toronto, Canada.
CORRESPONDENCE ADDRESS
N.T. Vozoris, Division of Respirology, Department of Medicine, St. Michael’s
Hospital, 30 Bond Street, Toronto, Canada. Email: nick.vozoris@utoronto.ca
SOURCE
European Journal of Clinical Pharmacology (2017) 73:10 (1287-1295). Date of
Publication: 1 Oct 2017
ISSN
1432-1041 (electronic)
0031-6970
BOOK PUBLISHER
Springer Verlag, service@springer.de
ABSTRACT
Purpose: We evaluated whether incident opioid drug use was associated with
adverse cardiac events among older adults with chronic obstructive pulmonary
disease (COPD). Methods: This was an exploratory, retrospective cohort study
using health administrative data from Ontario, Canada, from 2008 to 2013.
Using a validated algorithm, we identified adults aged 66 years and older
with non-palliative COPD. Hazard ratios (HR) were estimated for adverse
cardiac events within 30 days of incident opioid receipt compared to
controls using inverse probability of treatment weighting using the
propensity score. Results: There were 134,408 community-dwelling individuals
and 14,685 long-term care residents with COPD identified, 67.0 and 60.6% of
whom received an incident opioid. Incident use of any opioid was associated
with significantly decreased rates of emergency room (ER) visits and
hospitalizations for congestive heart failure (CHF) among community-dwelling
older adults (HR 0.84; 95% CI 0.73–0.97), but significantly increased rates
of ischemic heart disease (IHD)-related mortality among long-term care
residents (HR 2.15; 95% CI 1.50–3.09). In the community-dwelling group,
users of more potent opioid-only agents without aspirin or acetaminophen
combined had significantly increased rates of ER visits and hospitalizations
for IHD (HR 1.38; 95% CI 1.08–1.77) and IHD-related mortality (HR 1.83; 95%
CI 1.32–2.53). Conclusions: New opioid use was associated with elevated
rates of IHD-related morbidity and mortality among older adults with COPD.
Adverse cardiac events may need to be considered when administering new
opioids to older adults with COPD, but further studies are required to
establish if the observed associations are causal or related to residual
confounding.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid plus caffeine plus dihydrocodeine (adverse drug
reaction)
anileridine (adverse drug reaction)
caffeine plus dihydrocodeine plus paracetamol (adverse drug reaction)
cocodamol (adverse drug reaction)
codeine phosphate (adverse drug reaction)
codeine sulfate (adverse drug reaction)
dextropropoxyphene (adverse drug reaction)
fentanyl (adverse drug reaction)
hydromorphone (adverse drug reaction)
levorphanol (adverse drug reaction)
morphine (adverse drug reaction)
morphine sulfate (adverse drug reaction)
oxycodone (adverse drug reaction)
oxycodone plus paracetamol (adverse drug reaction)
pethidine (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic obstructive lung disease
major adverse cardiac event (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
aged
algorithm
article
cardiovascular mortality
cardiovascular risk
cohort analysis
congestive heart failure (side effect)
controlled study
emergency treatment
exploratory research
hospitalization
human
ischemic heart disease (side effect)
morbidity
Ontario
priority journal
retrospective study
risk assessment
CAS REGISTRY NUMBERS
anileridine (126-12-5, 144-14-9)
codeine phosphate (52-28-8)
codeine sulfate (1420-53-7)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
levorphanol (125-72-4, 77-07-6)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170471464
PUI
L617119128
DOI
10.1007/s00228-017-2278-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s00228-017-2278-3
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 108
TITLE
Incidence and predictors of opioid prescription at discharge after traumatic
injury
AUTHOR NAMES
Chaudhary M.A.
Schoenfeld A.J.
Harlow A.F.
Ranjit A.
Scully R.
Chowdhury R.
Sharma M.
Nitzschke S.
Koehlmoos T.
Haider A.H.
AUTHOR ADDRESSES
(Chaudhary M.A., mchaudhary@bwh.harvard.edu; Schoenfeld A.J.; Harlow A.F.;
Ranjit A.; Scully R.; Chowdhury R.; Sharma M.; Nitzschke S.; Haider A.H.)
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard
Medical School, 1620 Tremont St, Ste 4-020, Boston, United States.
(Schoenfeld A.J.) Department of Orthopedic Surgery, Brigham and Women's
Hospital, Boston, United States.
(Nitzschke S.) Division of Trauma Burn and Surgical Critical Care,
Department of Surgery, Brigham and Women's Hospital, Boston, United States.
(Koehlmoos T.) Uniformed Services University of Health Sciences, Bethesda,
United States.
(Haider A.H.) JAMA Surgery, United States.
CORRESPONDENCE ADDRESS
M.A. Chaudhary, Center for Surgery and Public Health, Brigham and Women's
Hospital, Harvard Medical School, 1620 Tremont St, Ste 4-020, Boston, United
States. Email: mchaudhary@bwh.harvard.edu
SOURCE
JAMA Surgery (2017) 152:10 (930-936). Date of Publication: 1 Oct 2017
ISSN
2168-6254
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
ABSTRACT
IMPORTANCE: In the current health care environment with increased scrutiny
and growing concern regarding opioid use and abuse, there has been a push
toward greater regulation over prescriptions of opioids. Trauma patients
represent a population that may be affected by this regulation, as the
incidence of pain at hospital discharge is greater than 95%, and opioids are
considered the first line of treatment for pain management. However, the use
of opioid prescriptions in trauma patients at hospital discharge has not
been explored. OBJECTIVE: To study the incidence and predictors of opioid
prescription in trauma patients at discharge in a large national cohort.
DESIGN, SETTING, AND PARTICIPANTS: Analysis of adult (18-64 years),
opioid-naive trauma patients who were beneficiaries of Military Health
Insurance (military personnel and their dependents) treated at both military
health care facilities and civilian trauma centers and hospitals between
January 1, 2006, and December 31, 2013, was conducted. Patients with burns,
foreign body injury, toxic effects, or late complications of trauma were
excluded. Prior diagnosis of trauma within 1 year and in-hospital death were
also grounds for exclusion. Injury mechanism and severity, comorbid
conditions, mental health disorders, and demographic factors were considered
covariates. The Drug Enforcement Administration's list of scheduled
narcotics was used to query opioid use. Unadjusted and adjusted logistic
regression models were used to determine the predictors of opioid
prescription. Data analysis was performed from June 7 to August 21, 2016.
EXPOSURES: Injury mechanism and severity, comorbid conditions, mental health
disorders, and demographic factors. MAIN OUTCOMES AND MEASURES: Prescription
of opioid analgesics at discharge. RESULTS: Among the 33 762 patients
included in the study (26 997 [80.0%] men; mean [SD] age, 32.9 [13.3]
years), 18 338 (54.3%) received an opioid prescription at discharge. In
risk-adjusted models, older age (45-64 vs 18-24 years: odds ratio [OR],
1.28; 95% CI, 1.13-1.44), marriage (OR, 1.26; 95% CI, 1.20-1.34), and higher
Injury Severity Score (>9vs <9: OR, 1.40; 95% CI, 1.32-1.48) were associated
with a higher likelihood of opioid prescription at discharge. Male sex (OR,
0.76; 95% CI, 0.69-0.83) and anxiety (OR, 0.82; 95% CI, 0.73-0.93) were
associated with a decreased likelihood of opioid prescription at discharge.
CONCLUSIONS AND RELEVANCE: The incidence of opioid prescription at discharge
(54.3%) closely matches the incidence of moderate to severe pain in trauma
patients, indicating appropriate prescribing practices. We advocate that
injury severity and level of pain-not arbitrary regulations-should inform
the decision to prescribe opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital discharge
injury
prescription
EMTREE MEDICAL INDEX TERMS
adult
anxiety
article
burn
cohort analysis
demography
drug use
emergency health service
female
foreign body
government
health care facility
health insurance
human
incidence
injury scale
major clinical study
male
marriage
mental health
middle aged
priority journal
risk assessment
soldier
toxicity
young adult
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170767310
MEDLINE PMID
28636707 (http://www.ncbi.nlm.nih.gov/pubmed/28636707)
PUI
L619052158
DOI
10.1001/jamasurg.2017.1685
FULL TEXT LINK
http://dx.doi.org/10.1001/jamasurg.2017.1685
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 109
TITLE
Primary diffuse large B-cell lymphoma of the CNS: A rare case of spontaneous
remission
AUTHOR NAMES
Debonera F.
Nasta S.
Martinez-Lage M.
Schuster S.J.
Tsai D.E.
AUTHOR ADDRESSES
(Debonera F.; Nasta S.; Martinez-Lage M.; Schuster S.J.,
stephen.schuster@uphs.upenn.edu; Tsai D.E.) Abramson Cancer Center, Hospital
of the University of Pennsylvania, 12 South PCAM, Civic Center Blvd, United
States.
CORRESPONDENCE ADDRESS
S.J. Schuster, Abramson Cancer Center, Hospital of the University of
Pennsylvania, 12 South PCAM, Civic Center Blvd, United States. Email:
stephen.schuster@uphs.upenn.edu
SOURCE
International Journal of Hematologic Oncology (2017) 6:3 (69-73). Date of
Publication: 1 Oct 2017
ISSN
2045-1407 (electronic)
2045-1393
BOOK PUBLISHER
Future Medicine Ltd., info@futuremedicine.com
ABSTRACT
There is no consensus on the optimal therapy for primary CNS lymphoma.
Conventional treatment modalities include chemotherapy and radiation
therapy, which carry significant risks of morbidity and mortality. In
systemic lymphomas, there are situations where non-Hodgkin lymphomas have
resolved spontaneously. We now report the case of a nonimmunocompromised
patient with primary CNS lymphoma who underwent a spontaneous remission with
a durable response. This case suggests that not all patients with primary
CNS lymphomas require aggressive treatment with chemotherapy and radiation
therapy.
EMTREE DRUG INDEX TERMS
CD20 antigen (endogenous compound)
chlordane (endogenous compound)
immunoglobulin heavy chain (endogenous compound)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
central nervous system tumor (diagnosis)
diffuse large B cell lymphoma (diagnosis)
EMTREE MEDICAL INDEX TERMS
aged
article
body weight loss
brain biopsy
case report
CD3+ T lymphocyte
clinical article
computer assisted tomography
contrast enhancement
coronary artery dissection
emergency ward
Epstein Barr virus
eye examination
female
flank pain
follow up
headache
HIV test
hospital admission
human
hydronephrosis
hyperlipidemia
hypertension
hypothyroidism
medical history
nephrolithiasis
neuroimaging
night sweat
nuclear magnetic resonance imaging
priority journal
remission
tumor diagnosis
ultrasound
x-ray computed tomography
CAS REGISTRY NUMBERS
chlordane (12789-03-6, 57-74-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Cancer (16)
Hematology (25)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170822747
PUI
L619369453
DOI
10.2217/ijh-2017-0009
FULL TEXT LINK
http://dx.doi.org/10.2217/ijh-2017-0009
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 110
TITLE
Opioid abuse and poisoning: Trends in inpatient and emergency department
discharges
AUTHOR NAMES
Tedesco D.
Asch S.M.
Curtin C.
Hah J.
McDonald K.M.
Fantini M.P.
Hernandez-Boussard T.
AUTHOR ADDRESSES
(Tedesco D.) Department of Medicine, Stanford University, California, United
States.
(Asch S.M.) Center for Innovation to Implementation, Veterans Affairs Palo
Alto Health Care System, United States.
(Asch S.M.) Division of Primary Care and Population Health, Stanford
University, United States.
(Curtin C.) Palo Alto Veterans Affairs Hospital, Stanford University School
of Medicine, United States.
(Hah J.; Hernandez-Boussard T., boussard@stanford.edu) Stanford University
School of Medicine, United States.
(McDonald K.M.) Center for Health Policy, Center for Primary Care Outcomes
Research, Stanford University, United States.
(Fantini M.P.) Department of Biomedical and Neuromotor Sciences, University
of Bologna, Italy.
CORRESPONDENCE ADDRESS
T. Hernandez-Boussard, Stanford University School of Medicine, United
States. Email: boussard@stanford.edu
SOURCE
Health Affairs (2017) 36:10 (1748-1753). Date of Publication: 1 Oct 2017
ISSN
1544-5208 (electronic)
0278-2715
BOOK PUBLISHER
Project HOPE, jtucker@healthaffairs.org
ABSTRACT
Addressing the opioid epidemic is a national priority.We analyzed national
trends in inpatient and emergency department (ED) discharges for opioid
abuse, dependence, and poisoning using Healthcare Cost and Utilization
Project data. Inpatient and ED discharge rates increased overall across the
study period, but a decline was observed for prescription opioid-related
discharges beginning in 2010, while a sharp increase in heroin-related
discharges began in 2008.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug intoxication
emergency ward
hospital discharge
hospital patient
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
aged
article
female
health care cost
health care utilization
human
major clinical study
male
middle aged
prescription
trend study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170698144
PUI
L618572459
DOI
10.1377/hlthaff.2017.0260
FULL TEXT LINK
http://dx.doi.org/10.1377/hlthaff.2017.0260
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 111
TITLE
Opioid Overdose Outbreak - West Virginia, August 2016
AUTHOR NAMES
Massey J.
Kilkenny M.
Batdorf S.
Sanders S.K.
Ellison D.
Halpin J.
Gladden R.M.
Bixler D.
Haddy L.
Gupta R.
AUTHOR ADDRESSES
(Massey J.; Kilkenny M.; Batdorf S.; Sanders S.K.; Ellison D.; Halpin J.;
Gladden R.M.; Bixler D.; Haddy L.; Gupta R.)
SOURCE
MMWR. Morbidity and mortality weekly report (2017) 66:37 (975-980). Date of
Publication: 22 Sep 2017
ISSN
1545-861X (electronic)
ABSTRACT
On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington,
West Virginia, notified the Cabell-Huntington Health Department (CHHD) of
multiple calls regarding opioid overdose received by the emergency medical
system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation
and response conducted by the West Virginia Bureau for Public Health (BPH)
and CHHD identified 20 opioid overdose cases within a 53-hour period in
Cabell County; all cases included emergency department (ED) encounters. EMS
personnel, other first responders, and ED providers administered the opioid
antidote naloxone to 16 (80%) patients, six of whom were administered
multiple doses, suggesting exposure to a highly potent opioid. No patients
received referral for recovery support services. In addition to the public
health investigation, a public safety investigation was conducted;
comprehensive opioid toxicology testing of clinical specimens identified the
synthetic opioid fentanyl* and novel fentanyl analogs, including
carfentanil,† which had been used by patients who overdosed in Huntington.
Results of these two investigations highlight the importance of
collaboration between public health and public safety agencies to provide
in-depth surveillance data from opioid overdose outbreaks that involve
high-potency fentanyl analogs. These data facilitated a public health
response through increased awareness of powerful opioid substances requiring
multiple naloxone doses for reversal, and improved patient linkage to
recovery support services and a harm reduction program from the ED after
opioid overdose.
EMTREE DRUG INDEX TERMS
carfentanil
designer drug (drug toxicity)
fentanyl (drug toxicity)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
EMTREE MEDICAL INDEX TERMS
adolescent
adult
analogs and derivatives
drug overdose (drug therapy, epidemiology)
emergency health service
female
human
male
middle aged
opiate addiction (drug therapy, epidemiology)
statistics and numerical data
West Virginia
young adult
CAS REGISTRY NUMBERS
carfentanil (59708-52-0)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28934186 (http://www.ncbi.nlm.nih.gov/pubmed/28934186)
PUI
L618576310
DOI
10.15585/mmwr.mm6637a3
FULL TEXT LINK
http://dx.doi.org/10.15585/mmwr.mm6637a3
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 112
TITLE
Effect of an emergency department opioid prescription policy on prescribing
patterns
AUTHOR NAMES
Chacko J.
Greenstein J.
Ardolic B.
Berwald N.
AUTHOR ADDRESSES
(Chacko J., jchacko3@northwell.edu; Greenstein J.; Ardolic B.; Berwald N.)
Department of Emergency Medicine, Staten Island University Hospital,
Northwell Health, Staten Island, United States.
CORRESPONDENCE ADDRESS
J. Chacko, Department of Emergency Medicine, Staten Island University
Hospital, 475 Seaview Avenue, Staten Island, United States. Email:
jchacko3@northwell.edu
SOURCE
American Journal of Emergency Medicine (2017) 35:9 (1327-1329). Date of
Publication: 1 Sep 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Background Staten Island University Hospital is located in NYC, where the
opioid epidemic has resulted in significant mortalities from unintentional
overdoses. In 2013 as a response to the rising threat to our community, our
Emergency Department (ED) administration adopted a clinical practice policy
focused on decreasing the prescription of controlled substances. The effects
of this policy on our provider prescription patterns are presented here.
Methods A retrospective chart review of patients prescribed opioids from the
ED before and after policy implementation was performed. Dates chosen for
analysis was November 1, 2012 through January 31, 2013 and November 1, 2013
through January 31, 2014; these time periods were used to serve as a
seasonally comparative group pre and post clinical practice policy
implementation. Opioids written for the treatment of cough, and for children
under eighteen were excluded from analysis. Patient age, sex, diagnoses, and
prescription formulation, strength, and pill number was recorded for each
patient receiving an opioid prescription. Results There was a drop in the
total prescriptions from 1756 to 1128 without a change in the average number
of pills (12.78 vs 12.44) or average total dose prescribed (69.39 vs 68.98)
mg of morphine equivalent per prescription. Additionally, there were sizable
reductions in opioid prescriptions written for arthralgias/myalgias, dental
pain, soft tissue injuries, and headaches. Conclusion The opioid clinical
policy had a clear effect in decreasing the number of patients prescribed
opioids. Such policies may be the key to reducing the epidemic and saving
lives from unintentional opioid overdoses.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health care policy
prescription
EMTREE MEDICAL INDEX TERMS
abdominal pain
abrasion
adult
age
arthralgia
article
cellulitis
clinical practice
contusion
coughing
descriptive research
drug formulation
female
headache
human
major clinical study
male
middle aged
myalgia
pill
priority journal
retrospective study
soft tissue injury
thorax pain
tooth pain
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170454711
MEDLINE PMID
28663006 (http://www.ncbi.nlm.nih.gov/pubmed/28663006)
PUI
L616969325
DOI
10.1016/j.ajem.2017.06.024
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.06.024
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 113
TITLE
Heroin and pharmaceutical opioid overdose events: Emergency medical response
characteristics
AUTHOR NAMES
Banta-Green C.J.
Coffin P.O.
Schoeppe J.A.
Merrill J.O.
Whiteside L.K.
Ebersol A.K.
AUTHOR ADDRESSES
(Banta-Green C.J., calebbg@uw.edu; Schoeppe J.A., jennie.schoeppe@gmail.com)
Alcohol and Drug Abuse Institute, University of Washington, Seattle, United
States.
(Coffin P.O., pcoffin@gmail.com) San Francisco Department of Public Health,
San Francisco, United States.
(Schoeppe J.A., jennie.schoeppe@gmail.com) Group Health Research Institute,
Seattle, United States.
(Coffin P.O., pcoffin@gmail.com; Merrill J.O., joem@uw.edu; Ebersol A.K.,
aebersol@uw.edu) Department of Medicine, University of Washington School of
Medicine, Seattle, United States.
(Whiteside L.K., laurenkw@uw.edu) Division of Emergency Medicine, University
of Washington Seattle WA, United States.
(Banta-Green C.J., calebbg@uw.edu; Whiteside L.K., laurenkw@uw.edu)
Harborview Injury Prevention and Research Center, Seattle, United States.
CORRESPONDENCE ADDRESS
C.J. Banta-Green, Alcohol and Drug Abuse Institute, University of
Washington, Seattle, United States. Email: calebbg@uw.edu
SOURCE
Drug and Alcohol Dependence (2017) 178 (1-6). Date of Publication: 1 Sep
2017
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background Emergency Medical Services (EMS) data may provide insight into
opioid overdose incidence, clinical characteristics, and medical response.
This analysis describes patient characteristics, clinical features, and EMS
response to opioid overdoses, comparing heroin and pharmaceutical opioid
(PO) overdoses, using a structured opioid overdose case criteria definition.
Methods A case series study was conducted. EMS medical staff screened cases
for possible overdoses and study staff categorized the likelihood of opioid
overdose. Medical form data were abstracted. Patient characteristics,
clinical presentation, and medical response to heroin and PO-involved
overdoses were compared with bi-variate test statistics. Results We
identified 229 definite or probable opioid overdose cases over six months:
heroin in 98 (43%) cases (10 also involved PO), PO without heroin in 85
(37%) cases, and 46 (20%) that could not be categorized and were excluded
from analyses. Heroin overdose patients were younger than PO (median age 33
v 41 (p < 0.05)), more often male (80% v 61% (p = < 0.01)), intubated less
(8% v 22%, p < 0.01) and more likely to be administered naloxone (72% v 51%,
p < 0.01). No significant differences were found between heroin and PO
overdoses for initial respiratory rate, Glasgow Coma Scale score, or
co-ingestants, but heroin users were more likely to have miotic pupils
(p < 0.01). Conclusions While heroin and PO events presented similarly,
heroin-involved cases were more likely to receive naloxone and less likely
to be intubated. Standardized case definitions and data documentation could
aid opioid overdose surveillance as well as provide data for measuring the
impact of professional and lay interventions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
opiate
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
age
article
breathing rate
case study
endotracheal intubation
female
gender
Glasgow coma scale
human
incidence
major clinical study
male
miosis
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170430309
MEDLINE PMID
28623805 (http://www.ncbi.nlm.nih.gov/pubmed/28623805)
PUI
L616747709
DOI
10.1016/j.drugalcdep.2017.04.021
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2017.04.021
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 114
TITLE
A Case of a contraband body packer requiring high-dose naloxone
AUTHOR NAMES
Shamim K.
Khan N.U.
Baig M.A.
Waheed S.
Iqbal A.
AUTHOR ADDRESSES
(Shamim K.; Khan N.U.; Baig M.A., dr-akbar2007@hotmail.com; Waheed S.; Iqbal
A.) Department of Emergency Medicine, Aga Khan University Hospital, Karachi,
Pakistan.
CORRESPONDENCE ADDRESS
M.A. Baig, Department of Emergency Medicine, Aga Khan University Hospital,
Karachi, Pakistan. Email: dr-akbar2007@hotmail.com
SOURCE
Asia Pacific Journal of Medical Toxicology (2017) 6:3 (99-101). Date of
Publication: 1 Sep 2017
ISSN
2322-4320 (electronic)
2322-2611
BOOK PUBLISHER
Mashhad University of Medical Sciences, P.O. Box: 445, Daneshgah Avenue,
Mashhad, Iran. ijp@mums.ac.ir
ABSTRACT
Background: Body packers occasionally refer to the Emergency Department
(ED), after leakage of package contents within intestinal lumen, resulting
in life-threatening toxicities, depending upon the nature of the chemical
product. Case Presentation: We present a case report of a patient presented
with sudden onset of drowsiness while he was on board a flight. He was
brought in by the airport security staff. On arrival to the ED, his Glasgow
Coma Scale (GCS) was 3/15 and pupils were pinpoint bilaterally. He was
empirically treated with Naloxone on clinical suspicion of narcotic
overdose. He required a cumulative dose of 12 mg of Naloxone for reversal of
respiratory depression and coma. On subsequent investigation in the ED, he
was identified to be a body packer. Discussion: This case represents a rare
clinical example of narcotic overdose which resulted in a life-threatening
opioid toxicity due to leakage of the package contents into his bowels. In
this case, a dosage greater than 10 mg of the maximum recommended dose of
Naloxone is required for reversal of toxicity. Conclusion: It is imperative
to have a high level of suspicion for managing possible opioid intoxication
as immediate treatment can be diagnostic and lifesaving. Our case required
more than the recommended dosage of Naloxone, highlighting the possible
suggestion of further studies to look into the maximum threshold of this
reversal agent.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug combination)
narcotic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine
glucose (endogenous compound)
thiamine (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
body packing
EMTREE MEDICAL INDEX TERMS
abdominal radiography
adult
article
blood gas analysis
blood pressure
breathing pattern
case report
clinical article
colonoscopy
coma
decontamination
drowsiness
drug dose reduction
drug intoxication
drug megadose
electrocardiography
emergency ward
face mask
Glasgow coma scale
glucose blood level
heart infarction
heart rate
human
intestine loop
male
nasogastric tube
oxygen saturation
Q wave
respiration depression
resuscitation
unconsciousness
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180078049
PUI
L620565112
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 115
TITLE
High opioids tolerance due to transmucosal fentanyl abuse
AUTHOR NAMES
Eiden C.
Mathieu O.
Donnadieu-Rigole H.
Marrot C.
Peyrière H.
AUTHOR ADDRESSES
(Eiden C., c-eiden@chu-montpellier.fr; Mathieu O.; Donnadieu-Rigole H.;
Marrot C.; Peyrière H.) Centre Hospitalier Regional Universitaire de
Montpellier, Montpellier, France.
CORRESPONDENCE ADDRESS
C. Eiden, Centre Hospitalier Regional Universitaire de Montpellier,
Montpellier, France. Email: c-eiden@chu-montpellier.fr
SOURCE
European Journal of Clinical Pharmacology (2017) 73:9 (1195-1196). Date of
Publication: 1 Sep 2017
ISSN
1432-1041 (electronic)
0031-6970
BOOK PUBLISHER
Springer Verlag, service@springer.de
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl
opiate
EMTREE DRUG INDEX TERMS
bromazepam
methadone (drug therapy)
norfentanyl
paroxetine
unclassified drug
zolpidem
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug tolerance
narcotic dependence
EMTREE MEDICAL INDEX TERMS
adult
behavior change
case report
drug blood level
drug dose titration
emergency ward
hospitalization
human
letter
liquid chromatography-mass spectrometry
male
middle aged
prescription
priority journal
tranquilizing activity
withdrawal syndrome (drug therapy)
DRUG TRADE NAMES
pecfent
CAS REGISTRY NUMBERS
bromazepam (1812-30-2)
fentanyl (437-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paroxetine (61869-08-7)
zolpidem (82626-48-0)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170401844
PUI
L616605359
DOI
10.1007/s00228-017-2272-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s00228-017-2272-9
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 116
TITLE
Appropriate utilization and stocking of antidotes in Qatar public hospitals
AUTHOR NAMES
Salem W.A.
Salameh R.
Qureshi I.
Al-Bukari A.A.M.A.
Shaat E.B.J.
Moinudheen J.
Hoffman R.J.
Aleassi G.
AUTHOR ADDRESSES
(Salem W.A., Drwaleedawad79@gmail.com; Qureshi I.) Emergency Consultant,
Hamad General Hospital, Department of Emergency Medicine, Doha, Qatar.
(Salameh R.; Al-Bukari A.A.M.A.; Shaat E.B.J.; Moinudheen J.) Hamad General
Hospital, Department of Pharmacy, Doha, Qatar.
(Hoffman R.J.; Aleassi G.) Albert Einstein College of Medicine, Bronx,
United States.
CORRESPONDENCE ADDRESS
W.A. Salem, Emergency Consultant, Hamad General Hospital, Department of
Emergency Medicine, Doha, Qatar. Email: Drwaleedawad79@gmail.com
SOURCE
Asia Pacific Journal of Medical Toxicology (2017) 6:3 (72-78). Date of
Publication: 1 Sep 2017
ISSN
2322-4320 (electronic)
2322-2611
BOOK PUBLISHER
Mashhad University of Medical Sciences, P.O. Box: 445, Daneshgah Avenue,
Mashhad, Iran. ijp@mums.ac.ir
ABSTRACT
Background: There are a few studies that evaluate preparedness and
availability of antidotes in the emergency setting and none have been
conducted in Qatar. Published studies show that timely availability of
antidotes in the emergency department setting is a common issue. To address
this, we conducted a study to evaluate antidote stocking and utilization in
Qatar hospital pharmacies and emergency departments. Methods: In order to
evaluate the appropriate use and timely administration of antidotes,
research assistants prospectively collected data on ED patients. All ED
patients who received any key antidote over the 6-month study period were
identified through both ED and pharmacy records. In order to evaluate the
stocking of the 31 most important antidotes in our main public hospitals, a
survey assessing the stocking of these key antidotes was sent to the four
general hospitals in Qatar, to determine their availability and whether they
are stocked in the ED or only in the main pharmacy. Results: Poison exposure
was evaluated in 471 cases. Antidotes were given within 30 minutes in 73% of
cases, which included atropine, calcium, dextrose, flumazenil, naloxone,
pralidoxime, sodium bicarbonate, thiamine, Vitamin K and scorpion and snake
antivenoms. Administration occurred later than 60 minutes in 2% of cases,
exclusively with N-acetylcysteine and activated charcoal. Atropine, calcium,
dextrose, naloxone, pralidoxime (2-PAM), sodium bicarbonate, and anti-venoms
were clinically indicated 92% of the times they were ordered.
N-acetylcysteine was indicated in only 51.5% of administrations. Significant
variation in antidote stocking existed between hospitals, and there was no
stocked hydroxocobalamin as antidotes for cyanide poisoning or fomepizole
for toxic alcohol poisoning. Conclusion: Antidote stocking varied
significantly between hospitals, and antidotes necessary for cyanide and
toxic alcohol poisoning were deficient in all public hospitals. The
implication of this research indicates the need for the development of
national guidelines to standardize the stocking and administration protocols
of the antidotes among the country's public hospitals.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
activated carbon
alcohol
atropine
benzatropine
bicarbonate
calcium
calcium chloride
cyanide amyl nitrate
cyanide sodium thiosulfate
deferoxamine
digoxin
flumazenil
folic acid
glucagon
gluconate calcium
glucose
hydroxocobalamin
lipid emulsion
methylene blue
naloxone
octreotide
pralidoxime
scorpion venom antiserum
snake venom antiserum
thiamine
unclassified drug
unindexed drug
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug storage
drug utilization
public hospital
Qatar
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
alcohol intoxication
article
child
cyanide poisoning
drug use
emergency ward
female
general hospital
hospital pharmacy
human
major clinical study
male
prospective study
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
benzatropine (86-13-5)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2, 14092-94-5)
calcium chloride (10043-52-4)
deferoxamine (70-51-9)
digoxin (20830-75-5, 57285-89-9)
flumazenil (78755-81-4)
folic acid (59-30-3, 6484-89-5)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9, 1607842-55-6)
pralidoxime (6735-59-7)
thiamine (59-43-8, 67-03-8)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180078044
PUI
L620565097
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 117
TITLE
A retrospective review of unintentional opioid overdose risk and mitigating
factors among acutely injured trauma patients
AUTHOR NAMES
Baird J.
Faul M.
Green T.C.
Howland J.
Adams C.A.
George A.
Mello M.J.
AUTHOR ADDRESSES
(Baird J., jbaird@lifespan.org; Green T.C.; Howland J.; Mello M.J.) Warren
Alpert School of Medicine at Brown University, United States.
(Faul M.) Centers for Disease Control and Prevention, United States.
(Green T.C.; Howland J.) Boston University School of Medicine, United
States.
(Adams C.A.) Rhode Island Hospital, Division of Trauma and Surgical Critical
Care, United States.
(George A.) University Surgical Associates, United States.
(Mello M.J.) Brown University School of Public Health, United States.
CORRESPONDENCE ADDRESS
J. Baird, Warren Alpert School of Medicine at Brown University, United
States. Email: jbaird@lifespan.org
SOURCE
Drug and Alcohol Dependence (2017) 178 (130-135). Date of Publication: 1 Sep
2017
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background Opioid medication to treat acutely injured patients is usual care
in trauma settings. A higher prevalence of alcohol and other substance
misuse in this population compared to the general population increases the
vulnerability of such patients to both misuse of their prescribed opioids,
and also unintentional opioid overdose. The primary purpose of this study
was to assess the prevalence of substance use and unintentional opioid
overdose risk among acutely injured trauma patients, and to examine the
frequency and predictors of high opioid dose at discharge. Methods A
retrospective electronic medical record (EMR) review of three-months of data
from two Level 1 trauma centers. We assessed the prevalence of substance
misuse, unintentional opioid overdose risk, and presence of documentation of
clinical strategies to mitigate these risks, such as co-prescription of the
opioid agonist naloxone. Results In total, 352 patient EMRs were examined.
Over 40% of the patients reviewed had at least one indication of substance
misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose
risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]).
Dose of opioid medication was not significantly different for patients with
substance misuse versus those without. There was no co-prescription of
naloxone for any of the discharged patients. Conclusions Our results
indicate that despite the high rates of substance misuse, the potential for
misuse, dependence and unintentional overdose risk from prescribed opioid
medications are prevalent among acutely injured trauma patients. Prescribing
after acute trauma care should address these risk factors.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
amphetamine derivative
barbituric acid derivative
benzodiazepine derivative
cannabinoid
cocaine
methadone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (epidemiology)
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
drug misuse (epidemiology)
emergency health service
female
high risk population
human
major clinical study
male
medical record review
observational study
prediction
prevalence
priority journal
retrospective study
risk factor
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170795764
MEDLINE PMID
28647680 (http://www.ncbi.nlm.nih.gov/pubmed/28647680)
PUI
L619207718
DOI
10.1016/j.drugalcdep.2017.04.030
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2017.04.030
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 118
TITLE
Drugs of Abuse
AUTHOR NAMES
Akerele E.
Olupona T.
AUTHOR ADDRESSES
(Akerele E., eakerele@interfaithmedical.org; Olupona T.) Department of
Psychiatry and Behavioral Health, Interfaith Medical Center, 1545 Atlantic
Avenue, Brooklyn, United States.
CORRESPONDENCE ADDRESS
E. Akerele, Department of Psychiatry and Behavioral Health, Interfaith
Medical Center, 1545 Atlantic Avenue, Brooklyn, United States. Email:
eakerele@interfaithmedical.org
SOURCE
Psychiatric Clinics of North America (2017) 40:3 (501-517). Date of
Publication: 1 Sep 2017
ISSN
1558-3147 (electronic)
0193-953X
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Drug abuse and its consequences remain a significant public health issue. An
increasing number of individuals are present in the emergency room with
life-threatening drug intoxication. It is imperative that emergency room
physicians are cognizant of the signs, symptoms, and treatment to improve
the chances of early recognition and treatment. As a result, the proportion
of lives saved will increase significantly. In this article, we present some
of the most prevalent life-threatening drugs that lead to emergency room
admission. The signs, symptoms, and treatment modalities are discussed.
EMTREE DRUG INDEX TERMS
antidepressant agent (clinical trial, drug therapy)
buprenorphine
cannabinoid (drug toxicity)
cannabis (drug toxicity)
carbamazepine (clinical trial, drug therapy)
cathinone (drug toxicity)
cocaine (drug toxicity)
designer drug
diamorphine
diazepam
disulfiram (clinical trial, drug therapy)
dopamine receptor stimulating agent (clinical trial, drug therapy)
fentanyl
hydrocodone bitartrate plus paracetamol
modafinil (clinical trial, drug therapy)
naloxone (drug therapy)
opiate (drug toxicity)
oxycodone
oxycodone plus paracetamol
pentazocine
tiagabine (clinical trial, drug therapy)
topiramate (clinical trial, drug therapy)
vigabatrin (clinical trial, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
cannabis addiction
cocaine dependence (drug therapy, therapy)
cognitive behavioral therapy
comorbidity
death
drug intoxication
drug overdose (drug therapy)
emergency physician
heroin dependence
human
opiate addiction
priority journal
psychosocial care
review
withdrawal syndrome
DRUG TRADE NAMES
valium
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
cannabis (8001-45-4, 8063-14-7)
carbamazepine (298-46-4, 8047-84-5)
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
disulfiram (97-77-8)
fentanyl (437-38-7)
modafinil (68693-11-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pentazocine (359-83-1, 64024-15-3)
tiagabine (115103-54-3, 115103-55-4)
topiramate (97240-79-4)
vigabatrin (60643-86-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170577610
PUI
L617753765
DOI
10.1016/j.psc.2017.05.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.psc.2017.05.006
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 119
TITLE
Three-year retention in buprenorphine treatment for opioid use disorder
nationally in the Veterans Health Administration
AUTHOR NAMES
Manhapra A.
Petrakis I.
Rosenheck R.
AUTHOR ADDRESSES
(Manhapra A., ajay.manhapra@yale.edu; Petrakis I.; Rosenheck R.) VA New
England Mental Illness Research and Education Center, West Haven, United
States.
(Manhapra A., ajay.manhapra@yale.edu; Petrakis I.; Rosenheck R.) Department
of Psychiatry, Yale School of Medicine, New Haven, United States.
(Manhapra A., ajay.manhapra@yale.edu) Department of Internal Medicine, Yale
Medical School, New Haven, United States.
(Manhapra A., ajay.manhapra@yale.edu) VA Hampton Medical Center, Hampton,
United States.
CORRESPONDENCE ADDRESS
A. Manhapra, VA New England Mental Illness Research and Education Center,
West Haven, United States. Email: ajay.manhapra@yale.edu
SOURCE
American Journal on Addictions (2017) 26:6 (572-580). Date of Publication: 1
Sep 2017
ISSN
1521-0391 (electronic)
1055-0496
BOOK PUBLISHER
Wiley Blackwell, info@wiley.com
ABSTRACT
Background: Buprenorphine has become the major treatment for opioid use
disorder (OUD) but data on long treatment term retention and its correlates
are sparse. Methods: All veterans with OUD treated in Veterans Health
Administration (VHA) facilities nationally in fiscal year (FY) 2012, and who
began treatment with buprenorphine as indicated by a first prescription
after the first 60 days of the year were identified with the date of and
their last prescription from FY 2012–2015. Veterans were classified into
four groups based on time from first to last prescription: (0–30 days,
31–365 days; 1–3 years; and more than 3 years). These groups were compared
on socio-demographic, diagnoses and service, and psychotropic drug use.
Kaplan-Meier curves and Cox proportional hazards models were used to
identify variables independently associated with retention in buprenorphine
treatment. Results: Veterans newly started on buprenorphine (n = 3,151) were
retained in treatment for a mean duration of 1.68 years (standard deviation
[SD] 1.23), with 61.60% (n = 1,941) retained for more than a year and 31.83%
(n = 1,003) for more than 3 years. Cox proportion hazards model showed that
only black race (Hazards ratio [HR] 1.26; standard error [SE].06; p.0003),
the Charlson index (HR 1.03; SE.01; p.0132) and emergency room visits during
FY 2012 (HR 1.03; SE.01; p <.0001) were the only available variables
independently associated higher odds of buprenorphine discontinuation.
Conclusions: Buprenorphine retention was substantial among veterans treated
in VHA, but few individual characteristics correlated with retention.
Scientific Significance: Future research focused on identifying further
correlates of treatment retention is required to help devise interventions
to improve treatment continuation. (Am J Addict 2017;26:572–580).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care management
opiate addiction (drug therapy, drug therapy)
veterans health
EMTREE MEDICAL INDEX TERMS
adult
article
Black person
Charlson Comorbidity Index
demography
drug retention
drug use
emergency ward
female
health service
human
intervention study
major clinical study
male
prescription
treatment duration
treatment indication
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170332865
MEDLINE PMID
28472543 (http://www.ncbi.nlm.nih.gov/pubmed/28472543)
PUI
L616039977
DOI
10.1111/ajad.12553
FULL TEXT LINK
http://dx.doi.org/10.1111/ajad.12553
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 120
TITLE
Educational intervention for physicians to address the risk of opioid abuse
AUTHOR NAMES
Pasquale M.K.
Sheer R.L.
Mardekian J.
Masters E.T.
Patel N.C.
Hurwitch A.R.
Weber J.J.
Jorga A.
Roland C.L.
AUTHOR ADDRESSES
(Pasquale M.K.; Sheer R.L.; Patel N.C.) Comprehensive Health Insights, Inc.,
Louisville, United States.
(Mardekian J.; Jorga A.) Pfizer Inc., New York, United States.
(Masters E.T.) Outcomes and Evidence, Pfizer Inc., New York, United States.
(Hurwitch A.R.) Adverse Events-Pharmacy Patient Safety Programs Humana
Pharmacy Solutions, Louisville, United States.
(Weber J.J.) Pharmacy Patient Safety Programs Humana Pharmacy Solutions,
Louisville, United States.
(Roland C.L.) Global Innovative Pharma Business Clinical Sciences and
Outcomes and Evidence Pfizer Inc., Durham, United States.
SOURCE
Journal of Opioid Management (2017) 13:5 (303-313). Date of Publication: 1
Sep 2017
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Objective: To evaluate the impact of a pilot intervention for physicians to
support their treatment of patients at risk for opioid abuse. Setting,
design and patients, participants: Patients at risk for opioid abuse
enrolled in Medicare plans were identified from July 1, 2012 to April 30,
2014 (N = 2,391), based on a published predictive model, and linked to 4,353
opioidprescribing physicians. Patient-physician clusters were randomly
assigned to one of four interventions using factorial design. Interventions:
Physicians received one of the following: Arm 1, patient information; Arm 2,
links to educational materials for diagnosis and management of pain; Arm 3,
both patient information and links to educational materials; or Arm 4, no
communication. Main outcome measures: Difference-in-difference analyses
compared opioid and pain prescriptions, chronic high-dose opioid use,
uncoordinated opioid use, and opioid-related emergency department (ED)
visits. Logistic regression compared diagnosis of opioid abuse between cases
and controls postindex. Results: Mailings had no significant impact on
numbers of opioid or pain medications filled, chronic high-dose opioid use,
uncoordinated opioid use, ED visits, or rate of diagnosed opioid abuse.
Relative to Arm 4, odds ratios (95% CI) for diagnosed opioid abuse were Arm
1, 0.95(0.63-1.42); Arm 2, 0.83(0.55-1.27); Arm 3, 0.72(0.46-1.13). While
84.7 percent had ≥ 1 psychiatric diagnoses during preindex (p = 0.89 between
arms), only 9.5 percent had ≥ 1 visit with mental health specialists (p =
0.53 between arms). Conclusions: Although this intervention did not affect
pain-related outcomes, future interventions involving care coordination
across primary care and mental health may impact opioid abuse and improve
quality of life of patients with pain.
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medicare
opiate addiction
physician
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
coordination
diagnosis
drug megadose
drug therapy
emergency ward
female
human
major clinical study
male
mental health
pain
patient information
prescription
primary medical care
psychiatric diagnosis
quality of life
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20180225562
PUI
L621440854
DOI
10.5055/jom.2017.0399
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2017.0399
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 121
TITLE
Fentanyl laced heroin and its contribution to a spike in heroin overdose in
Miami-Dade County
AUTHOR NAMES
Bode A.D.
Singh M.
Andrews J.
Kapur G.B.
Baez A.A.
AUTHOR ADDRESSES
(Kapur G.B., girish.kapur@jhsmiami.org; Baez A.A., amado.baez@jhsmiami.org)
Jackson Memorial Hospital Department of Emergency Medicine, 1611 NW 12th
Ave, Miami, United States.
(Bode A.D., adb127@med.miami.edu; Singh M., mallika.singh@med.miami.edu;
Andrews J., james.andrews@med.miami.edu) University of Miami Leonard M.
Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, United States.
CORRESPONDENCE ADDRESS
A.D. Bode, University of Miami Leonard M. Miller School of Medicine, 1600 NW
10th Ave #1140, Miami, United States. Email: adb127@med.miami.edu
SOURCE
American Journal of Emergency Medicine (2017) 35:9 (1364-1365). Date of
Publication: 1 Sep 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
fentanyl derivative
fentanyl laced heroin
EMTREE DRUG INDEX TERMS
controlled substance
naloxone
opiate
opiate agonist
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
heroin overdose
EMTREE MEDICAL INDEX TERMS
cause of death
clinical effectiveness
clinical protocol
comparative study
cross-sectional study
drug potency
drug use
drug utilization
emergency ward
epidemiological data
harm reduction
human
ICD-10
letter
medical documentation
morbidity
mortality rate
opiate overdose
pharmaceutical care
priority journal
respiration depression
retrospective study
time to treatment
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170166013
MEDLINE PMID
28268113 (http://www.ncbi.nlm.nih.gov/pubmed/28268113)
PUI
L614666912
DOI
10.1016/j.ajem.2017.02.043
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.02.043
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 122
TITLE
US declares opioid epidemic a "national emergency"
AUTHOR NAMES
McCarthy M.
AUTHOR ADDRESSES
(McCarthy M.) Seattle
SOURCE
BMJ (Clinical research ed.) (2017) 358 (j3881). Date of Publication: 14 Aug
2017
ISSN
1756-1833 (electronic)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
EMTREE MEDICAL INDEX TERMS
drug overdose
human
mortality
opiate addiction (epidemiology)
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
28807927 (http://www.ncbi.nlm.nih.gov/pubmed/28807927)
PUI
L619663122
DOI
10.1136/bmj.j3881
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.j3881
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 123
TITLE
Intoxication by gamma hydroxybutyrate and related analogues: Clinical
characteristics and comparison between pure intoxication and that combined
with other substances of abuse
AUTHOR NAMES
Miró Ò.
Galicia M.
Dargan P.
Dines A.M.
Giraudon I.
Heyerdahl F.
Hovda K.E.
Yates C.
Wood D.M.
AUTHOR ADDRESSES
(Miró Ò.; Galicia M., mgalicia@clinic.cat) Emergency Department, Hospital
Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
(Dargan P.; Dines A.M.; Wood D.M.) Clinical Toxicology, Guy's and St Thomas’
NHS Foundation Trust and King's Health Partners, London, United Kingdom.
(Dargan P.; Wood D.M.) Clinical Toxicology, Faculty of Life Sciences and
Medicine, King's College London, London, United Kingdom.
(Giraudon I.) European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA), Lisbon, Portugal.
(Heyerdahl F.; Hovda K.E.) The National CBRNe Centre of Medicine, Department
of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway.
(Yates C.) Emergency Department and Clinical Toxicology Unit, Hospital
Universitari Son Espases, Mallorca, Spain.
()
CORRESPONDENCE ADDRESS
M. Galicia, Emergency Department, Hospital Clínic, IDIBAPS, University of
Barcelona, Barcelona, Spain. Email: mgalicia@clinic.cat
SOURCE
Toxicology Letters (2017) 277 (84-91). Date of Publication: 5 Aug 2017
ISSN
1879-3169 (electronic)
0378-4274
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Objective To study the profile of European gamma-hydroxybutyrate (GHB) and
gammabutyrolactone (GBL) intoxication and analyse the differences in the
clinical manifestations produced by intoxication by GHB/GBL alone and in
combination with other substances of abuse. Method We prospectively
collected data on all the patients attended in the Emergency Departments
(ED) of the centres participating in the Euro-DEN network over 12 months
(October 2013 to September 2014) with a primary presenting complaint of drug
intoxication (excluding ethanol alone) and registered the epidemiological
and clinical data and outcomes. Results We included 710 cases (83% males,
mean age 31 years), representing 12.6% of the total cases attended for drug
intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly
during weekend, and 71.7% consumed GHB/GBL in combination with other
substances of abuse, the most frequent additional agents being ethanol
(50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among
15 clinical features pre-defined in the project database, the 3 most
frequently identified were altered behaviour (39%), reduced consciousness
(34%) and anxiety (14%). The severity ranged from mild cases requiring no
treatment (308 cases, 43.4%) to severe cases requiring admission to
intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases,
6.9%). No deaths were reported. In comparison with only GHB/GBL consumption,
patients consuming GHB/GBL with co-intoxicants presented more vomiting (15%
vs. 3%, p < 0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p < 0.05), a
greater need for treatment (59.8% vs. 48.3%, p < 0.01) and a longer ED stay
(11.3% vs. 3.6% patients with ED stay >12 h, p < 0.01). Conclusions The
profile of the typical GHB/GBL-intoxicated European is a young male,
requiring care for altered behaviour and reduced level of consciousness,
mainly during the weekend. The clinical features are more severe when GHB is
consumed in combination with other substances of abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 hydroxybutyric acid (drug toxicity)
gamma butyrolactone (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
amphetamine (drug toxicity)
amphetamine derivative (drug toxicity)
benzodiazepine derivative (drug toxicity)
cannabis (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
flumazenil
ketamine (drug toxicity)
lysergide (drug toxicity)
methadone (drug toxicity)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
adult
aggression
agitation
anxiety
article
artificial ventilation
behavior disorder
clinical feature
comparative study
consciousness disorder
controlled study
disease severity
disorientation
endotracheal intubation
female
Glasgow coma scale
hallucination
heart arrhythmia
heart palpitation
human
intensive care
length of stay
major clinical study
male
mental hospital
observational study
paranoia
priority journal
prospective study
psychosis
thorax pain
toxicology
vomiting
ward
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
flumazenil (78755-81-4)
gamma butyrolactone (96-48-0)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lysergide (50-37-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170448659
MEDLINE PMID
28579487 (http://www.ncbi.nlm.nih.gov/pubmed/28579487)
PUI
L616876091
DOI
10.1016/j.toxlet.2017.05.030
FULL TEXT LINK
http://dx.doi.org/10.1016/j.toxlet.2017.05.030
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 124
TITLE
Cost-effectiveness of subdermal implantable buprenorphine versus sublingual
buprenorphine to treat opioid use disorder
AUTHOR NAMES
Carter J.A.
Dammerman R.
Frost M.
AUTHOR ADDRESSES
(Carter J.A., john.carter@epi-q.com) EPI-Q Inc., Oak Brook, United States.
(Dammerman R.) Formerly of Braeburn Pharmaceuticals, Princeton, United
States.
(Frost M.) Eagleville Hospital, Eagleville, United States.
CORRESPONDENCE ADDRESS
J.A. Carter, EPI-Q Inc, 1315 West 22nd Street, Suite 410, Oak Brook, United
States. Email: john.carter@epi-q.com
SOURCE
Journal of Medical Economics (2017) 20:8 (893-901). Date of Publication: 3
Aug 2017
ISSN
1941-837X (electronic)
1369-6998
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Aims: Subdermal implantable buprenorphine (BSI) was recently approved to
treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal
clinical trial, BSI was associated with a higher proportion of
completely-abstinent patients (85.7% vs 71.9%; p =.03) vs sublingual
buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated
with diminished treatment outcomes and increased costs. This study evaluated
the cost-effectiveness of BSI vs SL-BPN from a US societal perspective.
Methods: A Markov model simulated BSI and SL-BPN cohorts (clinically-stable
adults) transiting through four mutually-exclusive health states for 12
months. Cohorts accumulated direct medical costs from drug
acquisition/administration; treatment-diversion/abuse; newly-acquired
hepatitis-C; emergency room, hospital, and rehabilitation services; and
pediatric poisonings. Non-medical costs of criminality, lost
wages/work-productivity, and out-of-pocket expenses were also included.
Transition probabilities to a relapsed state were derived from the
aforementioned trial. Other transition probabilities, costs, and
health-state utilities were derived from observational studies and adjusted
for trial characteristics. Outcomes included incremental cost per
quality-adjusted-life-year (QALY) gained and incremental
net-monetary-benefit (INMB). Uncertainty was assessed by univariate and
probabilistic sensitivity analysis (PSA). Results: BSI was associated with
lower total costs (−$4,386), more QALYs (+0.031), and favorable INMB at all
willingness-to-pay (WTP) thresholds considered. Higher drug acquisition
costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency
room/hospital utilization (−$8,040) and criminality (−$1,212). BSI was
cost-effective in 89% of PSA model replicates, and had a significantly
higher NMB at $50,000/QALY ($20,783 vs $15,007; p <.05). Conclusions: BSI
was preferred over SL-BPN from a health-economic perspective for treatment
of OUD in clinically-stable adults. These findings should be interpreted
carefully, due to some relationships having been modeled from inputs derived
from multiple sources, and would benefit from comparison with outcomes from
studies that employ administrative claims data or a naturalistic comparative
design.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug administration, drug therapy, pharmacoeconomics,
sublingual drug administration, transdermal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cost effectiveness analysis
opiate addiction (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
biomedical technology assessment
cost
cost benefit analysis
criminal behavior
criminal justice
emergency ward
follow up
health care utilization
health status
hepatitis C
hospital utilization
hospitalization
human
outcome assessment
phase 3 clinical trial (topic)
prescription
quality adjusted life year
sensitivity analysis
treatment outcome
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170451489
PUI
L616933101
DOI
10.1080/13696998.2017.1341416
FULL TEXT LINK
http://dx.doi.org/10.1080/13696998.2017.1341416
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 125
TITLE
Impact of Hospital “Best Practice” Mandates on Prescription Opioid
Dispensing After an Emergency Department Visit
AUTHOR NAMES
Sun B.C.
Lupulescu-Mann N.
Charlesworth C.J.
Kim H.
Hartung D.M.
Deyo R.A.
John McConnell K.
AUTHOR ADDRESSES
(Sun B.C., sunb@ohsu.edu; John McConnell K.) Center for Policy
Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health
and Science University, Portland, United States.
(Lupulescu-Mann N.; Charlesworth C.J.; Kim H.; John McConnell K.) Center for
Health Systems Effectiveness, Oregon Health and Science University,
Portland, United States.
(Deyo R.A.) Department of Family Medicine, Department of Medicine,
Department of Public Health and Preventive Medicine, and Oregon Institute of
Occupational Health Sciences, Oregon Health and Science University,
Portland, United States.
(Hartung D.M.) College of Pharmacy, Oregon State University/Oregon Health
and Science University, Portland, United States.
CORRESPONDENCE ADDRESS
B.C. Sun, Center for Policy Research-Emergency Medicine, Department of
Emergency Medicine, Oregon Health and Science University, Portland, United
States. Email: sunb@ohsu.edu
SOURCE
Academic Emergency Medicine (2017) 24:8 (905-913). Date of Publication: 1
Aug 2017
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Washington State mandated seven hospital “best practices” in July
2012, several of which may affect emergency department (ED) opioid
prescribing and provide a policy template for addressing the opioid
prescription epidemic. We tested the hypothesis that the mandates would
reduce opioid dispensing after an ED visit. We further assessed for a
selective effect in patients with prior risky or chronic opioid use.
Methods: We performed a retrospective, observational analysis of ED visits
by Medicaid fee-for-service beneficiaries in Washington State, between July
1, 2011, and June 30, 2013. We used an interrupted time-series design to
control for temporal trends and patient characteristics. The primary outcome
was any opioid dispensing within 3 days after an ED visit. The secondary
outcome was total morphine milligram equivalents (MMEs) dispensed within 3
days. Results: We analyzed 266,614 ED visits. Mandates were associated with
a small reduction in opioid dispensing after an ED visit (–1.5%, 95%
confidence interval [CI] = –2.8% to –0.15%). The mandates were associated
with decreased opioid dispensing in 42,496 ED visits by patients with prior
risky opioid use behavior (–4.7%, 95% CI = –7.1% to –2.3%) and in 20,238
visits by patients with chronic opioid use (–3.6%, 95% CI = –5.6% to –1.7%).
Mandates were not associated with reductions in MMEs per dispense in the
overall cohort or in either subgroup. Conclusions: Washington State best
practice mandates were associated with small but nonselective reductions in
opioid prescribing rates. States should focus on alternative policies to
further reduce opioid dispensing in subgroups of high-risk and chronic
users.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
data analysis
female
human
major clinical study
male
medicaid
medical practice
patient information
priority journal
retrospective study
time series analysis
Washington
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170547428
MEDLINE PMID
28544288 (http://www.ncbi.nlm.nih.gov/pubmed/28544288)
PUI
L617587612
DOI
10.1111/acem.13230
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13230
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 126
TITLE
Electronic medication complete communication strategy for opioid
prescriptions in the emergency department: Rationale and design for a
three-arm provider randomized trial
AUTHOR NAMES
McCarthy D.M.
Courtney D.M.
Lank P.M.
Cameron K.A.
Russell A.M.
Curtis L.M.
Kim K.-Y.A.
Walton S.M.
Montague E.
Lyden A.L.
Gravenor S.J.
Wolf M.S.
AUTHOR ADDRESSES
(McCarthy D.M., d-mccarthy2@northwestern.edu; Courtney D.M.; Lank P.M.;
Gravenor S.J.) Department of Emergency Medicine, Northwestern University
Feinberg School of Medicine, Chicago, United States.
(Cameron K.A.) Division of General Internal Medicine and Geriatrics,
Northwestern University Feinberg School of Medicine, Chicago, United States.
(Russell A.M.; Curtis L.M.; Wolf M.S.) Health Literacy and Learning Program,
Division of General Internal Medicine, Northwestern University Feinberg
School of Medicine, Chicago, United States.
(Kim K.-Y.A.) Department of Preventative Medicine, Northwestern University
Feinberg School of Medicine, Chicago, United States.
(Walton S.M.) Department of Pharmacy System Outcomes and Policy, College of
Pharmacy, University of Illinois, Chicago, United States.
(Montague E.) School of Computing, DePaul University, Chicago, United
States.
(Lyden A.L.) College of Pharmacy, Rosalind Franklin University of Medicine
and Science, North Chicago, United States.
CORRESPONDENCE ADDRESS
D.M. McCarthy, Department of Emergency Medicine, 211 East Ontario, Suite
#200, Chicago, United States. Email: d-mccarthy2@northwestern.edu
SOURCE
Contemporary Clinical Trials (2017) 59 (22-29). Date of Publication: 1 Aug
2017
ISSN
1559-2030 (electronic)
1551-7144
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Background Thousands of people die annually from prescription opioid
overdoses; however there are few strategies to ensure patients receive
medication risk information at the time of prescribing. Objectives To
compare the effectiveness of the Emergency Department (ED) Electronic
Medication Complete Communication (EMC(2)) Opioid Strategy (with and without
text messaging) to promote safe medication use and improved patient
knowledge as compared to usual care. Methods The ED EMC(2) Opioid Strategy
consists of 5 automated components to promote safe medication use: 1)
physician reminder to counsel, 2) inbox message sent on to the patient's
primary care physician, 3) pharmacist message on the prescription to
counsel, 4) MedSheet supporting prescription information, and 5)
patient-centered Take-Wait-Stop wording of prescription instructions. This
strategy will be assessed both with and without the addition of text
messages via a three-arm randomized trial. The study will take place at an
urban academic ED (annual volume > 85,000) in Chicago, IL. Patients being
discharged with a new prescription for hydrocodone-acetaminophen will be
enrolled and randomized (based on their prescribing physician). The primary
outcome of the study is medication safe use as measured by a demonstrated
dosing task. Additionally actual safe use, patient knowledge and provider
counseling will be measured. Implementation fidelity as well as costs will
be reported. Conclusions The ED EMC(2) Opioid Strategy embeds a risk
communication strategy into the electronic health record and promotes
medication counseling with minimal workflow disruption. This trial will
evaluate the strategy's effectiveness and implementation fidelity as
compared to usual care. Trial registration This trial is registered on
clinicaltrials.gov with identifier NCT02431793.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
hydrocodone
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
electronic medication complete communication
electronic prescribing
emergency ward
interpersonal communication
EMTREE MEDICAL INDEX TERMS
article
comparative effectiveness
controlled study
electronic health record
general practitioner
human
knowledge
patient counseling
pharmacist
randomized controlled trial
reminder system
study design
text messaging
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT02431793)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170364976
PUI
L616281391
DOI
10.1016/j.cct.2017.05.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cct.2017.05.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 127
TITLE
When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal
Administration of Medications
AUTHOR NAMES
Rech M.A.
Barbas B.
Chaney W.
Greenhalgh E.
Turck C.
AUTHOR ADDRESSES
(Rech M.A., mrech@lumc.edu; Chaney W.; Greenhalgh E.) Department of
Pharmacy, Loyola University Medical Center, Maywood, United States.
(Rech M.A., mrech@lumc.edu; Barbas B.) Department of Emergency Medicine,
Loyola University Medical Center, Maywood, United States.
(Turck C.) ScientiaCME, LLC, Highland Park, United States.
CORRESPONDENCE ADDRESS
M.A. Rech, Department of Pharmacy, Loyola University Medical Center,
Maywood, United States. Email: mrech@lumc.edu
SOURCE
Annals of Emergency Medicine (2017) 70:2 (203-211). Date of Publication: 1
Aug 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
The intranasal route for medication administration is increasingly popular
in the emergency department and out-of-hospital setting because such
administration is simple and fast, and can be used for patients without
intravenous access and in situations in which obtaining an intravenous line
is difficult or time intensive (eg, for patients who are seizing or
combative). Several small studies (mostly pediatric) have shown midazolam to
be effective for procedural sedation, anxiolysis, and seizures. Intranasal
fentanyl demonstrates both safety and efficacy for the management of acute
pain. The intranasal route appears to be an effective alternative for
naloxone in opioid overdose. The literature is less clear on roles for
intranasal ketamine and dexmedetomidine.
EMTREE DRUG INDEX TERMS
dexmedetomidine (intranasal drug administration)
fentanyl (drug therapy, intranasal drug administration)
ketamine (intranasal drug administration)
midazolam (drug therapy, intranasal drug administration)
naloxone (drug therapy, intranasal drug administration)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
intranasal drug administration
outpatient care
EMTREE MEDICAL INDEX TERMS
anticonvulsant therapy
drug efficacy
drug intoxication (drug therapy)
drug overdose
drug safety
human
pain (drug therapy)
priority journal
review
seizure (drug therapy)
tranquilizing activity
CAS REGISTRY NUMBERS
dexmedetomidine (113775-47-6)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170243309
MEDLINE PMID
28366351 (http://www.ncbi.nlm.nih.gov/pubmed/28366351)
PUI
L615119902
DOI
10.1016/j.annemergmed.2017.02.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.02.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 128
TITLE
A Randomized Controlled Trial of a Citywide Emergency Department
Care-Coordination Program to Reduce Prescription Opioid-Related Visits: An
Economic Evaluation
AUTHOR NAMES
Murphy S.M.
Howell D.
McPherson S.
Grohs R.
Roll J.
Neven D.
AUTHOR ADDRESSES
(Murphy S.M.) Department of Health Policy and Administration, Washington
State University, Spokane, United States.
(Murphy S.M.; Howell D.; McPherson S.; Grohs R.; Roll J.; Neven D.) Program
of Excellence in Addictions Research, Washington State University, Spokane,
United States.
CORRESPONDENCE ADDRESS
S.M. Murphy, Department of Healthcare Policy and Research, Cornell
University, 425 East 61(st) Street, Suite 301, New York, United States.
SOURCE
Journal of Emergency Medicine (2017) 53:2 (186-194). Date of Publication: 1
Aug 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Care provided in the emergency department (ED) can cost up to
five times as much as care received for comparable diagnoses in alternative
settings. Small groups of patients, many of whom suffer from an opioid use
disorder, often account for a large proportion of total ED visits. We
recently conducted, and demonstrated the effectiveness of, the first
randomized controlled trial of a citywide ED care-coordination program
intending to reduce prescription-opioid-related ED visits. All EDs in the
metropolitan study area were connected to a Web-based information exchange
system. Objective The objective of this article was to perform an economic
evaluation of the 12-month trial from a third-party-payer perspective.
Methods We modeled the person-period monthly for the 12-month observation
period, and estimated total treatment costs and return on investment (ROI)
with regard to cost offsets, over time, for all visits where the patient was
admitted to and discharged from the ED. Results By the end of month 4, the
mean cumulative cost differential was significantly lower for intervention
relative to treatment-as-usual participants (−$1370; p = 0.03); this figure
climbed to −$3200 (p = 0.02) by the end of month 12. The ROI trended upward
throughout the observation period, but failed to reach statistical
significance by the end of month 12 (ROI = 3.39, p = 0.07). Conclusion The
intervention produced significant cost offsets by the end of month 4, which
continued to accumulate throughout the trial; however, ROI was not
significant. Because the per-patient administrative costs of the program are
incurred at the time of enrollment, our results highlight the importance of
future studies that are able to follow participants for a period beyond 12
months to more accurately estimate the program's ROI.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
economic evaluation
health program
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
cost
emergency ward
female
health care personnel
health care policy
human
investment
male
observational study
priority journal
randomized controlled trial
sensitivity analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170273758
PUI
L615370943
DOI
10.1016/j.jemermed.2017.02.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2017.02.014
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 129
TITLE
The extent of and factors associated with self-reported overdose and
self-reported receipt of naloxone among people who inject drugs (PWID) in
England, Wales and Northern Ireland
AUTHOR NAMES
O'Halloran C.
Cullen K.
Njoroge J.
Jessop L.
Smith J.
Hope V.
Ncube F.
AUTHOR ADDRESSES
(O'Halloran C., charlotte.ohalloran@phe.gov.uk; Cullen K.; Njoroge J.; Hope
V.; Ncube F.) HIV & STI Department, Public Health England, 61 Colindale
Avenue, London, United Kingdom.
(Jessop L.) Public Health Agency, Health Protection Service, 12-22 Linenhall
Street, Belfast, United Kingdom.
(Smith J.) Public Health Wales, Temple of Peace & Health, Cathays Park,
Cardiff, United Kingdom.
CORRESPONDENCE ADDRESS
C. O'Halloran, HIV & STI Department, Public Health England, 61 Colindale
Avenue, London, United Kingdom. Email: charlotte.ohalloran@phe.gov.uk
SOURCE
International Journal of Drug Policy (2017) 46 (34-40). Date of Publication:
1 Aug 2017
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background Overdose is a major cause of death among PWID, and for opioid
overdoses naloxone administration can reduce harm. However, globally there
is limited national level data on the extent of non-fatal overdose and
naloxone uptake. The first national level data on the extent of
self-reported overdose and self-reported receipt of naloxone among UK PWID,
providing a baseline to monitor the impact of the recent policy change
regarding naloxone availability, is presented. Methods Data on self-reported
overdose and receipt of naloxone during the preceding year for 2013–2014
from a national survey of PWID was analysed. Participants who reported
injecting during the preceding year were included. Results Participants
(3850) were predominantly male (75%); mean age was 36 years. The most
commonly injected drugs were: heroin (91%), crack (45%) and amphetamine
(29%). 15% (591) reported overdosing during the preceding year. There were
no differences in the proportion reporting overdose by age or gender, but
overdose was more common among those who: injected multiple drugs; recently
ceased addiction treatment; injected with used needles/syringes; ever had
transactional sex; had used a sexual health clinic or emergency department
and lived in Wales or Northern Ireland. Among those reporting an overdose
during the preceding year, a third reported two to four overdoses and 7.5%
five or more overdoses; half reported receiving naloxone. Those reporting
naloxone receipt in the preceding year were more likely to: live in Wales or
Northern Ireland; ever received used needles/syringes; ever been imprisoned;
and less likely to have injected two drug types. Conclusion These data
provide a baseline for monitoring the impact of the 2015 UK policy change to
improve take-home naloxone access. Interventions tackling overdose should
promote naloxone awareness and access, and target those who; are poly-drug
injectors, have ceased treatment, share needles/syringes and whose drug use
links to sexual activity.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
amphetamine
diamorphine
EMTREE MEDICAL INDEX TERMS
adult
article
cause of death
drug overdose
England
female
health care access
health care policy
health program
health promotion
home care
human
Ireland
major clinical study
male
patient monitoring
priority journal
self report
sexual behavior
CAS REGISTRY NUMBERS
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170403821
PUI
L616553018
DOI
10.1016/j.drugpo.2017.05.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2017.05.017
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 130
TITLE
Opioid prescription and usage in adolescents undergoing orthopaedic surgery
in the United States: A systematic review
AUTHOR NAMES
Dautremont E.A.
Ebramzadeh E.
Beck J.J.
Bowen R.E.
Sangiorgio S.N.
AUTHOR ADDRESSES
(Dautremont E.A., DO19.Erin.Dautremont@NV.Touro.edu; Ebramzadeh E.,
EEbramzadeh@mednet.UCLA.edu; Sangiorgio S.N., SSangiorgio@UCLA.edu) J.
Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of
Orthopaedic Surgery, University of California, Los Angeles, Los Angeles,
United States.
(Beck J.J., JJBeck@mednet.UCLA.edu; Bowen R.E., RBowen@mednet.UCLA.edu)
Orthopaedic Institute for Children, Department of Orthopaedic Surgery,
University of California, Los Angeles, Los Angeles, United States.
(Dautremont E.A., DO19.Erin.Dautremont@NV.Touro.edu) College of Osteopathic
Medicine, Touro University Nevada, Henderson, United States.
SOURCE
JBJS Reviews (2017) 5:8. Date of Publication: 1 Aug 2017
ISSN
2329-9185 (electronic)
BOOK PUBLISHER
Journal of Bone and Joint Surgery Inc.
ABSTRACT
Background: The proper use of opioid analgesia for postoperative pain
management is controversial. While opioids are considered the standard of
care for multimodal postoperative pain modulation in the United States,
there is a lack of established protocols for prescribing opioids in
adolescents undergoing outpatient orthopaedic surgery. The objective of this
review was to identify and report on current literature on opioid
prescription for pain management in adolescents undergoing all procedures,
as well as in adults undergoing outpatient orthopaedic surgery. Methods: A
comprehensive literature search using PRISMA guidelines was performed to
identify all articles relevant to opioid use in adolescents for
postoperative pain and in adults following outpatient orthopaedic
procedures. Results: A total of 4,446 results were identified from databases
and relevant journal web sites. Of these, 9 articles were selected that fit
the criteria for review. Five studies discussed the dosage and type of
opioids prescribed in adolescent populations, and 4 quantified patient
selfadministration in adult populations. Conclusions: Adolescent opioid pain
management following outpatient orthopaedic surgery is not documented.
Current recommendations for opioid prescription in adolescents lack support
and are primarily based on adult dosages. Adult studies suggest that opioid
medications may be overprescribed following outpatient orthopaedic surgery.
These results clearly indicate that there is a pressing need for
quantitative research on pain management following outpatient orthopaedic
surgery in the adolescent population in the United States. Clinical
Relevance: There appear to be no studies on self-administered opioid pain
medication following orthopaedic surgery in an adolescent population,
suggesting that there is no objective basis for the current prescription
recommendations. .
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
nonsteroid antiinflammatory agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
orthopedic surgery
postoperative pain
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
anterior cruciate ligament injury
bibliographic database
drug self administration
emergency ward
health care organization
human
outpatient department
pain assessment
postoperative care
postoperative period
randomized controlled trial (topic)
review
systematic review
United States
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170764607
PUI
L619043143
DOI
10.2106/JBJS.RVW.16.00093
FULL TEXT LINK
http://dx.doi.org/10.2106/JBJS.RVW.16.00093
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 131
TITLE
Effect of A "no Superuser Opioid Prescription" Policy on ED visits and
statewide opioid prescription
AUTHOR NAMES
Kahler Z.P.
Musey P.I.
Schaffer J.T.
Johnson A.N.
Strachan C.C.
Shufflebarger C.M.
AUTHOR ADDRESSES
(Kahler Z.P., zkahler@ghs.org; Musey P.I.; Schaffer J.T.; Johnson A.N.;
Strachan C.C.; Shufflebarger C.M.) Indiana University, School of Medicine,
Department of Emergency Medicine, Indianapolis, United States.
(Musey P.I.; Schaffer J.T.; Johnson A.N.; Strachan C.C.; Shufflebarger C.M.)
Indiana University Health Methodist Hospital, Indianapolis, United States.
(Kahler Z.P., zkahler@ghs.org) University of South Carolina, Greenville
School of Medicine, Department of Emergency Medicine, 701 Grove Road,
Greenville, United States.
CORRESPONDENCE ADDRESS
Z.P. Kahler, University of South Carolina, Greenville School of Medicine,
Department of Emergency Medicine, 701 Grove Road, Greenville, United States.
Email: zkahler@ghs.org
SOURCE
Western Journal of Emergency Medicine (2017) 18:5 (894-902). Date of
Publication: 1 Aug 2017
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: The U.S. opioid epidemic has highlighted the need to identify
patients at risk of opioid abuse and overdose. We initiated a novel
emergency department- (ED) based interventional protocol to transition our
superuser patients from the ED to an outpatient chronic pain program. The
objective was to evaluate the protocol's effect on superusers' annual ED
visits. Secondary outcomes included a quantitative evaluation of statewide
opioid prescriptions for these patients, unique prescribers of controlled
substances, and ancillary testing. Methods: Patients were referred to the
program with the following inclusion criteria: ≥ 6 visits per year to the
ED; at least one visit identified by the attendi ng physician as primarily
driven by opioid-seeking behavior; and a review by a committee comprising ED
administration and case management. Patients were referred to a pain
management clinic and informed that they would no longer receive opioid
prescriptions from visits to the ED for chronic pain complaints. Electronic
medical record (EMR) alerts notified ED providers of the patient's referral
at subsequent visits. We analyzed one year of data pre- and post-referral.
Results: A total of 243 patients had one year of data post-referral for
analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95%
CI [50 to 66]). We also found statistically significant decreases for these
patients' state prescription drug monitoring program (PDMP) opioid
prescriptions (21 to 13), total unique controlled-substance prescribers (11
to 7), computed tomography imaging (2 to 0), radiographs (5 to 1),
electrocardiograms (12 to 4), and labs run (47 to 13). Conclusion: This
program and the EMR-based alerts were successful at decreasing local ED
visits, annual opioid prescriptions, and hospital resource allocation for
this population of patients. There is no evidence that these patients
diverted their visits to neighboring EDs after being informed that they
would not receive opioids at this hospital, as opioid prescriptions obtained
by these patients decreased on a statewide level. This implies that
individual ED protocols can have significant impact on the behavior of
patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
prescription drug
EMTREE DRUG INDEX TERMS
controlled substance
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
article
case management
chronic pain
clinical protocol
computer assisted tomography
drug seeking behavior
electrocardiogram
electronic medical record
female
human
laboratory test
major clinical study
male
outcome assessment
quantitative study
radiography
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Radiology (14)
Public Health, Social Medicine and Epidemiology (17)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170595261
MEDLINE PMID
28874942 (http://www.ncbi.nlm.nih.gov/pubmed/28874942)
PUI
L617942578
DOI
10.5811/westjem.2017.6.33414
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2017.6.33414
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 132
TITLE
Cardiac arrest following drug abuse with intravenous tapentadol: Case report
and literature review
AUTHOR NAMES
Khaja M.
Lominadze G.
Millerman K.
AUTHOR ADDRESSES
(Khaja M., drkhaja@yahoo.com) Department of Medicine (Pulmonary and Critical
Care Medicine), Bronx-Lebanon Hospital Center Affiliated with Icahn School
of Medicine at Mount Sinai, Bronx, United States.
(Lominadze G.; Millerman K.) Division of Critical Care Medicine, New York
Presbyterian-Lawrence Hospital, Center Affiliated with Columbia University
College of Physician and Surgeons, Bronxville, United States.
CORRESPONDENCE ADDRESS
M. Khaja, Department of Medicine (Pulmonary and Critical Care Medicine),
Bronx-Lebanon Hospital Center Affiliated with Icahn School of Medicine at
Mount Sinai, Bronx, United States. Email: drkhaja@yahoo.com
SOURCE
American Journal of Case Reports (2017) 18 (817-821). Date of Publication:
21 Jul 2017
ISSN
1941-5923 (electronic)
BOOK PUBLISHER
International Scientific Information, Inc., office@isl-science.com
ABSTRACT
Objective: Rare disease Background: Tapentadol is a centrally acting opioid
analgesic, with a dual mode of action, as a norepinephrine reuptake
inhibitor and an agonist of the μ-opioid receptor (MOR). Tapentadol is used
for the management of musculoskel-etal pain, and neuropathic pain associated
with diabetic peripheral neuropathy. Case Report: A 32-year-old woman
attended hospital for evaluation of an intractable headache. Computed
tomography and magnetic resonance imaging of the brain were negative. She
was found unresponsive in the bathroom on the day following hospital
admission, and despite resuscitative measures, the patient died following
cardiac arrest. Autopsy toxicology revealed significantly elevated levels of
tapentadol, and bedside evidence suggested that the patient had
self-administered this medication intravenously before her death.
Conclusions: We report a rare adverse effect of tapentadol causing
respiratory depression leading to cardiac arrest. Medical examiners and
forensic toxicologists should be aware of the toxicity of this novel opiate
drug.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
tapentadol (adverse drug reaction, drug therapy, oral drug administration)
EMTREE DRUG INDEX TERMS
clorazepate
naloxone
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
drug abuse
heart arrest (side effect, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
adult
anxiety disorder
asthma
body mass
case report
cause of death
disease association
drug efficacy
drug safety
emergency ward
female
headache
hospital admission
human
intensive care unit
migraine
nausea
physical examination
QRS interval
QT interval
resuscitation
review
vomiting
CAS REGISTRY NUMBERS
clorazepate (20432-69-3, 23887-31-2)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9, 35763-26-9)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Radiology (14)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170546958
PUI
L617480092
DOI
10.12659/AJCR.904695
FULL TEXT LINK
http://dx.doi.org/10.12659/AJCR.904695
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 133
TITLE
Health care resource use and cost differences by opioid therapy type among
chronic noncancer pain patients
AUTHOR NAMES
Landsman-Blumberg P.B.
Katz N.
Gajria K.
D’Souza A.O.
Chaudhari S.L.
Yeung P.P.
White R.
AUTHOR ADDRESSES
(Landsman-Blumberg P.B.; D’Souza A.O.; Chaudhari S.L.) Real-World Evidence,
Xcenda LLC, Palm Harbor, United States.
(Katz N.) Analgesic Solutions, Natick, United States.
(Katz N.) Tufts University School of Medicine, Boston, United States.
(Gajria K., Kavita.Gajria@tevapharm.com) Global Health Economics Outcomes
Research, Teva Pharmaceuticals, Inc, Frazer, United States.
(Yeung P.P.) Migraine and Headache Clinical Development, Teva
Pharmaceuticals, Inc, Frazer, United States.
(White R.) Neuroscience, Angarrack Value Solutions, West Chester, United
States.
CORRESPONDENCE ADDRESS
K. Gajria, Teva Pharmaceuticals, Inc, 41 Moores Road, Frazer, United States.
Email: Kavita.Gajria@tevapharm.com
SOURCE
Journal of Pain Research (2017) 10 (1713-1722). Date of Publication: 21 Jul
2017
ISSN
1178-7090 (electronic)
BOOK PUBLISHER
Dove Medical Press Ltd., PO Box 300-008, Albany, Auckland, New Zealand.
ABSTRACT
The study assessed 12-month chronic pain (CP)-related health care
utilization and costs among chronic noncancer pain (CNCP) patients who
initiated various long-term opioid treatments. Treatments included
monotherapy with long-acting opioids (mono-LAOs), monotherapy with
short-acting opioids (mono-SAOs), both LAOs and SAOs (combination), and
opioid therapy initiated with SAO or LAO and switched to the other class
(switch). Using MarketScan® claims databases (2006–2012), we identified CNCP
patients with ≥90 days opioid supply after pain diagnosis and continuous
enrollment 12 months before pain diagnosis (baseline period) and 12 months
after opioid start (post-index period). Outcomes included CP-related health
care utilization and costs. Among CNCP patients (n=21,203), the cohort
distribution was 74% mono-SAOs, 22% combination, 2% mono-LAOs, and 2%
switch. During follow-up, the average daily morphine equivalent dose was
highest in mono-LAO patients (96.4 mg) compared with combination patients
(89.8 mg), switch patients (64.3 mg), and mono-SAO patients (36.2 mg). After
adjusting for baseline differences, the mono-LAO cohort had lower total
CP-related costs ($4,933) compared with the mono-SAO ($8,604), switch
($10,470), and combination ($15,190) cohorts (all: P<0.05). Mono-LAO
patients had greater CP-related prescription costs but lower medical costs
than the other cohorts during the follow-up period, including lower
CP-related hospitalizations (1% vs 11%–20%), emergency department visits (4%
vs 11%–18%), and diagnostic radiology use (21% vs 54%–61%) (all: P<0.001).
Use of pain-related medications and other treatment modalities was also
significantly lower in the mono-LAO cohort relative to the other cohorts.
CNCP patients using long-term monotherapy with LAOs had the lowest
CP-related total health care costs in the 12 months after opioid initiation
compared with mono-SAO, switch, or combination patients despite higher
opioid daily doses and higher prescription costs. Future research accounting
for severity and duration of pain would aid in determining the optimal
long-term opioid regimen for CNCP patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
anticonvulsive agent
antidepressant agent
benzodiazepine derivative
corticosteroid (drug therapy)
morphine
muscle relaxant agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy, therapy)
health care cost
health care utilization
EMTREE MEDICAL INDEX TERMS
adult
aged
article
controlled study
emergency ward
female
follow up
hospitalization
human
long term care
major clinical study
male
monotherapy
outcome assessment
pain severity
prescription
radiodiagnosis
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170550405
PUI
L617515847
DOI
10.2147/JPR.S130913
FULL TEXT LINK
http://dx.doi.org/10.2147/JPR.S130913
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 134
TITLE
Opioid Prescribing Practices in Pediatric Acute Care Settings
AUTHOR NAMES
DePhillips M.
Watts J.
Lowry J.
Dowd M.D.
AUTHOR ADDRESSES
(DePhillips M.) From the Departments of *Emergency Medicine and
†Pharmacology, Toxicology, and Therapeutic Innovations, Children’s Mercy
Hospital, Kansas City, MO.
(Watts J.; Lowry J.; Dowd M.D.)
CORRESPONDENCE ADDRESS
M. DePhillips, From the Departments of *Emergency Medicine and
†Pharmacology, Toxicology, and Therapeutic Innovations, Children’s Mercy
Hospital, Kansas City, MO.
SOURCE
Pediatric Emergency Care (2017). Date of Publication: 17 Jul 2017
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
OBJECTIVES: Deaths due to prescription opioid overdoses are at record-high
levels. Limiting the amount of opioid prescribed has been suggested as a
prevention strategy. The purpose of this study was to describe the opioid
prescribing practices in the emergency departments and urgent care sites of
a Midwestern tertiary care children’s hospital system. METHODS: This
retrospective medical record review examined the visits from the 2 pediatric
emergency departments and 2 pediatric urgent care sites in the system from
June 1, 2012, to May 31, 2013, during which an outpatient opioid
prescription was written. The primary outcome was number of days of opioid
prescribed. Other data collected included patient demographics, diagnosis,
and prescriber information; factors associated with prescriptions written
for more than 5 days were identified. RESULTS: A total of 4075 opioid
prescriptions were included in the 1-year study period, and 3991 of these
had complete data for analysis. The median amount prescribed was 3.3 days
with an interquartile range of 2.5 days. Odds of receiving a prescription of
more than 5 days’ duration were higher for children younger than 1 year
(odds ratio [OR], 12.3; 95% confidence interval [CI], 7.3–21.0), 1 to 4
years of age (OR, 7.7; 95% CI, 5.5–10.8), and 5 to 9 years of age (OR, 2.4;
95% CI, 1.7–3.4); for children with noninjury diagnoses (OR, 1.4; 95% CI,
1.2–1.7); or if prescribed by a resident physician (OR, 1.4; 95% CI,
1.1–1.8) or from the urgent care (OR, 1.4; 95% CI, 1.1–1.7). CONCLUSIONS:
Opioid prescriptions of more than 5 days were more frequently prescribed for
younger patients, noninjury diagnoses, or if prescribed by a resident
physician or from the urgent care. We need to focus on medical student,
resident, and provider education as well as further opioid research in order
to decrease unnecessary prescribing.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
prescription
EMTREE MEDICAL INDEX TERMS
child
clinical trial
confidence interval
diagnosis
drug therapy
education
emergency ward
female
hospital planning
human
male
medical record review
medical student
odds ratio
outpatient
preschool child
resident
school child
tertiary health care
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170520156
PUI
L617412713
DOI
10.1097/PEC.0000000000001239
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000001239
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 135
TITLE
Intoxications involving acrylfentanyl and other novel designer
fentanyls–results from the Swedish STRIDA project
AUTHOR NAMES
Helander A.
Bäckberg M.
Signell P.
Beck O.
AUTHOR ADDRESSES
(Helander A., anders.helander@ki.se; Beck O.) Department of Laboratory
Medicine, Karolinska Institutet, Stockholm, Sweden.
(Helander A., anders.helander@ki.se; Signell P.; Beck O.) Clinical
Pharmacology, Karolinska University Laboratory, Stockholm, Sweden.
(Bäckberg M.) Swedish Poisons Information Centre, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A. Helander, C1:74, Clinical Chemistry, Karolinska University Laboratory
Huddinge, Stockholm, Sweden. Email: anders.helander@ki.se
SOURCE
Clinical Toxicology (2017) 55:6 (589-599). Date of Publication: 3 Jul 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Background: The number of new psychoactive substances (NPS) introduced
through the online recreational drugs market increases continuously. This
report from the Swedish STRIDA project describes analytically confirmed
intoxications involving the novel fentanyl analogs acrylfentanyl,
4-chloroisobutyrfentanyl (4Cl-iBF), 4-fluoroisobutyrfentanyl (4F-iBF), and
tetrahydrofuranfentanyl (THF-F), and cyclopentylfentanyl in a drug product.
Methods: Patients with suspected NPS exposure presenting in emergency
departments (ED) or intensive care units (ICU) in Sweden and requiring
hospital care are invited to the STRIDA project. NPS analysis of serum and
urine samples was performed by multi-component liquid chromatography-mass
spectrometry. Data on clinical features were retrieved from telephone
consultations with the Swedish Poisons Information Centre and from medical
records. Results: Between April and October 2016, eleven intoxications
involving acrylfentanyl (8 cases), acrylfentanyl together with 4Cl-iBF (1),
4F-iBF (1), and THF-F (1) were analytically confirmed. Patients were aged
19–51 (median 28) years and 91% were men. Six (55%) were monitored at the
ED, and five admitted to the ICU. Typical clinical features were decreased
consciousness, respiratory depression, and miosis. In 8 cases, the antidote
naloxone was administered to counter the opioid effects. The 4F-iBF positive
patient eventually died of brain edema. The serum acrylfentanyl
concentration (n = 8) ranged 0.5–2.1 (median 0.9) ng/mL, and in urine (n =
9) 0.2–10.5 (mean 4.6, median 5.2) μg/mmol creatinine. For 4Cl-iBF, 4F-iBF,
and THF-F (n = 1 each), higher serum (5–45 ng/mL) and urine (11–136 μg/mmol
creatinine) concentrations were found. Other NPS (e.g., flunitrazolam)
and/or classical drugs were detected in five cases. In early 2016, nasal
sprays with a claimed content of acrylfentanyl brought to hospital by
patients or obtained by test purchase were demonstrated to instead contain
fentanyl. Conclusions: Potentially life-threatening opioid toxicity was seen
in 11 acute intoxications involving the fentanyl analogs acrylfentanyl,
4Cl-iBF, 4F-iBF, and THF-F, which are available through open Internet
trading. All patients were supported with acute and intensive hospital care,
and naloxone was effective to reverse the opioid symptoms. One patient died
of brain edema.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 chloroisobutyrfentanyl (drug toxicity)
4 fluoroisobutyrfentanyl (drug toxicity)
acrylfentanyl (drug toxicity)
cyclopentylfentanyl (drug toxicity)
fentanyl derivative (drug toxicity)
tetrahydrofuranfentanyl (drug toxicity)
EMTREE DRUG INDEX TERMS
creatinine (endogenous compound)
naloxone (drug therapy)
nose spray
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
agitation
apnea
article
aspiration pneumonia
blood sampling
brain edema
central nervous system depression
clinical article
continuous infusion
creatinine blood level
drug blood level
drug exposure
drug urine level
emergency ward
female
hospital admission
human
hypertension
intensive care unit
kidney failure
liquid chromatography-mass spectrometry
male
middle aged
miosis
myocarditis
oxygen supply
respiration depression
resuscitation
return of spontaneous circulation
Sweden
tachycardia
teleconsultation
unconsciousness
urine sampling
young adult
CAS REGISTRY NUMBERS
creatinine (19230-81-0, 60-27-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170233594
MEDLINE PMID
28349714 (http://www.ncbi.nlm.nih.gov/pubmed/28349714)
PUI
L615055958
DOI
10.1080/15563650.2017.1303141
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2017.1303141
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 136
TITLE
Drug misuse in adolescents presenting to the emergency department
AUTHOR NAMES
Finkelstein Y.
Goel G.
Hutson J.R.
Armstrong J.
Baum C.R.
Wax P.
Brent J.
AUTHOR ADDRESSES
(Finkelstein Y., yaron.finkelstein@sickkids.ca; Armstrong J.) Divisions of
Emergency Medicine, Hospital for Sick Children, Faculty of Medicine,
University of Toronto, 555 University Ave, Toronto, Canada.
(Finkelstein Y., yaron.finkelstein@sickkids.ca; Hutson J.R.) Clinical
Pharmacology and Toxicology, Hospital for Sick Children, Faculty of
Medicine, University of Toronto, Toronto, Canada.
(Goel G.) Department of Family and Community Medicine, St Michael's
Hospital, University of Toronto, Toronto, Canada.
(Baum C.R.) Center for Children's Environmental Toxicology, Yale-New Haven
Children's Hospital, Yale University School of Medicine, New Haven, United
States.
(Wax P.) Department of Surgery (Emergency Medicine), UT Southwestern School
of Medicine, Dallas, United States.
(Brent J.) Department of Medicine, University of Colorado, School of
Medicine, Colorado School of Public Health, Aurora, United States.
CORRESPONDENCE ADDRESS
Y. Finkelstein, Divisions of Emergency Medicine, Hospital for Sick Children,
Faculty of Medicine, University of Toronto, 555 University Ave, Toronto,
Canada. Email: yaron.finkelstein@sickkids.ca
SOURCE
Pediatric Emergency Care (2017) 33:7 (451-456). Date of Publication: 1 Jul
2017
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objectives Drug misuse is a disturbing, common practice among youth. One in
4 American adolescents reports consuming prescription medications without a
clinical indication. We sought to explore current trends of drug misuse in
adolescents. Methods Using the 37 participating sites of the ToxIC
(Toxicology Investigators Consortium) Case Registry, a cross-country
surveillance tool, we conducted an observational cohort study of all
adolescents (aged 13-18 years) who presented to emergency departments with
drug misuse and required a bedside medical toxicology consultation between
January 2010 and June 2013. Results Of 3043 poisonings, 202 (7%) involved
drug misuse (139 [69%] were males). Illicit drugs (primarily synthetic
cannabinoids and "bath salts") were encountered in 101 (50%), followed by
prescription medications (56 [28%]) and over-the-counter (OTC) drugs (51
[25%]). Dextromethorphan was the most commonly misused legal medication (24
[12%]). Polypharmacy exposure was documented in 74 (37%). One hundred
sixty-three adolescents (81%) were symptomatic; of these, 81% had central
nervous system impairments: psychosis (38%), agitation (30%), coma (26%),
myoclonus (11%), and seizures (10%); and 66 (41%) displayed a specific
toxidrome, most commonly sedative-hypnotic. Benzodiazepines were the most
frequently administered medications (46%). Antidotes were administered to
28% of adolescents, primarily naloxone, physostigmine, N-acetyl-cysteine,
and flumazenil. No deaths were recorded. Conclusions Adolescents presenting
with drug misuse may be exposed to a wide range and combinations of
therapeutics or illicit substances and frequently display central nervous
system abnormalities, compromising the ability to obtain a reliable history.
Frontline clinicians should maintain a high index of suspicion, as routine
toxicology screenings fail to detect most contemporary misused legal and
designer drugs.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
alcohol (drug toxicity)
alprazolam (drug toxicity)
amphetamine (drug toxicity)
analgesic agent (drug toxicity)
antidepressant agent (drug toxicity)
benzodiazepine derivative (drug toxicity)
cannabinoid (drug toxicity)
cathinone (drug toxicity)
chlorpheniramine (drug toxicity)
clonazepam (drug toxicity)
cocaine (drug toxicity)
dextromethorphan (drug toxicity)
diamorphine (drug toxicity)
diphenhydramine (drug toxicity)
doxylamine (drug toxicity)
flumazenil (drug therapy)
illicit drug
lysergide (drug toxicity)
methadone (drug toxicity)
methylphenidate (drug toxicity)
midomafetamine (drug toxicity)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adolescent behavior
drug misuse
EMTREE MEDICAL INDEX TERMS
acute kidney failure
acute psychosis
adolescent
adult
agitation
American
article
assisted ventilation
coma
delirium
depression
drug intoxication (drug therapy)
emergency ward
female
fluid resuscitation
human
hyperreflexia
intubation
leukocytosis
liver toxicity
major clinical study
male
metabolic acidosis
mydriasis
myoclonus
observational study
polypharmacy
prescription
psychosis
seizure
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
alprazolam (28981-97-7)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
chlorpheniramine (132-22-9)
clonazepam (1622-61-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextromethorphan (125-69-9, 125-71-3)
diamorphine (1502-95-0, 561-27-3)
diphenhydramine (147-24-0, 58-73-1)
doxylamine (469-21-6, 562-10-7, 7047-26-9)
flumazenil (78755-81-4)
lysergide (50-37-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methylphenidate (113-45-1, 298-59-9)
midomafetamine (42542-10-9)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015448995
MEDLINE PMID
26466148 (http://www.ncbi.nlm.nih.gov/pubmed/26466148)
PUI
L606470463
DOI
10.1097/PEC.0000000000000571
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000571
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 137
TITLE
Use of Emergency Department Data to Monitor and Respond to an Increase in
Opioid Overdoses in New Hampshire, 2011-2015
AUTHOR NAMES
Daly E.R.
Dufault K.
Swenson D.J.
Lakevicius P.
Metcalf E.
Chan B.P.
AUTHOR ADDRESSES
(Daly E.R.; Dufault K.; Swenson D.J.; Lakevicius P.; Metcalf E.; Chan B.P.)
1 New Hampshire Department of Health and Human Services, Concord, NH, USA
SOURCE
Public health reports (Washington, D.C. : 1974) (2017) 132:1 Supplement
(73S-79S). Date of Publication: 1 Jul 2017
ISSN
1468-2877 (electronic)
ABSTRACT
OBJECTIVES: Opioid-related overdoses and deaths in New Hampshire have
increased substantially in recent years, similar to increases observed
across the United States. We queried emergency department (ED) data in New
Hampshire to monitor opioid-related ED encounters as part of the public
health response to this health problem.METHODS: We obtained data on
opioid-related ED encounters for the period January 1, 2011, through
December 31, 2015, from New Hampshire's syndromic surveillance ED data
system by querying for (1) chief complaint text related to the words
"fentanyl," "heroin," "opiate," and "opioid" and (2) opioid-related
International Classification of Diseases ( ICD) codes. We then analyzed the
data to calculate frequencies of opioid-related ED encounters by age, sex,
residence, chief complaint text values, and ICD codes.RESULTS:
Opioid-related ED encounters increased by 70% during the study period, from
3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged
18-29 and in males. Of 20 994 total opioid-related ED visits, we identified
18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text
alone, and 1750 (8%) using both chief complaint text and ICD code. For those
encounters identified by ICD code only, the corresponding chief complaint
text included varied and nonspecific words, with the most common being
"pain" (n = 3335, 18%), "overdose" (n = 1555, 8%), "suicidal" (n = 816, 4%),
"drug" (n = 803, 4%), and "detox" (n = 750, 4%). Heroin-specific encounters
increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of
encounters in 2015.CONCLUSIONS: Opioid-related ED encounters in New
Hampshire increased substantially from 2011 to 2015. Data from New
Hampshire's ED syndromic surveillance system provided timely situational
awareness to public health partners to support the overall response to the
opioid epidemic.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
child
classification
drug overdose (diagnosis, epidemiology)
female
hospital emergency service
human
International Classification of Diseases
male
middle aged
New Hampshire
trends
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28692390 (http://www.ncbi.nlm.nih.gov/pubmed/28692390)
PUI
L617574315
DOI
10.1177/0033354917707934
FULL TEXT LINK
http://dx.doi.org/10.1177/0033354917707934
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 138
TITLE
Naloxone Access and Use for Suspected Opioid Overdoses
AUTHOR ADDRESSES
SOURCE
Annals of Emergency Medicine (2017) 70:1 (112-113). Date of Publication: 1
Jul 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
drug safety
editorial
emergency health service
emergency physician
health care access
human
law enforcement
priority journal
rescue personnel
respiration control
resuscitation
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170449295
MEDLINE PMID
28645392 (http://www.ncbi.nlm.nih.gov/pubmed/28645392)
PUI
L616902672
DOI
10.1016/j.annemergmed.2017.03.031
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.03.031
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 139
TITLE
First, do no harm: Advocating for opioid prescribing guidelines in Canadian
emergency departments
AUTHOR NAMES
Moore K.
Lew J.
Buttemer S.
Kielstra L.
AUTHOR ADDRESSES
(Moore K.) Department of Medicine, Public Health and Preventive Medicine,
Queen's University, Kingston, Canada.
(Lew J., julia.lew@queensu.ca; Kielstra L.) School of Medicine, Public
Health and Preventive Medicine, Queen's University, 15 Arch Street,
Kingston, Canada.
(Buttemer S.) Department of Family Medicine, Public Health and Preventive
Medicine, Queen's University, Kingston, Canada.
CORRESPONDENCE ADDRESS
J. Lew, School of Medicine, Public Health and Preventive Medicine, Queen's
University, 15 Arch Street, Kingston, Canada. Email: julia.lew@queensu.ca
SOURCE
Canadian Journal of Emergency Medicine (2017) 19:4 (324-326). Date of
Publication: 1 Jul 2017
ISSN
1481-8043 (electronic)
1481-8035
BOOK PUBLISHER
Cambridge University Press, info@bcdecker.com
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
Canadian
chronic pain
emergency ward
human
morbidity
mortality
note
palliative therapy
physician
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170524901
PUI
L617433247
DOI
10.1017/cem.2017.8
FULL TEXT LINK
http://dx.doi.org/10.1017/cem.2017.8
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 140
TITLE
Seeking solutions to the opioid crisis
AUTHOR NAMES
Stephen McIver J.
AUTHOR ADDRESSES
(Stephen McIver J.)
SOURCE
P and T (2017) 42:7 (478). Date of Publication: 1 Jul 2017
ISSN
1052-1372
BOOK PUBLISHER
Medi Media USA Inc, 780 Township Line Road, Yardley, United States.
jott@medimedia.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain
drug monitoring
emergency ward
heart valve
human
note
opiate addiction
patient comfort
prescription
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170483191
PUI
L617188090
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 141
TITLE
A Retrospective Cohort Study of Obstetric Outcomes in Opioid-Dependent Women
Treated with Implant Naltrexone, Oral Methadone or Sublingual Buprenorphine,
and Non-Dependent Controls
AUTHOR NAMES
Kelty E.
Hulse G.
AUTHOR ADDRESSES
(Kelty E., erin.kelty@uwa.edu.au; Hulse G.) School of Psychiatry and
Clinical Neuroscience, University of Western Australia, Sir Charles Gairdner
Hospital, Nedlands, Australia.
(Kelty E., erin.kelty@uwa.edu.au) School of Population and Global Health,
University of Western Australia, Crawley, Australia.
CORRESPONDENCE ADDRESS
E. Kelty, School of Psychiatry and Clinical Neuroscience, University of
Western Australia, Sir Charles Gairdner Hospital, Nedlands, Australia.
Email: erin.kelty@uwa.edu.au
SOURCE
Drugs (2017) 77:11 (1199-1210). Date of Publication: 1 Jul 2017
ISSN
1179-1950 (electronic)
0012-6667
BOOK PUBLISHER
Springer International Publishing
ABSTRACT
Background: Opioid pharmacotherapies play an important role in the treatment
of opioid-dependent women; however, very little is known about the safety of
naltrexone in pregnant patients. Objective: This study examined the
obstetric health of opioid-dependent women who were treated with implant
naltrexone during pregnancy, and compared them with women treated with
methadone and/or buprenorphine and a cohort of non-opioid-dependent
controls. Methods: Women treated with implant naltrexone, oral methadone or
sublingual buprenorphine between 2001 and 2010, along with a cohort of
age-matched controls, were linked with records from midwives, hospital and
emergency departments (EDs) and the death registry to identify pregnancy and
health events that occurred during pregnancy and in the post-partum period.
Results: Overall rates of pregnancy loss (requiring hospital or ED
attendance) were significantly elevated in naltrexone-treated women compared
with buprenorphine-treated women (p = 0.018) and controls (p < 0.001);
however, they were not statistically different to methadone-treated women
(p = 0.210). Birth rates in women on naltrexone implant treatment were
significantly higher than in all three comparison groups (p < 0.001). Rates
of hospital and ED attendance during pregnancy in the naltrexone-treated
women were not statistically different to those of either the methadone or
buprenorphine groups, and neither were overall complications during
pregnancy and labour. Overall rates of complications during pregnancy were
significantly higher in the naltrexone-treated women than in the controls.
Conclusion: Opioid-dependent women treated with naltrexone implant had
higher rates of birth than the other three groups (methadone- or
buprenorphine-treated women, or age-matched controls). Overall rates of
complications during pregnancy were elevated in naltrexone-treated women
when compared with the control group, but were generally not significantly
different to rates in methadone- or buprenorphine-treated women.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug combination, sublingual drug administration)
methadone (oral drug administration)
naltrexone
opiate
EMTREE DRUG INDEX TERMS
naloxone (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pregnancy outcome
EMTREE MEDICAL INDEX TERMS
adult
article
birth rate
cohort analysis
controlled study
ectopic pregnancy
emergency ward
female
follow up
hospital admission
human
hydatidiform mole
major clinical study
maternal death
medical abortion
methadone treatment
outcome assessment
pregnancy
pregnancy complication
pregnant woman
puerperium
retrospective study
spontaneous abortion
DRUG TRADE NAMES
suboxone , United KingdomReckitt Benckiser
subutex , United KingdomReckitt Benckiser
DRUG MANUFACTURERS
(Australia)go medical industries pty
(United Kingdom)Reckitt Benckiser
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170365386
MEDLINE PMID
28536980 (http://www.ncbi.nlm.nih.gov/pubmed/28536980)
PUI
L616352025
DOI
10.1007/s40265-017-0762-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s40265-017-0762-9
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 142
TITLE
Acute toxicity from intravenous use of the tricyclic antidepressant
tianeptine
AUTHOR NAMES
Dempsey S.K.
Poklis J.L.
Sweat K.
Cumpston K.
Wolf C.E.
AUTHOR ADDRESSES
(Dempsey S.K., dempseys@vcu.edu; Poklis J.L.) Department of Pharmacology and
Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond,
United States.
(Sweat K.; Cumpston K.) Department of Emergency Medicine, Virginia
Commonwealth University, PO Box 980613, Richmond, United States.
(Wolf C.E.) Department of Pathology, Virginia Commonwealth University, PO
Box 980613, Richmond, United States.
CORRESPONDENCE ADDRESS
S.K. Dempsey, Department of Pharmacology and Toxicology, Virginia
Commonwealth University, PO Box 980613, Richmond, United States. Email:
dempseys@vcu.edu
SOURCE
Journal of Analytical Toxicology (2017) 41:6 (547-550). Date of Publication:
1 Jul 2017
ISSN
1945-2403 (electronic)
0146-4760
BOOK PUBLISHER
Society of Forensic Toxicologists
ABSTRACT
Tianeptine
(7-[([3-chloro-6,11]-dihydro-6-methyldibenzo[c,f][1,2]thiazepin-11-yl)
amino] heptanoic acid S, S dioxide) is a tricyclic compound prescribed as an
antidepressant in European countries, but is not currently approved for use
in the United States. There are few published case reports of tianeptine
intoxication. Presented is the first case of acute toxicity associated with
the intravenous use of tianeptine. A 36-year-old male intentionally injected
tianeptine powder intravenously to "help him see into the future". He became
unresponsive and a bystander called emergency medical services. Upon arrival
to the Emergency Department, excessive constriction of the pupils, sedation,
and a respiratory rate of 6 respirations per minute (rpm) were noted. Blood
and urine were collected ~2 h post admission. The patient's serum ethanol
concentration was 133mg/dL. His toxicity was successfully reversed with two
doses of naloxone 0.4mg IV. He was started on a naloxone infusion at 0.2mg/h
and discharged 13 h after admittance awake, alert and oriented. The
patient's urine sample screened negative for common drugs of abuse and total
tricyclic antidepressants. A high performance liquid chromatography tandem
mass spectrometry method was developed and validated to quantify tianeptine
in urine. The calibration range was 1-100 ng/mL with linear regression
correlation (r(2)) of 0.9996 or greater. The limit of quantitation was
administratively set at 1 ng/mL. The bias of the assay was determined to be
within ±20% of the target value for each quality control specimen. The
intra-day and inter-day precision did not exceed 15% coefficient of
variation for each quality control specimen. Matrix effects, absolute
recovery, carryover and specificity were also evaluated. The patient's
tianeptine urine concentration was determined to be 2 ng/mL.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
tianeptine (drug analysis, drug toxicity, intravenous drug administration)
EMTREE DRUG INDEX TERMS
alcohol
naloxone (drug therapy, intravenous drug administration)
opiate receptor (endogenous compound)
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute toxicity (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
article
blood analysis
breathing rate
case report
clinical article
concentration process
conscious sedation
drug infusion
drug urine level
emergency health service
emergency ward
high performance liquid chromatography
hospital admission
hospital discharge
human
kidney concentrating capacity
limit of quantitation
male
medical history
pupil
quality control
tandem mass spectrometry
unconsciousness
urinalysis
urine sampling
wakefulness
CAS REGISTRY NUMBERS
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
tianeptine (66981-73-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170877103
MEDLINE PMID
28541419 (http://www.ncbi.nlm.nih.gov/pubmed/28541419)
PUI
L619722606
DOI
10.1093/jat/bkx034
FULL TEXT LINK
http://dx.doi.org/10.1093/jat/bkx034
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 143
TITLE
Predictors of Response in Emergency Department Patients Receiving
Intravenous Opioids for Severe Pain
AUTHOR NAMES
Radcliff J.A.
Rafeq R.M.
Bowen J.F.
Pontiggia L.
Sen S.
AUTHOR ADDRESSES
(Radcliff J.A., jaradcliff00@gmail.com; Bowen J.F.; Sen S.) Department of
Pharmacy Practice and Pharmacy Administration, Philadelphia College of
Pharmacy, University of the Sciences, Philadelphia, United States.
(Rafeq R.M.) Cooper University Hospital, Camden, United States.
(Pontiggia L.) Department of Mathematics, Physics, and Statistics,
University of the Sciences, Philadelphia, United States.
CORRESPONDENCE ADDRESS
J.A. Radcliff, Department of Pharmacy Practice and Pharmacy Administration,
Philadelphia College of Pharmacy, University of the Sciences, Philadelphia,
United States. Email: jaradcliff00@gmail.com
SOURCE
Pharmacotherapy (2017) 37:7 (799-805). Date of Publication: 1 Jul 2017
ISSN
1875-9114 (electronic)
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc.
ABSTRACT
The primary objective of this study was to identify significant
environmental and patient characteristics of emergency department (ED)
patients who responded to intravenous (IV) hydromorphone and IV morphine for
severe pain. Secondary objectives were to investigate the individual effect
of the significant environmental and patient characteristics of responders,
and to assess the nature and strength of the correlation of initial dose and
change in pain score from arrival to pre-administration. A retrospective
chart review was performed in patients who received IV hydromorphone or
morphine in the ED for severe pain. Key evaluated patient characteristics
included patient demographics, recent opioid use, history of drug or alcohol
abuse, and pain location, among others. Key evaluated environmental
characteristics included initial opioid administered, time to first dose,
initial pain score, and initial dose of opioid administered, among others.
Environmental and patient characteristics associated with response to pain
management were first identified using bivariate analyses and then entered
into a multiple stepwise logistic regression mode. Patients were excluded if
they were younger than 18 years, did not have a follow-up pain score within
2 hours of drug administration, or if they were discharged from the ED
within 1 hour of administration. Patients meeting the inclusion criteria
were grouped into two cohorts based on response and lack of response to
treatment. A total of 200 patients were included. A decrease in pain score
from arrival until pre-administration pain score and an inactive tobacco
history had a positive association with response (odds ratio [OR] 1.488, 95%
confidence interval [CI] 1.088–2.036, p=0.013, and OR 1.835, 95% CI
0.801–4.200, overall p=0.022, respectively). A higher initial dose and an
active tobacco history had a negative association with response (OR 0.715,
95% CI 0.580–0.881, p=0.002, and OR 0.582, 95% CI 0.296–1.144, overall
p=0.022, respectively). Two characteristics were associated with response to
IV opioid pain management in the ED, inactive tobacco history and an
increase in pain score from arrival until pre-administration, and two
characteristics were associated with nonresponse to IV opioid pain
management in the ED, active tobacco history and a higher initial dose.
Previous literature supports both characteristics identified as risk factors
but does not support either characteristic identified as protective factors,
prompting the need for further research.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (drug therapy, intravenous drug administration)
morphine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol abuse
article
case control study
controlled study
demography
drug abuse
female
follow up
human
major clinical study
male
medical history
medical record review
pain severity
risk factor
tobacco use
treatment response
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170526235
PUI
L617443506
DOI
10.1002/phar.1949
FULL TEXT LINK
http://dx.doi.org/10.1002/phar.1949
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 144
TITLE
Characterization and Management of Patients with Heroin versus Nonheroin
Opioid Overdoses: Experience at an Academic Medical Center
AUTHOR NAMES
Morizio K.M.
Baum R.A.
Dugan A.
Martin J.E.
Bailey A.M.
AUTHOR ADDRESSES
(Morizio K.M.) Department of Pharmacy, Banner University Medical Center at
the University of Arizona, Tucson, United States.
(Baum R.A.; Bailey A.M., Ammyna3@uky.edu) Department of Pharmacy, University
of Kentucky HealthCare, Lexington, United States.
(Dugan A.; Martin J.E.) Department of Emergency Medicine, University of
Kentucky HealthCare, Lexington, United States.
CORRESPONDENCE ADDRESS
A.M. Bailey, Department of Pharmacy, University of Kentucky HealthCare,
Lexington, United States. Email: Ammyna3@uky.edu
SOURCE
Pharmacotherapy (2017) 37:7 (781-790). Date of Publication: 1 Jul 2017
ISSN
1875-9114 (electronic)
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc.
ABSTRACT
Study Objectives: To characterize the differences between patients who had
heroin and nonheroin opioid overdoses and to determine whether there were
any significant differences in their management with regard to the naloxone
use. Design: Retrospective cohort study. Setting: Large academic medical
center. Patients: A total of 923 patients admitted to the medical center who
were identified for overdose by heroin or other opiate-related narcotics
between January 2010 and September 2015; 480 patients experienced a
nonheroin opioid overdose event, and 443 patients experienced a heroin
overdose event. Measurements and Main Results: Patients presenting with
heroin overdose tended to be younger and male, with higher rates of
hepatitis C virus (HCV) infection compared with those presenting with
nonheroin opioid overdose (p<0.05). Patients in the heroin group were also
more likely to have a previous overdose event, history of injection drug
use, and history of prescription opioid abuse compared with the nonheroin
group (p<0.05). Those presenting with heroin overdose were more likely to
receive naloxone in the prehospital setting (p<0.05) but were less likely to
receive naloxone once admitted (p<0.05). Patients with nonheroin opioid
overdoses required more continuous infusions of naloxone (p<0.05) and
admission to the intensive care unit (p<0.05). Of all 923 patients, 178
(19.3%) had a repeat admission for any reason, and 70 (7.6%) were readmitted
over the course of the study period for another overdose event with the same
drug. The proportion of patients presenting with a heroin overdose steadily
increased from 2010–2015; the number of patients presenting to the emergency
department with nonheroin opioid overdoses steadily decreased. As rates of
heroin overdose increased each year, the incidence of HCV infection
increased dramatically. Conclusion: This study indicates that the incidence
of heroin overdoses has significantly increased over the last several years,
and the rates of HCV infection 4-fold since the start of the study period.
Patients admitted for nonheroin opioid overdose were more likely to be
admitted to the hospital and intensive care unit compared with those
admitted for heroin overdose. The rise in overdose events only further
illustrates a gap in our understanding of the cycle of addiction, drug
abuse, and overdose events.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
cohort analysis
drug use
female
hepatitis C
hospital admission
human
intensive care unit
major clinical study
male
retrospective study
university hospital
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170154816
PUI
L614599732
DOI
10.1002/phar.1902
FULL TEXT LINK
http://dx.doi.org/10.1002/phar.1902
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 145
TITLE
Review of Intranasally Administered Medications for Use in the Emergency
Department
AUTHOR NAMES
Bailey A.M.
Baum R.A.
Horn K.
Lewis T.
Morizio K.
Schultz A.
Weant K.
Justice S.N.
AUTHOR ADDRESSES
(Bailey A.M.; Baum R.A.; Horn K.; Morizio K.) Department of Pharmacy,
University of Kentucky HealthCare, Lexington, United States.
(Lewis T.; Schultz A.) Department of Pharmacy, Charleston Area Medical
Center, Charleston, United States.
(Weant K.) Department of Pharmacy, Medical University of South Carolina,
Charleston, United States.
(Justice S.N.) Department of Pharmacy, St. Claire Regional Medical Center,
Morehead, United States.
CORRESPONDENCE ADDRESS
A.M. Bailey, University of Kentucky HealthCare, Emergency Medicine, 800 Rose
Street, H110, Lexington, United States.
SOURCE
Journal of Emergency Medicine (2017) 53:1 (38-48). Date of Publication: 1
Jul 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Intranasal (IN) medication delivery is a viable alternative to
other routes of administration, including intravenous (IV) and intramuscular
(IM) administration. The IN route bypasses the risk of needle-stick injuries
and alleviates the emotional trauma that may arise from the insertion of an
IV catheter. Objective This review aims to evaluate published literature on
medications administered via the IN route that are applicable to practice in
emergency medicine. Discussion The nasal mucosa is highly vascularized, and
the olfactory tissues provide a direct conduit to the central nervous
system, bypass first-pass metabolism, and lead to an onset of action similar
to IV drug administration. This route of administration has also been shown
to decrease delays in drug administration, which can have a profound impact
in a variety of emergent scenarios, such as seizures, acutely agitated or
combative patients, and trauma management. IN administration of midazolam,
lorazepam, flumazenil, dexmedetomidine, ketamine, fentanyl, hydromorphone,
butorphanol, naloxone, insulin, and haloperidol has been shown to be a safe,
effective alternative to IM or IV administration. As the use of IN
medications becomes a more common route of administration in the emergency
department setting, and in prehospital and outpatient settings, it is
increasingly important for providers to become more familiar with the
nuances of this novel route of medication delivery. Conclusions IN
administration of the reviewed medications has been shown to be a safe and
effective alternative to IM or IV administration. Use of IN is becoming more
commonplace in the emergency department setting and in prehospital settings.
EMTREE DRUG INDEX TERMS
butorphanol (drug administration, intranasal drug administration)
dexmedetomidine (drug administration, drug dose, intranasal drug
administration)
fentanyl (drug administration, drug dose, intranasal drug administration)
flumazenil (drug administration, drug dose, intranasal drug administration)
haloperidol (drug administration, drug dose, intranasal drug administration)
hydromorphone (drug administration, drug dose, intranasal drug
administration)
insulin (drug administration, intranasal drug administration)
ketamine (drug administration, drug dose, intranasal drug administration)
lorazepam (drug administration, drug dose, intranasal drug administration)
midazolam (drug administration, drug dose, intranasal drug administration)
naloxone (drug administration, intranasal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency medicine
emergency ward
intranasal drug administration
EMTREE MEDICAL INDEX TERMS
analgesia
article
central nervous system
drug efficacy
drug safety
first pass effect
human
injury
nose mucosa
priority journal
randomized controlled trial (topic)
sedation
seizure
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
dexmedetomidine (113775-47-6)
fentanyl (437-38-7)
flumazenil (78755-81-4)
haloperidol (52-86-8, 1511-16-6)
hydromorphone (466-99-9, 71-68-1)
insulin (9004-10-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170161455
PUI
L614642474
DOI
10.1016/j.jemermed.2017.01.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2017.01.020
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 146
TITLE
Detection of carfentanil by LC-MS-MS and reports of associated fatalities in
the USA
AUTHOR NAMES
Shanks K.G.
Behonick G.S.
AUTHOR ADDRESSES
(Shanks K.G., kshanks@axisfortox.com; Behonick G.S.) Axis Forensic
Toxicology, 5780 W 71st Street, Indianapolis, United States.
CORRESPONDENCE ADDRESS
K.G. Shanks, Axis Forensic Toxicology, 5780 W 71st Street, Indianapolis,
United States. Email: kshanks@axisfortox.com
SOURCE
Journal of Analytical Toxicology (2017) 41:6 (466-472). Date of Publication:
1 Jul 2017
ISSN
1945-2403 (electronic)
0146-4760
BOOK PUBLISHER
Society of Forensic Toxicologists
ABSTRACT
Carfentanil is a mu (μ) opioid receptor agonist and is estimated to be
~10,000 times more potent than morphine in animal (non-human) models. It is
not approved for human use and is only used to immobilize large exotic
animals in veterinary medicine. In mid-2016, carfentanil emerged as a
contaminant in street heroin in the USA and was central to a large number of
emergency department visits and deaths. We describe an analytical method for
the detection and quantification of carfentanil in whole blood specimens via
a protein precipitation extraction with acetonitrile and liquid
chromatography with triple quadrupole mass spectrometry. From 1 September
2016 to 1 January 2017, carfentanil was identified in 262 postmortem blood
specimens. Blood concentrations ranged from 10.2 to 2,000 ng/L, with a mean
concentration equal to 193 ng/L and a median concentration equal to 98.4
ng/L. We describe 13 fatalities from the Midwest region (Indiana, Kentucky,
Michigan and Ohio) of the USA in which our laboratory performed
comprehensive toxicology and in which carfentanil was detected and
associated with cause of death. We recommend that any analytical method
applied to the detection of this substance in human whole blood specimens be
sufficiently sensitive to detect sub-100 ng/L concentrations and preferably
utilize a 10-50 ng/L reporting limit.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carfentanil (adverse drug reaction, drug analysis, drug concentration, drug
toxicity)
EMTREE DRUG INDEX TERMS
alprazolam
amitriptyline
atorvastatin
benzoylecgonine
buprenorphine
caffeine
clonidine
codeine
cotinine
dronabinol
fentanyl derivative
furanylfentanyl
gabapentin
hydromorphone
ibuprofen
lisinopril
morphine
naloxone
norbuprenorphine
nordazepam
norfentanyl
ondansetron
oxazepam
phenytoin
quetiapine
sertraline
temazepam
tetrahydrocannabinolic acid
tramadol
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug determination
drug intoxication (side effect, side effect)
liquid chromatography-mass spectrometry
quadrupole mass spectrometry
triple quadrupole mass spectrometry
EMTREE MEDICAL INDEX TERMS
adrenal cortex adenoma
adult
article
autopsy
cardiomegaly
case report
cause of death
clinical article
drug blood level
fatty liver
female
heart ventricle hypertrophy
human
limit of quantitation
lung congestion
lung edema
male
middle aged
retention time
splenomegaly
United States
urinalysis
DRUG TRADE NAMES
advil
catapres
dilantin
lipitor
neurontin
seroquel
ultram
xanax
zofran
zoloft
DRUG MANUFACTURERS
(Canada)Toronto Research Chemicals
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
amitriptyline (50-48-6, 549-18-8)
atorvastatin (134523-00-5, 134523-03-8)
benzoylecgonine (519-09-5)
buprenorphine (52485-79-7, 53152-21-9)
caffeine (58-08-2)
carfentanil (59708-52-0)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
codeine (76-57-3)
cotinine (486-56-6)
dronabinol (7663-50-5)
gabapentin (60142-96-3)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
lisinopril (76547-98-3, 83915-83-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
norbuprenorphine (78715-23-8)
nordazepam (1088-11-5)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
oxazepam (604-75-1)
phenytoin (57-41-0, 630-93-3)
quetiapine (111974-72-2)
sertraline (79617-96-2)
temazepam (846-50-4)
tetrahydrocannabinolic acid (23978-85-0, 37347-91-4)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170877092
MEDLINE PMID
28830120 (http://www.ncbi.nlm.nih.gov/pubmed/28830120)
PUI
L619722531
DOI
10.1093/jat/bkx042
FULL TEXT LINK
http://dx.doi.org/10.1093/jat/bkx042
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 147
TITLE
Confirmation of carfentanil, U-47700 and other synthetic opioids in a human
performance case by LC-MS-MS
AUTHOR NAMES
Seither J.
Reidy L.
AUTHOR ADDRESSES
(Seither J.; Reidy L., lreidy@med.miami.edu) Department of Pathology and
Laboratory Medicine, University of Miami Miller School of Medicine,
Rosenstiel Medical Science Building (RMSB), 1600 NW 10th Avenue, 7th Floor
Suite 7020 (R-5), Miami, United States.
CORRESPONDENCE ADDRESS
L. Reidy, Department of Pathology and Laboratory Medicine, University of
Miami Miller School of Medicine, Rosenstiel Medical Science Building (RMSB),
1600 NW 10th Avenue, 7th Floor Suite 7020 (R-5), Miami, United States.
Email: lreidy@med.miami.edu
SOURCE
Journal of Analytical Toxicology (2017) 41:6 (493-497). Date of Publication:
1 Jul 2017
ISSN
1945-2403 (electronic)
0146-4760
BOOK PUBLISHER
Society of Forensic Toxicologists
ABSTRACT
Recently, it has been documented that there has been a rise in synthetic
opioid abuse. Synthetic opioids are compounds that were created to act as
agonists for the opioid receptors. Like synthetic cannabinoids, most of
these compounds were created by research groups or pharmaceutical companies
in an attempt to find compounds that have medicinal use. Synthetic opioids
have severe health implications when abused that can include hospitalization
and death. Due to the high potency and the low dose required to produce the
desired effects for these compounds, it was hypothesized that they may not
be detectable in human performance case samples. However, this report
documents a male driver who was involved in a single-vehicle incident. First
responders treated the subject with naloxone as opioid drug impairment was
suspected and he was transported to the local emergency room. The subject
consented to a blood draw for a driving under the influence (DUI)
investigation. Initial routine testing identified alprazolam at 55 ng/mL and
fentanyl at less than 0.5 ng/mL. Further testing using a validated liquid
chromatography-tandem mass spectrometry (LC-MS-MS) assay, confirmed the
presence of carfentanil, furanyl fentanyl, parafluoroisobutyryl fentanyl,
U-47700 and its metabolite. To the author's knowledge, this is the first
report of a DUI cases where carfentanil, U-47700 and other synthetic opioids
were confirmed and described in a human performance blood sample. This case
demonstrates the need to supplement routine toxicological analyses with a
sensitive methodology that can detect synthetic opioids in human performance
cases where opioid use may be implicated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carfentanil (drug concentration)
drug metabolite (drug concentration)
fentanyl derivative (drug concentration)
furanyl fentanyl (drug concentration)
parafluoroisobutyryl fentanyl (drug concentration)
u 47700 (drug concentration)
EMTREE DRUG INDEX TERMS
alprazolam
naloxone
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
liquid chromatography-mass spectrometry
EMTREE MEDICAL INDEX TERMS
adult
article
blood sampling
case report
clinical article
drug blood level
forensic toxicology
human
male
substance use
DRUG TRADE NAMES
u 47700
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
carfentanil (59708-52-0)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170877095
MEDLINE PMID
28830119 (http://www.ncbi.nlm.nih.gov/pubmed/28830119)
PUI
L619722555
DOI
10.1093/jat/bkx049
FULL TEXT LINK
http://dx.doi.org/10.1093/jat/bkx049
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 148
TITLE
Emergency Department-Initiated Buprenorphine for Opioid Dependence with
Continuation in Primary Care: Outcomes During and After Intervention
AUTHOR NAMES
D’Onofrio G.
Chawarski M.C.
O’Connor P.G.
Pantalon M.V.
Busch S.H.
Owens P.H.
Hawk K.
Bernstein S.L.
Fiellin D.A.
AUTHOR ADDRESSES
(D’Onofrio G., gail.donofrio@yale.edu; Chawarski M.C.; Pantalon M.V.; Owens
P.H.; Hawk K.; Bernstein S.L.) Department of Emergency Medicine, Yale School
of Medicine, New Haven, United States.
(Chawarski M.C.) Department of Psychiatry, Yale School of Medicine, New
Haven, United States.
(O’Connor P.G.; Fiellin D.A.) Department of General Medicine, Yale School of
Medicine, New Haven, United States.
(Busch S.H.; Fiellin D.A.) Yale School of Public Health, New Haven, United
States.
CORRESPONDENCE ADDRESS
G. D’Onofrio, Department of Emergency Medicine, Yale School of Medicine, New
Haven, United States. Email: gail.donofrio@yale.edu
SOURCE
Journal of General Internal Medicine (2017) 32:6 (660-666). Date of
Publication: 1 Jun 2017
ISSN
1525-1497 (electronic)
0884-8734
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Background: Emergency department (ED)-initiated buprenorphine/naloxone with
continuation in primary care was found to increase engagement in addiction
treatment and reduce illicit opioid use at 30 days compared to referral only
or a brief intervention with referral. Objective: To evaluate the long-term
outcomes at 2, 6 and 12 months following ED interventions. Design:
Evaluation of treatment engagement, drug use, and HIV risk among a cohort of
patients from a randomized trial who completed at least one long-term
follow-up assessment. Participants: A total of 290/329 patients (88% of the
randomized sample) were included. The followed cohort did not differ
significantly from the randomized sample. Interventions: ED-initiated
buprenorphine with 10-week continuation in primary care, referral, or brief
intervention were provided in the ED at study entry. Main Measures:
Self-reported engagement in formal addiction treatment, days of illicit
opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months).
Key Results: A greater number of patients in the buprenorphine group were
engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65–83]
compared with referral [42/79 (53%), 95% CI 42–64] and brief intervention
[39/83 (47%), 95% CI 37–58; p < 0.001]. The differences were not significant
at 6 months [51/92 (55%), 95% CI 45–65; 46/70 (66%) 95% CI 54–76; 43/76
(57%) 95% CI 45–67; p = 0.37] or 12 months [42/86 (49%) 95% CI 39–59; 37/73
(51%) 95% CI 39–62; 49/78 (63%) 95% CI 52–73; p = 0.16]. At 2 months, the
buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI
0.6–1.6)] versus referral [1.8 (95% CI 1.2–2.3)] and brief intervention [2.0
(95% CI 1.5–2.6), p = 0.04]. No significant differences in illicit opioid
use were observed at 6 or 12 months. There were no significant differences
in HIV risk or rates of opioid-negative urine results at any time.
Conclusions: ED-initiated buprenorphine was associated with increased
engagement in addiction treatment and reduced illicit opioid use during the
2-month interval when buprenorphine was continued in primary care. Outcomes
at 6 and 12 months were comparable across all groups.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction (drug therapy, drug therapy)
primary medical care
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
drug use
evaluation study
female
follow up
human
Human immunodeficiency virus infection
infection risk
major clinical study
male
patient referral
patient-reported outcome
randomized controlled trial
treatment duration
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170119344
MEDLINE PMID
28194688 (http://www.ncbi.nlm.nih.gov/pubmed/28194688)
PUI
L614423753
DOI
10.1007/s11606-017-3993-2
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-017-3993-2
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 149
TITLE
Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency
Department: A Randomized Controlled Trial
AUTHOR NAMES
Bowers K.J.
McAllister K.B.
Ray M.
Heitz C.
AUTHOR ADDRESSES
(Bowers K.J., kbowers@emory.edu) Virginia Tech Carilion School of Medicine,
Roanoke, United States.
(Bowers K.J., kbowers@emory.edu; Heitz C.) Department of Emergency Medicine,
Emory University School of Medicine, Atlanta, United States.
(McAllister K.B.) Department of Pharmacy, Carilion Clinic, Roanoke, United
States.
(Heitz C.) Department of Emergency Medicine, Carilion Clinic, Roanoke,
United States.
(Ray M.) Department of Epidemiology, Biostatistics and Environmental Health,
University of Memphis, Memphis, United States.
CORRESPONDENCE ADDRESS
K.J. Bowers, Virginia Tech Carilion School of Medicine, Roanoke, United
States. Email: kbowers@emory.edu
SOURCE
Academic Emergency Medicine (2017) 24:6 (676-685). Date of Publication: 1
Jun 2017
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives: This study had five objectives: 1) to measure and compare total
opioid use and number of opioid doses in patients treated with opioids
versus ketamine in conjunction with opioids; 2) to measure pain scores up to
2 hours after presentation in the ED patient with pain, comparing standard
opioid pain control to ketamine in conjunction with opioids; 3) to compare
patient satisfaction with pain control using opioids alone versus ketamine
in conjunction with opioids; 4) to monitor and compare side effects in
patients treated with opioids versus ketamine in conjunction with opioids;
and 5) to identify effect variation between different subgroups of patients,
with the purpose of focusing future research. We hypothesized that low-dose
ketamine, compared to placebo, as an adjunctive treatment to opioids would
result in better pain control over 2 hours and greater patient satisfaction
with pain control; further, this protocol will result in a lower opioid
dosage over 2 hours. Methods: This was a randomized, double-blinded,
placebo-controlled trial at a single academic emergency department
evaluating the use of ketamine versus placebo in conjunction with opioids
for moderate to severe pain. Subjects with a continued high level of pain
after an initial dose of opioid analgesia were randomized to receive either
0.1 mg/kg ketamine or placebo prior to protocol-based dosing of additional
opioid analgesia, if required. Over 120 minutes, subjects were assessed for
pain level (0–10), satisfaction with pain control (0–4), side effects,
sedation level, and need for additional pain medication. Total opioid dose,
including the initial dose, was compared between groups. Results:
Sixty-three subjects were randomized to the placebo group and 53 to the
ketamine group. No significant differences were found in demographics
between the groups. Patients receiving ketamine reported lower pain scores
over 120 minutes than patients receiving placebo (p = 0.015). Total opioid
dose was lower in the ketamine group (mean ± SD = 9.95 ± 4.83 mg) compared
to placebo (mean ± SD = 12.81 ± 6.81 mg; p = 0.02). Satisfaction did not
differ between groups. Fewer patients in the ketamine group required
additional opioid doses. More patients reported light-headedness and
dizziness in the ketamine group. Conclusions: Ketamine, as an adjunct to
opioid therapy, was more effective at reducing pain over 120 minutes and
resulted in a lower total opioid dose as well as fewer repeat doses of
analgesia. More side effects were reported in the ketamine group (51% vs.
19%), but the side effect profile appears tolerable.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (adverse drug reaction, drug comparison - placebo, drug comparison,
drug dose, drug therapy)
morphine (drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl
hydromorphone
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
article
backache
controlled study
convenience sample
disorientation (side effect)
dizziness (side effect)
double blind procedure
emergency ward
euphoria
female
flank pain
hip pain
human
inguinal pain
injury
laceration
low drug dose
major clinical study
male
medical record review
nausea (side effect)
nystagmus (side effect)
outcome assessment
pain assessment
patient satisfaction
postoperative pain
priority journal
pruritus (side effect)
randomized controlled trial
side effect (side effect)
tinnitus (side effect)
xerostomia (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170240488
MEDLINE PMID
28177167 (http://www.ncbi.nlm.nih.gov/pubmed/28177167)
PUI
L615097948
DOI
10.1111/acem.13172
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13172
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 150
TITLE
Characteristics and Treatment of Patients with Clinical Illness Due to
Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC
Database Study
AUTHOR NAMES
Monte A.A.
Calello D.P.
Gerona R.R.
Hamad E.
Campleman S.L.
Brent J.
Wax P.
Carlson R.G.
AUTHOR ADDRESSES
(Monte A.A., andrew.monte@ucdenver.edu; Brent J.) Department of Emergency
Medicine, University of Colorado School of Medicine, Aurora, United States.
(Monte A.A., andrew.monte@ucdenver.edu) Rocky Mountain Poison and Drug
Center, Denver Health and Hospital Authority, Denver, United States.
(Calello D.P.) New Jersey Poison Information and Education System, Rutgers
Biomedical and Health Sciences, Department of Emergency Medicine, New Jersey
Medical School, Newark, United States.
(Gerona R.R.) Department of Laboratory Medicine, University of
California-San Francisco, San Francisco, United States.
(Hamad E.) Department of Emergency Medicine, University of Massachusetts,
Worcester, United States.
(Campleman S.L.; Brent J.) Toxicology Investigators Consortium, American
College of Medical Toxicology, Phoenix, United States.
(Wax P.) Southwestern Medical School, University of Texas, Dallas, United
States.
(Carlson R.G.) Department of Community Health, Wright State University
Boonshoft School of Medicine, Dayton, United States.
()
CORRESPONDENCE ADDRESS
A.A. Monte, Department of Emergency Medicine, University of Colorado School
of Medicine, Aurora, United States. Email: andrew.monte@ucdenver.edu
SOURCE
Journal of Medical Toxicology (2017) 13:2 (146-152). Date of Publication: 1
Jun 2017
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Introduction : Synthetic cannabinoid (SC) abuse has resulted in numerous
outbreaks of severe clinical illness across the United States over the past
decade. The primary objective of this study was to determine the clinical
characteristics of patients abusing SC requiring bedside consultation by
medical toxicologists. Methods: This was a multicenter analysis from a
prospectively collected cohort of patients presenting to medical care after
synthetic cannabinoid exposure, utilizing the ToxIC Registry. Management of
cases by medical toxicologists in this cohort occurred in emergency
departments, inpatient medical floors, and intensive care units. Cases were
identified from January 5, 2010 – July 31, 2015. We characterized the
clinical presentations, treatments, outcomes, and sociologic factors
associated with SC use in these patients. Results: Medical toxicologists
participating in the ToxIC Registry cared for 39,925 cases between 2010 and
2015. Three hundred fifty three of these cases were determined to be SC
toxicity. The median age of patients was 25 (IQR: 18, 36) and the majority
were males (84%). The most common symptoms were agitation, delirium and
toxic psychosis, n=146 (41%). Forty-four (12.5%) had heart rates above 140
beats per minute. Bradycardia was the second most commonly reported severe
vital sign abnormality with 20 (5.7%) having heart rates of less than 50
beats per minute. Fifteen (4.2%) patients had hypotension. Fifty-nine (17%)
had seizures. The most common pharmacologic treatment provided was
benzodiazepines (n=131, 37%) followed by antipsychotics (n=36,
10%).Disposition was available for 276; of these 167 (61%) were managed in
the emergency department, 42 (15%) were admitted to the hospital floor, and
67 (24%) were admitted to the ICU. Conclusions: Synthetic cannabinoids are
associated with severe central nervous system and cardiovascular effects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabinoid (drug toxicity)
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug therapy)
anticonvulsive agent (drug therapy)
benzodiazepine (drug therapy)
cannabis
hypertensive agent (drug therapy)
methamphetamine (drug therapy)
naloxone
neuroleptic agent
neuromuscular blocking agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
illicit drug inhalation
EMTREE MEDICAL INDEX TERMS
acute kidney failure
adolescent
adult
aged
agitation
article
artificial ventilation
bradycardia
central nervous system depression
child
cohort analysis
coma
delirium
drug exposure
female
hallucination
heart arrhythmia (drug therapy)
heart rate
human
hyperthermia
hypotension (drug therapy)
major clinical study
male
multicenter study
preschool child
prospective study
psychosis
respiration depression
rhabdomyolysis
school child
seizure (drug therapy)
tachycardia
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
benzodiazepine (12794-10-4)
cannabis (8001-45-4, 8063-14-7)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170266353
MEDLINE PMID
28397128 (http://www.ncbi.nlm.nih.gov/pubmed/28397128)
PUI
L615300071
DOI
10.1007/s13181-017-0605-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-017-0605-9
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 151
TITLE
Capsule Commentary on D’Onofrio et al., Emergency Department-Initiated
Buprenorphine for Opioid Dependence with Continuation in Primary Care:
Outcomes During and After Intervention
AUTHOR NAMES
Murimi I.B.
AUTHOR ADDRESSES
(Murimi I.B., imurimi1@jhmi.edu) Center for Drug Safety and Effectiveness,
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, United States.
CORRESPONDENCE ADDRESS
I.B. Murimi, Center for Drug Safety and Effectiveness, Department of
Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,
United States. Email: imurimi1@jhmi.edu
SOURCE
Journal of General Internal Medicine (2017) 32:6 (683). Date of Publication:
1 Jun 2017
ISSN
1525-1497 (electronic)
0884-8734
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
emergency care
opiate addiction (drug therapy, drug therapy)
primary medical care
EMTREE MEDICAL INDEX TERMS
article
drug use
emergency ward
health care policy
human
Human immunodeficiency virus infection
infection risk
patient referral
self report
toxicity testing
treatment outcome
urinalysis
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170157593
PUI
L614614500
DOI
10.1007/s11606-017-4015-0
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-017-4015-0
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 152
TITLE
Low dose ketamine in the age of opioids
AUTHOR NAMES
Sobel R.M.
Steck A.R.
AUTHOR ADDRESSES
(Sobel R.M., rsobel@aol.com) Southern Regional Medical Center, Riverdale,
United States.
(Steck A.R.) Department of Emergency Medicine, Emory University, Atlanta,
United States.
CORRESPONDENCE ADDRESS
R.M. Sobel, Southern Regional Medical Center, Riverdale, United States.
Email: rsobel@aol.com
SOURCE
American Journal of Emergency Medicine (2017) 35:6 (917-918). Date of
Publication: 1 Jun 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain (drug therapy)
drug abuse
emergency physician
emergency ward
human
letter
low drug dose
medical decision making
patient safety
prescription
priority journal
CAS REGISTRY NUMBERS
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170243204
MEDLINE PMID
28366283 (http://www.ncbi.nlm.nih.gov/pubmed/28366283)
PUI
L615119391
DOI
10.1016/j.ajem.2017.03.062
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.03.062
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 153
TITLE
Predictors of Chronic Opioid Use in Newly Diagnosed Crohn's Disease
AUTHOR NAMES
Pauly N.J.
Michailidis L.
Kindred M.G.
Flomenhoft D.
Lofwall M.R.
Walsh S.L.
Talbert J.C.
Barrett T.A.
AUTHOR ADDRESSES
(Pauly N.J.; Talbert J.C.) University of Kentucky College of Pharmacy,
Institute for Pharmaceutical Outcomes and Policy, Lexington, United States.
(Michailidis L., michailidis@uky.edu) University of Kentucky College of
Medicine, Department of Internal Medicine, 800 Rose Street, MN649 Medical
Science Building, Lexington, United States.
(Kindred M.G.; Lofwall M.R.) University of Kentucky College of Medicine,
Department of Psychiatry, Lexington, United States.
(Flomenhoft D.; Barrett T.A.) University of Kentucky College of Medicine,
Department of Digestive Diseases and Nutrition, Lexington, United States.
(Walsh S.L.) University of Kentucky, Center on Drugs and Alcohol Research,
Lexington, United States.
CORRESPONDENCE ADDRESS
L. Michailidis, University of Kentucky College of Medicine, Department of
Internal Medicine, 800 Rose Street, MN649 Medical Science Building,
Lexington, United States. Email: michailidis@uky.edu
SOURCE
Inflammatory Bowel Diseases (2017) 23:6 (1004-1010). Date of Publication: 1
Jun 2017
ISSN
1536-4844 (electronic)
1078-0998
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Background and Aims: Patients with Crohn's disease (CD) are often prescribed
opioids chronically to manage pain associated with their disease. However,
little evidence exists to support this practice. Here, we examine newly
diagnosed patients with CD with and without chronic opioid use (COU) and
sought to identify predictors and consequences of COU. Methods: A nationally
representative administrative health care claims that data set identified
newly diagnosed patients with CD. Their data were examined during the
periods 6 months before and 2 years after diagnosis. Multivariable logistic
regression was used to assess predictors of COU at diagnosis. Results: The
final study cohort consisted of 47,164 patients with CD. Of them, 3.8% were
identified with new COU. Chronic opioid users were more likely women, older,
and likely who had more surgeries, endoscopies, admissions, and medication
usage compared with other patients. Features detected before CD diagnosis
that correlated with COU after diagnosis included previous opioid use (odds
ratio [OR] = 6.6), chronic pain (OR = 1.36), arthritis (OR = 1.95), and
mental disorders (OR = 1.58). Interestingly, emergency department visits
before CD Dx increased the risk of COU (OR = 1.11), whereas endoscopy
reduced COU risk (OR = 0.88). Conclusions: This study presents a nationally
representative assessment of COU in newly diagnosed patients with CD. The
results may be used to determine the impact of COU in this population and to
alert clinicians to those patients with CD at high risk of COU. Chronic
opioids are consistently associated with indicators of more severe disease;
however, additional research is needed to determine whether COU drives
disease severity or vice versa.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Crohn disease (diagnosis)
EMTREE MEDICAL INDEX TERMS
arthritis
article
chronic pain
emergency ward
female
health care
health care utilization
hospital admission
human
major clinical study
male
mental disease
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170387116
MEDLINE PMID
28368908 (http://www.ncbi.nlm.nih.gov/pubmed/28368908)
PUI
L616492574
DOI
10.1097/MIB.0000000000001087
FULL TEXT LINK
http://dx.doi.org/10.1097/MIB.0000000000001087
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 154
TITLE
Among opioid-naive patients receiving opioids, more intensive opioid
prescribing in the first month is associated with transition to long-term
opioid use
AUTHOR NAMES
Larochelle M.R.
AUTHOR ADDRESSES
(Larochelle M.R., marc.larochelle@bmc.org) Department of Medicine, Section
of General Internal Medicine, Boston University, School of Medicine, Boston
Medical Center, 801 Massachusetts Avenue, Boston, United States.
CORRESPONDENCE ADDRESS
M.R. Larochelle, Department of Medicine, Section of General Internal
Medicine, Boston University, School of Medicine, Boston Medical Center, 801
Massachusetts Avenue, Boston, United States. Email: marc.larochelle@bmc.org
SOURCE
Evidence-Based Medicine (2017) 22:3 (112). Date of Publication: 1 Jun 2017
ISSN
1473-6810 (electronic)
1356-5524
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
chronic pain (drug therapy, drug therapy)
long term care
prescription
transitional care
EMTREE MEDICAL INDEX TERMS
age
emergency ward
hospital discharge
human
incidence
major clinical study
note
outcome assessment
retrospective study
risk assessment
sensitivity analysis
systematic review (topic)
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170426318
MEDLINE PMID
28501803 (http://www.ncbi.nlm.nih.gov/pubmed/28501803)
PUI
L616785323
DOI
10.1136/ebmed-2017-110710
FULL TEXT LINK
http://dx.doi.org/10.1136/ebmed-2017-110710
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 155
TITLE
Atrial fibrillation following synthetic cannabinoid abuse
AUTHOR NAMES
Efe T.H.
Felekoglu M.A.
Çimen T.
Doǧan M.
AUTHOR ADDRESSES
(Efe T.H., medisay@gmail.com; Felekoglu M.A.; Çimen T.; Doǧan M.) Department
of Cardiology, Dişkapi Yildirim Beyazit Training and Research Hospital,
Ankara, Turkey.
CORRESPONDENCE ADDRESS
T.H. Efe, Dişkapi Yildirim Beyazit Eǧitim Ve Araştirma Hastanesi,
Kardiyoloji Kliniǧi, Ankara, Turkey. Email: medisay@gmail.com
SOURCE
Turk Kardiyoloji Dernegi Arsivi (2017) 45:4 (362-364). Date of Publication:
1 Jun 2017
ISSN
1308-4488 (electronic)
1016-5169
BOOK PUBLISHER
Turkish Society of Cardiology, kareyayincilik@gmail.com
ABSTRACT
Summary- Marijuana and its synthetic forms, called synthetic cannabinoids
(SCs), are used as recreational drugs. Bonzai is a kind of SC. Adverse
cardiovascular events have been reported with abuse of marijuana and SCs,
including arrhythmia, myocardial infarction, and sudden cardiac death.
Presently described is a case of a 23-year-old, previously healthy man, who
was admitted to the emergency department with atrial fibrillation after
Bonzai abuse. Sinus rhythm was restored during observation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bonzai (drug toxicity)
cannabinoid (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
oxygen (drug therapy, intranasal drug administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
atrial fibrillation (diagnosis)
drug abuse
EMTREE MEDICAL INDEX TERMS
adult
article
case report
confusion
dyspnea (drug therapy)
electrocardiogram
heart palpitation
human
leukocytosis
male
opiate addiction (drug therapy)
physical examination
sinus rhythm
tachycardia
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Turkish
EMBASE ACCESSION NUMBER
20170416480
MEDLINE PMID
28595208 (http://www.ncbi.nlm.nih.gov/pubmed/28595208)
PUI
L616709838
DOI
10.5543/tkda.2016.70367
FULL TEXT LINK
http://dx.doi.org/10.5543/tkda.2016.70367
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 156
TITLE
Continuous femoral nerve catheters decrease opioid-related side effects and
increase home disposition rates among geriatric hip fracture patients
AUTHOR NAMES
Arsoy D.
Gardner M.J.
Amanatullah D.F.
Huddleston J.I.
Goodman S.B.
Maloney W.J.
Bishop J.A.
AUTHOR ADDRESSES
(Arsoy D., diren.arsoy@gmail.com; Gardner M.J.; Amanatullah D.F.; Huddleston
J.I.; Goodman S.B.; Maloney W.J.; Bishop J.A.) Department of Orthopaedic
Surgery, Stanford University, School of Medicine, 450 Broadway St, Redwood
City, United States.
CORRESPONDENCE ADDRESS
D. Arsoy, Department of Orthopaedic Surgery, Stanford University, School of
Medicine, 450 Broadway St, Redwood City, United States. Email:
diren.arsoy@gmail.com
SOURCE
Journal of Orthopaedic Trauma (2017) 31:6 (e186-e189). Date of Publication:
1 Jun 2017
ISSN
1531-2291 (electronic)
0890-5339
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objective: To evaluate the effect of continuous femoral nerve catheter
(CFNC) for postoperative pain control in geriatric proximal femur fractures
compared with standard analgesia (SA) treatment. Design: Retrospective
comparative study. Setting: Academic Level 1 trauma center.
Patients/Participants: We retrospectively identified 265 consecutive
geriatric hip fracture patients who underwent surgical treatment.
Intervention: One hundred forty-nine patients were treated with standard
analgesia without nerve catheter whereas 116 patients received an indwelling
CFNC. Main Outcome Measurement: Daily average preoperative and postoperative
pain scores, daily morphine equivalent consumption, opioid-related side
effects and discharge disposition. Results: Patients with CFNC patients
reported lower average pain scores preoperatively (1.9 ± 1.7 for CFNC vs.
4.7 ± 2 for SA; P < 0.0001), on postoperative day 1 (1.5 ± 1.6 for CFNC vs.
3 ± 1.7 for SA; P < 0.0001) and postoperative day 2 (1.2 ± 1.5 for CFNC vs.
2.6 ± 2.1 for SA; P < 0.0001). CFNC group consumed 39% less morphine
equivalents on postoperative day 1 (4.4 ± 5.8 mg for CFNC vs. 7.2 ± 10.8 mg
for SA; P = 0.005) and 50% less morphine equivalent on postoperative day 2
(3.4 ± 4.4 mg for CFNC vs. 6.8 ± 13 mg for SA; P = 0.105). Patients with
CFNC had a lower rate of opioid-related side effects compared with patients
with SA (27.5% for CFNC vs. 47% for SA; P = 0.001). More patients with CFNC
were discharged to home with or without health services than patients with
SA (15% for CFNC vs. 6% for SA; P = 0.023). Conclusion: Continuous femoral
nerve catheter decreased daily average patient-reported pain scores,
narcotic consumption while decreasing the rate of opioid-related side
effects. Patients with CFNC were discharged to home more frequently. Level
of Evidence: Therapeutic Level III. See Instructions for Authors for a
complete description of levels of evidence.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
continuous femoral nerve catheter
indwelling catheter
postoperative analgesia
postoperative pain (drug therapy, drug therapy, therapy)
proximal femur fracture (surgery)
EMTREE MEDICAL INDEX TERMS
aged
arthroplasty
article
comparative study
emergency health service
female
follow up
geriatric patient
health service
human
ileus (side effect)
length of stay
major clinical study
male
osteosynthesis
outcome assessment
pain assessment
postoperative delirium (side effect)
postoperative nausea and vomiting (side effect)
priority journal
respiration depression (side effect)
retrospective study
urine retention (side effect)
very elderly
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Gerontology and Geriatrics (20)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170380989
MEDLINE PMID
28538458 (http://www.ncbi.nlm.nih.gov/pubmed/28538458)
PUI
L616454198
DOI
10.1097/BOT.0000000000000854
FULL TEXT LINK
http://dx.doi.org/10.1097/BOT.0000000000000854
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 157
TITLE
Opioid prescribing by emergency physicians and risk of long-term use
AUTHOR NAMES
Menchine M.
Kea B.
AUTHOR ADDRESSES
(Menchine M., menchine@usc.edu) Keck School of Medicine, University of
Southern California, Los Angeles, United States.
(Kea B.) Oregon Health and Science University, Portland, United States.
CORRESPONDENCE ADDRESS
M. Menchine, Keck School of Medicine, University of Southern California, Los
Angeles, United States. Email: menchine@usc.edu
SOURCE
New England Journal of Medicine (2017) 376:19 (1895). Date of Publication:
11 May 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic drug administration
emergency physician
prescription
EMTREE MEDICAL INDEX TERMS
drug megadose
drug use
emergency ward
human
letter
priority journal
risk assessment
treatment duration
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170358279
MEDLINE PMID
28489998 (http://www.ncbi.nlm.nih.gov/pubmed/28489998)
PUI
L616160367
DOI
10.1056/NEJMc1703338
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMc1703338
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 158
TITLE
Opioid prescribing by emergency physicians and risk of long-term use
AUTHOR NAMES
Beaudoin F.L.
Rich J.D.
AUTHOR ADDRESSES
(Beaudoin F.L., francesca_beaudoin@brown.edu; Rich J.D.) Warren Alpert
Medical School of Brown University, Providence, United States.
SOURCE
New England Journal of Medicine (2017) 376:19 (1895-1896). Date of
Publication: 11 May 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
prescription
EMTREE MEDICAL INDEX TERMS
ecological fallacy
human
letter
priority journal
risk benefit analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170357055
MEDLINE PMID
28492072 (http://www.ncbi.nlm.nih.gov/pubmed/28492072)
PUI
L616160371
DOI
10.1056/NEJMc1703338
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMc1703338
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 159
TITLE
Opioid prescribing by emergency physicians and risk of long-term use
AUTHOR NAMES
Barnett M.L.
Olenksi A.R.
Jena A.B.
AUTHOR ADDRESSES
(Barnett M.L., mbarnett@hsph.harvard.edu) Harvard T.H. Chan School of Public
Health, Boston, United States.
(Olenksi A.R.; Jena A.B.) Harvard Medical School, Boston, United States.
CORRESPONDENCE ADDRESS
M.L. Barnett, Harvard T.H. Chan School of Public Health, Boston, United
States. Email: mbarnett@hsph.harvard.edu
SOURCE
New England Journal of Medicine (2017) 376:19 (1895-1896). Date of
Publication: 11 May 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
long term care
prescription
EMTREE MEDICAL INDEX TERMS
case mix
clinical practice
correlation analysis
depression
disability
effect size
emergency ward
health care delivery
human
letter
patient safety
priority journal
risk assessment
selection bias
shift worker
treatment duration
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170358205
MEDLINE PMID
28489999 (http://www.ncbi.nlm.nih.gov/pubmed/28489999)
PUI
L616160375
DOI
10.1056/NEJMc1703338
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMc1703338
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 160
TITLE
Curbing the epidemic of fatal opioid abuse
AUTHOR NAMES
Bitanihirwe B.K.Y.
AUTHOR ADDRESSES
(Bitanihirwe B.K.Y., bbitanih@psych.umaryland.edu) Department of Psychiatry,
University of Maryland School of Medicine, Baltimore, United States.
(Bitanihirwe B.K.Y., bbitanih@psych.umaryland.edu) Centre for Public Health
Initiatives, University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
B.K.Y. Bitanihirwe, Department of Psychiatry, University of Maryland School
of Medicine, Baltimore, United States. Email: bbitanih@psych.umaryland.edu
SOURCE
Journal of Substance Use (2017) 22:3 (242-243). Date of Publication: 4 May
2017
ISSN
1475-9942 (electronic)
1465-9891
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
codeine
diamorphine
fentanyl
morphine
naloxone
oxycodone
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
epidemic
opiate addiction
EMTREE MEDICAL INDEX TERMS
drug intoxication
drug utilization review
emergency ward
food and drug administration
human
letter
medical education
medical school
mental health service
neonatal abstinence syndrome
prescription
preventive health service
priority journal
public health problem
risk factor
social status
world health organization
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160910805
PUI
L613689161
DOI
10.1080/14659891.2016.1217091
FULL TEXT LINK
http://dx.doi.org/10.1080/14659891.2016.1217091
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 161
TITLE
Rates of Hospital and Emergency Department Attendances in Opiate-dependent
Patients Treated with Implant Naltrexone, Methadone, or Buprenorphine
AUTHOR NAMES
Kelty E.
Hulse G.
AUTHOR ADDRESSES
(Kelty E., erin.kelty@uwa.edu.au; Hulse G.) School of Psychiatry and
Clinical Neurosciences, University of Western Australia, Stirling Highway,
Crawley, Australia.
(Kelty E., erin.kelty@uwa.edu.au) School of Population Health, University of
Western Australia, Crawley, Australia.
CORRESPONDENCE ADDRESS
E. Kelty, School of Psychiatry and Clinical Neurosciences, University of
Western Australia, Stirling Highway, Crawley, Australia. Email:
erin.kelty@uwa.edu.au
SOURCE
Addictive Disorders and their Treatment (2017) 16:2 (39-48). Date of
Publication: 1 May 2017
ISSN
1531-5754
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objective: To compare rates of hospital and emergency department (ED)
attendance in opiate-dependent patients treated implant naltrexone, with
patients treated with methadone and buprenorphine. Materials and Methods:
Treatment records for opiate-dependent patients treated with implant
naltrexone, methadone, or buprenorphine were linked with routine,
prospectively collected health data sets. Rates of hospital and ED
attendances were calculated for each cohort and compared using generalized
estimating equations. Results: Following the commencement of treatment,
rates of hospitalizations was significantly higher in patients treated with
implant naltrexone compared with both methadone [risk ratio (RR), 0.83,
confidence interval (CI), 0.77-0.89] and buprenorphine (RR, 0.92, CI,
0.85-0.99), as were rates of ED attendances in methadone-treated patients
(RR, 0.85, CI, 0.78-0.92), whereas rates of ED attendances in buprenorphine
patients were comparable (RR, 0.92, CI, 0.85-1.01). The difference was
largely attributable to the induction period (0 to 28 d), where rates of
hospital and ED attendances in naltrexone-treated patients were almost
double that of both methadone and buprenorphine. However, after the initial
period and following the cessation of treatment, rates of hospital and ED
attendances in naltrexone-treated patients were less than or equivalent to
methadone or buprenorphine patients. Conclusions: Rates of morbidity in
opiate-dependent patients treated with implant naltrexone were significantly
elevated compared with methadone and buprenorphine in the first 28 days of
treatment, however, are comparable after this initial period.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug comparison, drug therapy)
methadone (drug comparison, drug therapy)
naltrexone (drug comparison, drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
demography
emergency ward
female
hospital admission
hospitalization
human
major clinical study
male
morbidity
priority journal
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170142403
PUI
L614533576
DOI
10.1097/ADT.0000000000000101
FULL TEXT LINK
http://dx.doi.org/10.1097/ADT.0000000000000101
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 162
TITLE
The Impact of Prescription Drug Monitoring Programs and Prescribing
Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey
AUTHOR NAMES
Pomerleau A.C.
Nelson L.S.
Hoppe J.A.
Salzman M.
Weiss P.S.
Perrone J.
AUTHOR ADDRESSES
(Pomerleau A.C.) Department of Emergency Medicine, Emory University School
of Medicine, Atlanta, Georgia, USA
(Nelson L.S.) Department of Emergency Medicine, New York University School
of Medicine, New York, USA
(Hoppe J.A.) Department of Emergency Medicine, University of Colorado,
Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver, Colorado,
USA
(Salzman M.) Department of Emergency Medicine, Cooper Medical School at
Rowan University, Camden, New Jersey, USA
(Weiss P.S.) Rollins School of Public Health, Emory University, Atlanta,
Georgia, USA
(Perrone J.) Department of Emergency Medicine, Perelman School of Medicine
at the University of Pennsylvania, Philadelphia, USA
SOURCE
Pain medicine (Malden, Mass.) (2017) 18:5 (889-897). Date of Publication: 1
May 2017
ISSN
1526-4637 (electronic)
ABSTRACT
Methods: This was a multi-center cross-sectional Web-based survey of ED
providers who prescribe OA. Respondents were asked about their OA
prescribing decisions, their use of PDMPs, and their use of prescribing
guidelines. Data was analyzed using descriptive statistics and chi-square
tests of association were used to assess the relationship between providers'
opioid prescribing decisions and independent covariates.Results: The total
survey population was 957 individuals and 515 responded to the survey for an
overall response rate of 54%. The frequency respondents prescribed different
types of pain medication was variable between centers. of respondents were
registered to access a PDMP, and were not aware whether their state had a
PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines,
while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing
guidelines. No significant differences in OA prescribing decisions were
found between groups either by use of PDMP or by guideline
adherence.Conclusions: In this multi-center survey study of ED clinicians,
OA prescribing varied between centers The utilization of prescribing
guidelines and PDMPs was not associated with differences in OA prescribing
decisions.Objective: Emergency department (ED) providers are high volume but
low quantity prescribers of opioid analgesics (OA). Few studies have
examined differences in opioid prescribing decisions specifically among ED
providers. The aim of this study was to describe OA prescribing decisions of
ED providers at geographically diverse centers, including utilization of
prescribing guidelines and prescription drug monitoring programs (PDMP).
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
standards
utilization
EMTREE MEDICAL INDEX TERMS
adult
analgesia
clinical practice
clinical trial
drug monitoring
epidemiology
female
hospital emergency service
human
male
medication overuse (prevention)
middle aged
multicenter study
prescription
prescription drug monitoring program
protocol compliance
statistics and numerical data
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26995800 (http://www.ncbi.nlm.nih.gov/pubmed/26995800)
PUI
L621187705
DOI
10.1093/pm/pnw032
FULL TEXT LINK
http://dx.doi.org/10.1093/pm/pnw032
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 163
TITLE
Use of Intranasal Naloxone by Basic Life Support Providers
AUTHOR NAMES
Weiner S.G.
Mitchell P.M.
Temin E.S.
Langlois B.K.
Dyer K.S.
AUTHOR ADDRESSES
(Weiner S.G.; Mitchell P.M.; Temin E.S.; Langlois B.K.; Dyer K.S.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2017)
21:3 (322-326). Date of Publication: 1 May 2017
ISSN
1545-0066 (electronic)
ABSTRACT
STUDY OBJECTIVES: Intranasal delivery of naloxone to reverse the effects of
opioid overdose by Advanced Life Support (ALS) providers has been studied in
several prehospital settings. In 2006, in response to the increase in
opioid-related overdoses, a special waiver from the state allowed
administration of intranasal naloxone by Basic Life Support (BLS) providers
in our city. This study aimed to determine: 1) if patients who received a
2-mg dose of nasal naloxone administered by BLS required repeat dosing while
in the emergency department (ED), and 2) the disposition of these
patients.METHODS: This was a retrospective review of patients transported by
an inner-city municipal ambulance service to one of three academic medical
centers. We included patients aged 18 and older that were transported by
ambulance between 1/1/2006 and 12/12/2012 and who received intranasal
naloxone by BLS providers as per a state approved protocol. Site
investigators matched EMS run data to patients from each hospital's EMR and
performed a chart review to confirm that the patient was correctly
identified and to record the outcomes of interest. Descriptive statistics
were then generated.RESULTS: A total of 793 patients received nasal naloxone
by BLS and were transported to three hospitals. ALS intervened and
transported 116 (14.6%) patients, and 11 (1.4%) were intubated in the field.
There were 724 (91.3%) patients successfully matched to an ED chart.
Hospital A received 336 (46.4%) patients, Hospital B received 210 (29.0%)
patients, and Hospital C received 178 (24.6%) patients. Mean age was 36.2
(SD 10.5) years and 522 (72.1%) were male; 702 (97.1%) were reported to have
abused heroin while 21 (2.9%) used other opioids. Nasal naloxone had an
effect per the prehospital record in 689 (95.2%) patients. An additional
naloxone dose was given in the ED to 64 (8.8%) patients. ED dispositions
were: 507 (70.0%) discharged, 105 (14.5%) admitted, and 112 (15.5%) other
(e.g., left against medical advice, left without being seen, or
transferred).CONCLUSIONS: Only a small percentage of patients receiving
prehospital administration of nasal naloxone by BLS providers required
additional doses of naloxone in the ED and the majority of patients were
discharged.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
EMTREE MEDICAL INDEX TERMS
adult
drug overdose (drug therapy)
emergency health service
female
human
intranasal drug administration
long term care
male
resuscitation
retrospective study
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28166446 (http://www.ncbi.nlm.nih.gov/pubmed/28166446)
PUI
L617078993
DOI
10.1080/10903127.2017.1282562
FULL TEXT LINK
http://dx.doi.org/10.1080/10903127.2017.1282562
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 164
TITLE
Severe Carisoprodol Withdrawal After a 14-Year Addiction and Acute Overdose
AUTHOR NAMES
Vo K.T.
Horng H.
Smollin C.G.
Benowitz N.L.
AUTHOR ADDRESSES
(Vo K.T.; Smollin C.G.) Department of Emergency Medicine, University of
California, San Francisco, San Francisco, United States.
(Vo K.T.; Smollin C.G.; Benowitz N.L.) California Poison Control System, San
Francisco Division, San Francisco, United States.
(Horng H.) Department of Laboratory Medicine, University of California, San
Francisco, San Francisco, United States.
(Benowitz N.L.) Department of Clinical Pharmacy, University of California,
San Francisco, San Francisco, United States.
CORRESPONDENCE ADDRESS
K.T. Vo, Department of Emergency Medicine, University of California, San
Francisco, 2789 25(th) Street, Suite 2202, Box 1369, San Francisco, United
States.
SOURCE
Journal of Emergency Medicine (2017) 52:5 (680-683). Date of Publication: 1
May 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Carisoprodol, a centrally acting muscle relaxant with a high
abuse potential, has barbiturate-like properties at the GABA-A receptor,
leading to central nervous system depression and desired effects. Its
tolerance and dependence has been previously demonstrated in an animal
model, and withdrawal has been described in several recent case reports.
Many cases can be effectively managed with a short course of benzodiazepines
or antipsychotic agents. However, abrupt cessation in a patient with a
history of long-term and high-dose carisoprodol abuse may result in symptoms
that are more difficult for providers to treat. Case Report We present a
case of a 34-year-old man with a long history of carisoprodol abuse who was
found unresponsive after having ingested 7.5 grams of carisoprodol. He was
intubated and admitted to the intensive care unit. He was given propofol,
dexmedetomidine, fentanyl, ketamine, lorazepam, midazolam, quetiapine, and
haloperidol, some at high-dose infusions, before his agitation and
ventilator asynchrony could be controlled. His improvement coincided with
the addition of carisoprodol and phenobarbital to his treatment regimen. Why
Should an Emergency Physician Be Aware of This? Trends show increasing
emergency department presentations for drug-related disorders and treatment.
This case highlights an uncommon case of carisoprodol withdrawal that may be
encountered by emergency physicians, and demonstrates that benzodiazepines
may not be sufficient to suppress severe withdrawal symptoms. Treatment with
carisoprodol and phenobarbital provided additional benefit and
can be considered in cases of severe carisoprodol withdrawal.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carisoprodol (drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
dexmedetomidine
fentanyl
haloperidol
ketamine
lorazepam
meprobamate
midazolam (intravenous drug administration)
naloxone
oxygen (endogenous compound)
phenobarbital (intravenous drug administration)
phenytoin
propofol
quetiapine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute disease
drug dependence
withdrawal syndrome (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
agitation
article
case report
central nervous system depression
disease severity
drug abuse
drug dose reduction
drug intoxication (drug therapy)
drug overdose
emergency physician
emergency ward
human
intensive care unit
long term care
lung auscultation
male
muscle twitch
outpatient department
oxygen saturation
physical examination
priority journal
respiratory distress
sinus tachycardia
wheezing
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
carisoprodol (78-44-4)
dexmedetomidine (113775-47-6)
fentanyl (437-38-7)
haloperidol (52-86-8, 1511-16-6)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
meprobamate (57-53-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
propofol (2078-54-8)
quetiapine (111974-72-2)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170035637
PUI
L614032599
DOI
10.1016/j.jemermed.2016.11.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.11.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 165
TITLE
Do opioids, sedatives and proton-pump inhibitors increase the risk of
fractures?
AUTHOR NAMES
Thorsdottir G.
Benedikz E.
Thorgeirsdottir S.A.
Johannsson M.
AUTHOR ADDRESSES
(Thorsdottir G.; Benedikz E.; Thorgeirsdottir S.A.; Johannsson M.)
SOURCE
Laeknabladid (2017) 103:5 (231-235). Date of Publication: 1 May 2017
ISSN
0023-7213
ABSTRACT
INTRODUCTION: A pharmacoepidemiological study was conducted to analyse the
relationship between bone fracture and the use of certain
drugs.MATERIAL/METHODS: The study includes patients 40 years and older,
diagnosed with bone fractures in the Emergency Department of Landspitali
University Hospital in Reykjavik, Iceland, during a 10-year period
(2002-2011). Also were included those who picked up from a pharmacy 90 DDD
or more per year of the drugs included in the study in the capital region of
Iceland during same period. Opiates, benzodiazepines/hypnotics (sedatives)
were compared with HMG-CoA reductase inhibitors (statins), non-steroid
anti-inflammatory drugs (NSAID) and beta blockers. Proton-pump inhibitors
(PPI) and histamine H2-antagonists were also examined. To examine the
association between above drugs and fractures the data from electronic
hospital database were matched to the prescription database run by the
Directorate of Health.RESULTS: A total of 29,056 fractures in 22,891
individuals were identified. The females with fractures were significantly
older and twice as many, compared to males. The odds ratio (OR) for
fractures was not significantly different between the NSAID, statins and
beta blockers. OR for opiates showed almost double increased risk of
fractures, 40% increased risk for sedatives and 30% increased risk for PPIs
compared to beta blockers. No increased fracture-risk was noted in patients
taking H2 antagonists.CONCLUSION: This study shows a relationship between
the use of opiates, sedatives and bone fractures. The incidence of fractures
was also increased in patients taking PPIs which is interesting in the light
of the wide-spread use of PPIs in the community. Key words: Opiates,
sedatives, proton- pump inhibitors, fractures. Correspondence: Magnus
Johannsson, magjoh@hi.is.
EMTREE DRUG INDEX TERMS
hypnotic sedative agent (adverse drug reaction)
narcotic analgesic agent (adverse drug reaction)
proton pump inhibitor (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chemically induced
EMTREE MEDICAL INDEX TERMS
adult
diagnostic imaging
emergency health service
factual database
female
fracture (epidemiology)
human
Iceland
incidence
male
odds ratio
risk assessment
risk factor
time factor
university hospital
LANGUAGE OF ARTICLE
Icelandic
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28489008 (http://www.ncbi.nlm.nih.gov/pubmed/28489008)
PUI
L618061811
DOI
10.17992/lbl.2017.05.136
FULL TEXT LINK
http://dx.doi.org/10.17992/lbl.2017.05.136
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 166
TITLE
Opioid prescription practices at discharge and 30-day returns in children
with sickle cell disease and pain
AUTHOR NAMES
Okorji L.M.
Muntz D.S.
Liem R.I.
AUTHOR ADDRESSES
(Okorji L.M.; Muntz D.S.; Liem R.I., rliem@luriechildrens.org) Division of
Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, United States.
(Okorji L.M.; Muntz D.S.; Liem R.I., rliem@luriechildrens.org) Department of
Pediatrics, Northwestern University Feinberg School of Medicine, Chicago,
United States.
CORRESPONDENCE ADDRESS
R.I. Liem, Division of Hematology, Oncology & Stem Cell Transplant, Ann &
Robert H. Lurie Children's Hospital of Chicago, Chicago, United States.
Email: rliem@luriechildrens.org
SOURCE
Pediatric Blood and Cancer (2017) 64:5 Article Number: e26319. Date of
Publication: 1 May 2017
ISSN
1545-5017 (electronic)
1545-5009
BOOK PUBLISHER
John Wiley and Sons Inc., P.O.Box 18667, Newark, United States.
ABSTRACT
Background: Acute pain episodes in children with sickle cell disease (SCD)
represent a leading cause of readmissions. We examined prescription
practices at the time of discharge in children with SCD presenting with
acute pain to determine their impact on 30-day emergency department (ED)
revisits and readmissions. Methods: In this single-institution, 5-year
retrospective study, we reviewed 290 encounters of patients with SCD aged
7–21 years hospitalized or discharged from the ED with acute pain. We
reviewed demographic, treatment and discharge data, and 30-day returns,
defined as ED revisits and readmissions within 30 days of discharge.
Bivariate and multivariable analyses were performed to evaluate the
association between discharge prescription practices and 30-day returns.
Results: Compared to hospitalizations, treat-and-release ED visits for acute
pain were associated with a higher incidence of 30-day returns (OR = 2.7
[95% CI: 1.5–4.8], P < 0.01). We found no association between prescribed
opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12
[95% CI: 0.62–2.02], P = 0.70). By multivariable logistic regression, the
prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without
opioids, after treat-and-release ED visits was independently associated with
a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3–37.3], P =
0.03) but not readmissions. Conclusion: Variability exists in opioid
prescription practices after discharge in children with SCD and pain
episodes. Prescription of NSAIDs only, without opioids, was an independent
predictor of higher 30-day ED revisits. Formalized studies to better
understand factors that influence returns, including outpatient opioid
management, are warranted in this population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, intravenous drug administration, parenteral drug
administration)
EMTREE DRUG INDEX TERMS
hydrocodone bitartrate plus paracetamol (drug therapy)
hydromorphone (drug therapy, parenteral drug administration)
morphine (drug therapy, parenteral drug administration)
nonsteroid antiinflammatory agent (drug therapy)
oxycodone plus paracetamol (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
prescription
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
child
cohort analysis
emergency ward
female
hospital discharge
hospital readmission
hospitalization
human
incidence
major clinical study
male
priority journal
retrospective study
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160869930
MEDLINE PMID
27800652 (http://www.ncbi.nlm.nih.gov/pubmed/27800652)
PUI
L613450278
DOI
10.1002/pbc.26319
FULL TEXT LINK
http://dx.doi.org/10.1002/pbc.26319
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 167
TITLE
Circumstances surrounding non-fatal opioid overdoses attended by ambulance
services
AUTHOR NAMES
Madah-Amiri D.
Clausen T.
Myrmel L.
Brattebø G.
Lobmaier P.
AUTHOR ADDRESSES
(Madah-Amiri D.; Clausen T.; Lobmaier P.) The Norwegian Centre for Addiction
Research, The University of Oslo, Oslo, Norway
(Myrmel L.; Brattebø G.) Bergen Emergency Medical Services, Department of
Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen,
Norway
(Brattebø G.) Department of Clinical Medicine, University of Bergen, Bergen,
Norway
(Lobmaier P.) Division of Mental Health and Addiction, Oslo University
Hospital, Oslo, Norway
SOURCE
Drug and alcohol review (2017) 36:3 (288-294). Date of Publication: 1 May
2017
ISSN
1465-3362 (electronic)
ABSTRACT
INTRODUCTION AND AIMS: Opioid overdose fatalities are a significant concern
globally. Non-fatal overdoses have been described as a strong predictor for
future overdoses, and are often attended by the ambulance services. This
paper explores characteristics associated with non-fatal overdoses and aims
to identify possible trends among these events in an urban area in
Norway.DESIGN AND METHODS: This is a retrospective analysis of non-fatal
overdoses from Bergen ambulance services from 2012 to 2013. Demographic,
temporal and geographic data were explored.RESULTS: During the two years,
463 non-fatal opioid overdoses were attended by ambulance services.
Ambulance call-outs occurred primarily during the late afternoon and evening
hours of weekdays. Summer months had more overdoses than other seasons, with
a peak in August. Overdoses were nearly twice as likely to occur in a public
location in August (risk ratio 1.92, P = 0.042). Ambulance response times
were more likely to be longer to private locations, and these victims were
more likely to be treated and left at the scene. There was no difference in
arrival time for drug-related and non-drug related dispatch.DISCUSSION AND
CONCLUSIONS: The temporal patterns suggest that non-fatal overdoses occur
during non-recreational time periods. The longer ambulance response time and
disposition for private addresses indicate potential opportunities for peer
interventions. Our analysis describes circumstances surrounding non-fatal
overdoses and can be useful in guiding relevant, targeted prevention
interventions. [Madah-Amiri D, Clausen T, Myrmel L, Brattebø G, Lobmaier P.
Circumstances surrounding non-fatal opioid overdoses attended by ambulance
services. Drug Alcohol Rev 2017;36:288-294].
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulance
trends
EMTREE MEDICAL INDEX TERMS
adolescent
adult
drug overdose (diagnosis, drug therapy, epidemiology)
emergency health service
female
human
male
middle aged
Norway
retrospective study
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28036135 (http://www.ncbi.nlm.nih.gov/pubmed/28036135)
PUI
L620975532
DOI
10.1111/dar.12451
FULL TEXT LINK
http://dx.doi.org/10.1111/dar.12451
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 168
TITLE
Opioid analgesic use among patients presenting with acute abdominal pain and
factors associated with surgical diagnoses
AUTHOR NAMES
Khemani D.
Camilleri M.
Roldan A.
Nelson A.D.
Park S.-Y.
Acosta A.
Zinsmeister A.R.
AUTHOR ADDRESSES
(Khemani D.; Camilleri M., camilleri.michael@mayo.edu; Roldan A.; Nelson
A.D.; Park S.-Y.; Acosta A.) Clinical Enteric Neuroscience Translational and
Epidemiological Research (CENTER), Mayo Clinic, Rochester, United States.
(Zinsmeister A.R.) Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, United
States.
CORRESPONDENCE ADDRESS
M. Camilleri, Clinical Enteric Neuroscience Translational and
Epidemiological Research (CENTER), Mayo Clinic, Rochester, United States.
Email: camilleri.michael@mayo.edu
SOURCE
Neurogastroenterology and Motility (2017) 29:5 Article Number: e13000. Date
of Publication: 1 May 2017
ISSN
1365-2982 (electronic)
1350-1925
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Background: The prevalence of chronic opioid use among non-cancer patients
presenting with acute abdominal pain (AAP) is unknown. The aim was to
characterize opioid use, constipation, diagnoses, and risk factors for
surgical diagnoses among non-cancer patients presenting with AAP to an
emergency department (ED). Methods: We performed a retrospective,
observational cohort study of all (n=16,121) adult patients (88% from MN, IA
and WI) presenting during 2014 with AAP. We used electronic medical records,
and focused on 2352 adults with AAP who underwent abdominal CT scan within
24 hours of presentation. We determined odds ratios of association with
constipation and features predicting conditions that may require surgery
(surgical diagnosis). Key Results: There were 2352 eligible patients; 18.8%
were opioid users. Constipation was more frequent in opioid (35.1%) compared
to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical
diagnosis in the opioid and non-opioid users was 35.3% and 41.7%
respectively (P=.019). By univariate analysis, age and neutrophil count
independently predicted increased risk, and chronic opioid use decreased
risk of surgical diagnosis. Internal validation of logistic models using a
randomly selected validation subset (25% of entire cohort, 587/2352) showed
receiver operating characteristic (ROC) curves for the validation and full
cohorts were similar. Conclusions and Inferences: Approximately 19% of
adults presenting with AAP were opioid users; constipation is almost three
times as likely in opioid users compared to non-opioid users presenting with
AAP. Factors significantly associated with altered risk of surgical
diagnoses were age, opioid use, and neutrophil count.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
alanine aminotransferase (endogenous compound)
amylase (endogenous compound)
aspartate aminotransferase (endogenous compound)
bilirubin (endogenous compound)
C reactive protein (endogenous compound)
creatinine (endogenous compound)
hemoglobin (endogenous compound)
triacylglycerol lipase (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
acute appendicitis
adult
article
clinical feature
cohort analysis
constipation (side effect)
drug use
emergency ward
female
human
leukocyte count
major clinical study
male
neutrophil count
observational study
priority journal
retrospective study
risk factor
x-ray computed tomography
CAS REGISTRY NUMBERS
alanine aminotransferase (9000-86-6, 9014-30-6)
amylase (9000-90-2, 9000-92-4, 9001-19-8)
aspartate aminotransferase (9000-97-9)
bilirubin (18422-02-1, 635-65-4)
C reactive protein (9007-41-4)
creatinine (19230-81-0, 60-27-5)
hemoglobin (9008-02-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
triacylglycerol lipase (9001-62-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170001930
MEDLINE PMID
28019066 (http://www.ncbi.nlm.nih.gov/pubmed/28019066)
PUI
L613920463
DOI
10.1111/nmo.13000
FULL TEXT LINK
http://dx.doi.org/10.1111/nmo.13000
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 169
TITLE
Opioid management strategy decreases admissions in high-utilizing adults
with sickle cell disease
AUTHOR NAMES
Mager A.
Pelot K.
Koch K.
Miller L.
Hubler C.
Ndifor A.
Coan C.
Leonard C.
Field J.J.
AUTHOR ADDRESSES
(Mager A.; Koch K.; Ndifor A.) Department of Medicine, Medical College of
Wisconsin, Milwaukee, United States.
(Pelot K.) Department of Social Services, Froedtert Hospital, Wauwatosa,
United States.
(Miller L.) Department of Psychology, Rogers Memorial Hospital, West Allis,
United States.
(Hubler C.; Field J.J.) Medical Sciences Institute, BloodCenter of
Wisconsin, Milwaukee, United States.
(Coan C.) Department of Ambulatory Pharmacy, Proedtert Hospital, Wauwatosa,
United States.
(Leonard C.) Department of Ambulatory Nursing, Proedtert Hospital,
Wauwatosa, United States.
SOURCE
Journal of Opioid Management (2017) 13:3 (143-156). Date of Publication: 1
May 2017
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Background: A subset of adults with sickle cell disease (SCD) heavily
utilizes the emergency department (ED) and hospital. The objective of our
study was to determine the efficacy of a multidisciplinary strategy to
address unmet needs in highly utilizing adults with SCD. Methods: In a
prospective study, adults with SCD with ≥10 admissions per year were
assessed by a multidisciplinary team for gaps in medical, social, and
psychological care. Thereafter, the team decided upon the subject's
predominant domain that drove admissions and instituted an interventional
plan. All plans included an opioid management strategy. Preintervention and
postintervention admission rate, as well as opioid use, was compared.
Results: Twelve subjects were enrolled. Median rate of ED and hospital
admissions preintervention was 25 per year. The predominant domains
identified were social needs (n = 6), psychological disorder (n = 1), and
substance use disorder (n = 5). Multifaceted interventional plans were
developed to address a wide range of gaps in care, but an opioid management
strategy was the only intervention successfully completed. Even so, when the
preintervention versus postintervention admission rate was compared,
regardless of the domain, there was a 40 percent decline in hospital
admissions (p = 0.03). Consistent with the successful implementation of an
opioid management plan, the decrease in admissions was accompanied by a 37
percent decrease in intravenous opioid use (p = 0.02) and 10 percent
decrease in oral opioid use (p = 0.04). Conclusion: An opioid management
strategy, as part of a larger effort to improve care for high-utilizing
adults with SCD, decreased rate of admissions and opioid use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (clinical trial, drug therapy, intravenous drug administration,
oral drug administration)
EMTREE DRUG INDEX TERMS
hemoglobin (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
chronic pain (drug therapy, drug therapy)
health care utilization
hospital admission
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
advance care planning
article
clinical article
comparative study
controlled clinical trial
controlled study
daily life activity
drug dependence
drug efficacy
emergency care
female
hemoglobin blood level
hospital readmission
human
male
management
medical care
mental disease
middle aged
prospective study
psychologic assessment
psychosocial care
social care
social needs
social work
treatment planning
young adult
CAS REGISTRY NUMBERS
hemoglobin (9008-02-0)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Hematology (25)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170543299
PUI
L617550881
DOI
10.5055/jom.2017.0382
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2017.0382
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 170
TITLE
Corrigendum to ‘Trends in Opioid Prescriptions Among Part D Medicare
Recipients from 2007 to 2012’ (The American Journal of Medicine (2016)
129(2) (221.e21–221.e30) (S0002934315009997) (10.1016/j.amjmed.2015.10.002))
AUTHOR NAMES
Kuo Y.-F.
Raji M.A.
Chen N.-W.
Hasan H.
Goodwin J.S.
AUTHOR ADDRESSES
(Kuo Y.-F.; Raji M.A.; Hasan H.; Goodwin J.S.) Department of Internal
Medicine, The University of Texas Medical Branch, Galveston, United States.
(Kuo Y.-F.; Raji M.A.; Goodwin J.S.) Sealy Center on Aging, The University
of Texas Medical Branch, Galveston, United States.
(Kuo Y.-F.; Chen N.-W.; Goodwin J.S.) Department of Preventive Medicine and
Community Health, The University of Texas Medical Branch, Galveston, United
States.
(Kuo Y.-F.; Goodwin J.S.) Institute for Translational Science, The
University of Texas Medical Branch, Galveston, United States.
SOURCE
American Journal of Medicine (2017) 130:5 (615-616). Date of Publication: 1
May 2017
ISSN
1555-7162 (electronic)
0002-9343
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
The authors regret an error in our paper related to applying the definition
of opioid-related overdose originally used by Dunn et al. The result of the
error was to substantially underestimate the risk of emergency room (ER) and
hospital admissions associated with prolonged use of either schedule II or
III opioids. In the original paper we found significant associations of
prolonged opioid use with ER visits or hospitalizations for opioid overdose,
with ORs ranging from 1.4 to 1.8. After correcting the error, the ORs were
much higher, from 2.2 to 15.8. The corrected table 3 is printed here
(Table). These results are in line with previous publications.(1-3) There
were no changes in other analyses. The pattern of the results remained
unchanged. Our main findings on the increasing trend of prolonged opioid use
over time, the variation of prolonged opioid use across states, and the
limited impact of state laws on prolonged opioid use were not affected by
the error and stayed the same. We apologize for the error. Appendix:
Correction to: Trends in Opioid Prescriptions among Part D Medicare
Recipients from 2007 to 2012 Corrected Results: Table 3 shows the rate of ER
visits and hospitalizations related to potential overdose, stratified by
prolonged opioid prescription of schedule II drugs, schedule III drugs, and
combination. Prolonged combined opioid prescription was associated with
higher rates of overdose-related acute care events. Rates of ER visits were
203.35 vs. 11.73 per 100,000 for patients with and without opioid
prescriptions for schedule II/III combinations, respectively; for
hospitalizations, these rates were 298.43 vs. 25.77 per 100,000. After
adjusting for patient characteristics, the odds of having an ER visit
related to potential overdose were substantially larger for schedule II than
for schedule III prescriptions (OR: 15.78, 95% CI = 10.53 – 23.66 vs. OR:
4.50, 95% CI = 2.98 – 6.79). Results for hospitalization were similar. The
correlations were not significant between the rate of prolonged opioid
prescription use and the rates of ER visits or hospitalization across
states.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
error
EMTREE MEDICAL INDEX TERMS
erratum
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170287233
PUI
L615546467
DOI
10.1016/j.amjmed.2017.02.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amjmed.2017.02.005
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 171
TITLE
Drivers of excess costs of opioid abuse among a commercially insured
population
AUTHOR NAMES
Scarpati L.M.
Kirson N.Y.
Zichlin M.L.
Jia Z.B.
Birnbaum H.G.
Howard J.C.
AUTHOR ADDRESSES
(Scarpati L.M., lauren.scarpati@analysisgroup.com; Kirson N.Y.; Zichlin
M.L.; Jia Z.B.; Birnbaum H.G.; Howard J.C.) Analysis Group, Inc., 111
Huntington Ave, 14th Floor, Boston, United States.
CORRESPONDENCE ADDRESS
L.M. Scarpati, Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston,
United States. Email: lauren.scarpati@analysisgroup.com
SOURCE
American Journal of Managed Care (2017) 23:5 (276-282). Date of Publication:
1 May 2017
ISSN
1088-0224
BOOK PUBLISHER
Ascend Media, medentcirc@ascendmedia.com
ABSTRACT
OBJECTIVES: To replicate and extend a recently published analysis of the
drivers of excess costs of opioid abuse. STUDY DESIGN: Retrospective data
analysis using de-identified claims data from the Truven MarketScan
Commercial Claims and Encounter database. METHODS: Medical and prescription
drug claims from beneficiaries covered by large self-insured US companies
were used to select patients with incident diagnoses of opioid abuse between
2012 and 2015. Two cohorts, abusers and nonabusers, were matched using
propensity score methods. Excess healthcare costs were estimated over a
6-month baseline period and 12-month follow-up period. Cost drivers were
assessed by diagnosis (3-digit International Classification of Diseases,
Ninth Revision, Clinical Modification groupings) and place of service.
RESULTS: The analysis included 73,714 matched pairs of abusers and
nonabusers. Relative to nonabusers, abusers had considerably higher annual
healthcare costs of $10,989 per patient, or $1.98 per member per month.
Excess costs were similar, yet lower, than the previous analysis using
another commercial claims database. In both analyses, a ramp-up in excess
costs was observed prior to the incident abuse diagnosis, followed by a
decline post diagnosis, although not to baseline levels. Key drivers of
excess costs in the 2 studies included opioid use disorders, nonopioid
substance misuse, and painful and mental health conditions. From 2010 to
2014, the prevalence of diagnosed opioid abuse doubled, with incidence rates
exhibiting an increasing, though flatter, trend than earlier in the period.
CONCLUSIONS: Opioid abuse imposes a considerable economic burden on payers.
Many abusers have complex healthcare needs and may require care beyond that
which is required to treat opioid abuse. These results are robust and
consistent across different data sources.
EMTREE DRUG INDEX TERMS
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health insurance
opiate addiction (disease management)
EMTREE MEDICAL INDEX TERMS
adult
alcohol abuse
article
controlled study
cost of illness
drug cost
drug misuse
drug overdose
emergency ward
follow up
health care need
hospital patient
human
ICD-9-CM
incidence
major clinical study
major depression
mental health
outpatient
prescription
prevalence
priority journal
psychosis
rehabilitation center
retrospective study
United States
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170415926
PUI
L616694477
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 172
TITLE
Hot and Cold Drugs: National Park Service Medication Stability at the
Extremes of Temperature
AUTHOR NAMES
Armenian P.
Campagne D.
Stroh G.
Ives Tallman C.
Zeng W.Z.D.
Lin T.
Gerona R.R.
AUTHOR ADDRESSES
(Armenian P.; Campagne D.; Stroh G.; Ives Tallman C.; Zeng W.Z.D.; Lin T.;
Gerona R.R.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2017)
21:3 (378-385). Date of Publication: 1 May 2017
ISSN
1545-0066 (electronic)
ABSTRACT
STUDY OBJECTIVE: National Park Service (NPS) Parkmedics provide medical care
in austere environments. The objective of this study was to evaluate the
stability of specific medications used by Parkmedics at extremes of
temperatures likely to be faced in the field.METHODS: This is a bench
research study conducted in the laboratory setting over a 4-week period.
Parenteral medications were separated into 4 temperature exposure groups: A)
45°C (hot); B) -20°C (cold); C) hot then cold temperatures alternating
weekly; and D) cold then hot temperatures alternating weekly. At study start
and the end of each week, three aliquots from each group were sampled to
determine the remaining drug concentration through liquid
chromatography-quadrupole time-of-flight mass spectrometry (Agilent LC 1260-
QTOF/MS 6550). Quantitative analysis was done using Agilent MassHunter
Quantitative Analysis software. The mean drug concentration from triplicate
aliquots was expressed as percentage of its baseline concentration to
monitor the drug's stability during storage.RESULTS: Eight medications were
analyzed (atropine, diphenhydramine, fentanyl, hydromorphone, midazolam,
morphine, naloxone, ondansetron). Hydromorphone, morphine, and ondansetron
showed the greatest stability, at above 90% of original concentration in all
study arms. Diphenhydramine, fentanyl and midazolam showed heat independent
degradation, degrading the same way regardless of heat exposure. By the end
of the study period, 51-56% midazolam remained in all groups. Atropine and
naloxone showed heat dependent degradation, degrading more when exposed to
heat. Atropine had the most degradation, being undetectable after 4 weeks of
heat exposure.CONCLUSIONS: We recommend that EMS providers replace atropine,
naloxone, diphenhydramine, fentanyl, and midazolam frequently if they are
practicing in low call volume or high-temperature environments. Further
studies will be needed to determine if re-dosing midazolam, naloxone, and
atropine is the appropriate clinical strategy in this setting if adequate
clinical effect is not reached with a single dose.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug stability
recreational park
standards
EMTREE MEDICAL INDEX TERMS
cold
emergency health service
heat
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28059581 (http://www.ncbi.nlm.nih.gov/pubmed/28059581)
PUI
L617080719
DOI
10.1080/10903127.2016.1258098
FULL TEXT LINK
http://dx.doi.org/10.1080/10903127.2016.1258098
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 173
TITLE
President's message: The beast
AUTHOR NAMES
Bograkos W.
AUTHOR ADDRESSES
(Bograkos W.)
CORRESPONDENCE ADDRESS
W. Bograkos,
SOURCE
Journal of Addictive Diseases (2017) 36:2 (144-145). Date of Publication: 3
Apr 2017
ISSN
1545-0848 (electronic)
1055-0887
BOOK PUBLISHER
Routledge, aabs@uw.edu
EMTREE DRUG INDEX TERMS
carfentanil
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
EMTREE MEDICAL INDEX TERMS
cannabis addiction
emergency care
emergency health service
emergency medicine
human
note
opiate addiction
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
carfentanil (59708-52-0)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170279197
PUI
L615424122
DOI
10.1080/10550887.2017.1310578
FULL TEXT LINK
http://dx.doi.org/10.1080/10550887.2017.1310578
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 174
TITLE
Decreased Opioid Prescribing in a Pediatric Emergency Department After the
Rescheduling of Hydrocodone
AUTHOR NAMES
Chumpitazi C.E.
Rees C.A.
Camp E.A.
Bernhardt M.B.
AUTHOR ADDRESSES
(Chumpitazi C.E.; Camp E.A.) Department of Pediatrics, Section of Emergency
Medicine, Baylor College of Medicine, Houston, United States.
(Rees C.A.) Department of Pediatrics, Baylor College of Medicine, Houston,
United States.
(Bernhardt M.B.) Department of Pharmacy, Texas Children's Hospital, Houston,
United States.
CORRESPONDENCE ADDRESS
C.E. Chumpitazi, Assistant Professor of Pediatrics, Baylor College of
Medicine, 1102 Bates Street Ste. 1850.14, Houston, United States.
SOURCE
Journal of Emergency Medicine (2017) 52:4 (547-553). Date of Publication: 1
Apr 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background The Drug Enforcement Administration (DEA) changed
hydrocodone-containing products (HCPs) from Schedule III to II status on
October 6, 2014, making codeine-containing products (CCPs) the only
non–Schedule II oral opioid agents. Objectives We sought to describe
prescribing patterns of oral opioid agents in the pediatric emergency
department before and after the 2014 DEA rescheduling of HCPs. Methods We
performed a cross-sectional study evaluating prescribing patterns in the
pediatric emergency department at an urban, academic, quaternary care
children's hospital system for 6 months before and 6 months after the DEA
rescheduling of HCPs. Differences in patient demographics, provider type,
and diagnoses were assessed during the two time periods using Pearson's
chi-squared test. The Breslow–Day statistic was used to assess differences
in prescribing patterns by provider type. Results There were 1256
prescriptions for HCPs and CCPs in our pediatric emergency department during
the study period, and only 36 prescriptions for alternate oral opioid
medications. Prescriptions of all opioid pain medications decreased by 55%
after rescheduling. The odds of prescribing HCPs were reduced by 60% after
the DEA rescheduling (odds ratio 0.40 [95% confidence interval {CI}
0.30–0.54]; p < 0.001). There was no difference between monthly ordering
frequencies for CCPs before or after the DEA rescheduling (p = 0.75).
Conclusions The period after rescheduling of HCPs was associated with a
lower odds of HCP prescriptions in our emergency department without an
increase in the prescription of CCPs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydrocodone (drug combination)
opiate
EMTREE DRUG INDEX TERMS
cocodamol
codeine
codeine sulfate
hydromorphone
morphine sulfate
oxycodone (drug combination)
paracetamol (drug combination)
tramadol (oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
article
cross-sectional study
electronic medical record
elixir
female
government
hospital planning
human
male
pediatric hospital
sample size
study design
CAS REGISTRY NUMBERS
codeine (76-57-3)
codeine sulfate (1420-53-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160777390
MEDLINE PMID
27727038 (http://www.ncbi.nlm.nih.gov/pubmed/27727038)
PUI
L612947702
DOI
10.1016/j.jemermed.2016.08.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.08.026
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 175
TITLE
Naloxone administration for suspected opioid overdose: An expanded scope of
practice by a basic life support collegiate-based emergency medical services
agency
AUTHOR NAMES
Jeffery R.M.
Dickinson L.
Ng N.D.
DeGeorge L.M.
Nable J.V.
AUTHOR ADDRESSES
(Jeffery R.M.; Dickinson L.; Ng N.D.; Nable J.V.) a Georgetown Emergency
Response Medical Service , Georgetown University , Washington , District of
Columbia , USA
(DeGeorge L.M.) b MedStar Washington Hospital Center/Georgetown University
Hospital , Washington , District of Columbia , USA
(Nable J.V.) c Department of Emergency Medicine , MedStar Georgetown
University Hospital, Georgetown University School of Medicine , Washington ,
District of Columbia , USA
SOURCE
Journal of American college health : J of ACH (2017) 65:3 (212-216). Date of
Publication: 1 Apr 2017
ISSN
1940-3208 (electronic)
ABSTRACT
Opioid abuse is a growing and significant public health concern in the
United States. Naloxone is an opioid antagonist that can rapidly reverse the
respiratory depression associated with opioid toxicity. Georgetown
University's collegiate-based emergency medical services (EMS) agency
recently adopted a protocol, allowing providers to administer intranasal
naloxone for patients with suspected opioid overdose. While normally not
within the scope of practice of basic life support prehospital agencies, the
recognition of an increasing epidemic of opioid abuse has led many states,
including the District of Columbia, to expand access to naloxone for
prehospital providers of all levels of training. In particular, intranasal
naloxone is a method of administering this medication that potentially
avoids needlestick injuries among EMS providers. Universities with
collegiate-based EMS agencies are well positioned to provide life-saving
treatments for patients acutely ill from opioid overdose.
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug therapy)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
emergency health service
human
intranasal drug administration
organization and management
procedures
statistics and numerical data
student
trends
university
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28059635 (http://www.ncbi.nlm.nih.gov/pubmed/28059635)
PUI
L620574289
DOI
10.1080/07448481.2016.1277730
FULL TEXT LINK
http://dx.doi.org/10.1080/07448481.2016.1277730
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 176
TITLE
Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in
the Emergency Department
AUTHOR NAMES
Rowe C.
Vittinghoff E.
Santos G.-M.
Behar E.
Turner C.
Coffin P.O.
AUTHOR ADDRESSES
(Rowe C.; Santos G.-M.; Behar E.; Turner C.; Coffin P.O.,
phillip.coffin@sfdph.org) Center for Public Health Research, San Francisco
Department of Public Health, San Francisco, United States.
(Vittinghoff E.) School of Medicine, Department of Epidemiology and
Biostatistics, San Francisco, United States.
(Santos G.-M.) School of Nursing, Department of Community Health Systems,
San Francisco, United States.
(Behar E.) Department of Global Health Sciences, San Francisco, United
States.
(Coffin P.O., phillip.coffin@sfdph.org) School of Medicine, Division of HIV,
ID, and Global Health, University of California San Francisco, San
Francisco, United States.
CORRESPONDENCE ADDRESS
P.O. Coffin, Center for Public Health Research, San Francisco Department of
Public Health, San Francisco, United States. Email: phillip.coffin@sfdph.org
SOURCE
Academic Emergency Medicine (2017) 24:4 (475-483). Date of Publication: 1
Apr 2017
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives: Opioid overdose mortality has tripled in the United States since
2000 and opioids are responsible for more than half of all drug overdose
deaths, which reached an all-time high in 2014. Opioid overdoses resulting
in death, however, represent only a small fraction of all opioid overdose
events and efforts to improve surveillance of this public health problem
should include tracking nonfatal overdose events. International
Classification of Disease (ICD) diagnosis codes, increasingly used for the
surveillance of nonfatal drug overdose events, have not been rigorously
assessed for validity in capturing overdose events. The present study aimed
to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM)
codes in identifying opioid overdose events in the emergency department (ED)
by examining multiple performance measures, including sensitivity and
specificity. Methods: Data on ED visits from January 1, 2012, to December
31, 2014, including clinical determination of whether the visit constituted
an opioid overdose event, were abstracted from electronic medical records
for patients prescribed long-term opioids for pain from any of six safety
net primary care clinics in San Francisco, California. Combinations of
ICD-9-CM codes were validated in the detection of overdose events as
determined by medical chart review. Both sensitivity and specificity of
different combinations of ICD-9-CM codes were calculated. Unadjusted
logistic regression models with robust standard errors and accounting for
clustering by patient were used to explore whether overdose ED visits with
certain characteristics were more or less likely to be assigned an opioid
poisoning ICD-9-CM code by the documenting physician. Results: Forty-four
(1.4%) of 3,203 ED visits among 804 patients were determined to be opioid
overdose events. Opioid-poisoning ICD-9-CM codes (E850.2–E850.2,
965.00–965.09) identified overdose ED visits with a sensitivity of 25.0%
(95% confidence interval [CI] = 13.6% to 37.8%) and specificity of 99.9%
(95% CI = 99.8% to 100.0%). Expanding the ICD-9-CM codes to include both
nonspecified and general (i.e., without a decimal modifier) drug poisoning
and drug abuse codes identified overdose ED visits with a sensitivity of
56.8% (95% CI = 43.6%–72.7%) and specificity of 96.2% (95% CI =
94.8%–97.2%). Additional ICD-9-CM codes not explicitly relevant to opioid
overdose were necessary to further enhance sensitivity. Among the 44
overdose ED visits, neither naloxone administration during the visit,
whether the patient responded to the naloxone, nor the specific opioids
involved were associated with the assignment of an opioid poisoning ICD-9-CM
code (p ≥ 0.05). Conclusions: Tracking opioid overdose ED visits by
diagnostic coding is fairly specific but insensitive, and coding was not
influenced by administration of naloxone or the specific opioids involved.
The reason for the high rate of missed cases is uncertain, although these
results suggest that a more clearly defined case definition for overdose may
be necessary to ensure effective opioid overdose surveillance. Changes in
coding practices under ICD-10 might help to address these deficiencies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis)
emergency ward
ICD-9-CM
performance measurement system
EMTREE MEDICAL INDEX TERMS
adult
article
clinical article
diagnostic value
drug abuse
drug intoxication
female
human
intoxication
male
middle aged
mortality
physician
priority journal
sensitivity and specificity
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170203842
MEDLINE PMID
27763703 (http://www.ncbi.nlm.nih.gov/pubmed/27763703)
PUI
L614899170
DOI
10.1111/acem.13121
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13121
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 177
TITLE
State emergency department opioid guidelines: Current status
AUTHOR NAMES
Broida R.I.
Gronowski T.
Kalnow A.F.
Little A.G.
Lloyd C.M.
AUTHOR ADDRESSES
(Broida R.I.) US Acute Care Solutions, Risk Management Department, Canton,
United States.
(Gronowski T.; Kalnow A.F.; Little A.G., andyglittle@gmail.com; Lloyd C.M.)
Doctors Hospital, Department of Emergency Medicine, 5100 W. Broad St.,
Columbus, United States.
CORRESPONDENCE ADDRESS
A.G. Little, Doctors Hospital, Department of Emergency Medicine, 5100 W.
Broad St., Columbus, United States. Email: andyglittle@gmail.com
SOURCE
Western Journal of Emergency Medicine (2017) 18:3 (340-344). Date of
Publication: 1 Apr 2017
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: The purpose of this study was to evaluate and categorize
current state-sponsored opioid guidelines for the practice of emergency
medicine (EM). Methods: We conducted a comprehensive search of EM-specific
opioid prescribing guidelines and/or policies in each state to determine
current state involvement in EM opioid prescribing, as well as to evaluate
some of the specifics of each guideline or policy. The search was conducted
using an online query and a follow-up email request to each state chapter of
ACEP. Results: We found that 17 states had emergency department-specific
guidelines. We further organized the guidelines into four categories:
limiting prescriptions for opioids with 67 total recommendations;
preventing/diverting abuse with 56 total recommendations; addiction-related
guidelines with 29 total recommendations; and a community resources section
with 24 total recommendations. Our results showed that current state
guidelines focus on providers limiting opioid pain prescriptions and vetting
patients for possible abuse/diversion. Conclusion: This study highlights the
17 states that have addressed opioid prescribing guidelines and categorizes
their efforts to date. It is hoped that this study will provide the basis
for similar efforts in other states.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
EMTREE MEDICAL INDEX TERMS
article
clinical evaluation
drug abuse
drug dependence
drug surveillance program
emergency care
emergency medicine
emergency ward
follow up
human
prescription
substance abuse
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170284312
MEDLINE PMID
28435482 (http://www.ncbi.nlm.nih.gov/pubmed/28435482)
PUI
L615489074
DOI
10.5811/westjem.2016.12.30854
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.12.30854
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 178
TITLE
The development and feasibility of a pharmacy-delivered opioid intervention
in the emergency department
AUTHOR NAMES
Winstanley E.L.
Mashni R.
Schnee S.
Miller N.
Mashni S.M.
AUTHOR ADDRESSES
(Winstanley E.L., erin.winstanley@hsc.wvu.edu; Mashni R.; Schnee S.; Miller
N.; Mashni S.M.)
CORRESPONDENCE ADDRESS
E.L. Winstanley, Associate Professor, School of Pharmacy, West Virginia
University, PO Box 9510, Morgantown, United States. Email:
erin.winstanley@hsc.wvu.edu
SOURCE
Journal of the American Pharmacists Association (2017) 57:2 (S87-S91). Date
of Publication: 1 Apr 2017
ISSN
1544-3450 (electronic)
1544-3191
BOOK PUBLISHER
Elsevier B.V., InfoCenter@aphanet.org
ABSTRACT
Objectives To develop a brief intervention and to assess the feasibility of
pharmacy-delivered education on opioid safety and overdose prevention in the
emergency department. Methods A convenience sample of patients (n = 102)
approached between May and June 2016 at a single community-based suburban
emergency department located in the Midwest. Results The intervention
included scripted counseling to be delivered in person and 2 educational
brochures. The counseling took approximately 5 minutes, and only 2 patients
refused the counseling. All the patients were satisfied with the
intervention, and 97.4% of them reported that the counseling improved their
knowledge of opioid side effects. The majority of patients thought that
their own risk of addiction was significantly less than the general public's
risk of addiction when taking opioids. Conclusion This study provides
preliminary evidence that student pharmacists or pharmacists are able to
deliver opioid safety and overdose education in the emergency department.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
fentanyl
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
drug safety
patient education
EMTREE MEDICAL INDEX TERMS
addiction
adverse event
article
counseling
emergency ward
feasibility study
human
major clinical study
patient satisfaction
pharmacy student
prescription
risk factor
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170813076
MEDLINE PMID
28292506 (http://www.ncbi.nlm.nih.gov/pubmed/28292506)
PUI
L619271342
DOI
10.1016/j.japh.2017.01.021
FULL TEXT LINK
http://dx.doi.org/10.1016/j.japh.2017.01.021
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 179
TITLE
Challenges and Opportunities to Engaging Emergency Medical Service Providers
in Substance Use Research: A Qualitative Study
AUTHOR NAMES
Maragh-Bass A.C.
Fields J.C.
McWilliams J.
Knowlton A.R.
AUTHOR ADDRESSES
(Maragh-Bass A.C.) 1Center for Surgery and Public Health,Brigham and Women's
Hospital,Harvard Schools of Medicine and Public
Health,Boston,MassachusettsUSA
(Fields J.C.; McWilliams J.; Knowlton A.R.) 2Johns Hopkins Bloomberg School
of Public Health,Department of Health,Behavior and
Society,Baltimore,MarylandUSA
SOURCE
Prehospital and disaster medicine (2017) 32:2 (148-155). Date of
Publication: 1 Apr 2017
ISSN
1945-1938 (electronic)
ABSTRACT
Introduction Research suggests Emergency Medical Services (EMS) over-use in
urban cities is partly due to substance users with limited access to
medical/social services. Recent efforts to deliver brief, motivational
messages to encourage these individuals to enter treatment have not
considered EMS providers. Problem Little research has been done with EMS
providers who serve substance-using patients. The EMS providers were
interviewed about participating in a pilot program where they would be
trained to screen their patients for substance abuse and encourage them to
enter drug treatment.METHODS: Qualitative interviews were conducted with
Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers
(N=22). Topics included EMS misuse, work demands, and views on participating
in the pilot program. Interviews were transcribed and analyzed using
grounded theory and constant-comparison.RESULTS: Participants were mostly
white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%).
Mean age was 37.5 years. Providers described the "frequent flyer problem"
(eg, EMS over-use by a few repeat non-emergent cases). Providers expressed
disappointment with local health delivery due to resource limitations and
being excluded from decision making within their administration, leading to
reduced team morale and burnout. Nonetheless, providers acknowledged they
are well-positioned to intervene with substance-using patients because they
are in direct contact and have built rapport with them. They noted patients
might be most receptive to motivational messages immediately after overdose
revival, which several called "hitting their bottom." Several stated that
involvement with the proposed study would be facilitated by direct
incorporation into EMS providers' current workflow. Many recommended that
research team members accompany EMS providers while on-call to observe their
day-to-day work. Barriers identified by the providers included time
constraints to intervene, limited knowledge of substance abuse treatment
modalities, and fearing negative repercussions from supervisors and/or
patients. Despite reservations, several EMS providers expressed inclination
to deliver brief motivational messages to encourage substance-using patients
to consider treatment, given adequate training and
skill-building.CONCLUSIONS: Emergency Medical Service providers may have
many demands, including difficult case time/resource limitations. Even so,
participants recognized their unique position as first responders to deliver
motivational, harm-reduction messages to substance-using patients during
transport. With incentivized training, implementing this program could be
life- and cost-saving, improving emergency and behavioral health services.
Findings will inform future efforts to connect substance users with drug
treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC ,
Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to
engaging Emergency Medical Service providers in substance use research: a
qualitative study. Prehosp Disaster Med. 2017;32(2):148-155.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prevention and control
rescue personnel
EMTREE MEDICAL INDEX TERMS
adult
drug overdose (prevention)
female
human
interview
male
methodology
pilot study
substance abuse
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28122657 (http://www.ncbi.nlm.nih.gov/pubmed/28122657)
PUI
L618587780
DOI
10.1017/S1049023X16001424
FULL TEXT LINK
http://dx.doi.org/10.1017/S1049023X16001424
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 180
TITLE
Opioid Use Disorder: A Desperate Need for Novel Treatments
AUTHOR NAMES
Fuehrlein B.S.
Ross D.A.
AUTHOR ADDRESSES
(Fuehrlein B.S., brian.fuehrlein@yale.edu; Ross D.A.) Yale University
Department of Psychiatry, New Haven, United States.
CORRESPONDENCE ADDRESS
B.S. Fuehrlein, Yale University, Department of Psychiatry, 300 George
Street, Suite 901, New Haven, United States. Email: brian.fuehrlein@yale.edu
SOURCE
Biological Psychiatry (2017) 81:7 (e43-e45). Date of Publication: 1 Apr 2017
ISSN
1873-2402 (electronic)
0006-3223
BOOK PUBLISHER
Elsevier USA
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
4 (4 chlorophenyl) 2,3,9 trimethyl 6h thieno[3,2 f][1,2,4]triazolo[4,3
a][1,4]diazepine 6 acetic acid tert butyl ester
benzodiazepine derivative
buprenorphine
diamorphine
methadone
naloxone
vaccine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
opiate addiction
EMTREE MEDICAL INDEX TERMS
addiction
alcoholism
amygdala
brain
brain damage
brain depth stimulation
decision making
dopaminergic nerve cell
drug abuse
drug dependence
drug intoxication
emergency ward
feeding behavior
harm reduction
help seeking behavior
hippocampus
human
immunotherapy
learning
meta analysis
motivation
note
nucleus accumbens
prefrontal cortex
prescription
priority journal
psychoeducation
repetitive transcranial magnetic stimulation
reward
ventral tegmentum
CAS REGISTRY NUMBERS
4 (4 chlorophenyl) 2,3,9 trimethyl 6h thieno[3,2 f][1,2,4]triazolo[4,3
a][1,4]diazepine 6 acetic acid tert butyl ester (1268524-70-4)
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170175906
MEDLINE PMID
28283055 (http://www.ncbi.nlm.nih.gov/pubmed/28283055)
PUI
L614705491
DOI
10.1016/j.biopsych.2017.01.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.biopsych.2017.01.014
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 181
TITLE
Strategies and policies to address the opioid epidemic: A case study of Ohio
AUTHOR NAMES
Penm J.
MacKinnon N.J.
Boone J.M.
Ciaccia A.
McNamee C.
Winstanley E.L.
AUTHOR ADDRESSES
(Penm J., jonathan.penm@sydney.edu.au; MacKinnon N.J.; Boone J.M.; Ciaccia
A.; McNamee C.; Winstanley E.L.)
CORRESPONDENCE ADDRESS
J. Penm, Pharmacy and Bank Building A15, The University of Sydney, NSW,
Australia. Email: jonathan.penm@sydney.edu.au
SOURCE
Journal of the American Pharmacists Association (2017) 57:2 (S148-S153).
Date of Publication: 1 Apr 2017
ISSN
1544-3450 (electronic)
1544-3191
BOOK PUBLISHER
Elsevier B.V., InfoCenter@aphanet.org
ABSTRACT
Objective To describe the strategies and policies implemented in Ohio to
improve opioid safety and to discuss the role that pharmacists can play in
implementing, promoting, and enhancing the effectiveness of these policies.
Setting Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths
per 100,000) in the United States. Unintentional drug overdose has become
the leading cause of injury-related death in Ohio. In 2015, there were 3050
overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose
events reversed by emergency medical services with naloxone. Practice
description Not applicable. Practice policy innovation In 2011, the
Governor's Cabinet Opiate Action Team was created to implement a
multifaceted strategy, in part (1) to promote the responsible use of
opioids, (2) to reduce the supply of opioids, and (3) to support overdose
prevention and expand access to naloxone. Innovations to assist these goals
include the development of Ohio guidelines on the responsible use of
opioids, mandatory use of Ohio's prescription drug monitoring program,
closing pill mills, promotion of drug take-back programs and increased
access to naloxone and public health campaigns. Evaluation Not applicable.
Results Since the development of the Governor's Cabinet Opiate Action Team,
there were 81 million fewer doses of opioids dispensed to Ohio patients in
2015 compared with 782 million doses dispensed in 2011. As such, the
proportion of unintentional drug overdose deaths involving prescription
opioids has reduced from 45% in 2011 to 22% in 2015. Conclusion Strong
political support was crucial in Ohio to facilitate the rapid implementation
opioid overdose prevention programs and the promotion of public awareness
campaigns. However, the misuse and abuse of prescription opioids are complex
problems requiring a comprehensive and multifaceted approach. Pharmacists
are identified as a crucial component of the state strategy to addressing
opioid abuse by promoting responsible prescribing and adopting prevention
practices.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
fentanyl
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (epidemiology)
drug safety
epidemic
health care policy
EMTREE MEDICAL INDEX TERMS
article
case study
death
drug dependence
emergency health service
human
Ohio
pharmacist
prescription
public health campaign
United States
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170812947
MEDLINE PMID
28189539 (http://www.ncbi.nlm.nih.gov/pubmed/28189539)
PUI
L619271289
DOI
10.1016/j.japh.2017.01.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.japh.2017.01.001
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 182
TITLE
Comparing healthcare utilization and costs among medicaid-insured patients
with chronic noncancer pain with and without opioid-induced constipation: A
retrospective analysis
AUTHOR NAMES
Olufade T.
Kong A.M.
Princic N.
Juneau P.
Kulkarni R.
Zhang K.
Datto C.
AUTHOR ADDRESSES
(Olufade T.) Health Economics & Outcomes Research, AstraZeneca, Wilmington,
United States.
(Kong A.M.; Princic N.; Juneau P.; Kulkarni R.; Zhang K.) Truven Health
Analytics, An IBM Company, Bethesda, United States.
(Datto C.) US Medical Lead, AstraZeneca, United States.
SOURCE
American Health and Drug Benefits (2017) 10:2 (79-85). Date of Publication:
1 Apr 2017
ISSN
1942-2970 (electronic)
1942-2962
BOOK PUBLISHER
Engage Healthcare Communications, Inc., nick@engagehc.com
ABSTRACT
BACKGROUND: Constipation is a common adverse effect of opioid use and has
been associated with increased healthcare utilization and costs among
patients receiving opioids for pain management. OBJECTIVE: To compare the
healthcare utilization and costs of Medicaid patients with chronic noncancer
pain with and without constipation who were receiving opioids. METHODS: This
retrospective, claims-based study was conducted using data from the Truven
Health MarketScan Medicaid Multi-State database. Patients with no evidence
of cancer who initiated opioid therapy between January 1, 2009, and June 30,
2013, were eligible for the study. Patients had to have continuous
enrollment in the database in the 6 months before and 12 months after opioid
initiation, with no evidence of substance abuse or functional or
inflammatory bowel disease. Medical and pharmacy claims during the 12 months
after opioid initiation were evaluated for a diagnosis of constipation or
for prescription or over-the-counter medications indicative of constipation.
All-cause healthcare utilization and costs were measured over the same
period and were compared between propensity score– matched cohorts of
patients with evidence of constipation and patients without constipation.
RESULTS: Of the 25,744 patients meeting the study inclusion criteria, 2716
(10.5%) had evidence of constipation. After 1:1 propensity score matching,
the 2 cohorts had similar demographic and clinical characteristics (ie, mean
age, 47 years; 26%-27% male). During the 12-month follow-up period,
healthcare utilization was more frequent among patients with constipation,
including inpatient admissions and emergency department visits, than in the
matched patients without constipation. The total all-cause mean healthcare
costs were substantially higher among the patients with constipation
(28,234; 95% confidence interval [CI], 24,307-32,160) than in the patients
without constipation (13,709; 95% CI, 12,618-14,801), with a median cost
difference of 4166 per patient (P <.001). CONCLUSION: Among Medicaid
enrollees who receive opioids for chronic noncancer pain, constipation is
associated with increased all-cause healthcare utilization and costs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate agonist (adverse drug reaction)
EMTREE DRUG INDEX TERMS
enema
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain
constipation (side effect, side effect)
health care cost
health care utilization
medicaid
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
assessment of humans
chronic fatigue syndrome
chronic pain
cohort analysis
demography
Deyo Charlson Comorbidity Index
emergency ward
evaluation and follow up
female
fibromyalgia
headache
health care planning
hospitalization
human
ICD-9
intestine obstruction
low back pain
major clinical study
male
middle aged
neuralgia
osteoarthritis
outpatient care
prescription
propensity score
retrospective study
rheumatoid arthritis
scoring system
young adult
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170314297
PUI
L615828021
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 183
TITLE
Healthcare resource use and costs of opioid-induced constipation among
non-cancer and cancer patients on opioid therapy: A nationwide
register-based cohort study in Denmark
AUTHOR NAMES
Søndergaard J.
Christensen H.N.
Ibsen R.
Jarbøl D.E.
Kjellberg J.
AUTHOR ADDRESSES
(Søndergaard J.; Jarbøl D.E.) Research Unit of General Practice, Institute
of Public Health, University of Southern Denmark, Odense, Denmark.
(Christensen H.N., Helene.nordahlchristensen@astrazeneca.com) AstraZeneca
Nordic-Baltic, Södertälje, Sweden.
(Ibsen R.) i2minds, Århus, Denmark.
(Kjellberg J.) KORA, Danish Institute for Local and Regional Government
Research, Copenhagen, Denmark.
CORRESPONDENCE ADDRESS
H.N. Christensen, AstraZeneca Nordic-Baltic, Södertälje, Sweden. Email:
Helene.nordahlchristensen@astrazeneca.com
SOURCE
Scandinavian Journal of Pain (2017) 15 (83-90). Date of Publication: 1 Apr
2017
ISSN
1877-8879 (electronic)
1877-8860
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background and aim Opioid analgesics are often effective for pain
management, but may cause constipation. The aim of this study was to
determine healthcare resource use and costs in non-cancer and cancer
patients with opioid-induced constipation (OIC). Methods This was a
nationwide register-based cohort study including patients ≥18 years of age
initiating ≥4 weeks opioid therapy (1998–2012) in Denmark. A measure of OIC
was constructed based on data from Danish national health registries, and
defined as ≥1 diagnosis of constipation, diverticulitis, mega colon,
ileus/subileus, abdominal pain/acute abdomen or haemorrhoids and/or ≥2
subsequent prescription issues of laxatives. Total healthcare resource
utilization and costs (including pharmacy dispense, inpatient-, outpatient-,
emergency room- and primary care) were estimated according to OIC status,
opioid treatment dosage and length, gender, age, marital status, and
comorbidities using Generalised Linear Model. Results We identified 97 169
eligible opioid users (77 568 non-cancer and 19 601 patients with a cancer
diagnosis). Among non-cancer patients, 15% were classified with OIC, 10% had
previous constipation, and 75% were without OIC. Patients characteristics of
non-cancer OIC patients showed a higher frequency of strong opioid treatment
(69% versus 41%), long-term opioid treatment (1189 days versus 584 days),
advanced age (73 years versus 61 years), and cardiovascular disease (31%
versus 19%) compared to those without OIC (P < 0.001 for all comparisons).
Non-cancer patients with OIC had 34% higher total healthcare costs compared
to those without OIC (P < 0.001) after adjusting for age, gender, opioid
usage, marital status and comorbidities. Among cancer patients, 35% were
classified with OIC, 14% had previous constipation, and 51% were without
OIC. A higher proportion of cancer patients with OIC were continuous opioid
users (85% versus 83%) and strong opioid users (97% versus 85%), compared to
those without OIC (P < 0.001 for both comparisons). Further, the mean number
of days on opioids were higher for cancer patients with versus without OIC
(329 days versus 238 days, P < 0.001). Total healthcare costs were 25%
higher for cancer patients with versus without OIC (P < 0.001) after
adjusting for age, gender, opioid usage, marital status and comorbidities.
Conclusions The results of this nationwide study based on real life data
suggested that both non-cancer patients and cancer patients suffering from
opioid-induced constipation (OIC) may have higher healthcare resource
utilization and higher associated costs compared to those without OIC.
Implications Reducing the number of OIC patients has potential cost savings
for the health care system. Special attention should be on patients at
potential high risk of OIC, such as strong and long-term opioid treatment,
advanced age, and concomitant cardiovascular disease.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
laxative
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation (side effect, side effect)
health care cost
health care utilization
opioid induced constipation (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain
acute abdomen
adult
aged
article
cancer patient
cardiovascular disease
cohort analysis
comorbidity
cost control
diverticulitis
educational status
female
follow up
hemorrhoid
hospital admission
human
ileus
length of stay
major clinical study
male
marriage
megacolon
observational study
priority journal
therapy
treatment duration
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cancer (16)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170133744
PUI
L614457805
DOI
10.1016/j.sjpain.2017.01.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.sjpain.2017.01.006
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 184
TITLE
Renal colic in the emergency room: Nonsteroid antiinflammatory agents or
opiates?
ORIGINAL (NON-ENGLISH) TITLE
Nierenkoliken in der Notfallambulanz: Nichtsteroidale Antirheumatika oder
Opiate?
AUTHOR NAMES
Jungmayr P.
AUTHOR ADDRESSES
(Jungmayr P.) Esslingen, Germany.
CORRESPONDENCE ADDRESS
P. Jungmayr, Germany.
SOURCE
Krankenhauspharmazie (2017) 38:4 (209). Date of Publication: 1 Apr 2017
ISSN
0173-7597
BOOK PUBLISHER
Deutscher Apotheker Verlag, Birkenwaldstr.44,, Stuttgart, Germany.
KPH-AboService@Deutscher-Apotheker-Verlag.de
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nonsteroid antiinflammatory agent (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
kidney colic (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
note
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English, German
EMBASE ACCESSION NUMBER
20170260342
PUI
L615257234
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 185
TITLE
Can Naloxone Be Used to Treat Synthetic Cannabinoid Overdose?
AUTHOR NAMES
Jones J.D.
Nolan M.L.
Daver R.
Comer S.D.
Paone D.
AUTHOR ADDRESSES
(Jones J.D., jonesje@NYSPI.Columbia.edu; Comer S.D.) Division of Substance
Abuse, New York Psychiatric Institute, College of Physicians and Surgeons of
Columbia University, New York, United States.
(Jones J.D., jonesje@NYSPI.Columbia.edu; Comer S.D.) Department of
Psychiatry, College of Physicians and Surgeons of Columbia University, New
York, United States.
(Daver R.) Public Health/Preventive Medicine Residency Program, New York
City Department of Health and Mental Hygiene, Long Island City, United
States.
(Jones J.D., jonesje@NYSPI.Columbia.edu; Nolan M.L.; Daver R.; Paone D.)
Bureau of Alcohol and Drug Use Prevention, Care and Treatment, New York City
Department of Health and Mental Hygiene, Long Island City, United States.
CORRESPONDENCE ADDRESS
J.D. Jones, Columbia University, College of Physicians and Surgeons,
Division on Substance Abuse, 1051 Riverside Dr., New York, United States.
Email: jonesje@NYSPI.Columbia.edu
SOURCE
Biological Psychiatry (2017) 81:7 (e51-e52). Date of Publication: 1 Apr 2017
ISSN
1873-2402 (electronic)
0006-3223
BOOK PUBLISHER
Elsevier USA
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabinoid (drug toxicity)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
alcohol
oxygen (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
adverse outcome
alcohol blood level
blood pressure
breathing rate
case report
confusion
dizziness
drowsiness
emergency health service
evidence based practice
female
heart rate
human
hypercapnia
hypotension
lactic acidosis
lethargy
letter
male
medical record review
mental disease
middle aged
priority journal
respiration depression
respiratory acidosis
seizure
somnolence
tachycardia
thorax pain
treatment response
unconsciousness
vital sign
vomiting
CAS REGISTRY NUMBERS
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160919177
PUI
L613732463
DOI
10.1016/j.biopsych.2016.08.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.biopsych.2016.08.013
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 186
TITLE
We have to "think" before prescribing an opioid in Italian Emergency
Department?
AUTHOR NAMES
Lorenzati B.
Allione A.
Pizzolato E.
Dutto L.
Lauria G.
AUTHOR ADDRESSES
(Lorenzati B.) Emergency Medicine, Emergency Department, A.O.S. Croce e
Carle, Via Coppino 26, 12100, Cuneo, Italy. lorebato@gmail.com
(Allione A.; Pizzolato E.; Dutto L.; Lauria G.) Emergency Medicine,
Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo,
Italy
SOURCE
Internal and emergency medicine (2017) 12:3 (415-416). Date of Publication:
1 Apr 2017
ISSN
1970-9366 (electronic)
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital emergency service
EMTREE MEDICAL INDEX TERMS
clinical practice
human
LANGUAGE OF ARTICLE
English
MEDLINE PMID
28168588 (http://www.ncbi.nlm.nih.gov/pubmed/28168588)
PUI
L619669035
DOI
10.1007/s11739-017-1621-0
FULL TEXT LINK
http://dx.doi.org/10.1007/s11739-017-1621-0
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 187
TITLE
Traumatic injuries and persistent opioid use in the USA: findings from a
nationally representative survey
AUTHOR NAMES
Alghnam S.
Castillo R.
AUTHOR ADDRESSES
(Alghnam S.) King Abdullah International Medical Research Center, King Saud
Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi
Arabia
(Castillo R.) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Maryland, USA
SOURCE
Injury prevention : journal of the International Society for Child and
Adolescent Injury Prevention (2017) 23:2 (87-92). Date of Publication: 1 Apr
2017
ISSN
1475-5785 (electronic)
ABSTRACT
BACKGROUND: Although opioid abuse is a rising epidemic in the USA, there are
no studies to date on the incidence of persistent opioid use following
injuries. Therefore, the aims of this study are: (1) to examine the
incidence of persistent opioid use among a nationally representative sample
of injured and non-injured populations; (2) to evaluate whether an injury is
an independent predictor of persistent opioid use.METHOD: Data from the
Medical Expenditure Panel Survey were pooled (years 2009-2012). Adults were
followed for about 2 years, during which they were surveyed about injury
status and opioid use every 4-5 months. To determine whether injuries are
associated with persistent opioid use, weighted multiple logistic
regressions were constructed.RESULTS: While 2.3 million injured individuals
received any opioid during the follow-up, 371 170 (15.6%) individuals became
persistent opioid users (defined as opioid use across multiple time points).
In a multiple logistic regression analysis adjusting for sociodemographic
characteristics and self-reported health, those who sustained injuries were
1.4 times (95% CI 1.1 to 1.9) more likely to report persistent opioid use
than those without injuries.CONCLUSIONS: We found injuries to be
significantly associated with persistent opioid use in a nationally
representative sample. Further investment in injury prevention may
facilitate reduction of persistent opioid use and, thus, improve population
health and reduce health expenditures.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
chemically induced
clinical practice
complication
emergency health service
female
health care cost
health survey
hospitalization
human
incidence
injury (epidemiology, prevention)
male
meta analysis (topic)
middle aged
opiate addiction (epidemiology, prevention)
risk factor
statistical model
United States
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27597400 (http://www.ncbi.nlm.nih.gov/pubmed/27597400)
PUI
L620687409
DOI
10.1136/injuryprev-2016-042059
FULL TEXT LINK
http://dx.doi.org/10.1136/injuryprev-2016-042059
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 188
TITLE
An interventionist adherence scale for a specialized brief negotiation
interview focused on treatment engagement for opioid use disorders
AUTHOR NAMES
Pantalon M.V.
Dziura J.
Li F.-Y.
Owens P.H.
O'Connor P.G.
D'Onofrio G.
AUTHOR ADDRESSES
(Pantalon M.V.; Dziura J.; Owens P.H.; D'Onofrio G.) a Department of
Emergency Medicine , Yale University School of Medicine , New Haven ,
Connecticut , USA
(Li F.-Y.) b Yale University School of Public Health , New Haven ,
Connecticut , USA
(O'Connor P.G.) c Department of Internal Medicine , Yale University School
of Medicine , New Haven , Connecticut , USA
SOURCE
Substance abuse (2017) 38:2 (191-199). Date of Publication: 1 Apr 2017
ISSN
1547-0164 (electronic)
ABSTRACT
BACKGROUND: No psychometrically validated instrument for evaluating the
extent to which interventionists correctly implement brief interventions
designed to motivate treatment engagement for opioid use disorders has been
reported in the literature. The objective of this study was to develop and
examine the psychometric properties of the Brief Negotiation Interview (BNI)
Adherence Scale for Opioid Use Disorders (BAS-O).METHODS: In the context of
a randomized controlled trial evaluating the efficacy of 3 models of
emergency department care for opioid use disorders, the authors developed
and subsequently examined the psychometric properties of the BAS-O, a
38-item scale that required raters to answer whether or not ("Yes" or "No")
each of the critical actions of the BNI was correctly implemented by the
research interventionist. BAS-O items pertained to the BNI's 4 steps: (1)
Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4)
Negotiate and Advise. A total of 215 audio-recorded BNI and 88 control
encounters were rated by 3 trained raters who were independent of the study
team and blind to study hypotheses, treatment, and assignment.RESULTS: The
results indicated the BAS-O has fair to excellent psychometric properties,
in terms of good internal consistency, excellent interrater reliability,
discriminant validity, and construct validity, and fair predictive validity.
A 13-item, 2-factor solution accounted for nearly 80% of the variance, where
factor 1 addressed "Autonomy and Planning" (7 items) and factor 2 addressed
"Motivation and Problems" (6 items). However, predictive validity was found
for only one of the BAS-O factor items (i.e., Telling patients that
treatment will address a range of issues related to their opioid use
disorder).CONCLUSIONS: This study suggests that the BAS-O is a
psychometrically valid measure of adherence to the specialized BNI for
motivating treatment engagement in patients with opioid use disorders, thus
providing a brief (13-item), objective method of evaluating BNI skill
performance.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
attitude to health
psychology
EMTREE MEDICAL INDEX TERMS
hospital emergency service
human
opiate addiction
patient attitude
psychological interview
psychometry
questionnaire
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28398192 (http://www.ncbi.nlm.nih.gov/pubmed/28398192)
PUI
L621194790
DOI
10.1080/08897077.2017.1294548
FULL TEXT LINK
http://dx.doi.org/10.1080/08897077.2017.1294548
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 189
TITLE
Changes in Provider Prescribing Patterns After Implementation of an
Emergency Department Prescription Opioid Policy
AUTHOR NAMES
Osborn S.R.
Yu J.
Williams B.
Vasilyadis M.
Blackmore C.C.
AUTHOR ADDRESSES
(Osborn S.R.; Yu J.; Williams B.; Vasilyadis M.; Blackmore C.C.) Virginia
Mason Medical Center, Seattle, United States.
CORRESPONDENCE ADDRESS
S.R. Osborn, Virginia Mason Medical Center, 1010 Spring Street, Seattle,
United States.
SOURCE
Journal of Emergency Medicine (2017) 52:4 (538-546). Date of Publication: 1
Apr 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Prescription opioid-associated abuse and overdose is a
significant cause of morbidity and mortality in the United States. Opioid
prescriptions generated from emergency departments (EDs) nationwide have
increased dramatically over the past 20 years, and opioid-related overdose
deaths have become an epidemic, according to the Centers for Disease Control
and Prevention. Objective Our aim was to determine the effectiveness of
implementing a prescription policy for opioids on overall opioid prescribing
patterns in a hospital ED. Methods The ED provider group of an academic,
non-university–affiliated urban hospital with 23,000 annual patient visits
agreed to opioid prescribing guidelines for chronic pain with the goal of
limiting prescriptions that may be used for abuse or diversion. These
guidelines were instituted in the ED through collaborative staff meetings
and educational and training sessions. We used the electronic medical record
to analyze the number and type of opioid discharge prescriptions during the
study period from 2006–2014, before and after the prescribing guidelines
were instituted in the ED. Results The number of patients discharged with a
prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease
10.2%; 95% confidence interval [CI] 9.6–10.7; p < 0.001) after the
intervention. The improvements were sustained 2.5 years after the
intervention. Decreases were seen in all major opioids (hydrocodone,
oxycodone, hydromorphone, and codeine). The number of pills per prescription
also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI
2.6–3.1; p < 0.001). Conclusions Implementation of an ED prescription opioid
policy was associated with a significant reduction in total opioid
prescriptions and in the number of pills per prescription.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
codeine
hydrocodone
hydromorphone
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care policy
prescription
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesic agent abuse
arthralgia
article
chronic pain
early intervention
electronic medical record
female
follow up
human
inappropriate prescribing
length of stay
limb pain
low back pain
major clinical study
male
practice guideline
prescription drug diversion
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170058197
MEDLINE PMID
28111065 (http://www.ncbi.nlm.nih.gov/pubmed/28111065)
PUI
L614132145
DOI
10.1016/j.jemermed.2016.07.120
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.07.120
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 190
TITLE
Implementation of a pharmacy consult to reduce co-prescribing of opioids and
benzodiazepines in a Veteran population
AUTHOR NAMES
Pardo D.
Miller L.
Chiulli D.
AUTHOR ADDRESSES
(Pardo D.; Miller L.; Chiulli D.) a Veterans Affairs Palo Alto Health Care
System (VAPAHCS) , Palo Alto , California , USA
SOURCE
Substance abuse (2017) 38:2 (157-160). Date of Publication: 1 Apr 2017
ISSN
1547-0164 (electronic)
ABSTRACT
BACKGROUND: The dangers of co-administration of opioid pain relievers (OPRs)
and benzodiazepines (BZDs) are well documented. The combination of OPRs and
BZDs make up the majority of medications involved in prescription
drug-related overdose and are often used concomitantly. This pattern is
consistent among the veteran population where mental health illness and
substance abuse are prominent. The Veterans Health Administration
implemented the Opioid Safety Initiative (OSI) aimed at improving patient
safety surrounding OPRs. In alignment with OSI, the study facility
implemented a prior authorization pharmacy consult in an effort to reduce
OPR and BZD co-prescribing and optimize patient safety. The purpose of this
article is to report the frequency of co-prescribing before and after
implementation of the consult. Secondary aims include reporting the
emergency room visits and hospitalizations, prescribers' actions in the
setting of disapproved consults, patient characteristics associated with
co-prescribing, and frequency of co-prescribing without a consult.METHODS:
This was a single-center, retrospective chart review study. Microsoft
Structured Query Language server database and Veterans Health Information
Systems and Technology Architecture were used to extract data and identify
study patients. The Computerized Patient Record System was used to collect
patient data. Microsoft Access and Excel were utilized to organize, query,
and analyze the extracted data.RESULTS: There was a 34.6% reduction in
patients on chronic OPR therapy co-prescribed a BZD, and the total number of
overdose-related events decreased after implementation of the consult. In
the event of disapproved consults, pharmacists' evidence-based
recommendations were implemented 63% of the time. Patients for whom
co-prescribing consults were placed were more likely to have mental health
diagnoses.CONCLUSIONS: Following implementation of a pharmacy consult, there
was a reduction in co-prescribing and overdose-related events at the study
facility.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (adverse drug reaction)
narcotic analgesic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital pharmacy
trends
EMTREE MEDICAL INDEX TERMS
adolescent
adult
combination drug therapy
drug overdose (prevention)
factual database
female
hospitalization
human
male
middle aged
patient referral
retrospective study
statistics and numerical data
utilization
veteran
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28166464 (http://www.ncbi.nlm.nih.gov/pubmed/28166464)
PUI
L621194945
DOI
10.1080/08897077.2017.1290011
FULL TEXT LINK
http://dx.doi.org/10.1080/08897077.2017.1290011
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 191
TITLE
Bringing naloxone to ground zero: Huntington, West Virginia
AUTHOR NAMES
Babcock C.
Rockich-Winston N.
Booth C.
AUTHOR ADDRESSES
(Babcock C., babcockc@marshall.edu) Clinical Assistant Professor, Marshall
University School of Pharmacy, Huntington, United States.
(Rockich-Winston N.) Assistant Professor, Marshall University School of
Pharmacy, Huntington, United States.
(Booth C.) Clinical Assistant Professor, Marshall University School of
Pharmacy, Huntington, United States.
SOURCE
Journal of the American Pharmacists Association (2017) 57:2 (S9-S10). Date
of Publication: 1 Apr 2017
ISSN
1544-3450 (electronic)
1544-3191
BOOK PUBLISHER
Elsevier B.V., InfoCenter@aphanet.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
addiction
drug intoxication
emergency health service
harm reduction
human
letter
mortality rate
pharmacist
West Virginia
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170812942
PUI
L619271341
DOI
10.1016/j.japh.2016.09.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.japh.2016.09.006
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 192
TITLE
Pharmacist-led health-system approaches to reduce opioid overdose and death
AUTHOR NAMES
Saldaña S.N.
Weaver N.
Stanford B.
AUTHOR ADDRESSES
(Saldaña S.N., shannon.saldana@imail.org) Advanced Clinical Pharmacist in
Psychiatry, Intermountain Primary Children's Hospital, Department of
Pharmacy, Salt Lake City, United States.
(Weaver N.) Emergency Department Pharmacist Team Leader, Intermountain
Primary Children's Hospital, Department of Pharmacy, Salt Lake City, United
States.
(Stanford B.) Community Pharmacy Operations Director, Intermountain
Healthcare Pharmacy Services, Salt Lake City, United States.
SOURCE
Journal of the American Pharmacists Association (2017) 57:2 (S8-S9). Date of
Publication: 1 Apr 2017
ISSN
1544-3450 (electronic)
1544-3191
BOOK PUBLISHER
Elsevier B.V., InfoCenter@aphanet.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
naloxone
nose spray
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care
pharmacist
EMTREE MEDICAL INDEX TERMS
autoinjector
drug abuse
drug misuse
drug overdose
emergency ward
health care policy
hospital department
human
letter
pharmacy
prescription
Utah
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170813068
PUI
L619271347
DOI
10.1016/j.japh.2016.09.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.japh.2016.09.005
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 193
TITLE
A case of massive methadone overdose presented with refractory hypoglycemia
AUTHOR NAMES
Li A.T.Y.
Chu F.K.C.
AUTHOR ADDRESSES
(Li A.T.Y., lty032@ha.org.hk; Chu F.K.C.) Accident & Emergency Department,
Queen Elizabeth Hospital, Kowloon, Hong Kong.
CORRESPONDENCE ADDRESS
A.T.Y. Li, Accident & Emergency Department, Queen Elizabeth Hospital,
Kowloon, Hong Kong. Email: lty032@ha.org.hk
SOURCE
Clinical Toxicology (2017) 55:3 (233). Date of Publication: 16 Mar 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
glucose (endogenous compound)
insulin (endogenous compound)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
hypoglycemia
EMTREE MEDICAL INDEX TERMS
adult
case report
central nervous system depression
drug overdose
electrocardiography
emergency ward
female
Glasgow coma scale
glucose blood level
heroin dependence
human
hypoventilation (therapy)
insulin blood level
intensive care unit
letter
middle aged
oxygen desaturation
oxygen therapy
patient monitoring
QTc interval
schizophrenia
sinus tachycardia
CAS REGISTRY NUMBERS
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Endocrinology (3)
Drug Literature Index (37)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170074952
MEDLINE PMID
28114820 (http://www.ncbi.nlm.nih.gov/pubmed/28114820)
PUI
L614212690
DOI
10.1080/15563650.2016.1277236
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2016.1277236
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 194
TITLE
Clinical Reasoning: A young woman with respiratory failure, hearing loss,
and paraplegia
AUTHOR NAMES
Ntranos A.
Shoirah H.
Dhamoon M.S.
Hahn D.
Naidich T.P.
Shin S.
AUTHOR ADDRESSES
(Ntranos A.; Shoirah H.; Dhamoon M.S.; Hahn D.; Shin S.,
susan.shin@mssm.edu) Department of Neurology, New York, United States.
(Naidich T.P.) Department of Radiology, New York, United States.
(Shin S., susan.shin@mssm.edu) Icahn School of Medicine at Mount Sinai, New
York, United States.
CORRESPONDENCE ADDRESS
S. Shin, Department of Neurology, New York, United States. Email:
susan.shin@mssm.edu
SOURCE
Neurology (2017) 88:10 (e78-e84). Date of Publication: 7 Mar 2017
ISSN
1526-632X (electronic)
0028-3878
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS
alprazolam
benzodiazepine derivative
lamotrigine
mercury
naloxone
opiate
oxycodone
paracetamol
salicylic acid
venlafaxine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hearing impairment
paraplegia
respiratory failure
spinal cord infarction (diagnosis)
EMTREE MEDICAL INDEX TERMS
adduction
adult
article
Babinski reflex
bipolar disorder
body temperature
bradypnea
case report
chronic pain
consultation
diastolic blood pressure
emergency ward
female
heart rate
Hoffmann reflex
home care
human
hypercapnia
hypertransaminasemia
hypoxia
leukocytosis
medical history
neck
neurology
oxygen saturation
priority journal
proprioception
systolic blood pressure
urinalysis
vibration
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
lamotrigine (84057-84-1)
mercury (14302-87-5, 7439-97-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
venlafaxine (93413-69-5, 99300-78-4)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170188237
PUI
L614765190
DOI
10.1212/WNL.0000000000003684
FULL TEXT LINK
http://dx.doi.org/10.1212/WNL.0000000000003684
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 195
TITLE
Geospatial analysis of emergency department visits for targeting
community-based responses to the opioid epidemic
AUTHOR NAMES
Dworkis D.A.
Taylor L.A.
Peak D.A.
Bearnot B.
AUTHOR ADDRESSES
(Dworkis D.A., ddworkis@partners.org; Peak D.A.) Harvard Medical School,
Department of Emergency Medicine, Boston, United States.
(Dworkis D.A., ddworkis@partners.org; Peak D.A.) Massachusetts General
Hospital, Department of Emergency Medicine, Boston, United States.
(Taylor L.A.) Harvard Management Business School, Boston, United States.
(Bearnot B.) Harvard Medical School, Department of Medicine, Boston, United
States.
(Bearnot B.) Massachusetts General Hospital, Division of General Internal
Medicine, Department of Medicine, Boston, United States.
SOURCE
PLoS ONE (2017) 12:3 Article Number: e0175115. Date of Publication: 1 Mar
2017
ISSN
1932-6203 (electronic)
BOOK PUBLISHER
Public Library of Science, plos@plos.org
ABSTRACT
The opioid epidemic in the United States carries significant morbidity and
mortality and requires a coordinated response among emergency providers,
outpatient providers, public health departments, and communities.
Anecdotally, providers across the spectrum of care at Massachusetts General
Hospital (MGH) in Boston, MA have noticed that Charlestown, a community in
northeast Boston, has been particularly impacted by the opioid epidemic and
needs both emergency and longer-term resources. We hypothesized that
geospatial analysis of the home addresses of patients presenting to the MGH
emergency department (ED) with opioid-related emergencies might identify
"hot spots" of opioid-related healthcare needs within Charlestown that could
then be targeted for further investigation and resource deployment. Here, we
present a geospatial analysis at the United States census tract level of the
home addresses of all patients who presented to the MGH ED for
opioid-related emergency visits between 7/1/2012 and 6/30/2015, including
191 visits from 100 addresses in Charlestown, MA. Among the six census
tracts that comprise Charlestown, we find a 9.5-fold difference in
opioid-related ED visits, with 45% of all opioid-related visits from
Charlestown originating in tract 040401. The signal from this census tract
remains strong after adjusting for population differences between census
tracts, and while this tract is one of the higher utilizing census tracts in
Charlestown of the MGH ED for all cause visits, it also has a 2.9-fold
higher rate of opioid-related visits than the remainder of Charlestown.
Identifying this hot spot of opioid-related emergency needs within
Charlestown may help re-distribute existing resources efficiently, empower
community and ED-based physicians to advocate for their patients, and serve
as a catalyst for partnerships between MGH and local community groups. More
broadly, this analysis demonstrates that EDs can use geospatial analysis to
address the emergency and longer-term health needs of the communities they
are designed to serve.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
geospatial analysis
health care utilization
opiate addiction
spatial analysis
EMTREE MEDICAL INDEX TERMS
article
controlled study
emergency ward
general hospital
human
major clinical study
Massachusetts
spatial distribution
statistical distribution
United States
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170243887
MEDLINE PMID
28362828 (http://www.ncbi.nlm.nih.gov/pubmed/28362828)
PUI
L615075821
DOI
10.1371/journal.pone.0175115
FULL TEXT LINK
http://dx.doi.org/10.1371/journal.pone.0175115
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 196
TITLE
Factors Associated With Participation in an Emergency Department–Based
Take-Home Naloxone Program for At-Risk Opioid Users
AUTHOR NAMES
Kestler A.
Buxton J.
Meckling G.
Giesler A.
Lee M.
Fuller K.
Quian H.
Marks D.
Scheuermeyer F.
AUTHOR ADDRESSES
(Kestler A., andrew.kestler@ubc.ca; Fuller K.; Scheuermeyer F.) Department
of Emergency Medicine, St Paul's Hospital, Vancouver, Canada.
(Kestler A., andrew.kestler@ubc.ca; Scheuermeyer F.) Department of Emergency
Medicine, University of British Columbia, Vancouver, Canada.
(Buxton J.; Giesler A.) School of Population and Public Health, University
of British Columbia, Vancouver, Canada.
(Meckling G.) Faculty of Science, University of British Columbia, Vancouver,
Canada.
(Lee M.) School of Medicine, University of British Columbia, Vancouver,
Canada.
(Buxton J.) British Columbia Centre for Disease Control, Vancouver, Canada.
(Quian H.) Centre for Health Evaluation and Outcomes Sciences, Vancouver,
Canada.
(Marks D.) London School of Tropical Medicine & Hygiene, United Kingdom.
CORRESPONDENCE ADDRESS
A. Kestler, Department of Emergency Medicine, St Paul's Hospital, Vancouver,
Canada. Email: andrew.kestler@ubc.ca
SOURCE
Annals of Emergency Medicine (2017) 69:3 (340-346). Date of Publication: 1
Mar 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective Although the World Health Organization recommends take-home
naloxone to address the increasing global burden of opioid-related deaths,
few emergency departments (EDs) offer a take-home naloxone program. We seek
to determine the take-home naloxone acceptance rate among ED patients at
high risk of opioid overdose and to examine factors associated with
acceptance. Methods At a single urban ED, consecutive eligible patients at
risk of opioid overdose were invited to complete a survey about opioid use,
overdose experience, and take-home naloxone awareness, and then offered
take-home naloxone. The primary outcome was acceptance of take-home
naloxone, including the kit and standardized patient training. Univariate
and multivariable logistic analyses were used to evaluate factors associated
with acceptance. Results Of 241 eligible patients approached, 201 (83.4%)
completed the questionnaire. Three-quarters of respondents used injection
drugs, 37% were women, and 26% identified as “Indigenous.” Of 201
respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%)
accepted take-home naloxone. Multivariable analysis revealed that factors
associated with take-home naloxone acceptance included witnessing overdose
in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own
overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI
1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67).
Conclusion A two-thirds ED take-home naloxone acceptance rate in patients
using opioids should encourage all EDs to dispense take-home naloxone.
ED-based take-home naloxone programs have the potential to improve access to
take-home naloxone and awareness in individuals most vulnerable to
overdoses.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
take home naloxone
EMTREE MEDICAL INDEX TERMS
adult
article
death
drug overdose
drug use
female
gender
human
injection
major clinical study
male
multivariate analysis
priority journal
questionnaire
univariate analysis
urban area
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160895588
MEDLINE PMID
27745764 (http://www.ncbi.nlm.nih.gov/pubmed/27745764)
PUI
L613571698
DOI
10.1016/j.annemergmed.2016.07.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2016.07.027
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 197
TITLE
Opioid pain medication prescriptions obtained through emergency medical
visits in the Veterans Health Administration
AUTHOR NAMES
Grasso M.A.
Dezman Z.D.W.
Grasso C.T.
Jerrard D.A.
AUTHOR ADDRESSES
(Grasso M.A.; Dezman Z.D.W.; Jerrard D.A.) Department of Emergency Medicine,
University of Maryland, School of Medicine, Baltimore, United States.
(Grasso C.T.) Department of Computer Science and Electrical Engineering,
University of Maryland Baltimore County, Baltimore, United States.
SOURCE
Journal of Opioid Management (2017) 13:2 (77-84). Date of Publication: 1 Mar
2017
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Objective: This study sought to characterize national patterns for opioid
pain medication (OPM) prescriptions received during emergency medical
encounters in the Veterans Health Administration (VA). Design: The authors
conducted a retrospective study of all emergency department (ED) visits by
adults in the VA between January 2009 and June 2015-We examined
demographics, comorbidities, utilization measures, diagnoses, and
prescriptions. Main Outcome Measures: The percentage of ED visits that
culminated in the receipt of a prescription for an OPM. Results: There were
6,721,134 emergency medical visits by 1,708,545 individuals during the study
period. An OPM was prescribed during 913,872 visits (13-6 percent), and
407,408 individuals (27.5 percent) received at least one OPM prescription.
Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3
percent in 2015. The percentage of prescriptions limited to 12 pills
increased from 25.0 to 32.4percent. The heaviest users (top 1.5percent, n =
7,247) received an average 602.5 total doses, and had at least 10 ED visits
during the study period. The most frequently prescribed OPMs were
acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone.
Receiving a prescription was associated with younger patients,
musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a
history of mental illness, a history of substance abuse, prior heavy
prescription OPM use, and lower participation in outpatient services.
Conclusions: The writing of OPM prescriptions after an ED visit is on the
decline in the VA. Compliance with prescribing guidelines is increasing, but
is not yet at goal.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
baclofen (drug therapy)
camphor (drug therapy)
capsaicin (drug therapy)
codeine (drug therapy)
cyclobenzaprine (drug therapy)
diclofenac (drug therapy)
etodolac (drug therapy)
fentanyl (drug therapy, transdermal drug administration)
hydrocodone bitartrate plus paracetamol (drug therapy)
hydromorphone (drug therapy)
ibuprofen (drug therapy)
indometacin (drug therapy)
meloxicam (drug therapy)
methadone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
oxycodone plus paracetamol (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency treatment
pain (drug therapy, drug therapy)
prescription
veterans health
EMTREE MEDICAL INDEX TERMS
adult
age
article
chronic pain
female
human
major clinical study
male
medical history
mental disease
middle aged
musculoskeletal disease
outpatient care
pain severity
patient participation
retrospective study
substance abuse
CAS REGISTRY NUMBERS
baclofen (1134-47-0)
camphor (464-49-3, 76-22-2, 8008-51-3)
capsaicin (404-86-4)
codeine (76-57-3)
cyclobenzaprine (303-53-7, 6202-23-9)
diclofenac (15307-79-6, 15307-86-5)
etodolac (41340-25-4)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
indometacin (53-86-1, 74252-25-8, 7681-54-1)
meloxicam (71125-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170549997
PUI
L617598175
DOI
10.5055/jom.2017.0371
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2017.0371
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 198
TITLE
Eradicating the Overuse of Opioids on the Front Line
AUTHOR NAMES
Gillon J.
Muller L.S.
AUTHOR ADDRESSES
(Gillon J.) Jennifer Gillon, BSN, RN, has been an emergency department nurse
for more than 20 years at Englewood Hospital and Medical Center in
Englewood, NJ, where she is a three-time recipient of the Lifesaving Award.
Jen who received her nursing education and her bachelor of science and
nursing degree from William Paterson University is currently a master's
degree candidate in the adult nurse practitioner program at Saint Peters
University of Englewood Cliffs, NJ. When Jen is not in the clinical setting,
you will find her teaching several indoor cycling classes throughout the
week. Jen resides in Northern New Jersey and is the proud mother of two
sons. Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent
case manager, and managing partner of Muller & Muller. She is an adjunct
professor in the MSN and DNP programs at Saint Peter's University of New
Jersey. Lynn is a registered nurse and certified case manager with extensive
nursing and case management experience. Her law practice includes defense of
health care professionals before the state licensing boards, consultant on
such issues as regulatory compliance and accreditation, civil litigation,
Wills, Trusts and Estates, and Family law. Lynn is the author of numerous
articles and the legal chapters of the third edition of Case Management: A
Practical Guide for Education and Practice and the second edition of the
CMSA Core Curriculum for Case Management (as well as the third edition,
expected to be released in 2016). Lynn is a contributor to the CMSA Career &
Knowledge Pathways Project and Standards of Practice. She is as a former
commissioner for CCMC, a past president of the NJ Chapter of CMSA
(Muller L.S.)
SOURCE
Professional case management (2017) 22:2 (81-85). Date of Publication: 1 Mar
2017
ISSN
1932-8095 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
case management
practice guideline
standards
EMTREE MEDICAL INDEX TERMS
chronic pain (drug therapy)
emergency health service
human
opiate addiction (diagnosis, epidemiology, etiology, prevention)
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
28141758 (http://www.ncbi.nlm.nih.gov/pubmed/28141758)
PUI
L621464874
DOI
10.1097/NCM.0000000000000212
FULL TEXT LINK
http://dx.doi.org/10.1097/NCM.0000000000000212
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 199
TITLE
An Unusual Case of Alternating Ventricular Morphology on the 12-Lead
Electrocardiogram
AUTHOR NAMES
Sammon M.
Dawood A.
Beaudoin S.
Harrigan R.A.
AUTHOR ADDRESSES
(Sammon M.; Dawood A.; Beaudoin S.; Harrigan R.A.) Department of Emergency
Medicine, Temple University, Philadelphia, United States.
CORRESPONDENCE ADDRESS
M. Sammon, Department of Emergency Medicine, Temple University Hospital and
School of Medicine, Jones Hall Room 1005, Park Avenue and Ontario Street,
Philadelphia, United States.
SOURCE
Journal of Emergency Medicine (2017) 52:3 (348-353). Date of Publication: 1
Mar 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background One of the principal tasks of an emergency physician is
identifying potentially life-threatening conditions in the undifferentiated
patient; cardiac dysrhythmia is an example of such a condition. A systematic
approach to a patient with atypical dysrhythmia enables proper
identification of such-life threatening conditions. Case Report We describe
a 31-year-old man presenting to the emergency department with an
undifferentiated dysrhythmia after naloxone reversal of an opiate overdose.
A systematic approach to the electrocardiogram led to the rare diagnosis of
Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis
of this dysrhythmia and the initial evaluation of a patient with the WPW
pattern present on their electrocardiogram. Why Should an Emergency
Physician Be Aware of This? Emergency physicians should be prepared to use a
systematic approach to an undifferentiated dysrhythmia to identify
potentially life-threatening conditions.
EMTREE DRUG INDEX TERMS
naloxone (adverse drug reaction)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
electrocardiogram
heart arrhythmia (side effect, diagnosis, side effect)
Wolff Parkinson White syndrome (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
article
cardiac patient
case report
differential diagnosis
emergency physician
emergency ward
human
male
medical history
physical examination
prescription
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160777409
MEDLINE PMID
27727036 (http://www.ncbi.nlm.nih.gov/pubmed/27727036)
PUI
L612947733
DOI
10.1016/j.jemermed.2016.08.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.08.027
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 200
TITLE
Phenibut overdose
AUTHOR NAMES
Sankary S.
Canino P.
Jackson J.
AUTHOR ADDRESSES
(Sankary S., s.sankary@med.miami.edu; Canino P.; Jackson J.) University of
Miami, Miller School of Medicine, Miami, United States.
CORRESPONDENCE ADDRESS
S. Sankary, Email: s.sankary@med.miami.edu
SOURCE
American Journal of Emergency Medicine (2017) 35:3 (516.e1-516.e2). Date of
Publication: 1 Mar 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 amino 3 phenylbutyric acid (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
glucose (endogenous compound)
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
adult
arterial gas
article
blood cell count
blood pressure
breathing rate
carbon dioxide tension
case report
consciousness level
emergency ward
Glasgow coma scale
glucose blood level
human
male
mental health
oxygen tension
pH
physical examination
pill
poison center
priority journal
pulse rate
rectal temperature
somnolence
stupor
CAS REGISTRY NUMBERS
4 amino 3 phenylbutyric acid (1078-21-3)
alcohol (64-17-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160852527
MEDLINE PMID
27666756 (http://www.ncbi.nlm.nih.gov/pubmed/27666756)
PUI
L613341505
DOI
10.1016/j.ajem.2016.08.067
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2016.08.067
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 201
TITLE
The Opioid Crisis From Research to Practice
AUTHOR NAMES
Sharfstein J.M.
AUTHOR ADDRESSES
(Sharfstein J.M., Joshua.Sharfstein@jhu.edu)
CORRESPONDENCE ADDRESS
J.M. Sharfstein, Email: Joshua.Sharfstein@jhu.edu
SOURCE
Milbank Quarterly (2017) 95:1 (24-27). Date of Publication: 1 Mar 2017
ISSN
1468-0009 (electronic)
0887-378X
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
clinical research
opiate addiction (drug therapy, drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
criminal justice
drug efficacy
drug misuse
emergency ward
employability
follow up
health care access
health care availability
human
medicaid
medical education
mortality
note
patient referral
prescription
public health
randomized controlled trial (topic)
social problem
social stigma
treatment duration
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170176106
PUI
L614706217
DOI
10.1111/1468-0009.12241
FULL TEXT LINK
http://dx.doi.org/10.1111/1468-0009.12241
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 202
TITLE
Primary care-based models for the treatment of opioid use disorder: A
scoping review
AUTHOR NAMES
Korthuis P.T.
McCarty D.
Weimer M.
Bougatsos C.
Blazina I.
Zakher B.
Grusing S.
Devine B.
Chou R.
AUTHOR ADDRESSES
(Korthuis P.T., korthuis@ohsu.edu; McCarty D.; Weimer M.; Bougatsos C.;
Blazina I.; Zakher B.; Grusing S.; Devine B.; Chou R.) Oregon Health and
Science University, Portland, Oregon, and University of Washington, Seattle,
Washington
(Korthuis P.T., korthuis@ohsu.edu; Weimer M.) Oregon Health and Science
University, 3181 SW Sam Jackson Park Road, Mail Code L-475, Portland, United
States.
(McCarty D.) OHSU-PSU School of Public Health, CB669, 3186 SW Sam Jackson
Park Road, Portland, United States.
(Devine B.) University of Washington, Box 357630, Seattle, United States.
(Bougatsos C.; Blazina I.; Zakher B.; Grusing S.; Chou R.) Oregon Health and
Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland,
United States.
CORRESPONDENCE ADDRESS
P.T. Korthuis, Oregon Health and Science University, 3181 SW Sam Jackson
Park Road, Mail Code L-475, Portland, United States. Email:
korthuis@ohsu.edu
SOURCE
Annals of Internal Medicine (2017) 166:4 (268-278). Date of Publication: 21
Feb 2017
ISSN
1539-3704 (electronic)
0003-4819
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
ABSTRACT
Greater integration of medication-assisted treatment (MAT) for opioid use
disorder (OUD) in U.S. primary care settings would expand access to
treatment for this condition. Models for integrating MAT into primary care
vary in structure. This article summarizes findings of a technical report
for the Agency for Healthcare Research and Quality describing MAT models of
care for OUD, based on a literature review and interviews with key
informants in the field. The report describes 12 representative models of
care for integrating MAT into primary care settings that could be considered
for adaptation across diverse health care settings. Common components of
existing care models include pharmacotherapy with buprenorphine or
naltrexone, provider and community education, coordination and integration
of OUD treatment with other medical and psychological needs, and
psychosocial services and interventions. Models vary in how each component
is implemented. Decisions about adopting MAT models of care should be
individualized to address the unique milieu of each implementation setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
naloxone
naltrexone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
primary medical care
EMTREE MEDICAL INDEX TERMS
clinical outcome
community
emergency health service
emergency ward
health care
hospital patient
human
Human immunodeficiency virus
Human immunodeficiency virus infection
integrated health care system
manager
Massachusetts
medicaid
nurse
Oregon
prenatal care
prescription
priority journal
review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170426782
MEDLINE PMID
27919103 (http://www.ncbi.nlm.nih.gov/pubmed/27919103)
PUI
L616786519
DOI
10.7326/M16-2149
FULL TEXT LINK
http://dx.doi.org/10.7326/M16-2149
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 203
TITLE
Opioid-prescribing patterns of emergency physicians and risk of long-Term
use
AUTHOR NAMES
Barnett M.L.
Olenski A.R.
Jena A.B.
AUTHOR ADDRESSES
(Barnett M.L., mbarnett@hsph.harvard.edu) Department of Health Policy and
Management, Harvard T.H. Chan School of Public Health, Kresge Bldg., 4th
Fl., 677 Huntington Ave., Boston, United States.
(Olenski A.R.; Jena A.B.) Department of Health Care Policy, Harvard Medical
School, Boston, United States.
(Barnett M.L., mbarnett@hsph.harvard.edu) Department of Medicine, Division
of General Internal Medicine and Primary Care, Brigham and Women's Hospital,
Boston, United States.
(Olenski A.R.) Department of Medicine, Massachusetts General Hospital,
Boston, United States.
(Jena A.B.) National Bureau of Economic Research, Cambridge, United States.
CORRESPONDENCE ADDRESS
M.L. Barnett, Department of Health Policy and Management, Harvard T.H. Chan
School of Public Health, Kresge Bldg., 4th Fl., 677 Huntington Ave., Boston,
United States. Email: mbarnett@hsph.harvard.edu
SOURCE
New England Journal of Medicine (2017) 376:7 (663-673). Date of Publication:
16 Feb 2017
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
ABSTRACT
BACKGROUND Increasing overuse of opioids in the United States may be driven
in part by physician prescribing. However, the extent to which individual
physicians vary in opioid prescribing and the implications of that variation
for long-Term opioid use and adverse outcomes in patients are unknown.
METHODS We performed a retrospective analysis involving Medicare
beneficiaries who had an index emergency department visit in the period from
2008 through 2011 and had not received prescriptions for opioids within 6
months before that visit. After identifying the emergency physicians within
a hospital who cared for the patients, we categorized the physicians as
being high-intensity or low-intensity opioid prescribers according to
relative quartiles of prescribing rates within the same hospital. We
compared rates of long-Term opioid use, defined as 6 months of days
supplied, in the 12 months after a visit to the emergency department among
patients treated by high-intensity or low-intensity prescribers, with
adjustment for patient characteristics. RESULTS Our sample consisted of
215,678 patients who received treatment from low-intensity prescribers and
161,951 patients who received treatment from high-intensity prescribers.
Patient characteristics, including diagnoses in the emergency department,
were similar in the two treatment groups. Within individual hospitals, rates
of opioid prescribing varied widely between low-intensity and high-intensity
prescribers (7.3% vs. 24.1%). Long-Term opioid use was significantly higher
among patients treated by high-intensity prescribers than among patients
treated by lowintensity prescribers (adjusted odds ratio, 1.30; 95%
confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent
across multiple sensitivity analyses. CONCLUSIONS Wide variation in rates of
opioid prescribing existed among physicians practicing within the same
emergency department, and rates of long-Term opioid use were increased among
patients who had not previously received opioids and received treatment from
high-intensity opioid prescribers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency physician
prescription
treatment duration
EMTREE MEDICAL INDEX TERMS
aged
article
clinical outcome
controlled study
demography
female
human
major clinical study
male
medicare
morbidity
retrospective study
sensitivity analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170140417
MEDLINE PMID
28199807 (http://www.ncbi.nlm.nih.gov/pubmed/28199807)
PUI
L614492911
DOI
10.1056/NEJMsa1610524
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMsa1610524
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 204
TITLE
Do heroin overdose patients require observation after receiving naloxone?
AUTHOR NAMES
Willman M.W.
Liss D.B.
Schwarz E.S.
Mullins M.E.
AUTHOR ADDRESSES
(Willman M.W.; Liss D.B.; Schwarz E.S.; Mullins M.E., mullinsm@wustl.edu)
Division of Emergency Medicine, Washington University, St. Louis, United
States.
CORRESPONDENCE ADDRESS
M.E. Mullins, Division of Emergency Medicine, Washington University, 660 S.
Euclid Ave, Campus Box 8072, St. Louis, United States. Email:
mullinsm@wustl.edu
SOURCE
Clinical Toxicology (2017) 55:2 (81-87). Date of Publication: 7 Feb 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Context: Heroin use in the US has exploded in recent years, and heroin
overdoses requiring naloxone are very common. After awakening, some heroin
users refuse further treatment or transport to the hospital. These patients
may be at risk for recurrent respiratory depression or pulmonary edema. In
those transported to the emergency department, the duration of the
observation period is controversial. Additionally, non-medical first
responders and lay bystanders can administer naloxone for heroin and opioid
overdoses. There are concerns about the outcomes and safety of this practice
as well. Objectives: To search the medical literature related to the
following questions: (1) What are the medical risks to a heroin user who
refuses ambulance transport after naloxone? (2) If the heroin user is
treated in the emergency department with naloxone, how long must they be
observed prior to discharge? (3) How effective in heroin users is naloxone
administered by first responders and bystanders? Are there risks associated
with naloxone distribution programs? Methods: We searched PubMed and
GoogleScholar with search terms related to each of the questions listed
above. The search was limited to English language and excluded patents and
citations. The search was last updated on September 31, 2016. The articles
found were reviewed for relevance to our objective questions. Eight out of
1020 citations were relevant to the first 2 questions, 5 of 707 were
relevant to the third question and 15 of 287 were relevant to the fourth
question. In the prehospital environment, does a heroin user revived with
naloxone always require ambulance transport and what are the medical risks
if ambulance transport is refused after naloxone? The eight articles were
all observational studies done either prospectively or retrospectively. Two
studies focused on heroin overdoses and included 1069 patients not
transported to the hospital. No deaths occurred in this group. In counting
the patients from all eight studies, some of which included non-heroin
opioid overdoses, there were 5443 patients treated without transport and
four deaths from rebound opioid toxicity. The number needed to transport to
save one life (NNT) is 1361. Adverse effects were mostly related to opioid
withdrawal. If a heroin user is treated in the ED, how long must the patient
stay under observation before being safe for discharge? Five articles
addressing the duration of ED observation required for patients treated with
naloxone for opioid overdoses. Although a wide range of observation
durations were reported, one study supported observing patients for one
hour. If after this period the patient mobilizes as usual, has normal vital
signs, and a Glasgow Coma Scale of 15, they can be discharged safely. What
are the likely risks in heroin users following naloxone use by lay
bystanders or first responders? Of the 15 relevant papers, a systematic
review reported a 100% survival rate in eleven studies and a range of 96–99%
survival in the remaining four. Two other studies suffered from poor
follow-up and had lower success rates of 83% and 89%. Few if any risks were
associated with opioid overdose prevention programs in which lay people were
trained to administer naloxone. Conclusions: Patients revived with naloxone
after heroin overdose may be safely released without transport to the
hospital if they have normal mentation and vital signs. In the absence of
co-intoxicants and further opioid use there is very low risk of death from
rebound opioid toxicity. For those patients treated in the ED for opioid
overdose, an observation period of one hour is sufficient if they ambulate
as usual, have normal vital signs and a Glasgow Coma Scale of 15. Patients
suffering opioid toxicity can be administered naloxone safely by first
responders and trained lay people. Programs that train these individuals are
likely safe and beneficial, however further research is necessary.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
ambulance transportation
emergency ward
follow up
hospital discharge
human
observational study
prospective study
retrospective study
review
risk factor
survival rate
systematic review
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170050973
MEDLINE PMID
27849133 (http://www.ncbi.nlm.nih.gov/pubmed/27849133)
PUI
L614101868
DOI
10.1080/15563650.2016.1253846
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2016.1253846
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 205
TITLE
Multiple Fentanyl Overdoses - New Haven, Connecticut, June 23, 2016
AUTHOR NAMES
Tomassoni A.J.
Hawk K.F.
Jubanyik K.
Nogee D.P.
Durant T.
Lynch K.L.
Patel R.
Dinh D.
Ulrich A.
D'Onofrio G.
AUTHOR ADDRESSES
(Tomassoni A.J.; Hawk K.F.; Jubanyik K.; Nogee D.P.; Durant T.; Lynch K.L.;
Patel R.; Dinh D.; Ulrich A.; D'Onofrio G.)
SOURCE
MMWR. Morbidity and mortality weekly report (2017) 66:4 (107-111). Date of
Publication: 3 Feb 2017
ISSN
1545-861X (electronic)
ABSTRACT
On the evening of June 23, 2016, a white powder advertised as cocaine was
purchased off the streets from multiple sources and used by an unknown
number of persons in New Haven, Connecticut. During a period of less than 8
hours, 12 patients were brought to the emergency department (ED) at Yale New
Haven Hospital, experiencing signs and symptoms consistent with opioid
overdose. The route of intoxication was not known, but presumed to be
insufflation ("snorting") in most cases. Some patients required doses of the
opioid antidote naloxone exceeding 4 mg (usual initial dose = 0.1-0.2 mg
intravenously), and several patients who were alert after receiving naloxone
subsequently developed respiratory failure. Nine patients were admitted to
the hospital, including four to the intensive care unit (ICU); three
required endotracheal intubation, and one required continuous naloxone
infusion. Three patients died. The white powder was determined to be
fentanyl, a drug 50 times more potent than heroin, and it included trace
amounts of cocaine. The episode triggered rapid notification of public
health and law enforcement agencies, interviews of patients and their family
members to trace and limit further use or distribution of the fentanyl,
immediate naloxone resupply and augmentation for emergency medical services
(EMS) crews, public health alerts, and plans to accelerate naloxone
distribution to opioid users and their friends and families. Effective
communication and timely, coordinated, collaborative actions of community
partners reduced the harm caused by this event and prevented potential
subsequent episodes.
EMTREE DRUG INDEX TERMS
fentanyl (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
blood
case report
Connecticut
drug overdose (diagnosis, therapy)
fatality
female
hospital emergency service
human
male
middle aged
urine
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28151928 (http://www.ncbi.nlm.nih.gov/pubmed/28151928)
PUI
L616756021
DOI
10.15585/mm6604a4
FULL TEXT LINK
http://dx.doi.org/10.15585/mm6604a4
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 206
TITLE
Application of human factors engineering (HFE) to the design of a naloxone
auto-injector for the treatment of opioid emergencies
AUTHOR NAMES
Raffa R.B.
Taylor R.
Pergolizzi J.V.
Nalamachu S.
Edwards E.S.
Edwards E.T.
AUTHOR ADDRESSES
(Raffa R.B.) Temple University School of Pharmacy, Philadelphia, United
States.
(Taylor R.; Pergolizzi J.V.) NEMA Research, Bonita Springs, United States.
(Pergolizzi J.V.) Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, United States.
(Nalamachu S.) International Clinical Research Institute, Overland Park,
United States.
(Edwards E.S.; Edwards E.T., Evan.Edwards@kaleopharma.com) Kaleo, Inc.,
Richmond, United States.
CORRESPONDENCE ADDRESS
E.T. Edwards, Kaleo, Inc., Richmond, United States. Email:
Evan.Edwards@kaleopharma.com
SOURCE
Drug Delivery and Translational Research (2017) 7:1. Date of Publication: 1
Feb 2017
ISSN
2190-3948 (electronic)
2190-393X
BOOK PUBLISHER
Springer Verlag, service@springer.de
ABSTRACT
The increased use of opioids for chronic treatment of pain and the resulting
epidemic of opioid overdoses have created a major public health challenge.
Parenteral naloxone has been used since the 1970’s to treat opioid overdose.
Recently, a novel naloxone auto-injector device (EVZIO, kaleo, Inc.,
Richmond, VA) was approved by the Food and Drug Administration. In this
article, we review the Human Factors Engineering (HFE) process used in the
development and testing of this novel naloxone auto-injector currently used
in nonmedical settings for the emergency treatment of known or suspected
opioid overdose. HFE methods were employed throughout the product
development process for the naloxone auto-injector including formative and
summative studies in order to optimize the auto-injector’s user interface,
mitigate use-related hazards and increase reliability during an opioid
emergency use scenario. HFE was also used to optimize the product’s design
and user interface in order to reduce or prevent user confusion and misuse.
The naloxone auto-injector went through a rigorous HFE process that included
perceptual, cognitive, and physical action analysis; formative usability
evaluations; use error analysis and summative design validation studies.
Applying HFE resulted in the development of a product that is safe, fast,
easy and predictably reliable to deliver a potentially life-saving dose of
naloxone during an opioid overdose emergency. The naloxone auto-injector may
be considered as a universal precaution option for at-risk patients
prescribed opioids or those who are at increased risk for an opioid overdose
emergency.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, pharmaceutics)
opiate (drug dose, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
autoinjector
drug intoxication (drug therapy, drug therapy)
emergency care
engineering
equipment design
human factor engineering
EMTREE MEDICAL INDEX TERMS
article
drug overdose
evaluation study
human
phase 1 clinical trial (topic)
phase 2 clinical trial (topic)
phase 3 clinical trial (topic)
priority journal
product development
randomized controlled trial (topic)
training
validation study
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170057231
MEDLINE PMID
27562292 (http://www.ncbi.nlm.nih.gov/pubmed/27562292)
PUI
L614097462
DOI
10.1007/s13346-016-0323-x
FULL TEXT LINK
http://dx.doi.org/10.1007/s13346-016-0323-x
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 207
TITLE
Evaluating the impact of a national naloxone programme on ambulance
attendance at overdose incidents: a controlled time-series analysis
AUTHOR NAMES
McAuley A.
Bouttell J.
Barnsdale L.
Mackay D.
Lewsey J.
Hunter C.
Robinson M.
AUTHOR ADDRESSES
(McAuley A.) Health Protection Scotland, Meridian Court, Glasgow, UK
(McAuley A.) School of Health and Life Sciences, Glasgow Caledonian
University, Glasgow, UK
(Bouttell J.; Mackay D.; Lewsey J.) Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK
(Barnsdale L.) NHS National Services Scotland, Information Services
Division, Gyle Square, Edinburgh, UK
(Hunter C.) NHS Greater Glasgow and Clyde, Possilpark Health and Care
Centre, Glasgow, UK
(Robinson M.) Public Health Science Directorate, NHS Health Scotland,
Meridian Court, Glasgow, UK
SOURCE
Addiction (Abingdon, England) (2017) 112:2 (301-308). Date of Publication: 1
Feb 2017
ISSN
1360-0443 (electronic)
ABSTRACT
MEASUREMENTS: Primary outcome measure was weekly incidence (counts) of
call-outs to opioid-related overdoses at national and regional Health Board
level. Data were acquired from the Scottish Ambulance Service (SAS). Models
were adjusted for opioid replacement therapy using data acquired from the
Information Services Division on monthly sums of all dispensed methadone and
buprenorphine in the study period. Models were adjusted further for a
control group: weekly incidence (counts) of call-outs to heroin-related
overdose in the London Borough area acquired from the London Ambulance
Service.FINDINGS: There was no significant association between SAS call-outs
to opioid-related overdose incidents and THN kits in issue for Scotland as a
whole (coefficient 0.009, 95% confidence intervals = -0.01, 0.03, P = 0.39).
In addition, the magnitude of association between THN kits and SAS call-outs
did not differ significantly between pilot and non-pilot regions
(interaction test, P = 0.62).CONCLUSIONS: The supply of take-home naloxone
kits through a National Naloxone Programme in Scotland was not associated
clearly with a decrease in ambulance attendance at opioid-related overdose
incidents in the 4-year period after it was implemented in April
2011.BACKGROUND AND AIMS: It has been suggested that distributing naloxone
to people who inject drugs (PWID) will lead to fewer attendances by
emergency medical services at opioid-related overdose incidents if peer
administration of naloxone was perceived to have resuscitated the overdose
victim successfully. This study evaluated the impact of a national naloxone
programme (NNP) on ambulance attendance at opioid-related overdose incidents
throughout Scotland. Specifically, we aimed to answer the following research
questions: is there evidence of an association between ambulance call-outs
to opioid-related overdose incidents and the cumulative number of 'take-home
naloxone' (THN) kits in issue; and is there evidence of an association
between ambulance call-outs to opioid-related overdose incidents in early
adopter (pilot) or later adopting (non-pilot) regions and the cumulative
number of THN kits issued in those areas?DESIGN: Controlled time-series
analysis.SETTING: Scotland, UK, 2008-15.PARTICIPANTS: Pre-NNP implementation
period for the evaluation was defined as 1 April 2008 to 31 March 2011 and
the post-implementation period as 1 April 2011 to 31 March 2015. In total,
3721 ambulance attendances at opioid-related overdose were recorded for the
pre-NNP implementation period across 158 weeks (mean 23.6 attendances per
week) and 5258 attendances across 212 weeks in the post-implementation
period (mean 24.8 attendances per week).INTERVENTION: Scotland's NNP;
formally implemented on 1 April 2011.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
ambulance
drug overdose (drug therapy, epidemiology)
emergency health service
human
opiate addiction (epidemiology)
Scotland
substance abuse
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27614084 (http://www.ncbi.nlm.nih.gov/pubmed/27614084)
PUI
L620873725
DOI
10.1111/add.13602
FULL TEXT LINK
http://dx.doi.org/10.1111/add.13602
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 208
TITLE
Persistent pain after motor vehicle collision: Comparative effectiveness of
opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency
department- A propensity matched analysis
AUTHOR NAMES
Beaudoin F.L.
Gutman R.
Merchant R.C.
Clark M.A.
Swor R.A.
Jones J.S.
Lee D.C.
Peak D.A.
Domeier R.M.
Rathlev N.K.
McLean S.A.
AUTHOR ADDRESSES
(Beaudoin F.L., Francesca_Beaudoin@brown.edu; Merchant R.C.) Department of
Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown
University, 55 Claverick St, 2nd Floor, Providence, United States.
(Beaudoin F.L., Francesca_Beaudoin@brown.edu; Merchant R.C.; Clark M.A.)
Departments of Epidemiology, Brown University, Providence, United States.
(Gutman R.) Departments of Biostatistics, Brown University, Providence,
United States.
(Clark M.A.) Department of Quantitative Health Science, University of
Massachusetts Medical School, Worcester, United States.
(Swor R.A.) Department of Emergency Medicine, William Beaumont Hospital,
Royal Oak, United States.
(Jones J.S.) Department of Emergency Medicine, Spectrum Health Butterworth
Campus, Grand Rapids, United States.
(Lee D.C.) Department of Emergency Medicine, North Shore University
Hospital, Manhasset, United States.
(Peak D.A.) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, United States.
(Domeier R.M.) Department of Emergency Medicine, St Joseph Mercy Hospital,
Yipsilanti, United States.
(Rathlev N.K.) Department of Emergency Medicine, Baystate Medical Center,
Springfield, United States.
(McLean S.A.) Departments of Emergency Medicine, University of North
Carolina, Chapel Hill, United States.
(McLean S.A.) Departments of Anesthesiology, University of North Carolina,
Chapel Hill, United States.
(McLean S.A.) TRYUMPH Research Program, University of North Carolina, Chapel
Hill, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, Department of Emergency Medicine, Rhode Island Hospital,
Alpert Medical School of Brown University, 55 Claverick St, 2nd Floor,
Providence, United States. Email: Francesca_Beaudoin@brown.edu
SOURCE
Pain (2017) 158:2 (289-295). Date of Publication: 1 Feb 2017
ISSN
1872-6623 (electronic)
0304-3959
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
ABSTRACT
Each year millions of Americans present to the emergency department (ED) for
care after a motor vehicle collision (MVC); the majority (>90%) are
discharged to home after evaluation. Acute musculoskeletal pain is the norm
in this population, and such patients are typically discharged to home with
prescriptions for oral opioid analgesics or nonsteroidal antiinflammatory
drugs (NSAIDs). The influence of acute pain management on subsequent pain
outcomes in this common ED population is unknown. We evaluated the effect of
opioid analgesics vs NSAIDs initiated from the ED on the presence of
moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in
a large cohort of adult ED patients presenting to the ED after MVC (n =
948). The effect of opioids vs NSAIDs was evaluated using an innovative
quasi-experimental design method using propensity scores to account for
covariate imbalances between the 2 treatment groups. No difference in risk
for moderate to severe musculoskeletal pain at 6 weeks was observed between
those discharged with opioid analgesics vs NSAIDs (risk difference = 7.2%
[95% confidence interval:-5.2% to 19.5%]). However, at follow-up
participants prescribed opioids were more likely than those prescribed
NSAIDs to report use of prescription opioids medications at week 6 (risk
difference = 17.5% [95% confidence interval: 5.8%-29.3%]). These results
suggest that analgesic choice at ED discharge does not influence the
development of persistent moderate to severe musculoskeletal pain 6 weeks
after an MVC, but may result in continued use of prescription opioids.
Supported by NIAMS R01AR056328 and AHRQ 5K12HS022998.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nonsteroid antiinflammatory agent (drug comparison, drug therapy)
opiate (drug combination, drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
hydrocodone (drug therapy)
ibuprofen (drug therapy)
naproxen (drug therapy)
oxycodone (drug therapy)
paracetamol (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
musculoskeletal pain (drug therapy, drug therapy)
traffic accident
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
cohort analysis
comparative effectiveness
drug efficacy
emergency ward
female
follow up
hospital discharge
human
major clinical study
male
multicenter study (topic)
prescription
priority journal
propensity score
quasi experimental study
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
naproxen (22204-53-1, 26159-34-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170292137
MEDLINE PMID
28092325 (http://www.ncbi.nlm.nih.gov/pubmed/28092325)
PUI
L615607343
DOI
10.1097/j.pain.0000000000000756
FULL TEXT LINK
http://dx.doi.org/10.1097/j.pain.0000000000000756
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 209
TITLE
Something for pain: Responsible opioid use in emergency medicine
AUTHOR NAMES
Strayer R.J.
Motov S.M.
Nelson L.S.
AUTHOR ADDRESSES
(Strayer R.J., emupdates@gmail.com) Department of Emergency Medicine, Icahn
School of Medicine at Mount Sinai, 79-01 Broadway, Elmhurst, United States.
(Motov S.M.) Department of Emergency Medicine, Maimonides Medical Center,
4802 Tenth Ave, Brooklyn, United States.
(Nelson L.S.) Department of Emergency Medicine, Rutgers New Jersey Medical
School, 185 South Orange Avenue, Newark, United States.
CORRESPONDENCE ADDRESS
R.J. Strayer, Department of Emergency Medicine, Elmhurst Hospital, 79-01
Broadway, Room B1-27, Elmhurst, United States. Email: emupdates@gmail.com
SOURCE
American Journal of Emergency Medicine (2017) 35:2 (337-341). Date of
Publication: 1 Feb 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The United States is currently experiencing a public health crisis of opioid
addiction, which has its genesis in an industry marketing effort that
successfully encouraged clinicians to prescribe opioids liberally, and
asserted the safety of prescribing opioids for chronic non-cancer pain,
despite a preponderance of evidence demonstrating the risks of dependence
and misuse. The resulting rise in opioid use has pushed drug overdose deaths
in front of motor vehicle collisions to become the leading cause of
accidental death in the country. Emergency providers frequently treat
patients for complications of opioid abuse, and also manage patients with
acute and chronic pain, for which opioids are routinely prescribed.
Emergency providers are therefore well positioned to both prevent new cases
of opioid misuse and initiate appropriate treatment of existing opioid
addicts. In opioid-naive patients, this is accomplished by a careful
consideration of the likelihood of benefit and harm of an opioid
prescription for acute pain. If opioids are prescribed, the chance of harm
is reduced by matching the number of pills prescribed to the expected
duration of pain and selecting an opioid preparation with low abuse
liability. Patients who present to acute care with exacerbations of chronic
pain or painful conditions associated with opioid misuse are best managed by
treating symptoms with opioid alternatives and encouraging treatment for
opioid addiction.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
bupivacaine
dexmedetomidine
droperidol
ketamine
ketorolac
lidocaine
metoclopramide
nitrous oxide
paracetamol
propofol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
opiate addiction
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
article
chronic pain
clinical feature
disease exacerbation
epidemic
human
pain (drug therapy)
priority journal
risk benefit analysis
CAS REGISTRY NUMBERS
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5, 38396-39-3)
dexmedetomidine (113775-47-6)
droperidol (548-73-2)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160916853
MEDLINE PMID
27802876 (http://www.ncbi.nlm.nih.gov/pubmed/27802876)
PUI
L613715103
DOI
10.1016/j.ajem.2016.10.043
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2016.10.043
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 210
TITLE
A Case of Opioid Toxicity on Conversion From Extended-Release Oxycodone and
Naloxone to Extended-Release Oxycodone in a Patient With Liver Dysfunction
AUTHOR NAMES
Franklin A.E.
Lovell M.R.
Boyle F.
AUTHOR ADDRESSES
(Franklin A.E., aefranklin@doctors.net.uk; Lovell M.R.) HammondCare
Palliative and Supportive Care Service, Greenwich Hospital, Sydney,
Australia.
(Lovell M.R.) Northern Clinical School and Kolling Institute, The University
of Sydney, Sydney, Australia.
(Boyle F.) Department of Medical Oncology, The University of Sydney, Sydney,
Australia.
(Boyle F.) Patricia Ritchie Centre for Cancer Care and Research, Mater
Hospital, Sydney, Australia.
SOURCE
Journal of Pain and Symptom Management (2017) 53:2 (e1-e2). Date of
Publication: 1 Feb 2017
ISSN
1873-6513 (electronic)
0885-3924
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (parenteral drug administration)
naloxone plus oxycodone (drug dose, drug therapy, pharmacokinetics)
oxycodone (drug dose, drug therapy, drug toxicity, pharmacokinetics)
EMTREE DRUG INDEX TERMS
antineoplastic agent (drug therapy)
antineoplastic hormone agonists and antagonists (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
cancer pain (drug therapy, drug therapy)
drug metabolism
liver dysfunction (complication)
EMTREE MEDICAL INDEX TERMS
aged
bone metastasis
cancer adjuvant therapy
cancer hormone therapy
cancer patient
cancer prognosis
cancer radiotherapy
case report
consciousness level
drug dose reduction
drug dose titration
emergency ward
estrogen receptor positive breast cancer (drug therapy, radiotherapy)
female
human
intensive care unit
letter
liver function
liver metastasis
lymph node metastasis
outcome assessment
respiratory function
spleen metastasis
sustained drug release
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Cancer (16)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160934717
PUI
L613806219
DOI
10.1016/j.jpainsymman.2016.10.354
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpainsymman.2016.10.354
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 211
TITLE
Drug availability adjustments in population-based studies of prescription
opioid abuse
AUTHOR NAMES
Secora A.
Trinidad J.P.
Zhang R.
Gill R.
Dal Pan G.
AUTHOR ADDRESSES
(Secora A., alex.secora@fda.hhs.gov; Trinidad J.P.,
james.trinidad@fda.hhs.gov; Gill R.; Dal Pan G.) Office of Surveillance and
Epidemiology, Division of Epidemiology, Center for Drug Evaluation and
Research (CDER), Food and Drug Administration (FDA), United States.
(Zhang R.) Office of Biostatistics, Division of Biometrics VII, CDER, FDA,
United States.
CORRESPONDENCE ADDRESS
A. Secora, Office of Surveillance and Epidemiology, Division of
Epidemiology, Center for Drug Evaluation and Research (CDER), Food and Drug
Administration (FDA), United States. Email: alex.secora@fda.hhs.gov
SOURCE
Pharmacoepidemiology and Drug Safety (2017) 26:2 (180-191). Date of
Publication: 1 Feb 2017
ISSN
1099-1557 (electronic)
1053-8569
BOOK PUBLISHER
John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United
Kingdom.
ABSTRACT
Purpose: Population-based prescription opioid abuse studies in which one
drug is compared to another, or drugs are compared across time, often
account for the availability of those drugs in the community. The objective
of this investigation is to assess consistency in the relative abuse ratios
(RARs) across different approaches for adjusting for drug availability.
Methods: For the years 2004 through 2010, RARs for each of four prescription
opioids (hydrocodone, oxycodone, hydromorphone, and morphine) were
calculated using negative binomial regression. Measures of abuse (outcome)
were misuse/abuse-related emergency department visits obtained from the Drug
Abuse Warning Network. Measures of drug availability (offsets) were drug
utilization estimates obtained from IMS Health. Separate regression models
were run using each of five measures of drug utilization: unique patients
(URDD), prescriptions dispensed (RX), tablets dispensed (TD), kilograms
(KGs) sold, and morphine-equivalents (MEs) of kilograms sold. These results
were compared for consistency. Results: Aside from oxycodone-combination
products, across molecules, RARs adjusted by RXs, TDs, and URDDs were
generally similar to each other while RARs adjusted by KGs and MEs were
different. For example, compared to hydrocodone, oxycodone had statistically
significantly increased RARs of 3.6 (95%CI: 2.0–6.5), 3.5 (95%CI: 1.9–6.4),
and 2.7 (95%CI: 1.5–5.0) when adjusted by URDDs, RXs, and TDs, respectively,
but not when adjusted by KGs or MEs. Conclusions: Different drug utilization
adjustment approaches may yield inconsistent RAR estimates in
population-based prescription opioid abuse analyses. Published 2016. This
article is a U.S. Government work and is in the public domain in the USA.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmaceutics, pharmacoeconomics, pharmacokinetics)
EMTREE DRUG INDEX TERMS
hydrocodone (pharmaceutics, pharmacoeconomics, pharmacokinetics)
hydromorphone (pharmaceutics, pharmacoeconomics, pharmacokinetics)
morphine (pharmaceutics, pharmacoeconomics, pharmacokinetics)
oxycodone (pharmaceutics, pharmacoeconomics, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug bioavailability
drug utilization
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
binomial distribution
controlled study
drug abuse
drug manufacture
drug misuse
emergency ward
human
outcome assessment
pharmacy
prescription
priority journal
regression analysis
relative abuse ratio
tablet formulation
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170001702
MEDLINE PMID
28000295 (http://www.ncbi.nlm.nih.gov/pubmed/28000295)
PUI
L613919774
DOI
10.1002/pds.4139
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.4139
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 212
TITLE
Clinical parameters that predict the need for medium or intensive care
admission in intentional drug overdose patients: A retrospective cohort
study
AUTHOR NAMES
van den Oever H.L.A.
van Dam M.
van ‘t Riet E.
Jansman F.G.A.
AUTHOR ADDRESSES
(van den Oever H.L.A., h.vandenoever@dz.nl; van Dam M.,
mirjavandam@gmail.com) Intensive Care Unit, Deventer Hospital, Nico
Bolkesteinlaan 75, Deventer, Netherlands.
(van ‘t Riet E., e.vantriet@dz.nl) Teaching Hospital Deventer, Deventer
Hospital, Nico Bolkesteinlaan 75, Deventer, Netherlands.
(Jansman F.G.A., f.jansman@dz.nl) Department of Clinical Pharmacy, Deventer
Hospital, Nico Bolkesteinlaan 75, Deventer, Netherlands.
(Jansman F.G.A., f.jansman@dz.nl) Department of Pharmacotherapy,
Epidemiology and Economics, University Groningen, Antonius Deusinglaan 1,
Groningen, Netherlands.
CORRESPONDENCE ADDRESS
H.L.A. van den Oever, Intensive Care Unit, Deventer Hospital, Nico
Bolkesteinlaan 75, Deventer, Netherlands. Email: h.vandenoever@dz.nl
SOURCE
Journal of Critical Care (2017) 37 (156-161). Date of Publication: 1 Feb
2017
ISSN
1557-8615 (electronic)
0883-9441
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Introduction Many patients with intentional drug overdose (IDO) are admitted
to a medium (MC) or intensive care unit (IC) without ever requiring MC/IC
related interventions. The objective of this study was to develop a decision
tool, using parameters readily available in the emergency room (ER) for
patients with an IDO, to identify patients requiring admission to a
monitoring unit. Methods Retrospective cohort study among cases of IDO with
drugs having potentially acute effects on neurological, circulatory or
ventilatory function, admitted to the MC/IC unit between 2007 and 2013. A
decision tool was developed, using 6 criteria, representing intubation,
breathing, oxygenation, cardiac conduction, blood pressure, and
consciousness. Cases were labeled as ‘high acuity’ if one or more criteria
were present. Results Among 255 cases of IDO that met the inclusion
criteria, 197 were identified as “high acuity”. Only 70 of 255 cases
underwent one or more MC/IC related interventions, of which 67 were
identified as ‘high acuity by the decision tool (sensitivity 95.7%).
Conclusion In a population of patients with intentional drug overdose with
agents having potentially acute effect on vital functions, 95.7% of MC/IC
interventions could be predicted by clinical assessment, supplemented with
electrocardiogram and blood gas analysis, in the ER.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
antiarrhythmic agent (drug therapy, intravenous drug administration)
anticonvulsive agent (drug therapy)
atropine (drug therapy, intravenous drug administration)
biperiden (drug toxicity)
calcium (drug therapy, intravenous drug administration)
diazepam (drug toxicity)
enalapril (drug toxicity)
flumazenil (drug therapy)
haloperidol (drug combination)
magnesium (drug therapy, intravenous drug administration)
midazolam (drug combination, intravenous drug administration)
naloxone (drug therapy)
oxazepam (drug toxicity)
paracetamol (drug toxicity)
quetiapine (drug toxicity)
risperidone (drug toxicity)
sedative agent (drug therapy, intravenous drug administration)
temazepam (drug toxicity)
vasoactive agent (drug therapy, intravenous drug administration)
zuclopenthixol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical assessment tool
drug overdose (drug therapy, drug therapy)
health care need
hospital admission
intensive care admission
intentional drug overdose (drug therapy, drug therapy)
medical parameters
medium care admission
prediction
EMTREE MEDICAL INDEX TERMS
acute disease
adolescent
adult
aged
article
blood pressure
breathing disorder
breathing mechanics
cohort analysis
consciousness
controlled study
convulsion (drug therapy)
diagnostic test accuracy study
emergency ward
endotracheal intubation
female
heart arrhythmia (drug therapy)
heart conduction
human
intensive care
intensive care unit
ischemia
major clinical study
male
medical decision making
medium care unit
neurologic disease
oxygenation
patient monitoring
practice guideline
receiver operating characteristic
reference value
retrospective study
sensitivity and specificity
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
calcium (7440-70-2, 14092-94-5)
diazepam (439-14-5)
enalapril (75847-73-3)
flumazenil (78755-81-4)
haloperidol (52-86-8, 1511-16-6)
magnesium (7439-95-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxazepam (604-75-1)
paracetamol (103-90-2)
quetiapine (111974-72-2)
risperidone (106266-06-2)
temazepam (846-50-4)
zuclopenthixol (53772-83-1)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160919759
MEDLINE PMID
27744235 (http://www.ncbi.nlm.nih.gov/pubmed/27744235)
PUI
L613672291
DOI
10.1016/j.jcrc.2016.09.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jcrc.2016.09.020
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 213
TITLE
Opioids and overdoses: Time to get serious; time to get sensible
AUTHOR NAMES
Brindley P.G.
Douma M.J.
AUTHOR ADDRESSES
(Brindley P.G., brindley@ualberta.ca) Critical Care Medicine, Medical
Ethics, Anesthesiology, University of Alberta Hospital, Edmonton, Canada.
(Brindley P.G., brindley@ualberta.ca) Intensive Care Medicine, University of
Alberta Hospital, Edmonton, Canada.
(Douma M.J., matthew.douma@AHS.ca) Royal Alexandra Hospital Emergency
Department, Edmonton, Canada.
CORRESPONDENCE ADDRESS
M.J. Douma, Royal Alexandra Hospital Emergency Department, Edmonton, Canada.
Email: matthew.douma@AHS.ca
SOURCE
Journal of Critical Care (2017) 37 (254). Date of Publication: 1 Feb 2017
ISSN
1557-8615 (electronic)
0883-9441
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency treatment
EMTREE MEDICAL INDEX TERMS
health care availability
health care policy
health care system
heart arrest
heart muscle ischemia
human
intensive care
letter
mortality
patient attitude
prescription
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160891699
MEDLINE PMID
27717562 (http://www.ncbi.nlm.nih.gov/pubmed/27717562)
PUI
L613558156
DOI
10.1016/j.jcrc.2016.09.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jcrc.2016.09.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 214
TITLE
A Special Contribution from the Centers for Medicare and Medicaid Services:
Valuing Patient Experience While Addressing the Prescription Opioid Epidemic
AUTHOR NAMES
Tefera L.
Lehrman W.G.
Goldstein E.G.
Agrawal S.
AUTHOR ADDRESSES
(Tefera L., lemeneh.tefera@hhs.cms.gov) Quality Measurement and Value-Based
Incentives Group, Centers for Medicare & Medicaid Services, Baltimore,
United States.
(Lehrman W.G.; Goldstein E.G.) Division of Consumer Assessment and Plan
Performance, Centers for Medicare & Medicaid Services, Baltimore, United
States.
(Agrawal S.) Center for Program Integrity, Centers for Medicare & Medicaid
Services, Baltimore, United States.
CORRESPONDENCE ADDRESS
L. Tefera, Quality Measurement and Value-Based Incentives Group, Centers for
Medicare & Medicaid Services, Baltimore, United States. Email:
lemeneh.tefera@hhs.cms.gov
SOURCE
Annals of Emergency Medicine (2017) 69:2 (181-183). Date of Publication: 1
Feb 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
medicaid
medicare
opiate addiction
personal experience
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain (drug therapy)
drug industry
editorial
emergency ward
health care cost
health care quality
hospital discharge
hospital purchasing
hospitalization
human
patient care
patient satisfaction
priority journal
total quality management
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160546450
MEDLINE PMID
27451119 (http://www.ncbi.nlm.nih.gov/pubmed/27451119)
PUI
L611340818
DOI
10.1016/j.annemergmed.2016.06.047
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2016.06.047
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 215
TITLE
Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department
Patients With Acute Fracture Pain: A Pilot Study
AUTHOR NAMES
Chai P.R.
Carreiro S.
Innes B.J.
Rosen R.K.
O'Cleirigh C.
Mayer K.H.
Boyer E.W.
AUTHOR ADDRESSES
(Chai P.R.; Boyer E.W.) Division of Medical Toxicology, Department of
Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Carreiro S.) Division of Medical Toxicology, Department of Emergency
Medicine, University of Massachusetts Medical School, Worcester, MA, United
States
(Innes B.J.) University of Massachusetts Medical School, Worcester, MA,
United States
(Rosen R.K.) Behavioral and Preventative Medicine, The Miriam Hospital,
Brown School of Public Health, Providence, RI, United States
(O'Cleirigh C.) Department of Psychiatry, Massachusetts General Hospital,
Boston, MA, United States
(Mayer K.H.) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
SOURCE
Journal of medical Internet research (2017) 19:1 (e19). Date of Publication:
13 Jan 2017
ISSN
1438-8871 (electronic)
ABSTRACT
BACKGROUND: Nonadherence to prescribed regimens for opioid analgesic agents
contributes to increasing opioid abuse and overdose death. Opioids are
frequently prescribed on an as-needed basis, placing the responsibility to
determine opioid dose and frequency with the patient. There is wide
variability in physician prescribing patterns because of the lack of data
describing how patients actually use as-needed opioid analgesics. Digital
pill systems have a radiofrequency emitter that directly measures medication
ingestion events, and they provide an opportunity to discover the dose,
timing, and duration of opioid therapy.OBJECTIVE: The purpose of this study
was to determine the feasibility of a novel digital pill system to measure
as-needed opioid ingestion patterns in patients discharged from the
emergency department (ED) after an acute bony fracture.METHODS: We used a
digital pill with individuals who presented to a teaching hospital ED with
an acute extremity fracture. The digital pill consisted of a digital
radiofrequency emitter within a standard gelatin capsule that encapsulated
an oxycodone tablet. When ingested, the gastric chloride ion gradient
activated the digital pill, transmitting a radiofrequency signal that was
received by a hip-worn receiver, which then transmitted the ingestion data
to a cloud-based server. After a brief, hands-on training session in the ED,
study participants were discharged home and used the digital pill system to
ingest oxycodone prescribed as needed for pain for one week. We conducted
pill counts to verify digital pill data and open-ended interviews with
participants at their follow-up appointment with orthopedics or at one week
after enrollment in the study to determine the knowledge, attitudes,
beliefs, and practices regarding digital pills. We analyzed open-ended
interviews using applied thematic analysis.RESULTS: We recruited 10 study
participants and recorded 96 ingestion events (87.3%, 96/110 accuracy).
Study participants reported being able to operate all aspects of the digital
pill system after their training. Two participants stopped using the digital
pill, reporting they were in too much pain to focus on the novel technology.
The digital pill system detected multiple simultaneous ingestion events by
the digital pill system. Participants ingested a mean 8 (SD 5) digital pills
during the study period and four participants continued on opioids at the
end of the study period. After interacting with the digital pill system in
the real world, participants found the system highly acceptable (80%, 8/10)
and reported a willingness to continue to use a digital pill to improve
medication adherence monitoring (90%, 9/10).CONCLUSIONS: The digital pill is
a feasible method to measure real-time opioid ingestion patterns in
individuals with acute pain and to develop real-time interventions if opioid
abuse is detected. Deploying digital pills is possible through the ED with a
short instructional course. Patients who used the digital pill accepted the
technology.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug administration)
oxycodone (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pathophysiology
EMTREE MEDICAL INDEX TERMS
adult
clinical practice
clinical trial
female
fracture (drug therapy)
genetic procedures
hospital emergency service
human
male
medication compliance
middle aged
pain (drug therapy, etiology)
pilot study
radiofrequency radiation
CAS REGISTRY NUMBERS
oxycodone (124-90-3, 76-42-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28087496 (http://www.ncbi.nlm.nih.gov/pubmed/28087496)
PUI
L617828701
DOI
10.2196/jmir.7050
FULL TEXT LINK
http://dx.doi.org/10.2196/jmir.7050
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 216
TITLE
Opioid overdose prevention and naloxone rescue kits: what we know and what
we don't know
AUTHOR NAMES
Kerensky T.
Walley A.Y.
AUTHOR ADDRESSES
(Kerensky T., Todd.Kerensky@bmc.org) Instructor of Medicine, Boston
University School of Medicine, Boston Medical Center, 801 Massachusetts
Avenue, Floor 2, Boston, MA, 02118, USA
(Walley A.Y.) Section of General Internal Medicine, Clinical Addiction
Research and Education Unit, Boston University School of Medicine, Boston
Medical Center, 801 Massachusetts Avenue, Floor 2, Boston, MA, 02118, USA
SOURCE
Addiction science & clinical practice (2017) 12:1 (4). Date of Publication:
7 Jan 2017
ISSN
1940-0640 (electronic)
ABSTRACT
The opioid use and overdose crisis is persistent and dynamic. Opioid
overdoses were initially driven in the 1990s and 2000s by the increasing
availability and misuse of prescription opioids. More recently, opioid
overdoses are increasing at alarming rates due to wider use of heroin, which
in some places is mixed with fentanyl or fentanyl derivatives. Naloxone
access for opioid overdose rescue is one of the US Department of Health and
Human Services' three priority areas for responding to the opioid crisis.
This article summarizes the known benefits of naloxone access and details
unanswered questions about overdose education and naloxone rescue kits.
Hopefully future research will address these knowledge gaps, improve the
effectiveness of opioid overdose education and naloxone distribution
programs, and unlock the full promise of naloxone rescue kits.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS
drug overdose (prevention)
drug use
female
hospital emergency service
human
male
opiate addiction (drug therapy)
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28061909 (http://www.ncbi.nlm.nih.gov/pubmed/28061909)
PUI
L619702797
DOI
10.1186/s13722-016-0068-3
FULL TEXT LINK
http://dx.doi.org/10.1186/s13722-016-0068-3
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 217
TITLE
Near death from a novel synthetic opioid labeled U-47700: emergence of a new
opioid class
AUTHOR NAMES
Schneir A.
Metushi I.G.
Sloane C.
Benaron D.J.
Fitzgerald R.L.
AUTHOR ADDRESSES
(Schneir A., aschneir@ucsd.edu) Division of Medical Toxicology, University
of California, San Diego Health System, San Diego, United States.
(Schneir A., aschneir@ucsd.edu; Sloane C.; Benaron D.J.) Department of
Emergency Medicine, University of California, San Diego Health System, San
Diego, United States.
(Metushi I.G.; Fitzgerald R.L.) Department of Pathology, Center for Advanced
Laboratory Medicine, University of California, San Diego Health System, San
Diego, United States.
CORRESPONDENCE ADDRESS
A. Schneir, Division of Medical Toxicology, University of California, San
Diego Health System, San Diego, United States. Email: aschneir@ucsd.edu
SOURCE
Clinical Toxicology (2017) 55:1 (51-54). Date of Publication: 2 Jan 2017
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Background: In the last decade there has been a worldwide surge in the
recreational abuse of novel psychoactive substances, particularly
amphetamine derivatives and synthetic cannabinoids. Synthetic opioids such
as AH-7921, MT-45, and U-47700, with structures distinct from those ever
used therapeutically or described recreationally, have also recently
emerged. Case details: We report a patient who suffered respiratory failure
and depressed level of consciousness after recreationally using a novel
synthetic opioid labeled U-47700. A single dose of naloxone administered by
paramedics completely reversed his opioid poisoning. Comprehensive
laboratory analysis confirmed the presence of a novel synthetic opioid and
excluded other drugs. The drug used appeared to have caused a false positive
benzodiazepine result on the initial urine drugs of abuse panel. Conclusion:
The case we describe of toxicity from the synthetic opioid labeled U-47700
highlights the emerging trend of novel synthetic opioid abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
3,4 dichloro n [2 (dimethylamino)cyclohexyl] n methylbenzamide (drug
toxicity)
naloxone (drug therapy, intravenous drug administration)
opiate agonist (drug toxicity)
EMTREE DRUG INDEX TERMS
alprazolam
benzodiazepine
clonazepam
diazepam
flurazepam
lorazepam
midazolam
oxazepam
temazepam
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abrasion
adult
apnea
article
blood cell count
blood pressure
bradypnea
case report
coma
consciousness level
ego development
electrocardiogram
emergency health service
emergency ward
Glasgow coma scale
human
immunoassay
leukocytosis
liquid chromatography-mass spectrometry
lymphocyte
male
manual emergency ventilator
neutrophil
oxygen saturation
physical examination
pulse oximetry
respiration depression
respiratory failure
resuscitation
retention time
sedation
single drug dose
thorax radiography
time of flight mass spectrometry
urine sampling
vital sign
young adult
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
benzodiazepine (12794-10-4)
clonazepam (1622-61-3)
diazepam (439-14-5)
flurazepam (1172-18-5, 17617-23-1)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxazepam (604-75-1)
temazepam (846-50-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160556652
MEDLINE PMID
27448790 (http://www.ncbi.nlm.nih.gov/pubmed/27448790)
PUI
L611400532
DOI
10.1080/15563650.2016.1209764
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650.2016.1209764
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 218
TITLE
Acceptability of an Opioid Relapse Prevention Text-message Intervention for
Emergency Department Patients
AUTHOR NAMES
Suffoletto B.
Yanta J.
Kurtz R.
Cochran G.
Douaihy A.
Chung T.
AUTHOR ADDRESSES
(Suffoletto B., suffbp@upmc.edu; Yanta J.; Kurtz R.) Department of Emergency
Medicine, University of Pittsburgh School of Medicine, Iroquois Building,
3600 Forbes Avenue, Pittsburgh, United States.
(Cochran G.) School of Social Work, University of Pittsburgh, Pittsburgh,
United States.
(Douaihy A.; Chung T.) Department of Psychiatry, University of Pittsburgh,
Pittsburgh, United States.
CORRESPONDENCE ADDRESS
B. Suffoletto, Department of Emergency Medicine, University of Pittsburgh
School of Medicine, Iroquois Building, 3600 Forbes Avenue, Pittsburgh,
United States. Email: suffbp@upmc.edu
SOURCE
Journal of Addiction Medicine (2017) 11:6 (475-482). Date of Publication:
2017
ISSN
1935-3227 (electronic)
1932-0620
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
ABSTRACT
Objective: To explore whether a text message-based relapse prevention
intervention (Preventing and Interrupting Early Relapse [PIER]1) is
acceptable to treatment-seeking adults with opioid use disorder (OUD) after
Emergency Department (ED) discharge using mixed-methods design. Methods:
Adults seeking care in an urban ED for OUD (n=20; mean age 22; 55% female;
75% white race) completed a baseline survey, and were invited to enroll in
PIER1, which was delivered in 7-day blocks, with the option to re-enroll at
the end of each block, up to 4 blocks. PIER1 included a morning "push"
message focused on positive thinking, adaptive coping feedback tailored to
twice-daily assessments of craving severity and contextual correlates of
craving, and end-of-day feedback on daily opioid use and goal commitment.
Participants were asked to complete a follow-up phone interview after the
first 7 days of PIER1. Transcripts were thematically coded. Results:
Seventeen out of 20 participants enrolled in PIER1. In the first 7 days,
response rates to text-message assessments averaged 30%. Ten out of 17
participants re-enrolled after 7 days. Main themes from follow-up interviews
(n=9) included ease of use, social connection, and self-empowerment.
Participants desired more personalized support and the ability to
communicate through text messaging with another person about their
struggles. Event-level data suggest that higher craving severity increased
risk of opioid lapses. Conclusions: In this mixed-methods intervention
development study, we found conflicting evidence supporting an automated
text-message intervention providing relapse prevention support for
treatment-seeking individuals with OUD discharged from the ED. Qualitative
feedback suggests that PIER1 could be useful and acceptability enhanced
through personalized human support.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
opioid use disorder
relapse
text messaging
EMTREE MEDICAL INDEX TERMS
adult
article
clinical article
coping behavior
drug craving
empowerment
female
human
interpersonal communication
male
patient attitude
priority journal
social interaction
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170803699
PUI
L619262803
DOI
10.1097/ADM.0000000000000351
FULL TEXT LINK
http://dx.doi.org/10.1097/ADM.0000000000000351
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 219
TITLE
Effects of opioid medications on cognitive skills among Emergency Department
patients
AUTHOR NAMES
Marco C.A.
Mann D.
Rasp J.
Ballester M.
Perkins O.
Holbrook M.B.
Rako K.
AUTHOR ADDRESSES
(Marco C.A., Catherine.Marco@wright.edu; Mann D.; Ballester M.; Perkins O.;
Holbrook M.B.; Rako K.) Department of Emergency Medicine, Wright State
University Boonshoft School of Medicine, Dayton, OH, United States
(Rasp J.) Ohio State University, Columbus, OH, United States
CORRESPONDENCE ADDRESS
C.A. Marco, Department of Emergency Medicine, Wright State University
Boonshoft School of Medicine, Dayton, OH, United States Email:
Catherine.Marco@wright.edu
SOURCE
American Journal of Emergency Medicine (2017). Date of Publication: 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Introduction: Treatment for pain and related conditions has been identified
as the most common reason for Emergency Department (ED) visits. Concerns
exist regarding the effects of opioid pain medications on cognition and
patient ability to consent for procedures, hospital admission, or to refuse
recommended medical interventions. This study was undertaken to identify
cognitive skills before and after opioid pain medication in the ED setting.
Methods: This was a prospective study comparing performance on the
Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment
(MoCA) before and after administration of opioid pain medications. Eligible
participants included ED patients with pain, who received opioid treatment.
Participants were randomized to receive either the MMSE before pain
medication and the MoCA after medication, or the reverse. MoCA scores were
converted to MMSE equivalent scores for comparison. Results: Among 65
participants, the median age was 36 and median triage pain score was 8. 35%
of patients were considered cognitively impaired based on their MMSE score
prior to any opioid medication (MMSE. <. 27). There was a median decrease in
pain scores of 1 point following pain medication, p-value. <. 0.001. There
was a median decrease in MMSE scores of 1 point following pain medication,
p-value = 0.003. The range of change in scores (post minus pre) on the
MMSE-equivalent was -7 to 3. 35 patients (56%) had a decrease in scores, 6
(10%) had no change, and 21 (34%) had an increase. After medication, 31
(48%) were abnormal (MMSE score. <. 27). No differences in MMSE scores were
identified by gender, ethnicity, mode of arrival, insurance, age, triage
pain scores, opioid agent given, or ED diagnosis. Conclusions: There is an
association between opioid pain medication and decrease in cognitive
performance on the MMSE. Because of the wide range of cognitive performance
following opioid pain medication, assessment of individual patients'
cognitive function is indicated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
skill
EMTREE MEDICAL INDEX TERMS
adult
controlled study
diagnosis
drug therapy
emergency health service
ethnicity
female
gender
human
insurance
major clinical study
male
mental health
mentally disabled person
Montreal cognitive assessment
pain
prospective study
randomized controlled trial
statistical significance
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170799007
PUI
L619226338
DOI
10.1016/j.ajem.2017.11.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.11.017
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 220
TITLE
Emergency department naloxone rescue kit dispensing and patient follow-up
AUTHOR NAMES
Kaucher K.A.
Acquisto N.M.
Broderick K.B.
AUTHOR ADDRESSES
(Kaucher K.A., kevin.kaucher@dhha.org) Department of Pharmacy, Denver Health
Medical Center, 777 Bannock St. MC 0056, Denver, CO 80204, United States
(Acquisto N.M.) Department of Pharmacy, University of Rochester Medical
Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States
(Acquisto N.M.) Department of Emergency Medicine, University of Rochester
Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United
States
(Broderick K.B.) Department of Emergency Medicine, University of Colorado,
12401 E. 17th Avenue, Aurora, CO 80045, United States
(Broderick K.B.) Denver Health Medical Center, 777 Bannock Street, MC #0108,
Denver, CO 80204, United States
CORRESPONDENCE ADDRESS
K.A. Kaucher, Department of Pharmacy, Denver Health Medical Center, 777
Bannock St. MC 0056, Denver, CO 80204, United States Email:
kevin.kaucher@dhha.org
SOURCE
American Journal of Emergency Medicine (2017). Date of Publication: 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
follow up
EMTREE MEDICAL INDEX TERMS
adult
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170869410
PUI
L619615319
DOI
10.1016/j.ajem.2017.12.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.12.020
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 221
TITLE
Take-home naloxone treatment for opioid emergencies: a comparison of routes
of administration and associated delivery systems
AUTHOR NAMES
Elzey M.J.
Fudin J.
Edwards E.S.
AUTHOR ADDRESSES
(Elzey M.J., mark.elzey@kaleopharma.com; Edwards E.S.) Medical Affairs,
kaleo, Inc, Richmond, United States.
(Fudin J.) Scientific and Clinical Affairs at Remitigate, LLC, Delmar,
United States.
(Fudin J.) PGY2 Pharmacy Pain Management, Stratton VA Medical Center,
Albany, United States.
(Fudin J.) Albany College of Pharmacy & Health Sciences, Albany, United
States.
(Fudin J.) Western New England University College of Pharmacy, Springfield,
United States.
CORRESPONDENCE ADDRESS
M.J. Elzey, Medical Affairs, kaleo, Inc, Richmond, United States. Email:
mark.elzey@kaleopharma.com
SOURCE
Expert Opinion on Drug Delivery (2017) 14:9 (1045-1058). Date of
Publication: 2017
ISSN
1744-7593 (electronic)
1742-5247
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Introduction: Naloxone reversal of opioid-induced respiratory depression
outside of medical facilities has become more prevalent because of the
escalating opioid epidemic in the USA. Take-home naloxone for treatment of
opioid emergencies is now being recommended by numerous federal, state, and
professional organizations. Areas covered: The scope of the opioid overdose
epidemic is reviewed along with practical, clinical, regulatory, and
usability considerations for take-home naloxone routes of administration
currently available and associated delivery systems. Specific opioid-related
factors are discussed in detail with emphasis placed on life-threatening
respiratory depression and naloxone antagonism. A clinical overview,
including pharmacokinetic and FDA approval information for each take-home
naloxone product is discussed in detail as well as the impact of take-home
naloxone in the community. Finally, given these products are to be used in a
panic-stricken, life-threatening opioid emergency, an analysis of available
usability data is provided with proposed directions for further study.
Expert opinion: Based on the available clinical evidence, auto-injectable
naloxone should be the preferred administration route for take-home naloxone
treatment until additional safety, efficacy, and comparative outcomes data
are available for unconventional routes of administration that unequivocally
provide equal or superior results.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (clinical trial, drug administration, drug therapy, pharmaceutics,
pharmacokinetics)
opiate (adverse drug reaction, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug delivery system
emergency treatment
home care
respiration depression (drug therapy, side effect, drug therapy, side
effect)
EMTREE MEDICAL INDEX TERMS
community
drug approval
drug efficacy
drug overdose
drug use
experience
food and drug administration
human
randomized controlled trial (topic)
review
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170631087
MEDLINE PMID
27606669 (http://www.ncbi.nlm.nih.gov/pubmed/27606669)
PUI
L618178581
DOI
10.1080/17425247.2017.1230097
FULL TEXT LINK
http://dx.doi.org/10.1080/17425247.2017.1230097
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 222
TITLE
Past-year Prescription Drug Monitoring Program Opioid Prescriptions and
Self-reported Opioid Use in an Emergency Department Population With Opioid
Use Disorder
AUTHOR NAMES
Hawk K.
D'Onofrio G.
Fiellin D.A.
Chawarski M.C.
O'Connor P.G.
Owens P.H.
Pantalon M.V.
Bernstein S.L.
AUTHOR ADDRESSES
(Hawk K., kathryn.hawk@yale.edu; D'Onofrio G.; Fiellin D.A.; Owens P.H.;
Pantalon M.V.; Bernstein S.L.) Department of Emergency Medicine Yale School
of Medicine New Haven, CT
(Fiellin D.A.; O'Connor P.G.) Department of Internal Medicine Yale School of
Medicine New Haven, CT
(Chawarski M.C.) Department of Psychiatry Yale School of Medicine New Haven,
CT
(Fiellin D.A.; Bernstein S.L.) Yale School of Public Health New Haven, CT
CORRESPONDENCE ADDRESS
K. Hawk, Department of Emergency Medicine Yale School of Medicine New Haven,
CT Email: kathryn.hawk@yale.edu
SOURCE
Academic Emergency Medicine (2017). Date of Publication: 2017
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Background: Despite increasing reliance on prescription drug monitoring
programs (PDMPs) as a response to the opioid epidemic, the relationship
between aberrant drug-related behaviors captured by the PDMP and opioid use
disorder is incompletely understood. How PDMP data should guide emergency
department (ED) assessment has not been studied. Objectives: The objective
was to evaluate a relationship between PDMP opioid prescription records and
self-reported nonmedical opioid use of prescription opioids in a cohort of
opioid-dependent ED patients enrolled in a treatment trial. Methods: PDMP
opioid prescription records during 1 year prior to study enrollment on 329
adults meeting Diagnostic and Statistical Manual IV criteria for opioid
dependence entering a randomized clinical trial in a large, urban ED were
cross-tabulated with data on 30-day nonmedical prescription opioid use
self-report. The association among these two types of data was assessed by
the Goodman and Kruskal's gamma; a logistic regression was used to explore
characteristics of participants who had PDMP record of opioid prescriptions.
Results: During 1 year prior to study enrollment, 118 of 329 (36%) patients
had at least one opioid prescription (range = 1-51) in our states' PDMP.
Patients who reported ≥15 of 30 days of nonmedical prescription opioid use
were more likely to have at least four PDMP opioid prescriptions (20/38;
53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of
nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and
having health insurance were significantly more represented in the PDMP (p <
0.05 for both). Conclusion: PDMPs may be helpful in identifying patients
with certain aberrant drug-related behavior, but are unable to detect many
patients with opioid use disorder. The majority of ED patients with opioid
use disorder were not captured by the PDMP, highlighting the importance of
using additional methods such as screening and clinical history to identify
opioid use disorders in ED patients and the limitations of PDMPs to detect
opioid use disorders.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
monitoring
prescription
EMTREE MEDICAL INDEX TERMS
adult
cohort analysis
controlled study
diagnosis
drug therapy
female
health insurance
human
information processing
opiate addiction
randomized controlled trial
self report
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170901813
PUI
L619941721
DOI
10.1111/acem.13352
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13352
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 223
TITLE
Protocol adherence in prehospital medical care provided for patients with
chest pain and loss of consciousness; a brief report
AUTHOR NAMES
Mehrara M.
Tavakoli N.
Fathi M.
Mahshidfar B.
Zare M.A.
Asadi A.
Hosseinzadeh S.
Safdarian M.
AUTHOR ADDRESSES
(Mehrara M.; Tavakoli N.; Fathi M., marziehfathi@yahoo.com; Mahshidfar B.;
Zare M.A.; Asadi A.; Hosseinzadeh S.; Safdarian M.) Department of Emergency
Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical
Sciences, Tehran, Iran.
CORRESPONDENCE ADDRESS
M. Fathi, Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical
Centre, Iran University of Medical Sciences, Tehran, Iran. Email:
marziehfathi@yahoo.com
SOURCE
Emergency (2017) 5:1 (226-230). Date of Publication: 2017
ISSN
2345-4563 (electronic)
2345-4571
BOOK PUBLISHER
Shahid Beheshti University of Medical Sciences, mstzbmd@sbmu.ac.ir
ABSTRACT
Introduction: Although many protocols are available in the field of the
prehospital medical care (PMC), there is still a notable gap between
protocol based directions and applied clinical practice. This study measures
the rate of protocol adherence in PMC provided for patients with chest pain
and loss of consciousness (LOC).Methods: In this cross-sectional study, 10
educated research assistants audited the situation of provided PMC for
non-traumatic chest pain and LOC patients, presenting to the emergency
department of a tertiary level teaching hospital, compare to national
recommendations in these regards. Results: 101 cases with the mean age of
56.7 ± 12.3 years (30-78) were audited (55.4%male). 61 (60.3%) patients had
chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for
cardiac monitoring (62.3%), O(2) therapy (32.8%), nitroglycerin
administration (60.7%), and aspirin administration (52.5%) in prehospital
care of patients with chest pain were fair to poor. Protocol adherence rates
for correct patient positioning (25%), O(2) therapy (75%), cardiac
monitoring (25%), pupils examination (25%), bedside glucometery (50%), and
assessing for naloxone administration (55%) in prehospital care of patients
with LOC were fair to poor. Conclusion: There were more than 20% protocol
violation regarding prehospital care of chest pain patients regarding
cardiac monitoring, O(2) therapy, and nitroglycerin and aspirin
administration. There were same situation regarding O(2) therapy,
positioning, cardiac monitoring, pupils examination, bedside glucometery,
and assessing for naloxone administration of LOC patients in prehospital
setting.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
glyceryl trinitrate (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
consciousness disorder
medical care
prehospital medical care
protocol compliance
thorax pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
cross-sectional study
female
human
major clinical study
male
oxygen therapy
pneumothorax
vital sign
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
glyceryl trinitrate (55-63-0, 80738-44-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170056249
PUI
L614121270
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 224
TITLE
QT Prolongation by Baclofen Overdose
AUTHOR NAMES
Gill D.
Mann K.
Liu K.
AUTHOR ADDRESSES
(Gill D.) Department of Internal Medicine, SUNY Upstate Medical University,
Syracuse, United States.
(Mann K.) University of Medicine and Health Sciences, Basseterre, St. Kitts,
Saint Kitts and Nevis.
(Liu K.) Department of Cardiology, SUNY Upstate Medical University,
Syracuse, United States.
SOURCE
American Journal of Therapeutics (2017) 24:5 (e625-e627). Date of
Publication: 2017
ISSN
1536-3686 (electronic)
1075-2765
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
baclofen (adverse drug reaction, drug toxicity)
EMTREE DRUG INDEX TERMS
bicarbonate (endogenous compound)
calcium (endogenous compound)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
QT prolongation (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
adult
Arnold Chiari malformation (surgery)
brain ventricle peritoneum shunt
case report
clinical article
Dandy Walker syndrome (surgery)
drug overdose
drug withdrawal
electrocardiogram
emergency health service
female
Glasgow coma scale
hospital discharge
human
lethargy (drug therapy)
letter
leukocyte
male
priority journal
CAS REGISTRY NUMBERS
baclofen (1134-47-0)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2, 14092-94-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160636513
PUI
L611972409
DOI
10.1097/MJT.0000000000000505
FULL TEXT LINK
http://dx.doi.org/10.1097/MJT.0000000000000505
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 225
TITLE
Timing of postoperative respiratory emergencies: When do they really occur?
AUTHOR NAMES
Weingarten T.N.
Warner L.L.
Sprung J.
AUTHOR ADDRESSES
(Weingarten T.N., weingarten.toby@mayo.edu; Warner L.L.; Sprung J.)
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester,
United States.
CORRESPONDENCE ADDRESS
T.N. Weingarten, Department of Anesthesiology, Mayo Clinic, 200 First St SW,
Rochester, United States. Email: weingarten.toby@mayo.edu
SOURCE
Current Opinion in Anaesthesiology (2017) 30:1 (156-162). Date of
Publication: 2017
ISSN
1473-6500 (electronic)
0952-7907
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
ABSTRACT
Purpose of review Opioid-induced postoperative respiratory depression has
garnered attention and calls for vigilance. However, a higher level of
monitoring equates to increased use of hospital resources and is impractical
to apply for all postoperative patients. Understanding the temporal pattern
of postoperative respiratory emergency occurrences would allow for improved
triage of monitoring resources for high-risk patients. Our objective is to
describe the temporal pattern of risk of postoperative opioid-induced
respiratory failure. Recent findings The literature suggests that
postoperative opioid-induced respiratory depression is more frequent and
severe than previously believed. In response, national patient advocacy
groups have proposed improved postoperative monitoring of high-risk
patients, especially those with sleep-disordered breathing. Published series
of patients who have had adverse respiratory events suggest that the first
24 postsurgical hours comprise the period of highest risk, with most events
occurring within the first 12 h. Further, study findings have suggested that
adverse respiratory events often occur shortly after administration of
opioid analgesics. Summary Emerging evidence indicates that the first
postsurgical day carries the highest risk of adverse respiratory events, and
this risk is often associated with opioid administration. Resources for
increased monitoring should be directed to these high-risk times.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
respiratory failure (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
high risk patient
hospital discharge
human
patient assessment
postoperative complication
priority journal
recovery room
respiration depression
review
sleep disordered breathing
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160706485
PUI
L612477211
DOI
10.1097/ACO.0000000000000401
FULL TEXT LINK
http://dx.doi.org/10.1097/ACO.0000000000000401
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 226
TITLE
Prescriptions Written for Opioid Pain Medication in the Veterans Health
Administration between 2000 and 2016
AUTHOR NAMES
Grasso M.A.
Grasso C.T.
Jerrard D.A.
AUTHOR ADDRESSES
(Grasso M.A., mgrasso@em.umaryland.edu) University of Maryland School of
Medicine, Department of Emergency Medicine, 110 South Paca Street,
Baltimore, United States.
(Grasso C.T.) University of Maryland Baltimore County, Department of
Computer Science and Electrical Engineering, Baltimore, United States.
(Jerrard D.A.) University of Maryland School of Medicine, Department of
Emergency Medicine, Baltimore, United States.
CORRESPONDENCE ADDRESS
M.A. Grasso, University of Maryland School of Medicine, Department of
Emergency Medicine, 110 South Paca Street, Baltimore, United States. Email:
mgrasso@em.umaryland.edu
SOURCE
Journal of Addiction Medicine (2017) 11:6 (483-488). Date of Publication:
2017
ISSN
1935-3227 (electronic)
1932-0620
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
ABSTRACT
Objectives: The purpose of this study was to identify national opioid pain
medication (OPM) prescribing trends within the Veterans Health
Administration (VA), and assess the impact of educational campaigns
introduced in 2010 and 2013. Methods: We created a national cohort that
documents more than 21 million patient records and 97 million outpatient OPM
prescriptions covering a 17-year period. We examined OPM prescriptions in
emergency departments, outpatient clinics, and inpatient settings. Results:
The cohort accounted for 2.5 billion outpatient clinic visits, 18.9 million
emergency department visits, and 12.4 million hospital admissions. The
number of OPM prescriptions peaked in 2011, when they were provided during
5% of all outpatient visits and 15% of all emergency department visits. The
morphine milligram equivalents (MMEs) peaked in 2014 at almost 17 billion in
outpatient clinics and at 137 million in emergency departments. In 2016, OPM
prescriptions were down 37% in outpatient clinics and 23% in emergency
departments, and MMEs were down 30% in both settings. Prescriptions for
hydrocodone and tramadol increased markedly between 2011 and 2015. OPM doses
in inpatient settings continued to rise until 2015. Conclusions: We used a
large national cohort to study trends in OPM prescriptions within the VA.
Educational efforts to reduce the number of OPM prescriptions coincided with
these reductions, but were initially associated with an increase in OPM
dosage, an increase in the use of tramadol and hydrocodone, and an increase
in the use of OPMs in inpatient settings.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy)
hydrocodone (drug therapy)
hydromorphone (drug therapy, intravenous drug administration, oral drug
administration)
methadone (drug therapy)
morphine (drug therapy, intravenous drug administration, oral drug
administration)
oxycodone (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
aged
article
cohort analysis
comorbidity
coronary artery disease
depression
diabetes mellitus
drug use
emergency ward
female
hospital admission
hospital department
human
major clinical study
male
outpatient department
priority journal
substance abuse
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170803700
PUI
L619262819
DOI
10.1097/ADM.0000000000000352
FULL TEXT LINK
http://dx.doi.org/10.1097/ADM.0000000000000352
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 227
TITLE
Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid
Beneficiaries?
AUTHOR NAMES
Sun B.C.
Lupulescu-Mann N.
Charlesworth C.J.
Kim H.
Hartung D.M.
Deyo R.A.
McConnell K.J.
AUTHOR ADDRESSES
(Sun B.C., sunb@ohsu.edu; McConnell K.J.) Center for Policy
Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health
and Science University, Portland, OR
(Lupulescu-Mann N.; Charlesworth C.J.; Kim H.; McConnell K.J.) Center for
Health Systems Effectiveness, Oregon Health and Science University,
Portland, OR
(Hartung D.M.) College of Pharmacy, Oregon State University, Oregon Health
and Science University, Portland, OR
(Deyo R.A.) Department of Family Medicine, Department of Medicine and Oregon
Institute of Occupational Health Sciences, Oregon Health and Science
University, Portland, OR
CORRESPONDENCE ADDRESS
B.C. Sun, Center for Policy Research-Emergency Medicine, Department of
Emergency Medicine, Oregon Health and Science University, Portland, OR
Email: sunb@ohsu.edu
SOURCE
Annals of Emergency Medicine (2017). Date of Publication: 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective: The link between prescription opioid shopping and overdose
events is poorly understood. We test the hypothesis that a history of
prescription opioid shopping is associated with increased risk of overdose
events. Methods: This is a secondary analysis of a linked claims and
controlled substance dispense database. We studied adult Medicaid
beneficiaries in 2014 with prescription opioid use in the 6 months before an
ambulatory care or emergency department visit with a pain-related diagnosis.
The primary outcome was a nonfatal overdose event within 6 months of the
cohort entry date. The exposure of interest (opioid shopping) was defined as
having opioid prescriptions by different prescribers with greater than or
equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months
before cohort entry. We used a propensity score to match shoppers with
nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome
rates between shoppers and nonshoppers. Results: We studied 66,328 patients,
including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in
the overall cohort who experienced a nonfatal overdose. In unadjusted
analyses, shoppers had higher event rates than nonshoppers (rate difference
of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After
propensity score matching, there were no outcome differences between
shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95%
confidence interval -4.7 to 5.5). These findings were robust to various
definitions of opioid shoppers and look-back periods. Conclusion:
Prescription opioid shopping is not independently associated with increased
risk of overdose events.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
controlled substance
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medicaid
prescription
shopping
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
cohort analysis
diagnosis
drug overdose
emergency ward
female
human
major clinical study
male
outcome assessment
pain
pharmacy
propensity score
secondary analysis
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170838286
PUI
L619443843
DOI
10.1016/j.annemergmed.2017.10.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.10.007
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 228
TITLE
Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?
AUTHOR NAMES
Kolinsky D.
Keim S.M.
Cohn B.G.
Schwarz E.S.
Yealy D.M.
AUTHOR ADDRESSES
(Kolinsky D.; Cohn B.G.; Schwarz E.S.) Division of Emergency Medicine,
Washington University School of Medicine, St. Louis, United States.
(Keim S.M.) Department of Emergency Medicine, The University of Arizona
College of Medicine, Tucson, United States.
(Yealy D.M.) Department of Emergency Medicine, University of Pittsburgh
School of Medicine, Pittsburgh, United States.
CORRESPONDENCE ADDRESS
S.M. Keim, Department of Emergency Medicine, The University of Arizona
College of Medicine, PO Box 245057, Tucson, United States.
SOURCE
Journal of Emergency Medicine (2017) 52:1 (52-58). Date of Publication: 1
Jan 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background The current standards for domestic emergency medical services
suggest that all patients suspected of opioid overdose be transported to the
emergency department for evaluation and treatment. This includes patients
who improve after naloxone administration in the field because of concerns
for rebound toxicity. However, various emergency medical services systems
release such patients at the scene after a 15- to 20-min observation period
as long as they return to their baseline. Objectives We sought to determine
if a “treat and release” clinical pathway is safe in prehospital patients
with suspected opioid overdose. Results Five studies were identified and
critically appraised. From a pooled total of 3875 patients who refused
transport to the emergency department after an opioid overdose, three
patient deaths were attributed to rebound toxicity. These results imply that
a “treat and release” policy might be safe with rare complications. A close
review of these studies reveals several confounding factors that make
extrapolation to our population limited. Conclusion The existing literature
suggests a “treat and release” policy for suspected prehospital opioid
overdose might be safe, but additional research should be conducted in a
prospective design.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
clinical pathway
clinical protocol
emergency ward
health care policy
heroin dependence
human
note
opiate addiction
patient safety
patient transport
priority journal
randomized controlled trial (topic)
substance abuse
treatment refusal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160915259
MEDLINE PMID
27769615 (http://www.ncbi.nlm.nih.gov/pubmed/27769615)
PUI
L613709756
DOI
10.1016/j.jemermed.2016.09.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.09.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 229
TITLE
Antidote availability in the municipality of Campinas, São Paulo, Brazil
ORIGINAL (NON-ENGLISH) TITLE
Disponibilidade de antídotos no município de Campinas, São Paulo
AUTHOR NAMES
Fernandes L.C.R.
Galvão T.F.
Ricardi A.S.T.
De Capitani E.M.
Hyslop S.
Bucaretchi F.
AUTHOR ADDRESSES
(Fernandes L.C.R.; Galvão T.F., taisgalvao@gmail.com; Ricardi A.S.T.; De
Capitani E.M.; Hyslop S.; Bucaretchi F.) Campinas Poison Control Center,
School of Medical Sciences, Universidade Estadual de Campinas (Unicamp),
Campinas, Brazil.
(Galvão T.F., taisgalvao@gmail.com) School of Pharmaceutical Sciences,
Universidade Estadual de Campinas (Unicamp), Campinas, Brazil.
(De Capitani E.M.) Campinas Poison Control Center, Department of Clinical
Medicine, School of Medical Sciences, Universidade Estadual de Campinas
(Unicamp), Campinas, Brazil.
(Hyslop S.) Campinas Poison Control Center, Department of Pharmacology,
School of Medical Sciences, Universidade Estadual de Campinas (Unicamp),
Campinas, Brazil.
(Bucaretchi F.) Campinas Poison Control Center, Department of Pediatrics,
School of Medical Sciences, Universidade Estadual de Campinas (Unicamp),
Campinas, Brazil.
(Galvão T.F., taisgalvao@gmail.com) Universidade Federal do Amazonas (UFAM),
Manaus, Brazil.
CORRESPONDENCE ADDRESS
T.F. Galvão, Faculdade de Ciências Farmacêuticas da Universidade Estadual,
Campinas (Unicamp), Rua Sérgio Buarque de Holanda, 250 Cidade Universitária,
Campinas, Brazil. Email: taisgalvao@gmail.com
SOURCE
Sao Paulo Medical Journal (2017) 135:1 (15-22). Date of Publication: 1 Jan
2017
ISSN
1516-3180
BOOK PUBLISHER
Associacao Paulista de Medicina, revistas@apm.org.br
ABSTRACT
CONTEXT AND OBJECTIVE: The lack of availability of antidotes in emergency
services is a worldwide concern. The aim of the present study was to
evaluate the availability of antidotes used for treating poisoning in
Campinas (SP). DESIGN AND SETTING: This was a cross-sectional study of
emergency services in Campinas, conducted in 2010-2012. METHODS: The
availability, amount in stock, place of storage and access time for 26
antidotal treatments was investigated. In the hospitals, the availability of
at least one complete treatment for a 70 kg adult over the first 24 hours of
admission was evaluated based on stock and access recommendations contained
in two international guidelines. RESULTS: 14 out of 17 functioning emergency
services participated in the study, comprising pre-hospital services such as
the public emergency ambulance service (SAMU; n = 1) and public emergency
rooms for admissions lasting ≤ 24 hours (UPAs; n = 3), and 10 hospitals with
emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam,
phytomenadione, flumazenil and calcium gluconate) were stocked in all the
services, followed by 13 units that also stocked activated charcoal,
naloxone and diphenhydramine or biperiden. No service stocked all of the
recommended antidotes; only the regional Poison Control Center had stocks
close to recommended (22/26 antidotal treatments). The 10 hospitals had
almost half of the antidotes for starting treatments, but only one quarter
of the antidotes was present with stocks sufficient for providing treatment
for 24 hours. CONCLUSION: The stock of antidotes for attending poisoning
emergencies in the municipality of Campinas is incomplete and needs to be
improved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
atropine
bicarbonate
biperiden
charcoal
dantrolene
deferoxamine
diazepam
dimercaprol
diphenhydramine
flumazenil
folinate calcium
glucagon
gluconate calcium
hydroxocobalamin
naloxone
octreotide
physostigmine
phytomenadione
pralidoxime
protamine sulfate
pyridoxine
sodium nitrite
sodium thiosulfate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
health care availability
EMTREE MEDICAL INDEX TERMS
article
Brazil
cross-sectional study
emergency ward
health care access
health care organization
hospital admission
human
intoxication
questionnaire
toxicology
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
biperiden (1235-82-1, 514-65-8)
charcoal (16291-96-6)
dantrolene (14663-23-1, 7261-97-4)
deferoxamine (70-51-9)
diazepam (439-14-5)
dimercaprol (59-52-9)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
folinate calcium (1492-18-8, 51057-63-7)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9, 1607842-55-6)
physostigmine (57-47-6, 64-47-1)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime (6735-59-7)
protamine sulfate (9009-65-8)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Portuguese
EMBASE ACCESSION NUMBER
20170258269
MEDLINE PMID
28301629 (http://www.ncbi.nlm.nih.gov/pubmed/28301629)
PUI
L615243874
DOI
10.1590/1516-3180.2016.00171120816
FULL TEXT LINK
http://dx.doi.org/10.1590/1516-3180.2016.00171120816
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 230
TITLE
Opioid-induced myoclonus and hyperalgesia following a short course of
low-dose oral morphine
AUTHOR NAMES
Woodward O.B.
Naraen S.
Naraen A.
AUTHOR ADDRESSES
(Woodward O.B., obwoodward@gmail.com; Naraen S.; Naraen A.) Arrowe Park
Hospital, Wirral, United Kingdom.
CORRESPONDENCE ADDRESS
O.B. Woodward, Arrowe Park Hospital, Wirral, United Kingdom. Email:
obwoodward@gmail.com
SOURCE
British Journal of Pain (2017) 11:1 (32-35). Date of Publication: 2017
ISSN
2049-4645 (electronic)
2049-4637
BOOK PUBLISHER
SAGE Publications Ltd, info@sagepub.co.uk
ABSTRACT
A 76-year-old man was admitted to hospital with a right-sided fractured neck
of femur requiring repair via a cemented hemiarthroplasty. Intraoperatively
he received 10 mg of intravenous morphine. Post-operatively he received a
short course of low-dose oral opioids and subsequently developed myoclonic
jerks and hyperalgesia. The opioids were discontinued and both adverse
effects resolved. This case report discusses the concurrent development of
myoclonus and hyperalgesia following a low dose of opioids and explores
possible management options.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (adverse drug reaction, intravenous drug administration,
oral drug administration)
EMTREE DRUG INDEX TERMS
n methyl dextro aspartic acid receptor stimulating agent
paracetamol
pregabalin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hyperalgesia (side effect, side effect)
myoclonus (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
aged
article
case report
computer assisted tomography
drug withdrawal
electrocardiography
emergency ward
femur fracture (surgery)
hemiarthroplasty
hospital discharge
human
low drug dose
lung angiography
male
nociception
postoperative analgesia
priority journal
soft tissue injury
thorax pain
thorax radiography
DRUG TRADE NAMES
oramorph
CAS REGISTRY NUMBERS
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
paracetamol (103-90-2)
pregabalin (148553-50-8)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170098714
PUI
L614289086
DOI
10.1177/2049463716664371
FULL TEXT LINK
http://dx.doi.org/10.1177/2049463716664371
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 231
TITLE
Baclofen and clonazepam overdose in a patient with chronic neck and shoulder
pain
AUTHOR NAMES
Ehler E.
Prax T.
Meleková A.
Štětkářová2 I.
AUTHOR ADDRESSES
(Ehler E.; Prax T.; Meleková A.) Department of Neurology, Faculty of Health
Studies, Pardubice University, Pardubice Hospital, Kyjevská 44 532 03,
Pardubice, Czech Republic.
(Štětkářová2 I., edvard.ehler@nempk.cz)
CORRESPONDENCE ADDRESS
E. Ehler, Department of Neurology, Third Faculty of Medicine, Charles
University, University Hospital Královské Vinohrady, Prague, Czech Republic.
Email: edvard.ehler@nempk.cz
SOURCE
Ceska a Slovenska Neurologie a Neurochirurgie (2017) 80:6 (714-716). Date of
Publication: 2017
ISSN
1802-4041 (electronic)
1210-7859
BOOK PUBLISHER
Czech Medical Association J.E. Purkyne, andrea.opletalova@meditorial.cz
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
baclofen (drug therapy, drug toxicity, oral drug administration)
clonazepam (drug therapy, drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
diazepam (drug therapy, intravenous drug administration)
midazolam (drug therapy, intravenous drug administration)
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
neck pain (drug therapy, drug therapy)
shoulder pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
angiography
blood pressure
case report
clinical article
coma
consciousness disorder
drowsiness
drug intoxication
dysarthria
electroencephalogram
emergency health service
headache
heart rate
human
letter
male
oxygen mask
oxygen saturation
seizure (drug therapy)
x-ray computed tomography
CAS REGISTRY NUMBERS
baclofen (1134-47-0)
clonazepam (1622-61-3)
diazepam (439-14-5)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
Epilepsy Abstracts (50)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170867574
PUI
L619603010
DOI
10.14735/amcsnn2017714
FULL TEXT LINK
http://dx.doi.org/10.14735/amcsnn2017714
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 232
TITLE
Curative effect of ganglioside sodium for adjuvant therapy on acute severe
craniocerebral injury
AUTHOR NAMES
Deng Y.-L.
AUTHOR ADDRESSES
(Deng Y.-L., dengshulanhb@163.com) Department of Neurosurgery, Zigong Fourth
People's Hospital, Zigong, Sichuan Province, China.
CORRESPONDENCE ADDRESS
Y.-L. Deng, Department of Neurosurgery, Zigong Fourth People's Hospital,
Zigong, Sichuan Province, China. Email: dengshulanhb@163.com
SOURCE
Journal of Acute Disease (2017) 6:1 (18-22). Date of Publication: 1 Jan 2017
ISSN
2221-6189
BOOK PUBLISHER
Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai, India.
ABSTRACT
Objective: To study the effect of adjuvant therapy of ganglioside sodium on
intracranial pressure (ICP), partial pressure of brain tissue oxygen
(P(bt)O(2)), nerve injury molecules, nerve protection molecules and indexes
of oxidative stress in patients with acute severe craniocerebral injury.
Methods: Forty-seven patients with severe craniocerebral injury treated in
the emergency department of our hospital during the period time from
December 2012 to October 2015 were selected for retrospective analyses. They
were divided into the ganglioside group and the normal treatment group
according to the usage of ganglioside sodium in the process of the emergency
treatment. At days 1, 3, 5 and 7 before and after treatment, the ICP and
P(bt)O(2) in patients of the two groups were measured. After 7 days of
treatment, the nerve injury molecules, nerve protection molecules and the
indexes of oxidative stress in serum of the patients of the two groups were
determined. Results: At days 1, 3, 5 and 7 before and after treatment, the
ICP in patients of the ganglioside group were all significantly lower than
those of the normal treatment group, while the P(bt)O(2) were all
significantly higher than those of normal treatment group. After 7 days of
treatment, the contents of serum methane dicarboxylic aldehyde, advanced
oxidation protein products, 8-hydroxy-2'-deoxyguanosine urine, S100β, glial
fibrillary acidic portein, neuron specific enolase, myelin basic protein,
neuroglobin and ubiquitin carboxyl-terminal hydrolase L1 in patients of the
ganglioside group were notably lower than those of the normal treatment
group, while the contents of superoxidase dismutase, glutathione peroxidase,
catalase, nerve growth factor and brain derived neurotrophic factor were
significantly higher than those of the normal treatment group. Conclusions:
The adjuvant therapy of ganglioside sodium in patients with severe
craniocerebral injury can effectively reduce ICP, improve P(bt)O(2) and
alleviate the injuries of neurons and glial cells caused by oxidative
stress.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ganglioside (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
8 hydroxydeoxyguanosine (endogenous compound)
advanced oxidation protein product (endogenous compound)
brain derived neurotrophic factor (endogenous compound)
catalase (endogenous compound)
furosemide
glial fibrillary acidic protein (endogenous compound)
glutathione peroxidase (endogenous compound)
mannitol (intravenous drug administration)
myelin basic protein (endogenous compound)
naloxone
nerve growth factor (endogenous compound)
neuroglobin (endogenous compound)
neuron specific enolase (endogenous compound)
superoxide dismutase (endogenous compound)
thrombin (intravenous drug administration)
ubiquitin thiolesterase (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adjuvant therapy
head injury (drug therapy, drug therapy)
injury severity
EMTREE MEDICAL INDEX TERMS
article
brain temperature
brain tissue
clinical article
controlled study
decompressive craniectomy
dehydration
drug effect
emergency treatment
emergency ward
female
human
hydraulic conductivity
intracranial pressure
male
nerve injury
neuroprotection
oxidative stress
partial pressure
priority journal
retrospective study
tissue oxygenation
CAS REGISTRY NUMBERS
brain derived neurotrophic factor (218441-99-7)
catalase (9001-05-2)
furosemide (54-31-9)
glutathione peroxidase (9013-66-5)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
nerve growth factor (9061-61-4)
superoxide dismutase (37294-21-6, 9016-01-7, 9054-89-1)
thrombin (9002-04-4, 869858-13-9)
ubiquitin thiolesterase (86480-67-3)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170746122
PUI
L618933063
DOI
10.12980/jad.6.2017JADWEB-2016-0060
FULL TEXT LINK
http://dx.doi.org/10.12980/jad.6.2017JADWEB-2016-0060
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 233
TITLE
Synthetic cannabinoid induced acute respiratory depression: Case series and
literature review
AUTHOR NAMES
Alon M.H.
Saint-Fleur M.O.
AUTHOR ADDRESSES
(Alon M.H., markhenry.alon@nychhc.org) Department of Internal Medicine, New
York City Health+Hospitals Harlem, Columbia University College of Physicians
and Surgeons, New York, United States.
(Saint-Fleur M.O.) Department of Internal Medicine, Division of Pulmonary
Medicine and Critical Care Medicine, New York City Health+Hospitals Harlem,
Columbia University College of Physicians and Surgeons, New York, United
States.
CORRESPONDENCE ADDRESS
M.H. Alon, Department of Internal Medicine, New York City Health+Hospitals
Harlem, Columbia University College of Physicians and Surgeons, New York,
United States. Email: markhenry.alon@nychhc.org
SOURCE
Respiratory Medicine Case Reports (2017) 22 (137-141). Date of Publication:
2017
ISSN
2213-0071 (electronic)
BOOK PUBLISHER
W.B. Saunders Ltd
ABSTRACT
Synthetic Cannabinoids are a street drug that is widely attainable and cheap
compared to natural cannabis, and has variable potency and unpredictable
effects with no commercially available diagnostic test to confirm its
presence. Similar to natural cannabis, Synthetic Cannabinoid intoxication
can present in several ways with the most common emergency room
presentations to be of neurologic and psychiatric manifestation. The
respiratory depressive effect of Synthetic Cannabinoids has not been well
documented in medical literature. We report four patients admitted in the
Intensive Care Unit with acute respiratory failure necessitating
endotracheal intubation after use of Synthetic Cannabinoid. All patients had
a reversal of respiratory failure in less than 24 h, three patients had a
complicated course due to aspiration pneumonia. All four patients exhibited
aggressive behavior, with two of them diagnosed with Bipolar Disorder and
Cocaine Use Disorder. The effect of Synthetic Cannabinoids in peripheral
receptors such as chemoreceptors and baroreceptors can increase bronchial
airway resistance. It is postulated that CB1 receptor stimulation could be
one of the possible mechanisms of synthetic cannabinoid-induced respiratory
depression. Chemical gases released after its inhalation may also cause
damage to the bronchiolar epithelium and has the potential to disrupt the
protective surfactant layer in the alveoli, which then could interfere with
effective gas exchange leading to hypoxia and acidosis. The stimulation of
CB1 receptors have a series of downstream signaling effects in the G
protein-coupled pathway and mitogen-activated protein kinase (MAPK) pathway,
causing suppression of both excitatory and inhibitory neuronal activity. The
aforementioned molecular changes in the central nervous system after CB1
receptor stimulation could impact respiration. The use of Synthetic
Cannabinoids can cause respiratory depression in individuals without an
underlying pulmonary disease and adds to the growing number of literature
about the presentation and debilitating adverse events from its consumption.
Although there is no specific toxidrome associated with it, clinicians
should have a high index of suspicion with its use especially in patients
presenting with a history of drug overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabinoid (drug toxicity)
EMTREE DRUG INDEX TERMS
antibiotic agent (drug therapy)
naloxone
street drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute respiratory failure (therapy)
EMTREE MEDICAL INDEX TERMS
acute kidney failure (diagnosis)
adult
aggression
agitation
arterial gas
article
aspiration pneumonia (complication, drug therapy)
atelectasis (diagnosis)
bipolar disorder
case report
case study
drug overdose
drug use
endotracheal intubation
extubation
female
follow up
human
intensive care unit
lactic acidosis (diagnosis)
male
medical history
middle aged
oxygen desaturation
priority journal
respiratory acidosis (diagnosis)
rhabdomyolysis (diagnosis)
seizure
stupor
toxicology
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170559594
PUI
L617618401
DOI
10.1016/j.rmcr.2017.07.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.rmcr.2017.07.011
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 234
TITLE
Two cases of non-fatal intoxication with a novel street hallucinogen:
3-methoxy-phencyclidine
AUTHOR NAMES
Zidkova M.
Hlozek T.
Balik M.
Kopecky O.
Tesinsky P.
Svanda J.
Balikova M.A.
AUTHOR ADDRESSES
(Zidkova M.; Hlozek T.; Balikova M.A., mbali@lf1.cuni.cz) Institute Forensic
Medicine and Toxicology, First Faculty of Medicine, Charles University and
General University Hospital, Ke Karlovu 2, Prague 2, Czech Republic.
(Balik M.; Kopecky O.) Department of Anaesthesiology, Resuscitation and
Intensive Medicine, First Faculty of Medicine, Charles University and
General University Hospital, U Nemocnice 2, Prague 2, Czech Republic.
(Tesinsky P.; Svanda J.) Department of Medicine 2, Third Faculty of
Medicine, Charles University and University Hospital, Srobarova 50, Prague
10, Czech Republic.
CORRESPONDENCE ADDRESS
M.A. Balikova, Institute Forensic Medicine and Toxicology, First Faculty of
Medicine, Charles University and General University Hospital, Ke Karlovu 2,
Prague 2, Czech Republic. Email: mbali@lf1.cuni.cz
SOURCE
Journal of Analytical Toxicology (2017) 41:4 (350-354). Date of Publication:
2017
ISSN
1945-2403 (electronic)
0146-4760
BOOK PUBLISHER
Society of Forensic Toxicologists
ABSTRACT
3-Methoxy-phencyclidine (3-MeO-PCP) is a structural derivative of the
dissociative hallucinogen phencyclidine (PCP). Although PCP toxicity is well
documented, little is known about this new psychoactive substance despite
being available on the black market even in central Europe. The objective of
this case report is to present clinical and laboratory data of analytically
confirmed non-fatal intoxication of two subjects with 3-MeO-PCP. A
preliminary assessment of potential metabolites excreted into urine was
enabled using the liquid chromatography high resolution mass spectrometric
method.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
3 methoxy phencyclidine (drug toxicity)
phencyclidine derivative (drug toxicity)
psychedelic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon
C reactive protein (endogenous compound)
drug metabolite
flumazenil
lactic acid (endogenous compound)
metoclopramide
naloxone
neostigmine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
adult
alcohol consumption
article
biochemical analysis
blood sampling
case report
clinical feature
consciousness disorder
disorientation
drug urine level
emergency health service
hallucination
hospital admission
human
hypertension
hypophosphatemia
laboratory test
lactate blood level
leukocyte count
liquid chromatography
male
mass spectrometry
medical intensive care unit
muscle cramp
oxygen therapy
patient transport
protein blood level
psychosis
spasticity
stomach lavage
toxicology
urinary excretion
urine sampling
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
C reactive protein (9007-41-4)
flumazenil (78755-81-4)
lactic acid (113-21-3, 50-21-5)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170377920
MEDLINE PMID
28158698 (http://www.ncbi.nlm.nih.gov/pubmed/28158698)
PUI
L616412435
DOI
10.1093/jat/bkx009
FULL TEXT LINK
http://dx.doi.org/10.1093/jat/bkx009
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 235
TITLE
Should Buprenorphine Be Administered to Patients With Opioid Withdrawal in
the Emergency Department?
AUTHOR NAMES
Love J.S.
Perrone J.
Nelson L.S.
AUTHOR ADDRESSES
(Love J.S.; Perrone J.) Department of Emergency Medicine, Perelman School of
Medicine at University of Pennsylvania, Philadelphia, PA
(Nelson L.S.) Department of Emergency Medicine, Rutgers New Jersey Medical
School, Newark, NJ
SOURCE
Annals of Emergency Medicine (2017). Date of Publication: 2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
drug therapy
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170780421
PUI
L619126935
DOI
10.1016/j.annemergmed.2017.10.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2017.10.002
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 236
TITLE
Drug use in business bathrooms: An exploratory study of manager encounters
in New York City
AUTHOR NAMES
Wolfson-Stofko B.
Bennett A.S.
Elliott L.
Curtis R.
AUTHOR ADDRESSES
(Wolfson-Stofko B., wolfson-stofko@ndri.org; Bennett A.S.; Elliott L.)
National Development & Research Institute, Institute for Special Populations
Research, 71 W. 23rd St., 4th Fl., New York, United States.
(Curtis R.) John Jay College of Criminal Justice, City University of New
York, Department of Law, Police Science and Criminal Justice Administration,
Department of Anthropology, 524 W. 59th St., New York, United States.
(Wolfson-Stofko B., wolfson-stofko@ndri.org; Bennett A.S.; Elliott L.;
Curtis R.) Center for Drug Use and HIV/HCV Research, Rory Meyers College of
Nursing, New York University, 433 First Avenue, New York, United States.
CORRESPONDENCE ADDRESS
B. Wolfson-Stofko, New York, United States. Email: wolfson-stofko@ndri.org
SOURCE
International Journal of Drug Policy (2017) 39 (69-77). Date of Publication:
1 Jan 2017
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier B.V.
ABSTRACT
Background Though public bathroom drug injection has been documented from
the perspective of people who inject drugs, no research has explored the
experiences of the business managers who oversee their business bathrooms
and respond to drug use. These managers, by default, are first-responders in
the event of a drug overdose and thus of intrinsic interest during the
current epidemic of opioid-related overdoses in the United States. This
exploratory study assists in elucidating the experiences that New York City
business managers have with people who inject drugs, their paraphernalia,
and their overdoses. Methods A survey instrument was designed to collect
data on manager encounters with drug use occurring in their business
bathrooms. Recruitment was guided by convenience and purposive approaches.
Results More than half of managers interviewed (58%, n = 50/86) encountered
drug use in their business bathrooms, more than a third (34%) of these
managers also found syringes, and the vast majority (90%) of managers had
received no overdose recognition or naloxone training. Seven managers
encountered unresponsive individuals who required emergency assistance.
Conclusion The results from this study underscore the need for additional
research on the experiences that community stakeholders have with public
injection as well as educational outreach efforts among business managers.
This research also suggests that there is need for a national dialogue about
potential interventions, including expanded overdose recognition and
naloxone training and supervised injection facilities (SIF)/drug consumption
rooms (DCR), that could reduce public injection and its associated health
risks.
EMTREE DRUG INDEX TERMS
cocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bath
commercial phenomena
intravenous drug abuse
EMTREE MEDICAL INDEX TERMS
article
drug overdose
emergency health service
exploratory research
health education
human
manager
mortality rate
preventive medicine
priority journal
work experience
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160767790
MEDLINE PMID
27768996 (http://www.ncbi.nlm.nih.gov/pubmed/27768996)
PUI
L612764412
DOI
10.1016/j.drugpo.2016.08.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2016.08.014
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 237
TITLE
Association between concurrent use of prescription opioids and
benzodiazepines and overdose: Retrospective analysis
AUTHOR NAMES
Sun E.C.
Dixit A.
Humphreys K.
Darnall B.D.
Baker L.C.
MacKey S.
AUTHOR ADDRESSES
(Sun E.C., esun1@stanford.edu; Darnall B.D.; MacKey S.) Department of
Anesthesiology Perioperative and Pain Medicine, Stanford University School
of Medicine, 300 Pasteur Dr, H3580, Stanford, United States.
(Dixit A.) Department of Anesthesiology and Perioperative Care, University
of California, San Francisco, 521 Parnassus Ave, San Francisco, United
States.
(Humphreys K.) Center for Innovation to Implementation, VA Palo Alto Health
Care System and Department of Psychiatry, Stanford University School of
Medicine, Stanford University, 401 N Quarry Road, MC:5717, Stanford, United
States.
(Baker L.C.) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford University and National Bureau of Economic
Research, HRP Redwood Building, 150 Governor's Lane, Stanford, United
States.
CORRESPONDENCE ADDRESS
E.C. Sun, Department of Anesthesiology Perioperative and Pain Medicine,
Stanford University School of Medicine, 300 Pasteur Dr, H3580, Stanford,
United States. Email: esun1@stanford.edu
SOURCE
BMJ (Online) (2017) 356 Article Number: j760. Date of Publication: 2017
ISSN
1756-1833 (electronic)
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Objectives To identify trends in concurrent use of a benzodiazepine and an
opioid and to identify the impact of these trends on admissions to hospital
and emergency room visits for opioid overdose. Design Retrospective analysis
of claims data, 2001-13. Setting Administrative health claims database.
Participants 315 428 privately insured people aged 18-64 who were
continuously enrolled in a health plan with medical and pharmacy benefits
during the study period and who also filled at least one prescription for an
opioid. Interventions Concurrent benzodiazepine/opioid use, defined as an
overlap of at least one day in the time periods covered by prescriptions for
each drug. Main outcome measures Annual percentage of opioid users with
concurrent benzodiazepine use; annual incidence of visits to emergency room
and inpatient admissions for opioid overdose. Results 9% of opioid users
also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative
increase). This increase was driven mainly by increases among intermittent,
as opposed to chronic, opioid users. Compared with opioid users who did not
use benzodiazepines, concurrent use of both drugs was associated with an
increased risk of an emergency room visit or inpatient admission for opioid
overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24;
P<0.001) among all opioid users. The adjusted odds ratio for an emergency
room visit or inpatient admission for opioid overdose was 1.42 (1.33 to
1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96;
P<0.001) chronic opioid users. If this association is causal, elimination of
concurrent benzodiazepine/opioid use could reduce the risk of emergency room
visits related to opioid use and inpatient admissions for opioid overdose by
an estimated 15% (95% confidence interval 14 to 16). Conclusions From 2001
to 2013, concurrent benzodiazepine/opioid use sharply increased in a large
sample of privately insured patients in the US and significantly contributed
to the overall population risk of opioid overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine (drug combination)
opiate (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
drug overdose
emergency ward
female
hospital admission
hospital patient
human
major clinical study
male
private health insurance
retrospective study
risk reduction
trend study
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170213327
MEDLINE PMID
28292769 (http://www.ncbi.nlm.nih.gov/pubmed/28292769)
PUI
L614851920
DOI
10.1136/bmj.j760
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.j760
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 238
TITLE
Fatal Fentanyl: One Pill Can Kill
AUTHOR NAMES
Sutter M.E.
Gerona R.R.
Davis M.T.
Roche B.M.
Colby D.K.
Chenoweth J.A.
Adams A.J.
Owen K.P.
Ford J.B.
Black H.B.
Albertson T.E.
AUTHOR ADDRESSES
(Sutter M.E., mesutter@ucdavis.edu; Davis M.T.; Roche B.M.; Colby D.K.;
Chenoweth J.A.; Owen K.P.; Ford J.B.) Division of Medical Toxicology,
Department of Emergency Medicine, University of California, Davis,
Sacramento, United States.
(Sutter M.E., mesutter@ucdavis.edu; Davis M.T.; Roche B.M.; Colby D.K.;
Chenoweth J.A.; Owen K.P.; Ford J.B.; Black H.B.; Albertson T.E.) Veterans
Affairs Northern California, Mather, United States.
(Gerona R.R.) Division of Laboratory Medicine, University of California, San
Francisco, San Francisco, United States.
(Adams A.J.) University of California San Francisco School of Medicine, San
Francisco, United States.
(Black H.B.; Albertson T.E.) Division of Pulmonary and Critical Care,
University of California, Davis, Patient Services Support Building,
Sacramento, United States.
CORRESPONDENCE ADDRESS
M.E. Sutter, Division of Medical Toxicology, Department of Emergency
Medicine, University of California, Davis, Sacramento, United States. Email:
mesutter@ucdavis.edu
SOURCE
Academic Emergency Medicine (2017) 24:1 (106-113). Date of Publication: 1
Jan 2017
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: The current national opioid epidemic is a public health
emergency. We have identified an outbreak of exaggerated opioid toxicity
caused by fentanyl adulterated tablets purchased on the street as
hydrocodone/acetaminophen. Methods: Over an 8-day period in late March 2016,
a total of 18 patients presented to our institution with exaggerated opioid
toxicity. The patients provided a similar history: ingesting their “normal
dose” of hydrocodone/acetaminophen tablets but with more pronounced
symptoms. Toxicology testing and analysis was performed on serum, urine, and
surrendered pills. Results: One of the 18 patients died in hospital. Five
patients underwent cardiopulmonary resuscitation, one required
extracorporeal life support, three required intubation, and two received
bag-valve-mask ventilation. One patient had recurrence of toxicity after 8
hours after naloxone discontinuation. Seventeen of 18 patients required
boluses of naloxone, and four required prolonged naloxone infusions (26–39
hours). All 18 patients tested positive for fentanyl in the serum.
Quantitative assays conducted in 13 of the sera revealed fentanyl
concentrations of 7.9 to 162 ng/mL (mean = 52.9 ng/mL). Pill analysis
revealed fentanyl amounts of 600–6,900 μg/pill. The pills are virtually
indistinguishable from authentic hydrocodone/acetaminophen tablets and are
similar in weight. To date, our county has reported 56 cases of fentanyl
opioid toxicity, with 15 fatalities. In our institution, the outbreak has
stressed the capabilities and resources of the emergency department and
intensive care units. Conclusions: A serious outbreak of exaggerated opioid
toxicity caused by fentanyl-adulterated tablets purchased on the street as
hydrocodone/acetaminophen is under way in California. These patients
required higher dosing and prolonged infusions of naloxone. Additionally,
observation periods off naloxone were extended due to delayed, recurrent
toxicity. The outbreak has serious ramifications for public health and
safety, law enforcement, and healthcare facilities and resources.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
EMTREE DRUG INDEX TERMS
cocaine
dihydrocodeine
hydrocodone (adverse drug reaction, drug toxicity)
levamisole
methadone
methamphetamine
naloxone (drug toxicity, intranasal drug administration, intravenous drug
administration)
paracetamol (adverse drug reaction, drug toxicity)
promethazine
trazodone
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
artificial ventilation
assisted ventilation
clinical article
drug infusion
drug overdose
drug withdrawal
female
human
hypotension (side effect)
intubation
male
manual emergency ventilator
middle aged
pill
priority journal
quantitative analysis
respiratory failure (side effect)
resuscitation
toxicity testing
young adult
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
levamisole (14769-73-4, 16595-80-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
promethazine (58-33-3, 60-87-7)
trazodone (19794-93-5, 25332-39-2)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160855178
PUI
L613351077
DOI
10.1111/acem.13034
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.13034
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 239
TITLE
An (un)fortune cookie a 2-year-old with altered mental status
AUTHOR NAMES
Osterhoudt K.C.
Friedman N.
Gantz J.
Finkelstein Y.
AUTHOR ADDRESSES
(Osterhoudt K.C., OsterhoudtK@email.chop.edu; Friedman N.; Gantz J.;
Finkelstein Y.)
SOURCE
Pediatric Emergency Care (2017) 33:12 (811-814). Date of Publication: 2017
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dronabinol (drug toxicity)
EMTREE DRUG INDEX TERMS
glucose
naloxone
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cookie
drug intoxication (diagnosis)
mental disease
EMTREE MEDICAL INDEX TERMS
alertness
article
behavior change
case report
child
child behavior
clinical article
deterioration
drowsiness
emergency ward
female
Glasgow coma scale
grandmother
human
immunoassay
medical assessment
preschool child
pupil reflex
single drug dose
sleep arousal disorder
urinalysis
vomiting
CAS REGISTRY NUMBERS
dronabinol (7663-50-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20180196087
PUI
L621306243
DOI
10.1097/PEC.0000000000001336
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000001336
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 240
TITLE
Suicidal Patients with a Do-Not-Resuscitate Order
AUTHOR NAMES
Henman M.P.
AUTHOR ADDRESSES
(Henman M.P.) Meriter Hospital, Madison, United States.
CORRESPONDENCE ADDRESS
M.P. Henman, Meriter Hospital, 202 South Park Street, Madison, United
States.
SOURCE
Journal of Emergency Medicine (2017) 52:1 (117-120). Date of Publication: 1
Jan 2017
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background A suicidal person with a do-not-resuscitate (DNR) order presents
an ethical dilemma to the emergency physician. Many believe that suicide is
an irrational action, and therefore, all suicide attempts must be treated.
Others believe a DNR order should be respected even in the setting of a
suicide attempt. Case Report An elderly woman with a known terminal illness
presented to the emergency department after a suspected suicide attempt. She
had a DNR order during her previous hospitalization. The emergency physician
felt obligated to intubate the woman despite his recognition that she was
terminally ill. Discussion Reasons to both honor and not honor a DNR order
after a suicide attempt are reviewed. Conclusion Not all patients who
attempt suicide are necessarily incapable of making a rational decision
about their health care. In some cases it may be appropriate to withhold
resuscitation attempts in suicidal patients who have a preexisting DNR
order. Institutional policies are needed to provide guidance in this
situation.
EMTREE DRUG INDEX TERMS
naloxone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
do not resuscitate order
medical order
suicide attempt
terminal care
EMTREE MEDICAL INDEX TERMS
aged
article
artificial ventilation
bone metastasis
case report
chronic lung disease
female
human
intubation
lung cancer
medical history
pill
pneumonia
power of attorney
prescription
priority journal
very elderly
DRUG TRADE NAMES
oxycontin , United StatesPurdue
DRUG MANUFACTURERS
(United States)Purdue
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cancer (16)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160744198
MEDLINE PMID
27751701 (http://www.ncbi.nlm.nih.gov/pubmed/27751701)
PUI
L612773891
DOI
10.1016/j.jemermed.2016.09.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.09.004
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 241
TITLE
Fentanyl and a Novel Synthetic Opioid U-47700 Masquerading as Street “Norco”
in Central California: A Case Report
AUTHOR NAMES
Armenian P.
Olson A.
Anaya A.
Kurtz A.
Ruegner R.
Gerona R.R.
AUTHOR ADDRESSES
(Armenian P., parmenian@fresno.ucsf.edu; Anaya A.; Kurtz A.; Ruegner R.)
Department of Emergency Medicine, University of California, San
Francisco–Fresno, Fresno, United States.
(Olson A.; Gerona R.R.) Department of Laboratory Medicine, University of
California, San Francisco, United States.
CORRESPONDENCE ADDRESS
P. Armenian, Department of Emergency Medicine, University of California, San
Francisco–Fresno, Fresno, United States. Email: parmenian@fresno.ucsf.edu
SOURCE
Annals of Emergency Medicine (2017) 69:1 (87-90). Date of Publication: 1 Jan
2017
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
In 2013 and 2014, more than 700 deaths were attributed to fentanyl and
fentanyl analogues in the United States. Of recent concern is the cluster of
unintentional fentanyl overdoses because of tablets thought to be “Norco”
purchased on the street in Northern California. U-47700
(trans-3,4-dichloro-N-[2-(dimethyl-amino)cyclohexyl]-N-methylbenz-amide) is
a nonfentanyl-based synthetic opioid with 7.5 times the binding affinity of
morphine to μ-opioid. We report a case of fentanyl and U-47700 intoxication
from what was thought to be illicitly purchased Norco. A 41-year-old woman
presented to the emergency department (ED) for altered mental status shortly
after ingesting 3 beige Norco pills bearing a Watson imprint. She had
pinpoint pupils and respiratory depression, which reversed after 0.4 mg
naloxone administration intravenously. She had complete recovery and was
discharged from the ED after a 4-hour observation period. Serum testing with
liquid chromatography–quadrupole time-of-flight mass spectrometry (LC 1260
QTOF/MS 6550; Agilent, Santa Clara, CA) confirmed the presence of the
medications the patient reported receiving, and additionally fentanyl (15.2
ng/mL) and U-47700 (7.6 ng/mL). In this case report, street Norco purchased
in Central California resulted in altered mental status requiring naloxone
reversal because of fentanyl and the novel synthetic opioid U-47700. Because
these compounds are not detected by routine urine drug testing and physical
examination findings are similar to those of a traditional opioid toxidrome,
emergency providers should use the patient's history and other
circumstantial details to aid in diagnosis. In cases with suspicion of
opioid or opioid analogue cause, we recommend that emergency providers
contact their local poison control center, medical toxicologist, or public
health department to aid in the investigation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzamide derivative (adverse drug reaction, drug concentration)
fentanyl (adverse drug reaction, drug concentration)
hydrocodone bitartrate plus paracetamol
mu opiate receptor agonist (adverse drug reaction, drug concentration)
narcotic analgesic agent (adverse drug reaction, drug concentration)
trans 3,4 dichloro n [2 (dimethyl amino)cyclohexyl] n methylbenz amide
(adverse drug reaction, drug concentration)
EMTREE DRUG INDEX TERMS
baclofen (drug concentration)
benzoylecgonine
diphenhydramine (drug therapy, intravenous drug administration)
gabapentin (drug concentration)
glucose (endogenous compound)
hydrocodone (drug combination, drug concentration, drug therapy)
lorazepam (drug therapy, intravenous drug administration)
naloxone (adverse drug reaction, drug therapy, intravenous drug
administration)
paracetamol (drug combination, drug concentration, drug therapy)
sertraline (drug concentration)
unclassified drug
EMTREE MEDICAL INDEX TERMS
adult
analgesia
anxiety disorder (drug therapy, side effect)
article
backache (drug therapy)
blood oxygen tension
blood pressure
breathing rate
California
case report
chronic pain (drug therapy)
clinical observation
consciousness disorder (side effect)
convalescence
drug blood level
drug exposure
female
hospital discharge
human
limit of detection
limit of quantitation
liquid chromatography-mass spectrometry
mental disease
miosis (drug therapy, side effect)
priority journal
pruritus (drug therapy, side effect)
quadrupole mass spectrometry
quantitative analysis
respiration depression (drug therapy, side effect)
sense of coherence
somnolence
time of flight mass spectrometry
vital sign
DRUG TRADE NAMES
norco
u 47700
CAS REGISTRY NUMBERS
baclofen (1134-47-0)
benzoylecgonine (519-09-5)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
gabapentin (60142-96-3)
glucose (50-99-7, 84778-64-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
sertraline (79617-96-2)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160865871
MEDLINE PMID
27473610 (http://www.ncbi.nlm.nih.gov/pubmed/27473610)
PUI
L613431030
DOI
10.1016/j.annemergmed.2016.06.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2016.06.014
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 242
TITLE
Accidental hypothermic cardiac arrest and rapid mediastinal warming with
pleural lavage: A survivor after 3.5 hours of manual CPR
AUTHOR NAMES
Little G.
AUTHOR ADDRESSES
(Little G., george.little@hse.ie) Naas General Hospital, Naas, Kildare,
Ireland.
CORRESPONDENCE ADDRESS
G. Little, Naas General Hospital, Naas, Kildare, Ireland. Email:
george.little@hse.ie
SOURCE
BMJ Case Reports (2017) 2017 Article Number: 220900. Date of Publication:
2017
ISSN
1757-790X (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On
arrival in the emergency department, rectal core temperature was 23°C.
Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical
chest compression device was available, and active and passive rewarming was
undertaken. Bilateral thoracostomies confirmed good lung inflation.
Defibrillation and intravenous epinephrine were discontinued until core
temperature was elevated above 30°C. Extracorporeal rewarming was
unavailable. When no increase in rectal temperature was achieved after 90
min, an alternative oesophageal probe confirmed mediastinal temperature as
23°C. Bilateral chest drain insertion, followed by microwave-heated saline
pleural lavage, rapidly raised the oesophageal temperature above 30°C with
subsequent successful defibrillation, initially to pulseless electrical
activity and finally return of spontaneous circulation 3.5 hours after the
commencement of CPR. The patient recovered fully and was discharged without
neurological deficit. Rapid mediastinal warming with pleural lavage should
be considered in units with no access to extracorporeal rewarming service.
EMTREE DRUG INDEX TERMS
amiodarone (drug therapy, intraosseous drug administration)
antibiotic agent (drug therapy, intravenous drug administration)
bicarbonate (intravenous drug administration)
epinephrine (drug therapy, intraosseous drug administration)
flumazenil (drug therapy, intravenous drug administration)
magnesium sulfate (intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
accidental hypothermia (diagnosis)
heart arrest (drug therapy, diagnosis, drug therapy, therapy)
lung lavage
resuscitation
survivor
warming
EMTREE MEDICAL INDEX TERMS
adult
article
bleeding (therapy)
blood gas analysis
blood sampling
brain contusion (diagnosis)
case report
chest tube
computer assisted tomography
defibrillation
differential diagnosis
direct current
drug toxicity (drug therapy)
echocardiography
electrolyte disturbance (diagnosis)
electrotherapy
endocarditis (diagnosis, drug therapy)
endotracheal intubation
erythrocyte transfusion
follow up
heart ventricle fibrillation (diagnosis, drug therapy)
hospital admission
hospital discharge
human
intensive care unit
male
outpatient care
pneumothorax (surgery)
positive end expiratory pressure
priority journal
rhabdomyolysis (diagnosis)
thermal regulating system
thoracostomy
thorax radiography
traffic accident
unconsciousness (diagnosis)
X ray
CAS REGISTRY NUMBERS
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
bicarbonate (144-55-8, 71-52-3)
epinephrine (51-43-4, 55-31-2, 6912-68-1)
flumazenil (78755-81-4)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170555881
PUI
L617547565
DOI
10.1136/bcr-2017-220900
FULL TEXT LINK
http://dx.doi.org/10.1136/bcr-2017-220900
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 243
TITLE
In opioid withdrawal, with no help in sight
AUTHOR NAMES
Rieder T.N.
AUTHOR ADDRESSES
(Rieder T.N., trieder@jhu.edu) Johns Hopkins Berman Institute of Bioethics,
Baltimore, United States.
CORRESPONDENCE ADDRESS
T.N. Rieder, Johns Hopkins Berman Institute of Bioethics, Baltimore, United
States. Email: trieder@jhu.edu
SOURCE
Health Affairs (2017) 36:1 (182-185). Date of Publication: 2017
ISSN
1544-5208 (electronic)
0278-2715
BOOK PUBLISHER
Project HOPE, jtucker@healthaffairs.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
fentanyl
hydromorphone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
analgesia
article
drug withdrawal
emergency ward
hospitalization
human
intensive care
length of stay
plastic surgeon
prescription
skin graft
traffic accident
trauma surgeon
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170109029
PUI
L614375551
DOI
10.1377/HLTHAFF.2016.0347
FULL TEXT LINK
http://dx.doi.org/10.1377/HLTHAFF.2016.0347
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 244
TITLE
Emergency department opioid pain medication prescribing: Influence of
patient satisfaction and other factors
AUTHOR NAMES
Merriman M.S.
Acquisto N.M.
Nelson S.
Jones C.M.C.
Li T.
McCann M.
Adler D.H.
AUTHOR ADDRESSES
(Merriman M.S.; Acquisto N.M., Nicole_acquisto@urmc.rochester.edu; Nelson
S.) Department of Emergency Medicine, University of Rochester Medical
Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United States
(Jones C.M.C.; Li T.; McCann M.; Adler D.H.) Emergency Medicine Research,
Emergency Medicine and Public Health Services, University of Rochester, 601
Elmwood Ave., Box 655, Rochester, NY 14642, United States
(Acquisto N.M., Nicole_acquisto@urmc.rochester.edu) Department of Pharmacy,
601 Elmwood Ave. Box 638, Rochester, NY 14642
CORRESPONDENCE ADDRESS
N.M. Acquisto, Department of Emergency Medicine, University of Rochester
Medical Center, 601 Elmwood Ave., Box 655, Rochester, NY 14642, United
States Email: Nicole_acquisto@urmc.rochester.edu
SOURCE
American Journal of Emergency Medicine (2017). Date of Publication: 2017
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
patient satisfaction
perception
prescription
EMTREE MEDICAL INDEX TERMS
human
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170683584
PUI
L618500887
DOI
10.1016/j.ajem.2017.09.039
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2017.09.039
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 245
TITLE
An Algorithm for Opioid and Barbiturate Reduction in the Acute Management of
Headache in the Emergency Department
AUTHOR NAMES
Ahmed Z.A.
Nacopoulos D.A.
John S.
Papesh N.
Levine D.
Bamford C.C.
AUTHOR ADDRESSES
(Ahmed Z.A., zahmed.01@gmail.com) Division of Headache, Department of
Neurology, University of Utah, Salt Lake City, United States.
(Nacopoulos D.A.; John S.; Papesh N.) Department of Adult Neurology,
Cleveland Clinic, Neurological Institute, Cleveland, United States.
(Levine D.) Department of Emergency Medicine, Lakewood Hospital, Lakewood,
United States.
(Bamford C.C.) Center for Neuro-Restoration, Center for Headache and Pain,
Cleveland Clinic, Neurological Institute, Cleveland, United States.
CORRESPONDENCE ADDRESS
Z.A. Ahmed, Division of Headache, Department of Neurology, University of
Utah, Salt Lake City, United States. Email: zahmed.01@gmail.com
SOURCE
Headache (2017) 57:1 (71-79). Date of Publication: 1 Jan 2017
ISSN
1526-4610 (electronic)
0017-8748
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: To develop and implement an algorithm for the management of
headaches presenting to the emergency department (ED) in order to decrease
the frequency of opioid and barbiturate treatment both acutely as well as on
discharge. Background: Headache is the fifth leading cause of ED visits in
the United States. In the case of primary headache, particularly migraine,
treatment in the ED can be highly variable. Patients with migraine continue
to be treated with opioids more commonly than nonopioid, migraine specific
medications. In addition, discharge plans seldom include measures to prevent
recurrence or instructions to re-treat if pain persists. At this time, there
is no standardized management protocol directed at acute headaches
presenting to the ED. Methods: An ED headache treatment algorithm with
step-wise instructions for diagnosis, treatment, and discharge planning was
piloted at Lakewood Hospital, a regional Cleveland Clinic affiliated
hospital. This non-randomized interventional study compared outcomes after
implementation of the algorithm to historical controls. Patient demographic
data including age, gender, and payer mix was collected. Outcomes measured
included the frequency of treatment with opioids or barbiturates, imaging,
neurology consults, admissions, and a patient reported pain score. Data
relevant to patient disposition and follow-up, including prescriptions for
opioids or barbiturates given at discharge, and ensuring PCP or neurology
follow-up appointments at discharge was also reviewed. Results: Demographic
data did not differ significantly between the pre- and post-algorithm
groups. There was a significant decline in the number of patients treated
with opioids and barbiturates from 66.0% pre-algorithm to 6.8% immediately
after algorithm implementation (P <. 001), and to 28% (P <.001) one year
after algorithm implementation, indicating both an immediate effect of the
algorithm and a sustained effect. Similarly, pre-algorithm implementation,
37% of patients were discharged with a prescription for opioids or
barbiturates as compared to 12% and 6% in the early post-algorithm cohort
and at 1 year, respectively. There was also an increase in scheduled
follow-up appointments after discharge from the ED from 59% to 98%
immediately post algorithm (P <.001). Other measures including the frequency
of imaging, and patient reported pain did not significantly change. There
was a significant increase in neurology consults and admissions a year after
the algorithm was implemented. Conclusions: A quality improvement pilot
study aimed at treating headache in an Emergency Department setting was
successfully implemented in a regional Cleveland Clinic Hospital. Our
results demonstrated significant decrease in acute treatment with opioids or
barbiturates and a decrease in prescriptions written for opioids or
barbiturates on discharge. This study is limited by small sample size. More
data are needed to determine the reason for 1) increased consultation and
subsequent admission after algorithm implementation and 2) decreased
scheduled follow-up appointments at one-year post algorithm.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
barbituric acid derivative (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
algorithm
emergency care
headache (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age
aged
article
clinical practice
cohort analysis
controlled study
female
follow up
hospital discharge
human
intervention study
major clinical study
male
neuroimaging
outcome assessment
pain assessment
prescription
priority journal
sex difference
total quality management
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170011808
MEDLINE PMID
27861834 (http://www.ncbi.nlm.nih.gov/pubmed/27861834)
PUI
L613955277
DOI
10.1111/head.12961
FULL TEXT LINK
http://dx.doi.org/10.1111/head.12961
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 246
TITLE
Histone deacetylase inhibitor-induced emergence of synaptic δ-opioid
receptors and behavioral antinociception in persistent neuropathic pain
AUTHOR NAMES
Tao W.
Zhou W.
Wang Y.
Sun T.
Wang H.
Zhang Z.
Jin Y.
AUTHOR ADDRESSES
(Tao W.; Zhou W.; Wang Y.; Sun T.; Wang H.; Zhang Z., zhizhang@ustc.edu.cn;
Jin Y., jinyan@ustc.edu.cn) Key Laboratory of Brain Function and Disease of
Chinese Academy of Science and Collaborative Innovation Center of Chemistry
for Life Sciences, Department of Biophysics and Neurobiology, University of
Science and Technology of China, Hefei, China.
CORRESPONDENCE ADDRESS
Z. Zhang, Key Laboratory of Brain Function and Disease of Chinese Academy of
Science and Collaborative Innovation Center of Chemistry for Life Sciences,
Department of Biophysics and Neurobiology, University of Science and
Technology of China, Hefei, China. Email: zhizhang@ustc.edu.cn
SOURCE
Neuroscience (2016) 339 (54-63). Date of Publication: 17 Dec 2016
ISSN
1873-7544 (electronic)
0306-4522
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
The efficacy of opioids in patients with chronic neuropathic pain remains
controversial. Although activation of δ-opioid receptors (DORs) in the
brainstem reduces inflammation-induced persistent hyperalgesia, it is not
effective under persistent neuropathic pain conditions and these clinical
problems remain largely unknown. In this study, by using a chronic
constriction injury (CCI) of the sciatic nerve in rats, we found that in the
brainstem nucleus raphe magnus (NRM), DORs emerged on the surface membrane
of central synaptic terminals on day 3 after CCI surgery and disappeared on
day 14. Histone deacetylase (HDAC) inhibitors microinjected into the NRM in
vivo increased the level of synaptosomal DOR protein and NRM infusion of DOR
agonists producing an antinociceptive effect in a nerve growth factor (NGF)
signaling-dependent manner. In vitro, in CCI rat slices incubated with HDAC
inhibitors, DOR agonists significantly inhibited EPSCs. This effect was
blocked by tyrosine receptor kinase A antagonists. Chromatin
immunoprecipitation analysis revealed that NRM infusion of HDAC inhibitors
in CCI rats increased the level of histone H4 acetylation at Ngf gene
promoter regions. NGF was infused into the NRM or incubated CCI rat slices
drove DORs to the surface membrane of synaptic terminals. Taken together,
epigenetic upregulation of NGF activity by HDAC inhibitors in the NRM
promotes the trafficking of DORs to pain-modulating neuronal synapses under
neuropathic pain conditions, leading to δ-opioid analgesia. These findings
indicate that therapeutic use of DOR agonists combined with HDAC inhibitors
might be effective in chronic neuropathic pain managements.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
delta opiate receptor (endogenous compound)
trichostatin A (drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
histone H4 (endogenous compound)
nerve growth factor (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
antinociception
neuropathic pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
animal experiment
animal model
animal tissue
article
chronic constriction injury
controlled study
enzyme activity
epigenetics
excitatory postsynaptic potential
histone acetylation
in vitro study
in vivo study
incubation time
limit of quantitation
male
nerve ending
Ngf gene
nonhuman
priority journal
promoter region
raphe magnus nucleus
rat
signal transduction
upregulation
CAS REGISTRY NUMBERS
nerve growth factor (9061-61-4)
trichostatin A (58880-19-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160747814
MEDLINE PMID
27646288 (http://www.ncbi.nlm.nih.gov/pubmed/27646288)
PUI
L612617934
DOI
10.1016/j.neuroscience.2016.09.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.neuroscience.2016.09.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 247
TITLE
The rising price of naloxone-risks to efforts to stem overdose deaths
AUTHOR NAMES
Gupta R.
Shah N.D.
Ross J.S.
AUTHOR ADDRESSES
(Gupta R.; Ross J.S.) Yale University School of Medicine, New Haven, United
States.
(Ross J.S.) Department of Health Policy and Management, Yale University
School of Public Health, New Haven, United States.
(Ross J.S.) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, United States.
(Shah N.D.) Division of Health Care Policy and Research, Kern Center for the
Science of Health Care Delivery, Mayo Clinic, Rochester, United States.
SOURCE
New England Journal of Medicine (2016) 375:23 (2213-2215). Date of
Publication: 8 Dec 2016
ISSN
1533-4406 (electronic)
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, pharmacoeconomics)
opiate
EMTREE DRUG INDEX TERMS
diamorphine
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug cost
drug overdose (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
drug approval
emergency health service
food and drug administration
human
practice guideline
prescription
priority journal
review
DRUG TRADE NAMES
evzio
narcan
DRUG MANUFACTURERS
Amphastar
Hospira
Mylan
West Ward
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160905235
MEDLINE PMID
27959694 (http://www.ncbi.nlm.nih.gov/pubmed/27959694)
PUI
L613544514
DOI
10.1056/NEJMp1609578
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMp1609578
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 248
TITLE
An investigation of completion times on the screener and opioid assessment
for patients with pain – Revised (SOAPP-R)
AUTHOR NAMES
Finkelman M.D.
Kulich R.J.
Butler S.F.
Jackson W.C.
Friedman F.D.
Smits N.
Weiner S.G.
AUTHOR ADDRESSES
(Finkelman M.D., matthew.finkelman@tufts.edu) Department of Public Health
and Community Service, Tufts University School of Dental Medicine, Boston,
United States.
(Kulich R.J.) Craniofacial Pain and Headache Center, Tufts University School
of Dental Medicine, Boston, United States.
(Kulich R.J.; Jackson W.C.) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, United States.
(Butler S.F.) Inflexxion Inc, Newton, United States.
(Friedman F.D.) Department of Emergency Medicine, Tufts Medical Center,
Boston, United States.
(Smits N.) Department of Methods and Statistics, Research Institute of Child
Development and Education, University of Amsterdam, Amsterdam, Netherlands.
(Weiner S.G.) Department of Emergency Medicine, Brigham and Women’s
Hospital, Boston, United States.
CORRESPONDENCE ADDRESS
M.D. Finkelman, Department of Public Health and Community Service, Tufts
University School of Dental Medicine, 1 Kneeland Street, Boston, United
States. Email: matthew.finkelman@tufts.edu
SOURCE
Journal of Pain Research (2016) 9 (1163-1171). Date of Publication: 5 Dec
2016
ISSN
1178-7090 (electronic)
BOOK PUBLISHER
Dove Medical Press Ltd., PO Box 300-008, Albany, Auckland, New Zealand.
ABSTRACT
Background: Respondents’ scores to the Screener and Opioid Assessment for
Patients with Pain – revised (SOAPP-R) have been shown to be predictive of
aberrant drug-related behavior (ADB). However, research is lacking on
whether an individual’s completion time (the amount of time that he/she
takes to finish the screener) has utility in predicting ADB, despite the
fact that response speed has been useful in predicting behavior in other
fields. The purpose of this study was to evaluate the degree to which
SOAPP-R completion time is predictive of ADB. Materials and methods: This
retrospective study analyzed completion-time data from 82 adult emergency
department patients who completed the SOAPP-R on a tablet computer. The
utility of SOAPP-R completion times in predicting ADB was assessed via
logistic regression and the area under the curve (AUC) statistic. An
external measure of ADB using Prescription Drug Monitoring Program data
defined ADB to have occurred in individuals with at least four opioid
prescriptions and at least four prescribers in 12 months. Results: Although
there was a slight trend for individuals with greater completion times to
have greater odds of ADB (odds ratio 1.004 in simple logistic regression),
the association between SOAPP-R completion time and ADB was not
statistically significant in either simple logistic regression (P=0.307) or
multiple logistic regression adjusting for SOAPP-R score (P=0.419). AUC
values for the prediction of ADB using completion time alone, SOAPP-R score
alone, and both completion time and SOAPP-R score were 0.63, 0.64, and 0.65,
respectively. Conclusion: There was no significant evidence that SOAPP-R
completion times were predictive of ADB among emergency department patients.
However, the AUC value for completion times was only slightly less than that
for SOAPP-R total scores.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aberrant drug related behavior (diagnosis)
drug abuse
opiate addiction (diagnosis)
scoring system
Screener and Opioid Assessment for Patients with Pain revised
EMTREE MEDICAL INDEX TERMS
adult
aged
article
controlled study
emergency patient
female
human
major clinical study
male
pain (drug therapy)
predictive value
prescription
receiver operating characteristic
retrospective study
sensitivity and specificity
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170013363
PUI
L613897568
DOI
10.2147/JPR.S123454
FULL TEXT LINK
http://dx.doi.org/10.2147/JPR.S123454
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 249
TITLE
Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in
U.S. Emergency Departments
AUTHOR NAMES
Mazer-Amirshahi M.
Mullins P.M.
Sun C.
Pines J.M.
Nelson L.S.
Perrone J.
AUTHOR ADDRESSES
(Mazer-Amirshahi M.; Sun C.; Nelson L.S.) *Department of Emergency Medicine,
MedStar Washington Hospital Center, Washington, DC
(Mazer-Amirshahi M.; Sun C.) Georgetown University School of Medicine,
Washington, DC
(Mullins P.M.; Pines J.M.) Center for Clinical Practice Innovation, The
George Washington University, Washington, DC
(Pines J.M.) Department of Emergency Medicine, The George Washington
University, Washington, DC
(Nelson L.S.) Ronald O. Perelman Department of Emergency Medicine, New York
University School of Medicine, New York, New York
(Perrone J.) Department of Emergency Medicine, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, Pennsylvania, USA
SOURCE
Pain medicine (Malden, Mass.) (2016) 17:12 (2389-2396). Date of Publication:
1 Dec 2016
ISSN
1526-4637 (electronic)
ABSTRACT
BACKGROUND: Opioid analgesic use has increased dramatically in emergency
departments (EDs), but the relative contribution of physician trainees has
not been explored. We assessed trends in opioid utilization focusing on ED
encounters where a physician trainee was involved.METHODS: We studied ED
visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011.
Adult ED visits in which an opioid was administered in the ED or prescribed
at discharge were stratified by whether or not there was trainee
involvement. Trends in use over time for five common opioids (codeine,
hydrocodone, hydromorphone, morphine, oxycodone) were tested using
survey-weighted logistic regression.RESULTS: From 2001-02 to 2009-11, the
proportion of ED visits where an opioid analgesic was used increased 31.5%
from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1).
Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3)
seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid
use in visits with trainee involvement did not change significantly over
time relative to visits without a trainee (increase of 36.8% compared to
31.2% without trainees, P = 0.652). Trends in opioid utilization for trainee
visits paralleled non-trainee visits. Hydromorphone had the greatest
relative increase in use for all providers. Adjusted for patient- and
hospital-level factors, the probability of receiving opioids when a trainee
was involved increased to a greater extent than among non-trainee visits
(30.9% vs. 24.0%).CONCLUSION: Opioid utilization patterns for visits
involving trainees reflect similar trends in attending practice, and
highlights the more liberal opioid prescribing climate over time.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
clinical practice
health care survey
hospital emergency service
human
medical education
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28025373 (http://www.ncbi.nlm.nih.gov/pubmed/28025373)
PUI
L618622749
DOI
10.1093/pm/pnw048
FULL TEXT LINK
http://dx.doi.org/10.1093/pm/pnw048
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 250
TITLE
Is There a Role for Intravenous Subdissociative-Dose Ketamine Administered
as an Adjunct to Opioids or as a Single Agent for Acute Pain Management in
the Emergency Department?
AUTHOR NAMES
Motov S.
Rosenbaum S.
Vilke G.M.
Nakajima Y.
AUTHOR ADDRESSES
(Motov S.) Maimonides Medical Center, Brooklyn, United States.
(Rosenbaum S.) American Academy of Emergency Medicine, Milwaukee, United
States.
(Vilke G.M.; Nakajima Y.) University of California, San Diego Medical
Center, San Diego, United States.
CORRESPONDENCE ADDRESS
Y. Nakajima, University of California, San Diego Medical Center, San Diego,
United States.
SOURCE
Journal of Emergency Medicine (2016) 51:6 (752-757). Date of Publication: 1
Dec 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Whether acute or chronic, emergency physicians frequently
encounter patients reporting pain. It is the responsibility of the emergency
physician to assess and evaluate, and if appropriate, safely and effectively
reduce pain. Recently, analgesics other than opioids are being considered in
an effort to provide safe alternatives for pain management in the emergency
department (ED). Opioids have significant adverse effects such as
respiratory depression, hypotension, and sedation, to say nothing of their
potential for abuse. Although ketamine has long been used in the ED for
procedural sedation and rapid sequence intubation, it is used infrequently
for analgesia. Recent evidence suggests that ketamine use in subdissociative
doses proves to be effective for pain control and serves as a feasible
alternative to traditional opioids. This paper evaluates ketamine's
analgesic effectiveness and safety in the ED. Methods This is a literature
review of randomized controlled trials, systematic reviews, meta-analyses,
and observational studies evaluating ketamine for pain control in the ED
setting. Based on these search parameters, eight studies were included in
the final analysis and graded based on the American Academy of Emergency
Medicine Clinical Practice Committee manuscript review process. Results A
total of eight papers were reviewed in detail and graded. Recommendations
were given based upon this review process. Conclusions Subdissociative-dose
ketamine (low-dose ketamine) is effective and safe to use alone or in
combination with opioid analgesics for the treatment of acute pain in the
ED. Its use is associated with higher rates of minor, but well-tolerated
adverse side effects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug therapy, intravenous drug administration)
opiate (drug combination, drug therapy)
EMTREE DRUG INDEX TERMS
hydromorphone (adverse drug reaction, clinical trial, drug combination, drug
therapy, intravenous drug administration)
midazolam
morphine (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug therapy, intravenous drug administration)
naloxone
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
agitation
analgesic activity
backache (drug therapy)
bone pain (drug therapy)
chronic pain (drug therapy)
diplopia (side effect)
dizziness (side effect)
drug efficacy
drug safety
drug use
dysphoria (side effect)
emergency physician
flank pain (drug therapy)
hallucination (side effect)
heart disease (side effect)
human
limb pain (drug therapy)
low back pain (drug therapy)
low drug dose
lung disease (side effect)
meta analysis (topic)
musculoskeletal pain (drug therapy)
nausea (side effect)
note
pain intensity
patient satisfaction
posttraumatic pain (drug therapy)
priority journal
randomized controlled trial (topic)
sedation
side effect (side effect)
systematic review (topic)
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160874528
MEDLINE PMID
27693070 (http://www.ncbi.nlm.nih.gov/pubmed/27693070)
PUI
L613479033
DOI
10.1016/j.jemermed.2016.07.087
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.07.087
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 251
TITLE
Naloxone infusion in the setting of an unknown ingestion: A case report
AUTHOR NAMES
Zivanovic R.
Wood E.
Nolan S.
AUTHOR ADDRESSES
(Zivanovic R.; Wood E.; Nolan S., seonaidn@gmail.com) British Columbia
Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard
Street, Vancouver, Canada.
(Wood E.; Nolan S., seonaidn@gmail.com) Department of Medicine, University
of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street,
Vancouver, Canada.
CORRESPONDENCE ADDRESS
S. Nolan, Centre for Excellence in HIV/AIDS, Department of Medicine,
University of British Columbia, Canada. Email: seonaidn@gmail.com
SOURCE
Canadian Journal of Addiction (2016) 7:4 (19-24). Date of Publication: 1 Dec
2016
ISSN
2368-4720
BOOK PUBLISHER
Canadian Society of Addiction Medicine, admin@csam.org
ABSTRACT
Drug-related overdoses and deaths are a major public health concern in
Canada. Reasons for this include high rates of opioid and benzodiazepine
prescribing in addition to a surge of high potency opioids, such as
fentanyl, in Canada's illicit drug markets. The vast majority of
opioid-related overdose deaths are accidental in nature and require
emergency resuscitation with naloxone, a pure mu opioid receptor antagonist.
Though established as an effective antidote for opioid overdose, there is
some literature to suggest naloxone may also be an effective intervention
for a variety of non-opioid toxicities. Here we report a case of a patient
who presented to the emergency department of an urban hospital located in
downtown Vancouver, Canada due to an overdose after intentionally ingesting
multiple unknown illicitly purchased pills. Despite empiric treatment with a
naloxone infusion, which was associated with clinical improvement, the
patient's urine mass spectrometry collected over 40 hours after initial
presentation was negative for all opioids and their metabolites. This case
reinforces the importance of prompt urine drug screen collection and
emphasizes the complexity in detecting a potential highpotency opioid
overdose. Furthermore, it highlights the potential difficulty in
differentiating the clinical presentation of a benzodiazepine from opioid
induced overdose and considers what role, if any, naloxone might play in the
management of a non-opioid toxicity.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
escitalopram
narcotic agent
oxazepam
quetiapine
temazepam
topiramate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical article
consciousness disorder
drug dose increase
drug efficacy
drug screening
drug tolerability
drug urine level
emergency treatment
female
human
mass spectrometry
middle aged
suicide attempt
urinalysis
CAS REGISTRY NUMBERS
escitalopram (128196-01-0, 219861-08-2)
naloxone (357-08-4, 465-65-6)
oxazepam (604-75-1)
quetiapine (111974-72-2)
temazepam (846-50-4)
topiramate (97240-79-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20170703866
PUI
L618655112
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 252
TITLE
Drug Toxicities of Common Analgesic Medications in the Emergency Department
AUTHOR NAMES
Ciejka M.
Nguyen K.
Bluth M.H.
Dubey E.
AUTHOR ADDRESSES
(Ciejka M.; Nguyen K.; Dubey E., edube@med.wayne.edu) Department of
Emergency Medicine, Wayne State University School of Medicine, 4201 St.
Antoine, 6F UHC, Detroit, United States.
(Bluth M.H.) Department of Pathology, Wayne State University School of
Medicine, 540 East Canfield, Detroit, United States.
(Bluth M.H.) Consolidated Laboratory Management Systems, 24555 Southfield
Road, Southfield, United States.
CORRESPONDENCE ADDRESS
E. Dubey, Department of Emergency Medicine, Wayne State University School of
Medicine, 4201 St. Antoine, 6F UHC, Detroit, United States. Email:
edube@med.wayne.edu
SOURCE
Clinics in Laboratory Medicine (2016) 36:4 (761-776). Date of Publication: 1
Dec 2016
ISSN
1557-9832 (electronic)
0272-2712
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
About 75% of patients present to the emergency department with a complaint
of pain. There are multiple prescribed and over-the-counter medications that
are available for the treatment of pain. Acetaminophen, opioids, and aspirin
are commonly used agents that are available as single agents or in
combination with other medications. However, all of these agents are
susceptible to toxic overdose, which requires prompt recognition through
clinical and laboratory assessment modalities and initiation of therapy to
reduce the risk of morbidity and mortality.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
EMTREE DRUG INDEX TERMS
acetylcysteine (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration)
acetylsalicylic acid (adverse drug reaction, drug concentration)
activated carbon
buprenorphine (adverse drug reaction)
codeine (oral drug administration)
dextromethorphan (adverse drug reaction)
fentanyl (intravenous drug administration, transdermal drug administration)
hydrocodone (oral drug administration)
hydromorphone (intramuscular drug administration, intravenous drug
administration, oral drug administration)
isoniazid (adverse drug reaction, drug combination)
methadone (adverse drug reaction, oral drug administration)
morphine (intramuscular drug administration, intravenous drug
administration, oral drug administration)
naloxone (drug therapy, intramuscular drug administration, intranasal drug
administration, intraosseous drug administration, intravenous drug
administration, subcutaneous drug administration)
narcotic analgesic agent (adverse drug reaction, drug therapy, drug
toxicity, intramuscular drug administration, intranasal drug administration,
oral drug administration, subcutaneous drug administration)
oxycodone (oral drug administration)
paracetamol (adverse drug reaction, drug combination, drug concentration)
pethidine (adverse drug reaction)
phenytoin (adverse drug reaction, drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
EMTREE MEDICAL INDEX TERMS
acute liver failure (side effect)
aerobic metabolism
anaphylaxis (side effect)
angioneurotic edema (side effect)
artificial ventilation
bronchospasm (side effect)
central nervous system depression
chronic pain (drug therapy)
coma (side effect)
drug blood level
drug half life
drug metabolism
drug overdose
fulminant hepatic failure (side effect)
gastrointestinal motility
hemodialysis
human
hyperthermia (side effect)
hypokalemia (side effect)
hypotension (side effect)
ileus (side effect)
liver dysfunction (drug therapy, side effect)
liver toxicity (side effect)
loading drug dose
lung edema (side effect)
metabolic acidosis (side effect)
nausea (side effect)
opiate addiction
pain
pathophysiology
pharmacoepidemiology
priority journal
pruritus (side effect)
pupil disease (side effect)
pupillary constriction (side effect)
pupillary constriction (side effect)
rash (side effect)
recommended drug dose
respiration depression (drug therapy, side effect)
respiratory chain
review
seizure (side effect)
serotonin syndrome (side effect)
shock (side effect)
side effect (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
dextromethorphan (125-69-9, 125-71-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenytoin (57-41-0, 630-93-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160848094
MEDLINE PMID
27842792 (http://www.ncbi.nlm.nih.gov/pubmed/27842792)
PUI
L613312885
DOI
10.1016/j.cll.2016.07.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cll.2016.07.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 253
TITLE
Implementation of online opioid overdose prevention, recognition and
response trainings for professional first responders: Year 1 survey results
AUTHOR NAMES
Simmons J.
Rajan S.
Goldsamt L.
Elliott L.
AUTHOR ADDRESSES
(Simmons J., simmons@ndri.org; Elliott L.) National Development and Research
Institutes, Inc. 71 West 23rd Street, New York, United States.
(Rajan S.) Department of Health and Behavior Studies, Teachers College,
Columbia University, Box 114, 525 West 120th Street, New York, United
States.
(Goldsamt L.) New York University Meyers College of Nursing, 433 First
Avenue, Room 739, New York, United States.
CORRESPONDENCE ADDRESS
J. Simmons, National Development and Research Institutes, Inc. 71 West 23rd
Street, New York, United States. Email: simmons@ndri.org
SOURCE
Drug and Alcohol Dependence (2016) 169 (1-4). Date of Publication: 1 Dec
2016
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background This article reports on the first web-based implementation of an
opioid-overdose prevention, recognition and response training for
professional first responders. The training was disseminated nationally over
one listserv in November 2014. The same year, following Act 139, which
mandated the provision of an online training for police officers in
Pennsylvania, the Pennsylvania Department of Health approved the training.
It was subsequently adopted as the primary training tool for police and
other first responders in Pennsylvania and has been used as a training tool
by first responders nationally. Methods Analyses employed descriptive
statistics to report characteristics of a sample of 387 professional first
responders who completed a survey about their experience with the online
training. Z-ratios were used to compare independent proportions related to
overdose, naloxone, and satisfaction with the training between key
subgroups, and paired t-tests were used to compare participant responses to
a range of items pre- and post-participation in the training. Results
Between January–October 2015, 4804 first responders took the training; 1697
(35.3%) agreed to be contacted; of these, 387 (22.8%) completed a survey
about the training and subsequent overdose response experiences. The
majority (86.4%) were from Pennsylvania, with police representing over half
of the sample. Analysis of the post-training survey indicates high
satisfaction with content, format and mode of delivery, and high
satisfaction with items related to confidence and overdose reversal
preparedness. Conclusions This study demonstrates the feasibility and
acceptability of implementing online training for first responders in
overdose prevention, recognition and response.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intranasal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fire fighter
in service training
Internet
intoxication (drug therapy, drug therapy, prevention)
police
rescue personnel
EMTREE MEDICAL INDEX TERMS
article
drug overdose
emergency treatment
human
Pennsylvania
priority journal
professional knowledge
satisfaction
DRUG TRADE NAMES
narcan Adapt Pharma
DRUG MANUFACTURERS
Adapt Pharma
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160763375
MEDLINE PMID
27744100 (http://www.ncbi.nlm.nih.gov/pubmed/27744100)
PUI
L612657200
DOI
10.1016/j.drugalcdep.2016.10.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2016.10.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 254
TITLE
Variation in opioid prescribing patterns between ED providers
AUTHOR NAMES
Smulowitz P.B.
Cary C.
Boyle K.L.
Novack V.
Jagminas L.
AUTHOR ADDRESSES
(Smulowitz P.B.) Department of Emergency Medicine, Beth Israel Deaconess
Medical Center, Boston, MA, USA. psmulowi@bidmc.harvard.edu
(Cary C.) Harvard Affiliated Emergency Medicine Residency, Beth Israel
Deaconess Medical Center, Boston, MA, USA
(Boyle K.L.) Department of Emergency Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, USA
(Novack V.) Soroka University Medical Center and Faculty of Health Sciences,
Ben-Gurion University of the Negev, Beersheba, Israel
(Jagminas L.) Department of Emergency Medicine, Beth Israel Deaconess
Hospital-Plymouth, Plymouth, MA, USA
SOURCE
Internal and emergency medicine (2016) 11:8 (1121-1124). Date of
Publication: 1 Dec 2016
ISSN
1970-9366 (electronic)
ABSTRACT
Abuse of opioid prescription drugs has become an epidemic across the
developed world. Despite the fact that emergency physicians overall account
for a small proportion of total opioids prescribed, the number of
prescriptions has risen dramatically in the past decade and, to some degree,
contributes to the available supply of opioids in the community, some of
which are diverted for non-medical use. Since successfully reducing opioid
prescribing on the individual level first requires knowledge of current
prescribing patterns, we sought to determine to what extent variation exists
in opioid prescribing patterns at our institution. This was a
single-institution observational study at a community hospital with an
annual ED volume of 47,000 visits. We determined the number of prescriptions
written by each provider, both total number and accounting for the number of
patients seen. Our primary outcome measure was the level of variation at the
physician level for number of prescriptions written per patient. We also
identified the mean number of pills written per prescription. We analyzed
data from November 13, 2014 through July 31, 2015 for 21 full-time
providers. There were a total of 2211 prescriptions for opioids written over
this time period for a total of 17,382 patients seen. On a per-patient
basis, the rate of opioid prescriptions written per patient during this
period was 127 per 1000 visits (95 % CI 122-132). There was a variation on
the individual provider level, with rates ranging from 33 per to 332 per
1000 visits. There was also substantial variation by provider in the number
of pills written per prescription with coefficient of variation (standard
deviation divided by mean) averaged over different opioids ranging from 16
to 40 %. There was significant variation in opioid prescribing patterns at
the individual physician level, even when accounting for the number of
patients seen.
EMTREE DRUG INDEX TERMS
analgesic agent (adverse drug reaction, drug therapy)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
manpower
procedures
EMTREE MEDICAL INDEX TERMS
analgesia
clinical practice
emergency medicine
hospital emergency service
human
organization and management
prescription drug misuse (side effect)
retrospective study
statistics and numerical data
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27424280 (http://www.ncbi.nlm.nih.gov/pubmed/27424280)
PUI
L618409402
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 255
TITLE
High-Dose opioid prescribing and opioid-related hospitalization: A
population-Based study
AUTHOR NAMES
Fernandes K.
Martins D.
Juurlink D.
Mamdani M.
Paterson J.M.
Spooner L.
Singh S.
Gomes T.
AUTHOR ADDRESSES
(Fernandes K.; Martins D.; Juurlink D.; Mamdani M.; Paterson J.M.; Singh S.;
Gomes T., GomesT@smh.ca) Institute for Clinical Evaluative Sciences,
Toronto, Canada.
(Juurlink D.) Sunnybrook Research Institute, Sunnybrook Health Sciences
Centre, Toronto, Canada.
(Mamdani M.) Department of Medicine, St. Michael's Hospital, Toronto,
Canada.
(Mamdani M.; Paterson J.M.; Gomes T., GomesT@smh.ca) Institute of Health
Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
(Mamdani M.; Gomes T., GomesT@smh.ca) Leslie Dan Faculty of Pharmacy,
University of Toronto, Toronto, Canada.
(Mamdani M.; Gomes T., GomesT@smh.ca) Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, Canada.
(Paterson J.M.) Department of Family Medicine, McMaster University,
Hamilton, Canada.
(Spooner L.) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, Canada.
CORRESPONDENCE ADDRESS
T. Gomes, Institute for Clinical Evaluative Sciences, Toronto, Canada.
Email: GomesT@smh.ca
SOURCE
PLoS ONE (2016) 11:12 Article Number: e0167479. Date of Publication: 1 Dec
2016
ISSN
1932-6203 (electronic)
BOOK PUBLISHER
Public Library of Science, plos@plos.org
ABSTRACT
Aims To examine the impact of national clinical practice guidelines and
provincial drug policy interventions on prevalence of high-dose opioid
prescribing and rates of hospitalization for opioid toxicity. Design
Interventional time-series analysis. Setting Ontario, Canada, from 2003 to
2014. Participants Ontario Drug Benefit (ODB) beneficiaries aged 15 to 64
years from 2003 to 2014. Interventions Publication of Canadian clinical
practice guidelines for use of opioids in chronic non-cancer pain (May 2010)
and implementation of Ontario's Narcotics Safety and Awareness Act (NSAA;
November 2011). Measurements Three outcomes were explored: the rate of
opioid use among ODB beneficiaries, the prevalence of opioid prescriptions
exceeding 200 mg and 400 mg morphine equivalents per day, and rates of
opioid-related emergency department visits and hospital admissions. Findings
Over the 12 year study period, the rate of opioid use declined 15.2%, from
2764 to 2342 users per 10,000 ODB eligible persons. The rate of opioid use
was significantly impacted by the Canadian clinical practice guidelines
(p-value = .03) which led to a decline in use, but no impact was observed by
the enactment of the NSAA (p-value = .43). Among opioid users, the
prevalence of high-dose prescribing doubled (from 4.2% to 8.7%) over the
study period. By 2014, 40.9% of recipients of long-acting opioids exceeded
daily doses of 200 mg morphine or equivalent, including 55.8% of long-acting
oxycodone users and 76.3% of transdermal fentanyl users. Moreover, in the
last period, 18.7% of long-acting opioid users exceeded daily doses of 400
mg morphine or equivalent. Rates of opioid-related emergency department
visits and hospital admissions increased 55.0% over the study period from
9.0 to 14.0 per 10,000 ODB beneficiaries from 2003 to 2013. This rate was
not significantly impacted by the Canadian clinical practice guidelines
(p-value = .68) or enactment of the NSAA (p-value = .59). Conclusions
Although the Canadian clinical practice guidelines for use of opioids in
chronic non-cancer pain led to a decline in opioid prescribing rates among
ODB beneficiaries these guidelines and subsequent Ontario legislation did
not result in a significant change in rates of opioidrelated
hospitalizations. Given the prevalence of high dose opioid prescribing in
this population, this suggests that improved strategies and programs for the
safe prescribing of longacting opioids are needed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction, drug dose, drug therapy)
morphine (adverse drug reaction, drug dose, drug therapy)
oxycodone (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse outcome
disease association
hospitalization
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
Canada
clinical practice
dose response
drug dose comparison
drug megadose
drug safety
emergency ward
health care policy
health program
hospital admission
human
outcome assessment
pain (drug therapy)
practice guideline
prevalence
publication
side effect (drug therapy, side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160919990
PUI
L613668909
DOI
10.1371/journal.pone.0167479
FULL TEXT LINK
http://dx.doi.org/10.1371/journal.pone.0167479
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 256
TITLE
Health Care Utilization and Costs Associated with Nausea and Vomiting in
Patients Receiving Oral Immediate-Release Opioids for Outpatient Acute Pain
Management
AUTHOR NAMES
Marrett E.
Kwong W.J.
Frech F.
Qian C.
AUTHOR ADDRESSES
(Marrett E., emarrett@dsi.com; Kwong W.J.; Qian C.) Daiichi Sankyo, Inc.,
Parsippany, United States.
(Frech F.) Spring, United States.
CORRESPONDENCE ADDRESS
E. Marrett, Daiichi Sankyo, Inc., Parsippany, United States. Email:
emarrett@dsi.com
SOURCE
Pain and Therapy (2016) 5:2 (215-226). Date of Publication: 1 Dec 2016
ISSN
2193-651X (electronic)
2193-8237
BOOK PUBLISHER
Springer Healthcare
ABSTRACT
Introduction: Nausea and vomiting (NV) are common side effects of opioid use
and limiting factors in pain management. This study sought to quantify the
frequency of antiemetic prescribing and the impact of NV on health care
resource utilization and costs in outpatients prescribed opioids for acute
pain. The perspective was that of a commercial health plan. Methods: Medical
and pharmacy claims from IMS PharMetrics Plus were used to identify patients
initiating opioid therapy with a prescription for an oxycodone-,
hydrocodone- or codeine-containing immediate-release product for acute use
(≤15-day supply) between October 1, 2013 and September 30, 2014. Patients
with a medical claim for NV (International Classification of Diseases, Ninth
Revision, Clinical Modification codes 787.0x), with or without an antiemetic
prescription fill, were compared with patients with no NV claim or
antiemetic prescription fill to assess differences in all-cause health care
utilization and costs over 1 month. Propensity score matching (PSM) was used
to adjust for between-group differences in baseline patient characteristics.
Results: The co-prescribing of opioids with antiemetic agents was 10.2%.
After PSM (n = 45,790 per group), patients with NV claims had significantly
more hospitalizations (11.5% vs 4.2%), emergency department visits (65.0% vs
12.1%), and physician office visits (85.2% vs 64.5%) compared with patients
with no NV claims (all P < 0.0001). Mean total health care costs were higher
among patients with a NV claim versus those without evidence of the side
effect ($6290 vs $2309; P < 0.0001). Among patients with a recent
hospitalization, patients with NV claims had higher rates of 30-day
rehospitalization than those with no NV claims (24.4% vs 3.0%; P < 0.0001).
Conclusions: Among outpatients prescribed opioids for management of acute
pain, co-prescribing with antiemetics was low, and the economic burden
associated with NV was high. Efforts to prevent NV in patients receiving
opioid therapy may improve patient outcomes and provide cost savings to the
health care system. Funding: Daiichi Sankyo, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacoeconomics)
EMTREE DRUG INDEX TERMS
hydrocodone (pharmacoeconomics)
narcotic analgesic agent (pharmacoeconomics)
oxycodone (pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia (disease management)
health care utilization
nausea and vomiting
EMTREE MEDICAL INDEX TERMS
adult
aged
article
comorbidity
emergency ward
female
follow up
health care cost
health care system
hospitalization
human
major clinical study
male
middle aged
priority journal
retrospective study
risk factor
treatment outcome
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160884444
PUI
L613475159
DOI
10.1007/s40122-016-0057-y
FULL TEXT LINK
http://dx.doi.org/10.1007/s40122-016-0057-y
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 257
TITLE
A cross sectional study on opioid poisoning in children at a tertiary center
AUTHOR NAMES
Ghaemi N.
Alikhani S.
Bagheri S.
Sezavar M.
AUTHOR ADDRESSES
(Ghaemi N.) Department of Pediatric Endocrinology, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran.
(Alikhani S.) Mashhad University of Medical Sciences, Mashhad, Iran.
(Bagheri S.; Sezavar M., Sezavar.majid@yahoo.com) Department of Pediatrics,
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
CORRESPONDENCE ADDRESS
M. Sezavar, Department of Pediatrics, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran. Email:
Sezavar.majid@yahoo.com
SOURCE
Asia Pacific Journal of Medical Toxicology (2016) 5:4 (115-118). Date of
Publication: 1 Dec 2016
ISSN
2322-4320 (electronic)
2322-2611
BOOK PUBLISHER
Mashhad University of Medical Sciences, P.O. Box: 445, Daneshgah Avenue,
Mashhad, Iran. ijp@mums.ac.ir
ABSTRACT
Background: Poisoning in children is a world-wide problem and one of the
most important reasons for children's hospital admission. Incidence of
toxicity based on cultural and economic characteristics vary in different
communities. Methods: All children with proven opioid toxicity who admitted
to children emergency ward of Imam Reza hospital of Mashhad through June
2014 to June 2015 were included the study. Age, sex, weight, parent's
educational level and job, causes and kinds of ingested opioid, addiction in
family, clinical manifestations, laboratory findings, changes in QT
corrected (QTC), and mortality rate were recorded. Finally, all data were
analyzed with SPSS. Results: In this study, 126 opioid-intoxicated children
were recruited. No significant age difference was seen between genders (P
value = 0.24). Parent's educational levels in most cases were low. Addiction
to opium was also common among fathers (68.3%). Methadone was the most
common agent causing opioid poisoning (52.4%), followed by opium (43.7%).
The cause of poisoning was accidental in 58% of patients. The common signs
and symptoms were drowsiness (77.8%), miotic pupil (69 %), decreased levels
of O2 saturation (67.5%), Bradypnea (37.3%), apnea (27.8%) and convulsions
(8.7%). Venous blood gases (VBG) in most cases (69.8%) was abnormal,
leukocytosis (26.2%), hyperglycemia (11.1%), hyponatremia (9.5%),
hypernatremia (5.6%), increases in distance of QT in Electrocardiography
(2.4%) were seen. Conclusion: Opioid poisonings are severe and
life-threatening in children. Methadone was the most common cause of
poisoning in more than the half of cases (52.4%). Poisonings were due to low
parental knowledge about methadone poisoning and careless storage of
methadone at their home.
EMTREE DRUG INDEX TERMS
buprenorphine
codeine
diphenoxylate
methadone
opiate
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
accident
adolescent
apnea
article
blood gas analysis
bradypnea
child
convulsion
cross-sectional study
drowsiness
educational status
electrocardiography
emergency ward
error
father
female
human
hyperglycemia
hypernatremia
hypoglycemia
hyponatremia
infant
Iran
leukocytosis
major clinical study
male
miosis
oxygen saturation
QT prolongation
questionnaire
respiratory acidosis
tertiary care center
venous blood
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
diphenoxylate (3810-80-8, 915-30-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Endocrinology (3)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170260145
PUI
L615256903
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 258
TITLE
Management of body stuffers presenting to the emergency department
AUTHOR NAMES
Yamamoto T.
Malavasi E.
Archer J.R.H.
Dargan P.I.
Wood D.M.
AUTHOR ADDRESSES
(Yamamoto T., takahiro.yamamoto@gstt.nhs.uk; Malavasi E.; Archer J.R.H.;
Dargan P.I.; Wood D.M.) Clinical Toxicology, Guy's and St Thomas' NHS
Foundation Trust, King's Health Partners, Clinical Toxicology Office, St
Thomas' Hospital, Block C, South Wing, Westminster Bridge Road, London,
United Kingdom.
(Dargan P.I.; Wood D.M.) King's College London, London, United Kingdom.
(Malavasi E.) Poison Control Center Bergamo, Papa Giovanni XXIII Hospital,
Bergamo, Italy.
CORRESPONDENCE ADDRESS
T. Yamamoto, Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust,
King's Health Partners, Clinical Toxicology Office, St Thomas' Hospital,
Block C, South Wing, Westminster Bridge Road, London, United Kingdom. Email:
takahiro.yamamoto@gstt.nhs.uk
SOURCE
European Journal of Emergency Medicine (2016) 23:6 (425-429). Date of
Publication: 1 Dec 2016
ISSN
1473-5695 (electronic)
0969-9546
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objective The aim of this study was to establish a management protocol for
body stuffers presenting to the emergency department. Methods This is a
retrospective observational case series of patients presenting to the
emergency department of a large inner-city hospital as 'body stuffers'
during the period between 1 January 2006 and 31 October 2011, irrespective
of the type of drug ingested. We reviewed demographic data, ingestion
characteristics, clinical progress and outcome. Results A total of 126
patients were included in the study, with a mean age of 31±8.10 years (range
15-58 years), among whom 106 were male (84%). Drugs ingested were as
follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%)
and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one
drug. At presentation, 96 had features of drug toxicity. The presence of
depressant drug toxidrome was more commonly observed among heroin users, but
stimulant drug toxidromes were seen across all groups. Of the patients, 12
developed changes in clinical state, with a mean time to development of
symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min).
Abdominal radiography showed the presence of foreign bodies in 8% of the
tests performed, and packets were recovered from one patient who underwent
gut decontamination. Conclusion Patients developed new or worsening features
of drug toxicity within 6 h of presentation. Toxidromes observed are often
not drug/class specific, and treatment including gut decontamination and
radiography do not aid in expediting discharge. We propose an observation
period of 6 h from the time of admission as the time required if the patient
is asymptomatic or there is resolution of presenting signs and symptoms.
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
alcohol
benzocaine
benzodiazepine (drug therapy)
cannabis
cellophane
central stimulant agent
cocaine
codeine
diamorphine
diazepam
methamphetamine
midomafetamine
naloxone (drug therapy)
plastic
toxidrome
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
body packing (drug therapy, drug therapy)
drug use
foreign body (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal radiography
adolescent
adult
agitation
aluminum foil
article
cardiovascular system examination
case study
cigarette paper
clinical feature
colon lavage
condom
continuous cardiac monitoring
emergency ward
female
Glasgow coma scale
hospital discharge
human
hypertension
ingestion
length of stay
major clinical study
male
observational study
oxygen therapy
paper
patient monitoring
priority journal
retrospective study
single drug dose
smoking
tachycardia
thorax radiography
treatment outcome
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
benzocaine (1333-08-0, 94-09-7)
benzodiazepine (12794-10-4)
cannabis (8001-45-4, 8063-14-7)
cellophane (9005-81-6)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160803680
MEDLINE PMID
25969343 (http://www.ncbi.nlm.nih.gov/pubmed/25969343)
PUI
L613125315
DOI
10.1097/MEJ.0000000000000277
FULL TEXT LINK
http://dx.doi.org/10.1097/MEJ.0000000000000277
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 259
TITLE
National study on the adequacy of antidotes stocking in Lebanese hospitals
providing emergency care
AUTHOR NAMES
Mansour A.
Al-Bizri L.
El-Maamary J.
al-Helou A.
Hamade R.
Saliba E.
Khammash D.
Makhoul K.
Matli K.
Ghosn N.
Deeb M.
Faour W.H.
AUTHOR ADDRESSES
(Mansour A., anthony.mansour@lau.edu; Al-Bizri L., layla.albizri@lau.edu;
El-Maamary J., jad.elmaamary@lau.edu; al-Helou A., amanda.alhelou@lau.edu;
Hamade R., rayan.hamade@lau.edu; Saliba E., elie.saliba01@lau.edu; Khammash
D., dina.khammash@lau.edu; Makhoul K., karim.makhoul@lau.edu; Matli K.,
kamal.matli@lau.edu; Deeb M., mary.deeb@lau.edu.lb; Faour W.H.,
wissam.faour@lau.edu.lb) School of Medicine, Lebanese American University,
P.O. Box 36, Byblos, Lebanon.
(Ghosn N., esumoh@moph.gov.lb) Lebanese Ministry of Public Health, Beirut,
Lebanon.
(Faour W.H., wissam.faour@lau.edu.lb) School of Medicine, Lebanese American
University, P.O. Box 36, Byblos, Lebanon.
CORRESPONDENCE ADDRESS
W.H. Faour, School of Medicine, Lebanese American University, P.O. Box 36,
Byblos, Lebanon. Email: wissam.faour@lau.edu.lb
SOURCE
BMC Pharmacology and Toxicology (2016) 17:1 Article Number: 51. Date of
Publication: 7 Nov 2016
ISSN
2050-6511 (electronic)
BOOK PUBLISHER
BioMed Central Ltd., info@biomedcentral.com
ABSTRACT
Background: Antidotes stocking is a critical component of hospital care for
poisoned patients in emergency. Antidote stocking represents a major health
challenge worldwide and in Lebanon. Systematic data monitoring of antidote
stocking in Lebanese hospitals is lacking. The objective of this study is to
assess the adequacy of antidotes stocking in Lebanese hospitals according to
type and quantity and explore the characteristics associated with their
differential availability. Methods: Data collection to assess antidote
availability and its correlate was undertaken through a self-administered
questionnaire. The questionnaires were distributed by the unit of
surveillance at the Ministry of Public Health to eligible hospitals
providing emergency care services. The list of essential antidotes was
adapted from the World Health Organization (WHO) list and the British
Columbia Drug and Poison Information Centre. Results: Among the 85 Lebanese
hospitals surveyed none had in stock all the 35 essential antidotes
required. The frequency of stocking by type of antidote varied from a
minimum of 1.2 % of the hospitals having a (cyanide kit) to 100 %
availability of (atropine and calcium gluconate). Teaching hospitals and
those with a large bed-capacity reported a higher number of available
antidotes for both immediate and non-immediate use than non-teaching
hospitals while controlling for the hospital geographical region and public
vs private sector. Conclusion: The Lebanese hospitals have a suboptimal
stock of essential antidotes supply. It is recommended that the Lebanese
Ministry of Public Health monitors closely on the hospital premises the
adequacy and availability of essential antidotes stock.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
activated carbon
alcohol
atropine
bicarbonate
calcium chloride
colestyramine
deferoxamine
edetic acid
flumazenil
folic acid
folinic acid
glucagon
gluconate calcium
glucose
hydroxocobalamin
insulin
isoprenaline
macrogol derivative
magnesium
methylene blue
naloxone
neostigmine
octreotide
pralidoxime
protamine sulfate
pyridoxine
sodium nitrate
unindexed drug
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
health care availability
health care facility
EMTREE MEDICAL INDEX TERMS
article
cross-sectional study
geographic distribution
health care delivery
health care survey
health service
hospital bed capacity
human
Lebanon
questionnaire
teaching hospital
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
colestyramine (11041-12-6, 58391-37-0)
deferoxamine (70-51-9)
edetic acid (150-43-6, 60-00-4)
flumazenil (78755-81-4)
folic acid (59-30-3, 6484-89-5)
folinic acid (58-05-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
insulin (9004-10-8)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
magnesium (7439-95-4)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
octreotide (83150-76-9, 1607842-55-6)
pralidoxime (6735-59-7)
protamine sulfate (9009-65-8)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
sodium nitrate (7631-99-4)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160819676
MEDLINE PMID
27817746 (http://www.ncbi.nlm.nih.gov/pubmed/27817746)
PUI
L613083000
DOI
10.1186/s40360-016-0092-7
FULL TEXT LINK
http://dx.doi.org/10.1186/s40360-016-0092-7
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 260
TITLE
Police Officers Can Safely and Effectively Administer Intranasal Naloxone
AUTHOR NAMES
Fisher R.
O'Donnell D.
Ray B.
Rusyniak D.
AUTHOR ADDRESSES
(Fisher R.; O'Donnell D.; Ray B.; Rusyniak D.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2016)
20:6 (675-680). Date of Publication: 1 Nov 2016
ISSN
1545-0066 (electronic)
ABSTRACT
INTRODUCTION: Opioid overdose rates continue to rise at an alarming rate.
One method used to combat this epidemic is the administration of naloxone by
law enforcement. Many cities have implemented police naloxone administration
programs, but there is a minimal amount of research examining this policy.
The following study examines data over 18 months, after implementation of a
police naloxone program in an urban setting. We describe the most common
indications and outcomes of naloxone administration as well as examine the
incidence of arrest, immediate detention, or voluntary transport to the
hospital. In doing so, this study seeks to describe the clinical factors
surrounding police use of naloxone, and the effects of police
administration.METHODS: All police officer administrations were queried from
April 2014 through September 2015 (n = 126). For each incident we collected
the indication, response, and disposition of the patient that was recorded
on a "sick-injured civilian" report that officers were required to complete
after administration of naloxone. All of the relevant information was
abstracted from this report into an electronic data collection form that was
then input into SPSS for analysis.RESULTS: The most common indication for
administration was unconscious/unresponsive (n = 117; 92.9%) followed by
slowed breathing (n = 72; 57.1%), appeared blue (n = 63; 50.0%) and not
breathing (n = 41; 32.5%). After administration of naloxone the majority of
patients regained consciousness (n = 82; 65.1%) followed by began to breath
(n = 71; 56.3%). However, in 17.5% (n = 22) of the cases "Nothing" happened
when naloxone was administered. The majority of patients were transported
voluntarily to the hospital (n = 122; 96.8%). Lastly, there was only one
report where the patient became combative.CONCLUSION: Our study shows that
police officers trained in naloxone administration can correctly recognize
symptoms of opioid overdose, and can appropriately administer naloxone
without significant adverse effects or outcomes. Furthermore, the
administration of police naloxone does not result in a significant incidence
of combativeness or need for scene escalations such as immediate detention.
Further research is needed to investigate the impact of police naloxone;
specifically, comparing outcomes of police delivery to EMS alone, as well as
the impact on rural opioid overdoses.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adult
drug overdose (drug therapy, epidemiology)
emergency health service
female
human
incidence
intranasal drug administration
male
middle aged
opiate addiction (drug therapy, epidemiology)
police
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27218446 (http://www.ncbi.nlm.nih.gov/pubmed/27218446)
PUI
L620883968
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 261
TITLE
A Randomized Controlled Trial of a Citywide Emergency Department Care
Coordination Program to Reduce Prescription Opioid Related Emergency
Department Visits
AUTHOR NAMES
Neven D.
Paulozzi L.
Howell D.
McPherson S.
Murphy S.M.
Grohs B.
Marsh L.
Lederhos C.
Roll J.
AUTHOR ADDRESSES
(Neven D.; Howell D.; Murphy S.M.; Grohs B.; Lederhos C.; Roll J.) Program
of Excellence in Addictions Research, Washington State University College of
Nursing, Spokane, United States.
(Neven D.) Elson S. Floyd College of Medicine, Washington State University,
Spokane, United States.
(Paulozzi L.) National Center for Injury Prevention and Control, Centers for
Disease Control and Prevention, Atlanta, Georgia.
(McPherson S.) Elson S. Floyd College of Medicine, Washington State
University, Spokane, United States.
(Murphy S.M.) Department of Health Policy and Administration, Washington
State University College of Nursing, Spokane, United States.
(Marsh L.) Providence Sacred Heart Medical Center and Children's Hospital,
Spokane, United States.
CORRESPONDENCE ADDRESS
D. Neven, Program of Excellence in Addictions Research, Elson S. Floyd
College of Medicine, Washington State University, PO Box 1495, Spokane,
United States.
SOURCE
Journal of Emergency Medicine (2016) 51:5 (498-507). Date of Publication: 1
Nov 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Increasing prescription overdose deaths have demonstrated the
need for safer emergency department (ED) prescribing practices for patients
who are frequent ED users. Objectives We hypothesized that the care of
frequent ED users would improve using a citywide care coordination program
combined with an ED care coordination information system, as measured by
fewer ED visits by and decreased controlled substance prescribing to these
patients. Methods We conducted a multisite randomized controlled trial (RCT)
across all EDs in a metropolitan area; 165 patients with the most ED visits
for complaints of pain were randomized. For the treatment arm, drivers of ED
use were identified by medical record review. Patients and their primary
care providers were contacted by phone. Each patient was discussed at a
community multidisciplinary meeting where recommendations for ED care were
formed. The ED care recommendations were stored in an ED information
exchange system that faxed them to the treating ED provider when the patient
presented to the ED. The control arm was subjected to treatment as usual.
Results The intervention arm experienced a 34% decrease (incident rate
ratios = 0.66, p < 0.001; 95% confidence interval 0.57–0.78) in ED visits
and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving
an opioid prescription from the ED relative to the control group. Declines
of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for
morphine milligram equivalents, controlled substance pills, prescriptions,
and prescribers, respectively. Conclusion This RCT showed the effectiveness
of a citywide ED care coordination program in reducing ED visits and
controlled substance prescribing.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
morphine
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory care
emergency health service
emergency ward
medical information system
EMTREE MEDICAL INDEX TERMS
adult
article
city
clinical effectiveness
controlled study
female
health care management
human
incidence
major clinical study
male
pain
prescription
priority journal
randomized controlled trial
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160826720
MEDLINE PMID
27624507 (http://www.ncbi.nlm.nih.gov/pubmed/27624507)
PUI
L613220177
DOI
10.1016/j.jemermed.2016.06.057
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2016.06.057
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 262
TITLE
Opioid substitution treatment planning in a disaster context: Perspectives
from emergency management and health professionals in Aotearoa/New Zealand
AUTHOR NAMES
Blake D.
Lyons A.
AUTHOR ADDRESSES
(Blake D., d.blake@massey.ac.nz) Joint Centre for Disaster Research, School
of Psychology, Massey University, Wellington, New Zealand.
(Lyons A., A.Lyons@massey.ac.nz) School of Psychology, Massey University,
Wellington, New Zealand.
CORRESPONDENCE ADDRESS
D. Blake, Joint Centre for Disaster Research, School of Psychology, Massey
University, Wellington, New Zealand. Email: d.blake@massey.ac.nz
SOURCE
International Journal of Environmental Research and Public Health (2016)
13:11 Article Number: 1122. Date of Publication: 1 Nov 2016
ISSN
1660-4601 (electronic)
1661-7827
BOOK PUBLISHER
MDPI AG, Postfach, Basel, Switzerland.
ABSTRACT
Opioid Substitution Treatment (OST) is a harm reduction strategy enabling
opiate consumers to avoid withdrawal symptoms and maintain health and
wellbeing. Some research shows that within a disaster context service
disruptions and infrastructure damage affect OST services, including
problems with accessibility, dosing, and scripts. Currently little is known
about planning for OST in the reduction and response phases of a disaster.
This study aimed to identify the views of three professional groups working
in Aotearoa/New Zealand about OST provision following a disaster. In-depth,
semi-structured interviews were conducted with 17 service workers, health
professionals, and emergency managers in OST and disaster planning fields.
Thematic analysis of transcripts identified three key themes, namely “health
and wellbeing”, “developing an emergency management plan”, and “stock, dose
verification, and scripts” which led to an overarching concept of “service
continuity in OST preparedness planning”. Participants viewed service
continuity as essential for reducing physical and psychological distress for
OST clients, their families, and wider communities. Alcohol and drug and OST
health professionals understood the specific needs of clients, while
emergency managers discussed the need for sufficient preparedness planning
to minimise harm. It is concluded that OST preparedness planning must be
multidisciplinary, flexible, and inclusive.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
health practitioner
opiate substitution treatment
EMTREE MEDICAL INDEX TERMS
article
distress syndrome
health
health care planning
human
New Zealand
opiate addiction
pharmacist
prescription
public health
semi structured interview
thematic analysis
wellbeing
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160835489
MEDLINE PMID
27834915 (http://www.ncbi.nlm.nih.gov/pubmed/27834915)
PUI
L613150368
DOI
10.3390/ijerph13111122
FULL TEXT LINK
http://dx.doi.org/10.3390/ijerph13111122
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 263
TITLE
Addressing the Opioid Epidemic With Multimodal Pain Management
AUTHOR NAMES
Kelly M.A.
AUTHOR ADDRESSES
(Kelly M.A.) Department of Orthopaedic Surgery, Hackensack University
Medical Center, Hackensack, NJ; Insall Scott Kelly Institute for
Orthopaedics and Sports Medicine, New York, NY
SOURCE
American journal of orthopedics (Belle Mead, N.J.) (2016) 45:7 (S6-S8). Date
of Publication: 1 Nov 2016
ISSN
1934-3418 (electronic)
ABSTRACT
The opioid epidemic has become a national public health and safety problem
affecting both adults and adolescents. There is little doubt that this
epidemic is rooted in the need for pain control after surgery and that
orthopedic surgeons have in part contributed to opioid overprescription.
Indeed, opioid abuse, misuse, and diversion are associated with increased
hospitalizations, emergency department visits, and associated health care
costs. In addition, postoperative exposure to opioids correlates with
long-term use and abuse.Moreover, opioid-related adverse effects are the
leading cause of preventable harm in hospitals and can result in unexpected
death. As such, there is an urgent need to address the opioid epidemic.
Toward that end, several professional and governmental organizations have
recommended opioid-sparing pain management approaches for
surgeries-approaches that target different pain pathways to achieve adequate
pain control. Such multimodal analgesia approaches are expected to reduce
the writing of postoperative opioid prescriptions and their related adverse
effects.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse effects
EMTREE MEDICAL INDEX TERMS
analgesia
human
opiate addiction (etiology, prevention)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
28005123 (http://www.ncbi.nlm.nih.gov/pubmed/28005123)
PUI
L616762761
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 264
TITLE
Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing
Perspective
AUTHOR NAMES
Sullivan D.
Lyons M.
Montgomery R.
Quinlan-Colwell A.
AUTHOR ADDRESSES
(Sullivan D.) Anesthesiology/Pain Management Service, Jacobi Medical Center,
Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern
Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons);
Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr
Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center,
Wilmington, North Carolina (Dr Quinlan-Colwell)
(Lyons M.; Montgomery R.; Quinlan-Colwell A.)
SOURCE
Journal of trauma nursing : the official journal of the Society of Trauma
Nurses (2016) 23:6 (361-375). Date of Publication: 1 Nov 2016
ISSN
1078-7496
ABSTRACT
Challenges with opioids (e.g., adverse events, misuse and abuse with
long-term administration) have led to a renewed emphasis on opioid-sparing
multimodal management of trauma pain. To assess the extent to which
currently available evidence supports the efficacy and safety of various
nonopioid analgesics and techniques to manage trauma pain, a literature
search of recently published references was performed. Additional citations
were included on the basis of authors' knowledge of the literature.
Effective options for opioid-sparing analgesics include oral and intravenous
(IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via
multiple routes; and anticonvulsants, which are especially effective for
neuropathic pain associated with trauma. Intravenous routes (e.g., IV
acetaminophen, IV ketorolac) may be associated with a faster onset of action
than oral routes. Additional adjuvants for the treatment of trauma pain are
muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional
techniques play an important role in multimodal therapy but require medical
and nursing support. Nonpharmacologic treatments (e.g., cryotherapy,
distraction techniques, breathing and relaxation, acupuncture) supplement
pharmacologic analgesics and can be safe and easy to implement. In
conclusion, opioid-sparing multimodal analgesia addresses concerns
associated with high doses of opioids, and many pharmacologic and
nonpharmacologic options are available to implement this strategy. Nurses
play key roles in comprehensive patient assessment; administration of
patient-focused, opioid-sparing, multimodal analgesia in trauma; and
monitoring for safety concerns.
EMTREE DRUG INDEX TERMS
analgesic agent (drug administration, pharmacology)
nonsteroid antiinflammatory agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
organization and management
EMTREE MEDICAL INDEX TERMS
analgesia
complication
emergency health service
female
human
injury (diagnosis)
intravenous drug administration
male
meta analysis
oral drug administration
pain (drug therapy, etiology)
pain measurement
pathophysiology
procedures
treatment outcome
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27828892 (http://www.ncbi.nlm.nih.gov/pubmed/27828892)
PUI
L618406338
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 265
TITLE
Pittsburgh project takes novel approach in fighting opioid epidemic
AUTHOR NAMES
Thompson C.A.
AUTHOR ADDRESSES
(Thompson C.A.)
CORRESPONDENCE ADDRESS
C.A. Thompson,
SOURCE
American Journal of Health-System Pharmacy (2016) 73:21 (1717-1718). Date of
Publication: 1 Nov 2016
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
cannabis
carfentanil
daptomycin
diamorphine
morphine
morphine 6 acetate
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epidemic
EMTREE MEDICAL INDEX TERMS
autopsy
blood sampling
clinical pharmacy
coroner
death certificate
drug dependence (prevention)
emergency ward
health care personnel
human
medical specialist
prescription
priority journal
short survey
urine sampling
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
carfentanil (59708-52-0)
daptomycin (103060-53-3)
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
morphine 6 acetate (2784-73-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160796404
PUI
L613089954
DOI
10.2146/news160062
FULL TEXT LINK
http://dx.doi.org/10.2146/news160062
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 266
TITLE
Overdose Nation: A look at EMS' role in the U.S. opioid epidemic
AUTHOR NAMES
Garza A.
Dyer S.
AUTHOR ADDRESSES
(Garza A.; Dyer S.)
SOURCE
JEMS : a journal of emergency medical services (2016) 41:11 (41-45). Date of
Publication: 1 Nov 2016
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
procedures
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy, epidemiology)
emergency health service
human
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
29188960 (http://www.ncbi.nlm.nih.gov/pubmed/29188960)
PUI
L620154921
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 267
TITLE
Revisiting Naloxone: A different take on overdose guidelines from Lee
County, Fla
AUTHOR NAMES
Hamel M.G.
AUTHOR ADDRESSES
(Hamel M.G.)
SOURCE
JEMS : a journal of emergency medical services (2016) 41:11 (46-48). Date of
Publication: 1 Nov 2016
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
organization and management
practice guideline
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
emergency health service
Florida
human
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
29188963 (http://www.ncbi.nlm.nih.gov/pubmed/29188963)
PUI
L620154938
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 268
TITLE
Fentanyl Rising: EMS strategies for combatting the increasing use and abuse
of highly potent opioids
AUTHOR NAMES
Linder S.H.
Huang L.C.
Hodge K.
AUTHOR ADDRESSES
(Linder S.H.; Huang L.C.; Hodge K.)
SOURCE
JEMS : a journal of emergency medical services (2016) 41:11 (49-51). Date of
Publication: 1 Nov 2016
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
fentanyl (drug toxicity)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
organization and management
EMTREE MEDICAL INDEX TERMS
drug overdose (therapy)
emergency health service
human
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
29188965 (http://www.ncbi.nlm.nih.gov/pubmed/29188965)
PUI
L620154960
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 269
TITLE
Naloxone Conundrum: Reduce risk in managing the opioid overdose patient
AUTHOR NAMES
Wirth S.R.
AUTHOR ADDRESSES
(Wirth S.R.)
SOURCE
JEMS : a journal of emergency medical services (2016) 41:11 (14-15). Date of
Publication: 1 Nov 2016
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
emergency health service
human
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
29188938 (http://www.ncbi.nlm.nih.gov/pubmed/29188938)
PUI
L620152023
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 270
TITLE
Multicenter Evaluation of Prehospital Opioid Pain Management in Injured
Children
AUTHOR NAMES
Browne L.R.
Shah M.I.
Studnek J.R.
Ostermayer D.G.
Reynolds S.
Guse C.E.
Brousseau D.C.
Lerner E.B.
AUTHOR ADDRESSES
(Browne L.R.; Shah M.I.; Studnek J.R.; Ostermayer D.G.; Reynolds S.; Guse
C.E.; Brousseau D.C.; Lerner E.B.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2016)
20:6 (759-767). Date of Publication: 1 Nov 2016
ISSN
1545-0066 (electronic)
ABSTRACT
BACKGROUND: The National Association of Emergency Medical Services
Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and
the joint National Highway Traffic Safety Administration (NHTSA) and
Emergency Medical Services for Children (EMSC) Evidence-based Guideline for
Prehospital Analgesia in Trauma aim to improve the recognition, assessment,
and treatment of prehospital pain. The impact of implementation of these
guidelines on pain management in children by emergency medical services
(EMS) agencies has not been assessed.OBJECTIVE: Determine the change in
frequency of documented pain severity assessment and opiate administration
among injured pediatric patients in three EMS agencies after adoption of
best practice recommendations.METHODS: This is a retrospective study of
children <18 years of age with a prehospital injury-related primary
impression from three EMS agencies. Each agency independently implemented
pain protocol changes which included adding the use of age-appropriate pain
scales, decreasing the minimum age for opiate administration, and updating
fentanyl dosing. We abstracted data from prehospital electronic patient
records before and after changes to the pain management protocols. The
primary outcomes were the frequency of administration of opioid analgesia
and documentation of pain severity assessment as recorded in the prehospital
patient care record.CONCLUSION: The proportion of injured children who
receive prehospital opioid analgesia remains suboptimal despite
implementation of best practice recommendations. Frequency of pain severity
assessment of injured children is low. Intranasal fentanyl administration
may be an underutilized modality of prehospital opiate
administration.RESULTS: A total of 3,597 injured children were transported
prior to pain protocol changes and 3,743 children after changes. Opiate
administration to eligible patients across study sites regardless of
documentation of pain severity was 156/3,089 (5%) before protocol changes
and 175/3,509 (5%) after (p = 0.97). Prior to protocol changes, 580 (18%)
children had documented pain assessments and 430 (74%) had
moderate-to-severe pain. After protocol changes, 644 (18%) patients had pain
severity documented with 464 (72%) in moderate-to-severe pain. For all study
agencies, pain severity was documented in 13%, 19%, and 22% of patient
records both before and after protocol changes. There was a difference in
intranasal fentanyl administration rates before (27%) and after (17%)
protocol changes (p = 0.02).
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
EMTREE MEDICAL INDEX TERMS
adolescent
analgesia
child
clinical trial
documentation
emergency health service
female
human
male
multicenter study
pain (drug therapy)
pain measurement
retrospective study
statistics and numerical data
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27411064 (http://www.ncbi.nlm.nih.gov/pubmed/27411064)
PUI
L620884007
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 271
TITLE
Pharmacological Reversal Agents in Dental Practice: Keys to Patient Safety
AUTHOR NAMES
Donaldson M.
Goodchild J.H.
AUTHOR ADDRESSES
(Donaldson M.) Director of Clinical Pharmacy, Vizient Advisory Services,
Whitefish, Montana; Clinical Professor, School of Pharmacy, University of
Montana, Missoula, Montana; Clinical Assistant Professor, School of
Dentistry, Oregon Health and Sciences University, Portland, Oregon
(Goodchild J.H.) Clinical Associate Professor, Department of Oral Medicine,
University of Pennsylvania School of Dental Medicine, Philadelphia,
Pennsylvania; Associate Professor and Chairman, Department of Diagnostic
Sciences, Creighton University School of Dentistry, Omaha, Nebraska; Private
Practice, Havertown, Pennsylvania
SOURCE
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
(2016) 37:10 (681-688). Date of Publication: 1 Nov 2016
ISSN
2158-1797 (electronic)
ABSTRACT
Though uncommon, medical emergencies in the dental office are harrowing
occurrences that can be the result of adverse drug reactions.
Pharmacological antagonists have been developed for administration as
reversal agents in emergency situations in which patients may have an
untoward effect, typically caused by too much medication. Dental
practitioners should be familiar with these agents to keep patients safe and
help mitigate drug-induced medical emergencies. This article reviews the
pharmacokinetic and pharmacodynamic principles of pharmacological
antagonists; it emphasizes six specific reversal agents as they relate to
the clinical practice of dentistry: naloxone, flumazenil, epinephrine,
diphenhydramine, phentolamine, and atropine. Outside of emergency
situations, the pharmacological antagonist phentolamine has been developed
to reverse the effects of the vasoconstrictor in dental local anesthesia
preparations when the effects of the agonist medication are no longer
required. Such newer reversal agents are being considered for more routine
use once the dental procedure is complete. This article is intended to
assist dental practitioners who are familiar with pharmacological
antagonists to be better able to help mitigate drug-induced medical
emergencies should they occur.
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
diphenhydramine (drug therapy)
epinephrine (drug therapy)
flumazenil (drug therapy)
naloxone (drug therapy)
phentolamine (drug therapy)
EMTREE MEDICAL INDEX TERMS
adverse drug reaction (drug therapy)
emergency health service
human
patient safety
procedures
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
diphenhydramine (147-24-0, 58-73-1)
epinephrine (51-43-4, 55-31-2, 6912-68-1)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
phentolamine (50-60-2, 73-05-2)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27875053 (http://www.ncbi.nlm.nih.gov/pubmed/27875053)
PUI
L621387472
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 272
TITLE
Notes from the Field: Pediatric Emergency Department Visits for
Buprenorphine/Naloxone Ingestion - United States, 2008-2015
AUTHOR NAMES
Budnitz D.S.
Lovegrove M.C.
Sapiano M.R.
Mathew J.
Kegler S.R.
Geller A.I.
Hampp C.
AUTHOR ADDRESSES
(Budnitz D.S.; Lovegrove M.C.; Sapiano M.R.; Mathew J.; Kegler S.R.; Geller
A.I.; Hampp C.)
SOURCE
MMWR. Morbidity and mortality weekly report (2016) 65:41 (1148-1149). Date
of Publication: 21 Oct 2016
ISSN
1545-861X (electronic)
ABSTRACT
Expanding access to office-based medication-assisted treatment with
buprenorphine/naloxone for opioid dependence is a key part of the national
strategy to address the opioid abuse epidemic (1). However, as
buprenorphine/naloxone prescribing increased, emergency department (ED)
visits and hospitalizations for unsupervised ingestions by young children
began to increase, with buprenorphine/naloxone ingestions becoming the most
common cause of hospitalization for medication ingestions by young children
during 2010-2011 (2). Buprenorphine ingestions might be asymptomatic or can
cause drowsiness, vomiting, or respiratory depression, which if untreated
can result in death (3). Buprenorphine/naloxone was available only as
tablets in multidose child-resistant bottles (Suboxone) until late 2010,
when film strips packaged in unit-dose, child-resistant pouches were
introduced. In 2013, tablets became available in unit-dose packaging
(Zubsolv). Because unit-dose, child-resistant packaging encloses each dose
until opened, it might limit unintended ingestions by young children
compared with traditional child-resistant bottles that must be resecured
after every use (4). This study compared ED visits for pediatric
buprenorphine/naloxone ingestions before and after these product
packaging/formulation changes.
EMTREE DRUG INDEX TERMS
buprenorphine (drug toxicity)
buprenorphine plus naloxone
naloxone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatrics
utilization
EMTREE MEDICAL INDEX TERMS
drug packaging
eating
female
hospital emergency service
hospitalization
human
infant
male
preschool child
statistics and numerical data
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27764078 (http://www.ncbi.nlm.nih.gov/pubmed/27764078)
PUI
L616616515
DOI
10.15585/mmwr.mm6541a5
FULL TEXT LINK
http://dx.doi.org/10.15585/mmwr.mm6541a5
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 273
TITLE
Why is it so hard to implement change? A qualitative examination of barriers
and facilitators to distribution of naloxone for overdose prevention in a
safety net environment
AUTHOR NAMES
Drainoni M.-L.
Koppelman E.A.
Feldman J.A.
Walley A.Y.
Mitchell P.M.
Ellison J.
Bernstein E.
AUTHOR ADDRESSES
(Drainoni M.-L., drainoni@bu.edu.Boston; Koppelman E.A.; Ellison J.;
Bernstein E.) Boston University School of Public Health, 715 Albany Street,
T3 W, Boston, MA, 02118, USA
(Drainoni M.-L., drainoni@bu.edu.Boston; Feldman J.A.; Walley A.Y.; Mitchell
P.M.; Bernstein E.) Boston University School of Medicine, Boston, MA, USA
(Drainoni M.-L., drainoni@bu.edu.Boston; Koppelman E.A.) Center for
Healthcare Organization and Implementation Research, ENRM Veterans
Administration Hospital, Bedford, MA, USA
(Feldman J.A.; Walley A.Y.; Mitchell P.M.; Bernstein E.) Boston Medical
Center, Boston, MA, USA
SOURCE
BMC research notes (2016) 9:1 (465). Date of Publication: 18 Oct 2016
ISSN
1756-0500 (electronic)
ABSTRACT
BACKGROUND: The increase in opioid overdose deaths has become a national
public health crisis. Naloxone is an important tool in opioid overdose
prevention. Distribution of nasal naloxone has been found to be a feasible,
and effective intervention in community settings and may have potential high
applicability in the emergency department, which is often the initial point
of care for persons at high risk of overdose. One safety net hospital
introduced an innovative policy to offer take-home nasal naloxone via a
standing order to ensure distribution to patients at risk for overdose. The
aims of this study were to examine acceptance and uptake of the policy and
assess facilitators and barriers to implementation.METHODS: After obtaining
pre-post data on naloxone distribution, we conducted a qualitative study.
The PARiHS framework steered development of the qualitative guide. We used
theoretical sampling in order to include the range of types of emergency
department staff (50 total). The constant comparative method was initially
used to code the transcripts and identify themes; the themes that emerged
from the coding were then mapped back to the evidence, context and
facilitation constructs of the PARiHS framework.RESULTS: Acceptance of the
policy was good but uptake was low. Primary themes related to facilitators
included: real-world driven intervention with philosophical, clinician and
leadership support; basic education and training efforts; availability of
resources; and ability to leave the ED with the naloxone kit in hand.
Barriers fell into five general categories: protocol and policy; workflow
and logistical; patient-related; staff roles and responsibilities; and
education and training.CONCLUSIONS: The actual implementation of a new
innovation in healthcare delivery is largely driven by factors beyond
acceptance. Despite support and resources, implementation was challenging,
with low uptake. While the potential of this innovation is unknown,
understanding the experience is important to improve uptake in this setting
and offer possible solutions for other facilities to address the opioid
overdose crisis. Use of the PARiHS framework allowed us to recognize and
understand key evidence, contextual and facilitation barriers to the
successful implementation of the policy and to identify areas for
improvement.
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug therapy)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
patient attitude
psychology
EMTREE MEDICAL INDEX TERMS
adult
aged
drug overdose (prevention)
female
hospital emergency service
hospital personnel
human
intranasal drug administration
male
middle aged
supply and distribution
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27756427 (http://www.ncbi.nlm.nih.gov/pubmed/27756427)
PUI
L616658482
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 274
TITLE
The ethics of opioids for chronic noncancer pain
AUTHOR NAMES
Bockhold C.R.
Hughes A.K.
AUTHOR ADDRESSES
(Bockhold C.R.) Colleen R. Bockhold works in quality management and Ashley
Kate Hughes is a nurse practitioner in the Central Texas Veteran's
Healthcare System in Temple, Tex. Yvonne D'Arcy, MS, RN, CRNP, CNS, FAANP is
the coordinator of Controlling Pain and a Nursing2016 editorial board member
(Hughes A.K.)
SOURCE
Nursing (2016) 46:10 (63-67). Date of Publication: 1 Oct 2016
ISSN
1538-8689 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medical ethics
nursing
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain (drug therapy)
drug administration
drug overdose (therapy)
emergency health service
epidemiology
human
male
middle aged
mortality
nurse patient relationship
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
27654445 (http://www.ncbi.nlm.nih.gov/pubmed/27654445)
PUI
L614893250
DOI
10.1097/01.NURSE.0000484981.83948.9c
FULL TEXT LINK
http://dx.doi.org/10.1097/01.NURSE.0000484981.83948.9c
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 275
TITLE
ED opioid prescribing is not associated with higher patient satisfaction
scores
AUTHOR NAMES
Kim H.S.
Lank P.M.
Pang P.S.
Courtney D.M.
Lambert B.L.
Gravenor S.J.
McCarthy D.M.
AUTHOR ADDRESSES
(Kim H.S., howard.kim@northwestern.edu; Lank P.M.; Courtney D.M.; Gravenor
S.J.; McCarthy D.M.) Department of Emergency Medicine, Northwestern
University Feinberg School of Medicine, Chicago, United States.
(Pang P.S.) Department of Emergency Medicine, Indiana University School of
Medicine, Indianapolis, United States.
(Lambert B.L.) Department of Communication Studies, Northwestern University,
Chicago, United States.
CORRESPONDENCE ADDRESS
H.S. Kim, 211 E Ontario St, Suite 200-300, Chicago, United States. Email:
howard.kim@northwestern.edu
SOURCE
American Journal of Emergency Medicine (2016) 34:10 (2032-2034). Date of
Publication: 1 Oct 2016
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
codeine
fentanyl
hydrocodone
hydromorphone
morphine
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
patient satisfaction
prescription
EMTREE MEDICAL INDEX TERMS
adult
cohort analysis
female
health survey
human
letter
major clinical study
male
middle aged
outcome assessment
priority journal
retrospective study
scoring system
treatment indication
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160564640
MEDLINE PMID
27471063 (http://www.ncbi.nlm.nih.gov/pubmed/27471063)
PUI
L611442270
DOI
10.1016/j.ajem.2016.07.033
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2016.07.033
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 276
TITLE
Bradycardia and hypotension after synthetic cannabinoid use: a case series
AUTHOR NAMES
Kane E.M.
Hinson J.S.
Jordan C.D.
Paziana K.
Sauber N.J.
Rothman R.E.
Stolbach A.I.
AUTHOR ADDRESSES
(Kane E.M., ekane9@jhmi.edu; Hinson J.S.; Jordan C.D.; Paziana K.; Sauber
N.J.; Rothman R.E.; Stolbach A.I.) Department of Emergency Medicine, Johns
Hopkins University School of Medicine, Baltimore, United States.
CORRESPONDENCE ADDRESS
E.M. Kane, 1830 E. Monument Street, Suite 6–100, Baltimore, United States.
Email: ekane9@jhmi.edu
SOURCE
American Journal of Emergency Medicine (2016) 34:10 (2055.e1-2055.e2). Date
of Publication: 1 Oct 2016
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabinoid (drug toxicity)
synthetic cannabinoid (drug toxicity)
EMTREE DRUG INDEX TERMS
amphetamine
atropine
codeine
dopamine
hypertensive factor
morphine
naloxone
noradrenalin
sodium chloride
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bradycardia
hypotension
EMTREE MEDICAL INDEX TERMS
adult
age
alcohol blood level
article
blood pressure measurement
body temperature
breathing rate
case report
comorbidity
electrocardiogram
emergency care
emergency health service
faintness
female
heart atrium contraction
heart rate
heart ventricle contraction
human
hypertension
male
middle aged
oxygen saturation
priority journal
pulse rate
sinus bradycardia
smoking
urinalysis
vital sign
CAS REGISTRY NUMBERS
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
codeine (76-57-3)
dopamine (51-61-6, 62-31-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160259037
MEDLINE PMID
27037136 (http://www.ncbi.nlm.nih.gov/pubmed/27037136)
PUI
L609365575
DOI
10.1016/j.ajem.2016.03.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2016.03.007
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 277
TITLE
Management of the poisoned patient
AUTHOR NAMES
McGlone M.M.
Teece S.C.
AUTHOR ADDRESSES
(McGlone M.M.; McGlone M.M.; Teece S.C.; Teece S.C.) Monklands District
General Hospital, Airdrie, United Kingdom.
SOURCE
Anaesthesia and Intensive Care Medicine (2016) 17:10 (506-509). Date of
Publication: 1 Oct 2016
ISSN
1878-7584 (electronic)
1472-0299
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
Poisoning is a common reason for attendance to emergency departments,
medical assessment and critical care areas. This, in the main, is due to
deliberate self-harm, however, there is an increasing concern that toxins
may be deliberately released as part of a terrorist attack. In many cases it
can be unclear from the history the exact toxins responsible. Knowledge of
toxidromes, a group of symptom clusters identified by the receptors targeted
may guide further management. Management of overdose utilizes methods of
gastric decontamination to prevent toxin absorption along with supportive
measures for the patient and, where available, the use of specific
antidotes. In the response to deliberate-release toxins there is a risk to
treating staff by contamination with the poisons used. Key to the management
is the use of personal protective equipment and the decontamination of
casualties before invasive medical care begins. There are a small number of
expected chemical agents likely to be used in deliberate release, each has
its own clinical characteristics and management.
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
activated carbon
alcohol
antidote
atropine
bicarbonate
calcium
chemical agent
cobalt edetate
deferoxamine
digoxin antibody
flumazenil
glucagon
glucose
hydroxocobalamin
insulin
lipid emulsion
naloxone
ovalbumin
pralidoxime
sodium nitrite
sodium thiosulfate
toxin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
patient care
EMTREE MEDICAL INDEX TERMS
accident
clinical feature
human
intensive care
oxygen therapy
priority journal
protective equipment
review
stomach lavage
symptom
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2, 14092-94-5)
cobalt edetate (14931-83-0, 36499-65-7)
deferoxamine (70-51-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
ovalbumin (77466-29-6)
pralidoxime (6735-59-7)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160770085
PUI
L612920940
DOI
10.1016/j.mpaic.2016.07.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.mpaic.2016.07.004
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 278
TITLE
Emergency department visits by pediatric patients for poisoning by
prescription opioids
AUTHOR NAMES
Tadros A.
Layman S.M.
Davis S.M.
Bozeman R.
Davidov D.M.
AUTHOR ADDRESSES
(Tadros A., atadros@hsc.wvu.edu; Layman S.M.; Davis S.M.; Bozeman R.;
Davidov D.M.) Department of Emergency Medicine, West Virginia University,
Morgantown, United States.
CORRESPONDENCE ADDRESS
A. Tadros, Department of Emergency Medicine, West Virginia University, 1
Medial Center Dr., PO Box 9149, Morgantown, United States. Email:
atadros@hsc.wvu.edu
SOURCE
American Journal of Drug and Alcohol Abuse (2016) 42:5 (550-555). Date of
Publication: 2 Sep 2016
ISSN
1097-9891 (electronic)
0095-2990
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Background: Prescription medication abuse is an increasingly recognized
problem in the United States. As more opioids are being prescribed and
abused by adults, there is an increased risk of both accidental and
intentional exposure to children and adolescents. The impact of pediatric
exposures to prescription pain pills has not been well studied. Objectives:
We sought to evaluate emergency department (ED) visits for poisoning by
prescription opioids in pediatric patients. Methods: This retrospective
study looked at clinical and demographic data from the Nationwide Emergency
Department Sample (NEDS) from 2006 to 2012. Results: There were 21,928
pediatric ED visits for prescription opioid poisonings and more than half
were unintentional. There was a bimodal age distribution of patients, with
slightly more than half occurring in females. The majority of patients were
discharged from the ED. More visits in the younger age group (0–5 years)
were unintentional, while the majority of visits in the adolescent age group
(15–17 years) were intentional. Mean charge per discharge was $1,840 and
$14,235 for admissions and surmounted to over $81 million in total charges.
Conclusion: Poisonings by prescription opioids largely impact both young
children and adolescents. These findings can be used to help target this
population for future preventive efforts.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
prescription drug (drug toxicity)
EMTREE DRUG INDEX TERMS
codeine (drug toxicity)
methadone (drug toxicity)
morphine (drug toxicity)
pethidine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug intoxication
emergency care
EMTREE MEDICAL INDEX TERMS
adolescent
article
artificial ventilation
child
demography
drug misuse
drug overdose
emergency ward
female
human
major clinical study
male
retrospective study
CAS REGISTRY NUMBERS
codeine (76-57-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160521353
MEDLINE PMID
27398815 (http://www.ncbi.nlm.nih.gov/pubmed/27398815)
PUI
L611216072
DOI
10.1080/00952990.2016.1194851
FULL TEXT LINK
http://dx.doi.org/10.1080/00952990.2016.1194851
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 279
TITLE
Opioid-related Policies in New England Emergency Departments
AUTHOR NAMES
Weiner S.G.
Raja A.S.
Bittner J.C.
Curtis K.M.
Weimersheimer P.
Hasegawa K.
Espinola J.A.
Camargo C.A.
AUTHOR ADDRESSES
(Weiner S.G., sweiner@massmed.org) Department of Emergency Medicine, Brigham
and Women's Hospital, Harvard Medical School, Boston, United States.
(Raja A.S.; Bittner J.C.; Hasegawa K.; Espinola J.A.; Camargo C.A.)
Department of Emergency Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, United States.
(Curtis K.M.) Section of Emergency Medicine, Dartmouth-Hitchcock Medical
Center, Geisel School of Medicine at Dartmouth, Lebanon, United States.
(Weimersheimer P.) Division of Emergency Medicine, Department of Surgery,
University of Vermont Medical Center, University of Vermont College of
Medicine, Burlington, United States.
CORRESPONDENCE ADDRESS
S.G. Weiner, Department of Emergency Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, United States. Email: sweiner@massmed.org
SOURCE
Academic Emergency Medicine (2016) 23:9 (1086-1090). Date of Publication: 1
Sep 2016
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives: The opioid abuse and overdose epidemic in the United States has
led to the need for new practice policies to guide clinicians. We describe
implementation of opioid-related policies in emergency departments (EDs) in
New England to gauge progress and determine where further work is needed.
Methods: This study analyzed data from the 2015 National Emergency
Department Inventory–New England survey. The survey queried directors of
every ED (n = 195) in the six New England states to determine the
implementation of five specific policies related to opioid management. ED
characteristics (e.g., annual visits, location, and admission rates) were
also obtained and a multivariable analysis was conducted to identify ED
characteristics independently associated with the number of opioid-related
policies implemented. Results: Overall, 169 EDs (87%) responded, with a >80%
response rate in each state. Implementation of opioid-related policies
varied as follows: 1) use of a screening tool for patients with suspected
prescription opioid abuse potential (n = 30, 18%), 2) access state
prescription drug monitoring program (PDMP) before prescribing opioids (n =
132, 78%), 3) notify the primary opioid prescriber when prescribing opioids
for ED patients with chronic pain (n = 69, 41%), 4) refer patients with
opioid abuse to recovery resources (n = 117, 70%), and 5) prescribe naloxone
to patients at risk of opioid overdose after ED discharge (n = 19, 12%). EDs
located in metropolitan areas and with at least one attending physician on
duty 24/7 were less likely to implement opioid policies (incident rate ratio
[IRR] = 0.65, 95% confidence interval [CI] = 0.48–0.89; and IRR = 0.78, 95%
CI = 0.6–1.0, respectively) while EDs with ≥15% hospitalization rate that
used electronic computerized medication ordering and those in Rhode Island
were more likely to implement opioid policies (IRR = 1.23, 95% CI =
1.03–1.48; IRR = 1.95, 95% CI = 1.19–3.22; and IRR = 1.30, 95% CI =
1.08–1.56, respectively). Conclusions: The implementation of opioid-related
policies varies among New England EDs. The presence of policies recommending
use of screening tools and prescribing naloxone for at-risk patients was
low, whereas those regarding utilization of the PDMP and referral of
patients with opioid abuse to recovery resources were more common. These
data provide important benchmarks for future evaluations and
recommendations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
naloxone
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health care policy
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
benchmarking
drug overdose
drug surveillance program
health care planning
health care survey
human
prescription
priority journal
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160661357
MEDLINE PMID
27098615 (http://www.ncbi.nlm.nih.gov/pubmed/27098615)
PUI
L612137093
DOI
10.1111/acem.12992
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12992
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 280
TITLE
Identifying patients for overdose prevention with ICD-9 classification in
the emergency department, Massachusetts, 2013-2014
AUTHOR NAMES
Ellison J.
Walley A.Y.
Feldman J.A.
Bernstein E.
Mitchell P.M.
Koppelman E.A.
Drainoni M.-L.
AUTHOR ADDRESSES
(Ellison J., ellisonj@bu.edu; Bernstein E.; Koppelman E.A.; Drainoni M.-L.)
Boston University School of Public Health, Boston, United States.
(Walley A.Y.; Feldman J.A.; Bernstein E.; Mitchell P.M.; Drainoni M.-L.)
Boston University School of Medicine, Boston, United States.
(Walley A.Y.) Clinical Addiction Research and Education Unit, Boston Medical
Center, Boston, United States.
(Feldman J.A.; Bernstein E.; Mitchell P.M.) Department of Emergency
Medicine, Boston Medical Center, Boston, United States.
CORRESPONDENCE ADDRESS
J. Ellison, Boston University School of Public Health, 715 Albany St., T3 W,
Boston, United States. Email: ellisonj@bu.edu
SOURCE
Public Health Reports (2016) 131:5 (671-675). Date of Publication: 1 Sep
2016
ISSN
1468-2877 (electronic)
0033-3549
BOOK PUBLISHER
Association of Schools of Public Health, info@sagepub.co.uk
ABSTRACT
The national rise in opioid overdose deaths signifies a need to integrate
overdose prevention within healthcare delivery settings. The emergency
department (ED) is an opportune location for such interventions. To
effectively integrate prevention services, the target population must be
clearly defined. We used ICD-9 discharge codes to establish and apply
overdose risk categories to ED patients seen from January 1, 2013 to
December 31, 2014 at an urban safety-net hospital in Massachusetts with the
goal of informing ED-based naloxone rescue kit distribution programs. Of
96,419 patients, 4,468 (4.6%) were at increased risk of opioid overdose,
defined by prior opioid overdose, misuse, or polysubstance misuse. A small
proportion of those at risk were prescribed opioids on a separate occasion.
Use of risk categories defined by ICD-9 codes identified a notable
proportion of ED patients at risk for overdose, and provides a systematic
means to prioritize and direct clinical overdose prevention efforts.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (side effect, prevention, side effect)
emergency ward
ICD-9
preventive health service
EMTREE MEDICAL INDEX TERMS
adult
aged
article
Caucasian
drug misuse
female
high risk population
hospital discharge
human
major clinical study
male
Massachusetts
prescription
priority journal
safety net hospital
very elderly
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160813468
MEDLINE PMID
28123207 (http://www.ncbi.nlm.nih.gov/pubmed/28123207)
PUI
L613165335
DOI
10.1177/0033354916661981
FULL TEXT LINK
http://dx.doi.org/10.1177/0033354916661981
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 281
TITLE
Trends in Emergency Department Resource Utilization for Poisoning-Related
Visits, 2003–2011
AUTHOR NAMES
Mazer-Amirshahi M.
Sun C.
Mullins P.
Perrone J.
Nelson L.
Pines J.M.
AUTHOR ADDRESSES
(Mazer-Amirshahi M., maryannmazer@gmail.com; Sun C.) Department of Emergency
Medicine, MedStar Washington Hospital Center, 110 Irving St NW, Washington,
United States.
(Mazer-Amirshahi M., maryannmazer@gmail.com) Georgetown University School of
Medicine, Washington, United States.
(Mullins P.) George Washington University School of Medicine and Health
Sciences, Washington, United States.
(Perrone J.) Department of Emergency Medicine, University of Pennsylvania
School of Medicine, Philadelphia, United States.
(Nelson L.) Department of Emergency Medicine, New York University, New York,
United States.
(Pines J.M.) Department of Emergency Medicine, George Washington University,
Washington, United States.
(Pines J.M.) Center for Clinical Practice Innovation, George Washington
University, Washington, United States.
CORRESPONDENCE ADDRESS
M. Mazer-Amirshahi, Department of Emergency Medicine, MedStar Washington
Hospital Center, 110 Irving St NW, Washington, United States. Email:
maryannmazer@gmail.com
SOURCE
Journal of Medical Toxicology (2016) 12:3 (248-254). Date of Publication: 1
Sep 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
In recent years, there has been an increase in poisoning-related emergency
department (ED) visits. This study examines trends in ED resource
utilization for poisoning-related visits over time. A retrospective review
of data from the National Hospital Ambulatory Medical Care Survey,
2003–2011, was conducted. All ED visits with a reason for visit or ICD-9
code related to poisoning were included. We examined the number of ED visits
and resources used including diagnostic studies and procedures performed,
medications provided, admission rates, and length of stay. The proportion of
visits involving resource use was tabulated and trends analyzed using
survey-weighted logistic regression, grouping into 2-year periods to ensure
adequate sample size. Of an estimated 843 million ED visits between 2003 and
2011, 8 million (0.9 %) were related to poisoning. Visits increased from 1.8
million (0.8 %) visits in 2003–2004 to 2.9 million (1.1 %) visits in
2010–2011, p = 0.001. Use of laboratory studies, EKGs, plain radiographs,
and procedures remained stable across the study period. CT use was more than
doubled, increasing from 5.2 to 13.7 % of visits, p = 0.001. ED length of
stay increased by 35.5 % from 254 to 344 min, p = 0.001. Admission rates
increased by 45.3 %, from 15.0 to 21.8 %, p = 0.046. Over the entire study
period, 52.0 % of poisoned patients arrived via ambulance, and 3.0 % of
patients had been discharged from the hospital within the previous 7 days.
Poisoning-related ED visits increased over the 8-year study period;
poisonings are resource-intensive visits and require increasingly longer
lengths of ED stay or hospital admission.
EMTREE DRUG INDEX TERMS
charcoal
haloperidol
lorazepam
naloxone
narcotic analgesic agent
ondansetron
paracetamol
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
health care utilization
intoxication (epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
ambulance transportation
article
child
computer assisted tomography
electrocardiography
female
hospital admission
human
length of stay
major clinical study
male
middle aged
radiography
retrospective study
trend study
urinalysis
DRUG TRADE NAMES
ativan
haldol
narcan
tylenol
zofran
CAS REGISTRY NUMBERS
charcoal (16291-96-6)
haloperidol (52-86-8, 1511-16-6)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
paracetamol (103-90-2)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160480352
MEDLINE PMID
27342464 (http://www.ncbi.nlm.nih.gov/pubmed/27342464)
PUI
L610985971
DOI
10.1007/s13181-016-0564-6
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-016-0564-6
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 282
TITLE
The peregrinating psychiatric patient in the emergency department
AUTHOR NAMES
Simpson S.A.
Pasic J.
AUTHOR ADDRESSES
(Simpson S.A., scott.simpson@dhha.org) University of Colorado, Denver,
United States.
(Simpson S.A., scott.simpson@dhha.org) School of Medicine, Department of
Psychiatry, Aurora, United States.
(Simpson S.A., scott.simpson@dhha.org) Denver Health Medical Center,
Department of Psychiatry, 777 Bannock St, MC 0116, Denver, United States.
(Pasic J.) University of Washington School of Medicine, Department of
Psychiatry, Seattle, United States.
CORRESPONDENCE ADDRESS
S.A. Simpson, University of Colorado, Denver, United States. Email:
scott.simpson@dhha.org
SOURCE
Western Journal of Emergency Medicine (2016) 17:5 (600-606). Date of
Publication: 1 Sep 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Many emergency department (ED) psychiatric patients present after traveling.
Although such travel, or peregrination, has long been associated with
factitious disorder, other diagnoses are more common among travelers,
including psychotic disorders, personality disorders, and substance abuse.
Travelers' intense psychopathology, disrupted social networks, lack of
collateral informants, and unawareness of local resources complicate
treatment. These patients can consume disproportionate time and resources
from emergency providers. We review the literature on the emergency
psychiatric treatment of peregrinating patients and use case examples to
illustrate common presentations and treatment strategies. Difficulties in
studying this population and suggestions for future research are discussed.
[West J Emerg Med. 2016;17(5)600-606.]
EMTREE DRUG INDEX TERMS
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
mental disease
psychiatric treatment
EMTREE MEDICAL INDEX TERMS
adult
borderline state
clinical article
depression
drug dependence
emergency ward
factitious disease
female
human
male
mental patient
middle aged
migration
neurosis
panic
prevalence
psychosis
review
schizophrenia
social network
suicidal ideation
travel
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160650039
MEDLINE PMID
27625725 (http://www.ncbi.nlm.nih.gov/pubmed/27625725)
PUI
L612047431
DOI
10.5811/westjem.2016.6.30179
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.6.30179
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 283
TITLE
Assessing the Risk of Prehospital Administration of Naloxone with Subsequent
Refusal of Care
AUTHOR NAMES
Levine M.
Sanko S.
Eckstein M.
AUTHOR ADDRESSES
(Levine M.; Sanko S.; Eckstein M.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2016)
20:5 (566-569). Date of Publication: 1 Sep 2016
ISSN
1545-0066 (electronic)
ABSTRACT
BACKGROUND: EMS providers frequently encounter opioid-toxic patients who
receive naloxone and then refuse further medical care. Older studies
revealed this practice to be safe. In light of the evolving patterns of
opioid abuse, this study attempted to determine the safety of this
practice.METHODS: This is a retrospective review of all patient encounters
by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31,
2013. All LAFD patient encounters are stored electronically. These
electronic records were reviewed for subjects who received naloxone had a
documented respiratory rate (RR) less than 12, and subsequently refused
transport. Data abstracted included name, social security number (SSN), date
of birth (DOB), date of EMS encounter, age, and treatment rendered. The
names, SSN, and DOB, as available, were supplied to the coroner's office.
The Coroner's records were reviewed to determine if a patient with the same
or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days,
or 6 months of the initial EMS encounter. The abstractor was blinded to the
study hypothesis.RESULTS: 205 subjects were identified; the median (IQR) age
was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within
24 hours of the initial EMS encounter. The cause of death (COD) was coronary
artery disease and heroin use. Two additional subjects (1. %) died within
30 days. One of these subjects died 6 days later; the COD is unknown. The
other subject died 20 days after the EMS encounter; the COD was
cardiovascular disease and liver cirrhosis. No additional subjects were
identified at the 6 month follow up. A third subject died of a heroin
overdose 16 months after the initial EMS encounter, but was beyond the
pre-defined follow up period.CONCLUSIONS: The practice of receiving
pre-hospital naloxone by paramedics and subsequently refusing care is
associated with an extremely low short- and intermediate-term mortality.
Despite an evolving pattern of opioid abuse, the results of this study are
consistent with previously reported studies.
EMTREE DRUG INDEX TERMS
naloxone (adverse drug reaction, drug therapy)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mortality
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adult
California
cause of death
drug overdose (drug therapy)
emergency health service
female
human
male
middle aged
opiate addiction (drug therapy)
procedures
retrospective study
risk assessment
treatment refusal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27018626 (http://www.ncbi.nlm.nih.gov/pubmed/27018626)
PUI
L620717860
DOI
10.3109/10903127.2016.1142626
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2016.1142626
COPYRIGHT
Copyright 2018 Medline is the source for the citation and abstract of this
record.
RECORD 284
TITLE
Access to prescription opioids-primum non nocere a teachable moment
AUTHOR NAMES
Tyler P.D.
Larochelle M.R.
Mafi J.N.
AUTHOR ADDRESSES
(Tyler P.D.) Beth Israel Deaconess Medical Center, Department of Medicine,
Harvard Medical School, Boston, United States.
(Larochelle M.R.) Section of General Internal Medicine, Department of
Medicine, Boston University School of Medicine and Boston Medical Center,
Boston, United States.
(Mafi J.N., jmafi@mednet.ucla.edu) Division of General Internal Medicine and
Health Services Research, UCLA David Geffen School of Medicine, Los Angeles,
United States.
(Mafi J.N., jmafi@mednet.ucla.edu) RAND Corporation, Santa Monica, United
States.
CORRESPONDENCE ADDRESS
J.N. Mafi, Division of General Internal Medicine and Health Services
Research, UCLA David Geffen School of Medicine, Los Angeles, United States.
Email: jmafi@mednet.ucla.edu
SOURCE
JAMA Internal Medicine (2016) 176:9 (1251-1252). Date of Publication: 1 Sep
2016
ISSN
2168-6106
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
buprenorphine
diamorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
health care access
prescription
EMTREE MEDICAL INDEX TERMS
backache
cancer pain
chronic pain
drug misuse
drug overdose
emergency ward
human
mortality
note
opiate addiction
patient counseling
practice guideline
priority journal
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160879210
PUI
L613499587
DOI
10.1001/jamainternmed.2016.3926
FULL TEXT LINK
http://dx.doi.org/10.1001/jamainternmed.2016.3926
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 285
TITLE
Pilot Study of the Importance of Factors Affecting Emergency Department
Opioid Analgesic Prescribing Decisions
AUTHOR NAMES
Pomerleau A.C.
Schrager J.D.
Morgan B.W.
AUTHOR ADDRESSES
(Pomerleau A.C., adam.pomerleau@emory.edu; Schrager J.D.; Morgan B.W.)
Department of Emergency Medicine, Emory University School of Medicine, 50
Hurt Plaza, Suite 600, Atlanta, United States.
CORRESPONDENCE ADDRESS
A.C. Pomerleau, Department of Emergency Medicine, Emory University School of
Medicine, 50 Hurt Plaza, Suite 600, Atlanta, United States. Email:
adam.pomerleau@emory.edu
SOURCE
Journal of Medical Toxicology (2016) 12:3 (282-288). Date of Publication: 1
Sep 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Introduction: Little is known about the factors driving decision-making
among emergency department (ED) providers when prescribing opioid analgesics
(OA). The aim of this pilot study was to identify the importance of factors
influencing OA-prescribing decisions and to determine how this varied among
different types of providers. Methods: This was an observational
cross-sectional survey study of 203 ED providers. The importance of
decisional factors was rated on a 5-point Likert scale. Differences between
provider groups were tested using Chi-squared or ANOVA tests where
applicable. Results: Overall, 142/203 (69.9 %) potential respondents
participated in the study. The five highest-rated factors were (mean ± SD)
patient’s opioid prescription history (4.4 ± 0.8), patient’s history of
substance abuse or dependence (4.4 ± 0.7), diagnosis thought to be the cause
of patient’s pain (4.2 ± 0.8), clinical gestalt (4.2 ± 0.7), and provider’s
concern about unsafe use of the medication (4.0 ± 0.9). The importance of 6
of 21 decisional factors varied significantly between different groups of
providers. Conclusion: In this pilot study of ED providers, the
self-reported importance of several factors influencing OA-prescribing
decisions were significantly different among attending physicians, resident
physicians, and advanced practice providers. Further investigation into how
ED providers make OA-prescribing decisions is needed to help guide
interventions aimed at improving appropriate pain management.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
medical decision making
prescription
EMTREE MEDICAL INDEX TERMS
adult
age
article
cross-sectional study
emergency ward
female
gestalt therapy
health care personnel
human
Likert scale
male
observational study
pain (drug therapy)
patient satisfaction
pilot study
questionnaire
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160359845
MEDLINE PMID
27150104 (http://www.ncbi.nlm.nih.gov/pubmed/27150104)
PUI
L610295788
DOI
10.1007/s13181-016-0553-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-016-0553-9
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 286
TITLE
Opioid Prescribing: How Well Do We Know Ourselves?
AUTHOR NAMES
Wightman R.S.
Nelson L.S.
AUTHOR ADDRESSES
(Wightman R.S., rachel.wightman@nyumc.org) Ronald O. Perelman Department of
Emergency Medicine, New York University School of Medicine, New York, United
States.
(Nelson L.S.) Department of Emergency Medicine, Rutgers New Jersey Medical
School, Newark, United States.
CORRESPONDENCE ADDRESS
R.S. Wightman, Ronald O. Perelman Department of Emergency Medicine, New York
University School of Medicine, New York, United States. Email:
rachel.wightman@nyumc.org
SOURCE
Journal of Medical Toxicology (2016) 12:3 (221-223). Date of Publication: 1
Sep 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
decision making
doctor patient relation
drug abuse
drug dependence
editorial
electronic medical record
emergency ward
human
medical fee
patient referral
patient satisfaction
physician attitude
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160585218
MEDLINE PMID
27492362 (http://www.ncbi.nlm.nih.gov/pubmed/27492362)
PUI
L611591767
DOI
10.1007/s13181-016-0576-2
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-016-0576-2
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 287
TITLE
Wearable Biosensors to Detect Physiologic Change During Opioid Use
AUTHOR NAMES
Carreiro S.
Wittbold K.
Indic P.
Fang H.
Zhang J.
Boyer E.W.
AUTHOR ADDRESSES
(Carreiro S., stephanie.carreiro@umassmemorial.org; Wittbold K.; Boyer E.W.)
Department of Emergency Medicine, Division of Medical Toxicology, University
of Massachusetts Medical School, 55 Lake Avenue North, Worcester, United
States.
(Indic P.) Department of Neurology, University of Massachusetts Medical
School, Worcester, United States.
(Fang H.; Zhang J.) Department of Quantitative Health Sciences, University
of Massachusetts Medical School, Worcester, United States.
CORRESPONDENCE ADDRESS
S. Carreiro, Department of Emergency Medicine, Division of Medical
Toxicology, University of Massachusetts Medical School, 55 Lake Avenue
North, Worcester, United States. Email: stephanie.carreiro@umassmemorial.org
SOURCE
Journal of Medical Toxicology (2016) 12:3 (255-262). Date of Publication: 1
Sep 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Introduction: Opioid analgesic use is a major cause of morbidity and
mortality in the US, yet effective treatment programs have a limited ability
to detect relapse. The utility of current drug detection methods is often
restricted due to their retrospective and subjective nature. Wearable
biosensors have the potential to improve detection of relapse by providing
objective, real time physiologic data on opioid use that can be used by
treating clinicians to augment behavioral interventions. Methods: Thirty
emergency department (ED) patients who were prescribed intravenous opioid
medication for acute pain were recruited to wear a wristband biosensor. The
biosensor measured electrodermal activity, skin temperature and locomotion
data, which was recorded before and after intravenous opioid administration.
Hilbert transform analyses combined with paired t-tests were used to compare
the biosensor data A) within subjects, before and after administration of
opioids; B) between subjects, based on hand dominance, gender, and opioid
use history. Results: Within subjects, a significant decrease in locomotion
and increase in skin temperature were consistently detected by the
biosensors after opioid administration. A significant change in
electrodermal activity was not consistently detected. Between subjects,
biometric changes varied with level of opioid use history (heavy vs.
nonheavy users), but did not vary with gender or type of opioid.
Specifically, heavy users demonstrated a greater decrease in short amplitude
movements (i.e. fidgeting movements) compared to non-heavy users.
Conclusion: A wearable biosensor showed a consistent physiologic pattern
after ED opioid administration and differences between patterns of heavy and
non-heavy opioid users were noted. Potential applications of biosensors to
drug addiction treatment and pain management should be studied further.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy, intravenous drug administration)
hydromorphone (drug therapy, intravenous drug administration)
morphine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
biosensor
physiologic monitoring
EMTREE MEDICAL INDEX TERMS
adult
age
aged
article
biometry
clinical article
drug abuse
electrodermal response
emergency ward
female
human
locomotion
male
pain (drug therapy)
prescription
relapse
signal processing
skin temperature
DEVICE TRADE NAMES
Q sensor
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Physiology (2)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160472898
MEDLINE PMID
27334894 (http://www.ncbi.nlm.nih.gov/pubmed/27334894)
PUI
L610940552
DOI
10.1007/s13181-016-0557-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-016-0557-5
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 288
TITLE
Incident opioid drug use and adverse respiratory outcomes among older adults
with COPD
AUTHOR NAMES
Vozoris N.T.
Wang X.
Fischer H.D.
Bell C.M.
O'Donnell D.E.
Austin P.C.
Stephenson A.L.
Gill S.S.
Rochon P.A.
AUTHOR ADDRESSES
(Vozoris N.T., nick.vozoris@utoronto.ca; Stephenson A.L.) Division of
Respirology, Dept of Medicine, St. Michael's Hospital, 30 Bond Street,
Toronto, Canada.
(Vozoris N.T., nick.vozoris@utoronto.ca; Stephenson A.L.) Keenan Research
Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital,
Toronto, Canada.
(Vozoris N.T., nick.vozoris@utoronto.ca; Bell C.M.; Stephenson A.L.; Rochon
P.A.) Dept of Medicine, University of Toronto, Toronto, Canada.
(Wang X.; Fischer H.D.; Bell C.M.; Austin P.C.; Gill S.S.; Rochon P.A.)
Institute for Clinical Evaluative Sciences, Toronto, Canada.
(Bell C.M.; Austin P.C.; Stephenson A.L.; Rochon P.A.) Institute of Health
Policy Management and Evaluation, University of Toronto, Toronto, Canada.
(Bell C.M.) Division of General Internal Medicine, Department of Medicine,
Mount Sinai Hospital, Toronto, Canada.
(O'Donnell D.E.; Gill S.S.) Dept of Medicine, Queen's University, Kingston,
Canada.
(Rochon P.A.) Women's College Research Institute, Women's College Hospital,
Toronto, Canada.
CORRESPONDENCE ADDRESS
N.T. Vozoris, Division of Respirology, Dept of Medicine, St. Michael's
Hospital, 30 Bond Street, Toronto, Canada. Email: nick.vozoris@utoronto.ca
SOURCE
European Respiratory Journal (2016) 48:3 (683-693). Date of Publication: 1
Sep 2016
ISSN
1399-3003 (electronic)
0903-1936
BOOK PUBLISHER
European Respiratory Society, info@ersnet.org
ABSTRACT
We evaluated risk of adverse respiratory outcomes associated with incident
opioid use among older adults with chronic obstructive pulmonary diseases
(COPD). This was a retrospective population-based cohort study using a
validated algorithm applied to health administrative data to identify adults
aged 66 years and older with COPD. Inverse probability of treatment
weighting using the propensity score was used to estimate hazard ratios
comparing adverse respiratory outcomes within 30 days of incident opioid use
compared to controls. Incident opioid use was associated with significantly
increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI
1.00-1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI
1.61-2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57-1.98;
p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88,
95% CI 0.83-0.94; p=0.0002). Use of more potent opioidonly agents was
associated with significantly increased outpatient exacerbations, emergency
room visits and hospitalisations for COPD or pneumonia, and COPD or
pneumonia-related and all-cause mortality. Incident opioid use, and in
particular use of the generally more potent opioid-only agents, was
associated with increased risk for adverse respiratory outcomes, including
respiratory-related mortality, among older adults with COPD. Potential
adverse respiratory outcomes should be considered when prescribing new
opioids in this population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, oral drug administration, transdermal drug
administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug combination, drug therapy)
anileridine (drug therapy, oral drug administration)
benzodiazepine (drug therapy)
codeine (drug combination, drug therapy)
codeine phosphate (drug combination, drug therapy, oral drug administration)
codeine sulfate (drug therapy, oral drug administration)
dextropropoxyphene (drug therapy, oral drug administration)
fentanyl (drug therapy, transdermal drug administration)
hydromorphone (drug therapy, oral drug administration, pharmaceutics)
levorphanol (drug therapy, oral drug administration)
morphine (pharmaceutics)
oxycodone (drug combination, drug therapy, oral drug administration)
paracetamol (drug combination, drug therapy)
pethidine (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic obstructive lung disease (drug therapy, drug therapy)
drug use
EMTREE MEDICAL INDEX TERMS
aged
article
cohort analysis
controlled study
disease exacerbation
drug formulation
female
hospitalization
human
major clinical study
male
mortality rate
pneumonia
population research
priority journal
retrospective study
treatment duration
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
anileridine (126-12-5, 144-14-9)
benzodiazepine (12794-10-4)
codeine (76-57-3)
codeine phosphate (52-28-8)
codeine sulfate (1420-53-7)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
levorphanol (125-72-4, 77-07-6)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160654736
MEDLINE PMID
27418553 (http://www.ncbi.nlm.nih.gov/pubmed/27418553)
PUI
L612077994
DOI
10.1183/13993003.01967-2015
FULL TEXT LINK
http://dx.doi.org/10.1183/13993003.01967-2015
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 289
TITLE
Medical encounters for opioid-related intoxications in Southern Nevada:
sociodemographic and clinical correlates
AUTHOR NAMES
Feng J.
Iser J.P.
Yang W.
AUTHOR ADDRESSES
(Feng J.; Iser J.P.) Southern Nevada Health District, PO Box 3902, Las
Vegas, NV, 89032, USA
(Yang W., weiyang@unr.edu) School of Community Health Sciences/MS274,
University of Nevada, Reno, Reno, NV, 89557, USA
SOURCE
BMC health services research (2016) 16 (438). Date of Publication: 24 Aug
2016
ISSN
1472-6963 (electronic)
ABSTRACT
BACKGROUND: Despite today's heightened concern over opioid overdose, the
lack of population-based data examining clinical and contextual factors
associated with opioid use represents a knowledge gap with relevance to
prevention and treatment interventions. We sought to quantify rates of
emergency department (ED) visits and inpatient hospitalizations for harmful
opioid effects and their sociodemographic differentials as well as clinical
correlates in Southern Nevada, using ED visit and hospital inpatient
discharge records from 2011 to 2013.METHODS: Cases were identified by
ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug
dependence and abuse as well as poisoning and adverse effect E-codes.
Comorbid conditions, including pain-related diagnoses, major chronic
diseases, affective disorders, sleep disorders, sexually transmitted
infections and viral hepatitis were assessed from all available diagnosis
fields. Counts by age-race per zip code were modeled by negative binomial
regression. Opioid injuries were further examined as a function both of
neighborhood income and individual characteristics, with mixed-effects
logistic regression to estimate the likelihood for an adverse
outcome.RESULTS: Opioid intoxications and comorbidities were more common in
low-income communities. The multivariable-adjusted rate for opioid-related
healthcare utilization was 42 % higher in the poorest vs. richest quartile
during the study period. The inter-quartile (quartile 1 vs. 4) rate
increases for chronic bodily pains (44 %), hypertension (89 %), renal
failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times),
and affective disorders (57 %) were statistically significant. Chronic
disease comorbidity was greater among non-Hispanic blacks, whereas
abuse/dependence related disorders, alcohol or benzodiazepine co-use,
chronic bodily pains, and affective disorders were more prevalent among
non-Hispanic whites than nonwhites.CONCLUSIONS: There were consistent
patterns of disparities in healthcare utilization across sociodemographic
groups for opioid-associated disorders. Further initiatives to evaluate the
determinants of overdose and abuse and to implement targeted response
efforts are needed.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (adverse drug reaction)
narcotic analgesic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
utilization
EMTREE MEDICAL INDEX TERMS
adolescent
adult
African American
Caucasian
chronic disease
comorbidity
drug overdose (epidemiology, rehabilitation)
ethnology
female
Hispanic
hospital emergency service
human
male
middle aged
Nevada
opiate addiction (epidemiology, rehabilitation)
poverty
prevalence
statistical model
statistics and numerical data
suicide attempt
urban health
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27557947 (http://www.ncbi.nlm.nih.gov/pubmed/27557947)
PUI
L618820156
DOI
10.1186/s12913-016-1692-z
FULL TEXT LINK
http://dx.doi.org/10.1186/s12913-016-1692-z
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 290
TITLE
Nonrandomized intervention study of naloxone coprescription for primary care
patients receiving long- Term opioid therapy for pain
AUTHOR NAMES
Coffin P.O.
Behar E.
Rowe C.
Santos G.-M.
Coffa D.
Bald M.
Vittinghoff E.
AUTHOR ADDRESSES
(Coffin P.O., phillip.coffin@ucsf.edu; Behar E.; Rowe C.; Santos G.-M.) San
Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San
Francisco, United States.
(Coffa D.) University of California School of Medicine, 1001 Potrero Avenue,
San Francisco, United States.
(Bald M.) Kaiser Permanente San Francisco, 2425 Geary Boulevard, San
Francisco, United States.
(Vittinghoff E.) University of California, 550 16th Street, San Francisco,
United States.
CORRESPONDENCE ADDRESS
P.O. Coffin, San Francisco Department of Public Health, 25 Van Ness Avenue,
Suite 500, San Francisco, United States. Email: phillip.coffin@ucsf.edu
SOURCE
Annals of Internal Medicine (2016) 165:4 (245-252). Date of Publication: 16
Aug 2016
ISSN
1539-3704 (electronic)
0003-4819
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
ABSTRACT
Background: Unintentional overdose involving opioid analgesics is a leading
cause of injury-related death in the United States. Objective: To evaluate
the feasibility and effect of implementing naloxone prescription to patients
prescribed opioids for chronic pain. Design: 2-year nonrandomized
intervention study. Setting: 6 safety-net primary care clinics in San
Francisco, California. Participants: 1985 adults receiving long- Term opioid
therapy for pain. Intervention: Providers and clinic staff were trained and
supported in naloxone prescribing. Measurements: Outcomes were proportion of
patients prescribed naloxone, opioid-related emergency department (ED)
visits, and prescribed opioid dose based on chart review. Results: 38.2% of
1985 patients receiving long- Term opioids were prescribed naloxone.
Patients prescribed higher doses of opioids and with an opioid-related ED
visit in the past 12 months were independently more likely to be prescribed
naloxone. Patients who received a naloxone prescription had 47% fewer
opioid-related ED visits per month in the 6 months after receipt of the
prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P =
0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P <
0.001) compared with patients who did not receive naloxone. There was no net
change over time in opioid dose among those who received naloxone and those
who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61). Limitation: Results
are observational and may not be generalizable beyond safety-net settings.
Conclusion: Naloxone can be coprescribed to primary care patients prescribed
opioids for pain. When advised to offer naloxone to all patients receiving
opioids, providers may prioritize those with established risk factors.
Providing naloxone in primary care settings may have ancillary benefits,
such as reducing opioid-related adverse events. Primary Funding Source:
National Institutes of Health.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
codeine (drug therapy)
fentanyl (drug therapy)
hydrocodone (drug therapy)
hydromorphone (drug therapy)
methadone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
pethidine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
long term care
prescription
primary medical care
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
California
emergency ward
feasibility study
female
growth
human
intervention study
major clinical study
male
medical record review
middle aged
outcome assessment
priority journal
safety net hospital
scale up
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160605190
MEDLINE PMID
27366987 (http://www.ncbi.nlm.nih.gov/pubmed/27366987)
PUI
L611734986
DOI
10.7326/M15-2771
FULL TEXT LINK
http://dx.doi.org/10.7326/M15-2771
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 291
TITLE
Racial-ethnic disparities in opioid prescriptions at emergency department
visits for conditions commonly associated with prescription drug abuse
AUTHOR NAMES
Singhal A.
Tien Y.-Y.
Hsia R.Y.
AUTHOR ADDRESSES
(Singhal A.) Health Policy and Health Services Research, Boston University
School of Dental Medicine, Boston, United States.
(Tien Y.-Y.) University of Iowa College of Pharmacy, Iowa City, United
States.
(Hsia R.Y., renee.hsia@ucsf.edu) Department of Emergency Medicine, Philip R.
Lee Institute for Health Policy Studies, University of California at San
Francisco, San Francisco, United States.
SOURCE
PLoS ONE (2016) 11:8 Article Number: e0159224. Date of Publication: 1 Aug
2016
ISSN
1932-6203 (electronic)
BOOK PUBLISHER
Public Library of Science, plos@plos.org
ABSTRACT
Prescription drug abuse is a growing problem nationally. In an effort to
curb this problem, emergency physicians might rely on subjective cues such
as race-ethnicity, often unknowingly, when prescribing opioids for
pain-related complaints, especially for conditions that are often associated
with drug-seeking behavior. Previous studies that examined racial-ethnic
disparities in opioid dispensing at emergency departments (EDs) did not
differentiate between prescriptions at discharge and drug administration in
the ED. We examined racial-ethnic disparities in opioid prescription at ED
visits for pain-related complaints often associated with drug-seeking
behavior and contrasted them with conditions objectively associated with
pain. We hypothesized a priori that racial-ethnic disparities will be
present among opioid prescriptions for conditions associated with
non-medical use, but not for objective pain-related conditions. Using data
from the National Hospital Ambulatory Medical Care Survey for 5 years
(2007-2011), the odds of opioid prescription during ED visits made by
nonelderly adults aged 18-65 for 'non-definitive' conditions (toothache,
back pain and abdominal pain) or 'definitive' conditions (long-bone fracture
and kidney stones) were modeled. Opioid prescription at discharge and opioid
administration at the ED were the primary outcomes. We found significant
racial-ethnic disparities, with non-Hispanic Blacks being less likely
(adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive
opioid prescription at discharge during ED visits for back pain and
abdominal pain, but not for toothache, fractures and kidney stones, compared
to non-Hispanic whites after adjusting for other covariates. Differential
prescription of opioids by race-ethnicity could lead to widening of existing
disparities in health, and may have implications for disproportionate burden
of opioid abuse among whites. The findings have important implications for
medical provider education to include sensitization exercises towards their
inherent biases, to enable them to consciously avoid these biases from
defining their practice behavior.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
ethnic difference
prescription
race difference
EMTREE MEDICAL INDEX TERMS
abdominal pain (disease management, drug therapy)
adult
aged
article
backache (disease management, drug therapy)
Black person
Caucasian
disease association
drug indication
drug seeking behavior
emergency physician
emergency ward
female
fracture (disease management, drug therapy)
health care disparity
health insurance
health survey
hospital discharge
human
major clinical study
male
medicaid
middle aged
nephrolithiasis (disease management, drug therapy)
odds ratio
opiate addiction
pain severity
tooth pain (disease management, drug therapy)
young adult
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160629114
MEDLINE PMID
27501459 (http://www.ncbi.nlm.nih.gov/pubmed/27501459)
PUI
L611725995
DOI
10.1371/journal.pone.0159224
FULL TEXT LINK
http://dx.doi.org/10.1371/journal.pone.0159224
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 292
TITLE
Prevalence and Detection of Prescription Opioid Misuse and Prescription
Opioid Use Disorder Among Emergency Department Patients 50 Years of Age and
Older: Performance of the Prescription Drug Use Questionnaire, Patient
Version
AUTHOR NAMES
Beaudoin F.L.
Merchant R.C.
Clark M.A.
AUTHOR ADDRESSES
(Beaudoin F.L., francesca_beaudoin@brown.edu; Merchant R.C.) Department of
Emergency Medicine, Alpert Medical School of Brown University, Providence,
United States.
(Merchant R.C.; Clark M.A.) Department of Epidemiology, School of Public
Health, Brown University, Providence, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, Department of Emergency Medicine, Alpert Medical School of
Brown University, 55 Claverick St, 2nd Floor, Providence, United States.
Email: francesca_beaudoin@brown.edu
SOURCE
American Journal of Geriatric Psychiatry (2016) 24:8 (627-636). Date of
Publication: 1 Aug 2016
ISSN
1545-7214 (electronic)
1064-7481
BOOK PUBLISHER
Elsevier B.V., agents@lww.com
ABSTRACT
Background Despite increased concern about prescription opioid misuse among
older adults, there is limited work examining the best means to identify
misuse by older adults. The goal of this investigation was to examine the
performance the Prescription Drug Use Questionnaire Patient Version (PDUQp),
in detecting prescription opioid misuse and prescription opioid use
disorders among adult emergency department (ED) patients aged 50 years and
older. Methods This was a cross-sectional study of a random sample of adult
ED patients, aged 50 years and older. All participants were without
cognitive impairment and reported prescription opioid use within the past 30
days. We evaluated the sensitivity, specificity, predictive values, and
receiver operating characteristics of the PDUQp against a standard
definition of opioid misuse and DSM-5 criteria for prescription opioid use
disorder. Results Overall, 112 participants completed the study; 74 were
aged 50–64 years and 38 were aged 65 years and older. Over half of the
participants satisfied DSM-5 criteria for prescription opioid use disorder,
with slightly less participants reporting misuse. Overall, the respective
sensitivity and specificity of the PDUQp was: 44% and 79% (Receiver
Operating Characteristic [ROC] area under the curve: 0.61) for prescription
opioid misuse, 38% and 81% (ROC area under the curve: 0.64) for the presence
of any prescription opioid use disorder, and 56% and 75% (ROC area under the
curve: 0.71) for moderate to severe prescription opioid use disorder.
Conclusions Based on this preliminary work, the PDUQp may be a viable
instrument to screen for prescription opioid misuse and prescription opioid
use disorder, but it likely requires modifications to optimize its
predictive ability in adults over age 50 years.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
attitude assessment
drug misuse
opiate addiction
prescription
prescription drug use questionnaire patient version
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
area under the curve
article
chronic pain (drug therapy)
cross-sectional study
DSM-5
emergency ward
female
human
major clinical study
male
middle aged
predictive value
prevalence
receiver operating characteristic
sensitivity and specificity
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160729394
MEDLINE PMID
27426210 (http://www.ncbi.nlm.nih.gov/pubmed/27426210)
PUI
L612647281
DOI
10.1016/j.jagp.2016.03.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jagp.2016.03.010
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 293
TITLE
Suicide attempt with a mix of synthetic cannabinoids and synthetic
cathinones: Case report of non-fatal intoxication with AB-CHMINACA,
AB-FUBINACA, alpha-PHP, alpha-PVP and 4-CMC
AUTHOR NAMES
Klavž J.
Gorenjak M.
Marinšek M.
AUTHOR ADDRESSES
(Klavž J., jani.klavz@t-2.net; Gorenjak M.) Department of Laboratory
Diagnostics, University Medical Centre Maribor, Slovenia.
(Marinšek M.) Department of Internal Intensive Medicine, University Medical
Centre Maribor, Slovenia.
CORRESPONDENCE ADDRESS
J. Klavž, Department of Laboratory Diagnostics, University Medical Centre
Maribor, Slovenia. Email: jani.klavz@t-2.net
SOURCE
Forensic Science International (2016) 265 (121-124). Date of Publication: 1
Aug 2016
ISSN
1872-6283 (electronic)
0379-0738
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
We report on a case of intoxication with a mix of new psychoactive
substances. A 38-year-old male was brought to the emergency department (ED)
following the ingestion of an unknown drug in a suicide attempt. During the
transport, he became progressively more somnolent and unresponsive to
painful stimuli. Urine and stomach content were collected on admission to be
screened for drugs of abuse and medicinal drugs. After admission, the
patient's next of kin presented five small grip seal plastic bags containing
different powders/crystals, and they were sent for analysis along with urine
and stomach content to the toxicology laboratory. An easy and rapid sample
preparation technique was applied for the extraction of urine and stomach
content. Samples were extracted with liquid-liquid extraction (LLE)
technique and analysed using gas chromatography-mass spectrometry (GC-MS). A
small amount of powder material from the bags was diluted in methanol and
injected directly into the GC-MS instrument. Obtained spectra (EI) were
evaluated against SWGDRUG library. Five different designer drugs were
identified in the powder material, including synthetic cannabinoids
(AB-CHMINACA, AB-FUBINACA) and synthetic cathinones (alpha-PHP, alpha-PVP
and 4-CMC). With the exception of 4-CMC, all of these substances were also
detected in the stomach content along with the prescription drugs. This is
the first time that a positive identification of these five drugs has been
made by a clinical laboratory in Slovenia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabinoid
cathinone
EMTREE DRUG INDEX TERMS
4 chloromethcathinone
ab chminaca
ab fubinaca
alpha pyrrolidinohexiophenone
diazepam
fluoxetine
glucose (intravenous drug administration)
methanol
naloxone
quetiapine
sodium chloride (intravenous drug administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
suicide attempt
EMTREE MEDICAL INDEX TERMS
adult
article
case report
comatose patient
dehydration
drug identification
drug screening
Glasgow coma scale
human
intensive care unit
liquid liquid extraction
male
mass fragmentography
mydriasis
priority journal
sinus tachycardia
Slovenia
somnolence
stimulus response
stomach content
urinalysis
CAS REGISTRY NUMBERS
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
diazepam (439-14-5)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
glucose (50-99-7, 84778-64-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
quetiapine (111974-72-2)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160130329
MEDLINE PMID
26890319 (http://www.ncbi.nlm.nih.gov/pubmed/26890319)
PUI
L608316237
DOI
10.1016/j.forsciint.2016.01.018
FULL TEXT LINK
http://dx.doi.org/10.1016/j.forsciint.2016.01.018
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 294
TITLE
Difficult airway management resources and capnography use in Japanese
intensive care units: a nationwide cross-sectional study
AUTHOR NAMES
Ono Y.
Tanigawa K.
Shinohara K.
Yano T.
Sorimachi K.
Sato L.
Inokuchi R.
Shimada J.
Tase C.
AUTHOR ADDRESSES
(Ono Y., windmill@fmu.ac.jp; Yano T.; Sorimachi K.; Sato L.; Shimada J.;
Tase C.) Emergency and Critical Care Medical Center, Fukushima Medical
University Hospital, 1 Hikarigaoka, Fukushima, Japan.
(Tanigawa K.) Fukushima Medical University, Fukushima, Japan.
(Tanigawa K.) Fukushima Global Medical Science Center, Fukushima, Japan.
(Ono Y., windmill@fmu.ac.jp; Shinohara K.) Department of Anesthesiology,
Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama,
Japan.
(Inokuchi R.) Department of General and Emergency Medicine, JR Tokyo General
Hospital, Tokyo, Japan.
CORRESPONDENCE ADDRESS
Y. Ono, Emergency and Critical Care Medical Center, Fukushima Medical
University Hospital, 1 Hikarigaoka, Fukushima, Japan. Email:
windmill@fmu.ac.jp
SOURCE
Journal of Anesthesia (2016) 30:4 (644-652). Date of Publication: 1 Aug 2016
ISSN
1438-8359 (electronic)
0913-8668
BOOK PUBLISHER
Springer Tokyo, orders@springer.jp
ABSTRACT
Purpose: The availability of difficult airway management (DAM) resources and
the extent of capnometry use in Japanese intensive care units (ICUs)
remained unclear. The purpose of this study was to clarify whether: (1) DAM
resources were adequate, and (2) capnometry was routinely applied in
Japanese ICUs. Methods: This nationwide cross-sectional study was conducted
from September 2015 to February 2016. All ICUs received a mailed
questionnaire about their DAM resources and use of capnometry. Outcome
measures were availability of: (1) 24-h in-house backup coverage; (2) a
supraglottic airway device (SGA); (3) a dedicated DAM cart; and (4) surgical
airway devices, and (5) routine use of capnometry to verify tube placement
and for continuous monitoring of ventilator-dependent patients. The
association between these outcomes and ICU type (academic, high-volume,
closed, surgical) was also analyzed. Results: Of the 289 ICUs, 196 (67.8 %)
returned completed questionnaires. In-house backup coverage and surgical
airway devices were highly available (89.3 and 95.9 %), but SGAs and
dedicated DAM carts were not (60.2 and 60.7 %). The routine use of
capnometry to confirm tube placement was reported by 55.6 % of the ICUs and
was highest in closed ICUs (67.2 %, p = 0.03). The rate of continuous
capnography monitoring was also 55.6 % and was highest in academic ICUs
(64.5 %, p = 0.04). Conclusion: In Japanese ICUs, SGAs and dedicated DAM
carts were less available, and capnometry was not universally applied either
to confirm tube placement, or for continuous monitoring of ventilated
patients. Our study revealed areas in need of improvement.
EMTREE DRUG INDEX TERMS
flumazenil
naloxone
neostigmine
neuromuscular blocking agent
pancuronium
rocuronium
sugammadex
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
airway creation device
capnometry
intensive care unit
respiration control
EMTREE MEDICAL INDEX TERMS
article
cross-sectional study
emergency health service
fiberoscope
human
laryngoscope
major clinical study
manual emergency ventilator
patient monitoring
questionnaire
rigid laryngoscope
supraglottic airway device
videolaryngoscope
Yankauer suction tip
DEVICE TRADE NAMES
Air-Q
Airway scope
Ambu AuraOnce
C-MAC
Combitube
COOPDECH Video Laryngoscope
GlideScope
King Vision
LMA Classic
LMA Flexible
LMA ProSeal
McGRATH MAC
MultiViewScope
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
rocuronium (119302-91-9)
sugammadex (343306-79-6, 343306-71-8)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160341013
MEDLINE PMID
27130212 (http://www.ncbi.nlm.nih.gov/pubmed/27130212)
PUI
L610188939
DOI
10.1007/s00540-016-2176-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s00540-016-2176-3
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 295
TITLE
Analgesia by telemedically supported paramedics compared with
physician-administered analgesia: A prospective, interventional, multicentre
trial
AUTHOR NAMES
Brokmann J.C.
Rossaint R.
Hirsch F.
Beckers S.K.
Czaplik M.
Chowanetz M.
Tamm M.
Bergrath S.
AUTHOR ADDRESSES
(Brokmann J.C.) Emergency Department, University Hospital RWTH Aachen,
Germany.
(Rossaint R.; Hirsch F.; Beckers S.K.; Czaplik M.; Chowanetz M.; Bergrath
S., sbergrath@ukaachen.de) Department of Anaesthesiology, University
Hospital RWTH Aachen, Germany.
(Tamm M.) Department of Medical Statistics, University Hospital RWTH Aachen,
Germany.
CORRESPONDENCE ADDRESS
S. Bergrath, Department of Anaesthesiology, University Hospital RWTH Aachen,
Germany. Email: sbergrath@ukaachen.de
SOURCE
European Journal of Pain (United Kingdom) (2016) 20:7 (1176-1184). Date of
Publication: 1 Aug 2016
ISSN
1532-2149 (electronic)
1090-3801
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Background: In German emergency medical services (EMS), the analgesia is
restricted to physicians. In this prospective, interventional, multicentre
trial, complications with and quality of telemedically delegated analgesia
were evaluated. Methods: If prehospital analgesia was necessary, five
telemedically equipped paramedic ambulances from four different districts
could consult a telemedicine centre. Analgesics were delegated based on a
predefined algorithm. Telemedically assisted cases were compared with local
historical regular EMS missions using matched pairs. The primary outcome was
the frequency of therapeutic complications (respiratory/circulatory
insufficiency, allergic reactions). Secondary outcomes were quality of
analgesia (11-point numerical rating scale, NRS) and the frequency of
nausea/vomiting. Results: Analgesia was necessary in 106 telemedically
assisted missions. In 23 cases, the telemedical procedure was used until an
EMS physician arrived. Of the remaining 83 cases, 80 could be matched to
comparable controls. Complications did not occur in either the study group
or the control group (0 vs. 0; p = N/A). Complete NRS documentation was
noted in 65/80 (study group) and 32/80 (control group) cases (p < 0.0001).
Adequate initial pain reduction (quality indicator: reduction of NRS ≥ 2
points or NRS < 5 at end of mission) occurred in 61/65 versus 31/32 cases
(p = 1.0); NRS reduction during mission was 3.78 ± 2.0 versus 4.38 ± 2.2
points (p = 0.0159). Nausea and vomiting occurred with equal frequency in
both groups. Conclusions: Telemedical delegation of analgesics to paramedics
was safe and led to a pain reduction superior to the published minimum
standard in both groups. The documentation quality was better in the
telemedicine group. What does this study add?: Little is known about the
safety and quality of prehospital analgesia carried out by emergency medical
services (EMS). Beside potential quality problems, in some countries
meaningful pain reduction is limited by legal regulations that allow only
physicians to administer analgesics. This first multicentre prospective
trial for telemedically delegated analgesia demonstrates that remote
analgesia is possible and safe and retains equivalent analgesic quality
compared with that administered by onsite EMS physicians.
EMTREE DRUG INDEX TERMS
analgesic agent
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
paramedical personnel
physician administered analgesia
teleconsultation
EMTREE MEDICAL INDEX TERMS
adolescent
adult
algorithm
allergic reaction
ambulance
article
child
controlled study
documentation
female
human
infant
major clinical study
male
medical documentation
nausea and vomiting
numeric rating scale
outcome assessment
paramedic ambulance
preschool child
priority journal
prospective study
rating scale
respiratory failure
school child
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Immunology, Serology and Transplantation (26)
Drug Literature Index (37)
Gastroenterology (48)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT01644032)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160181865
MEDLINE PMID
26914284 (http://www.ncbi.nlm.nih.gov/pubmed/26914284)
PUI
L608754147
DOI
10.1002/ejp.843
FULL TEXT LINK
http://dx.doi.org/10.1002/ejp.843
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 296
TITLE
Opioids and the Emergency Physician: Ducking Between Pendulum Swings
AUTHOR NAMES
Yealy D.M.
Green S.M.
AUTHOR ADDRESSES
(Yealy D.M., yealydm@upmc.edu) Department of Emergency Medicine, University
of Pittsburgh/UPMC, United States.
(Green S.M.) Department of Emergency Medicine, Loma Linda University, United
States.
CORRESPONDENCE ADDRESS
D.M. Yealy, Department of Emergency Medicine, University of Pittsburgh/UPMC,
United States. Email: yealydm@upmc.edu
SOURCE
Annals of Emergency Medicine (2016) 68:2 (209-212). Date of Publication: 1
Aug 2016
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
diamorphine
short acting drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
emergency care
EMTREE MEDICAL INDEX TERMS
analgesia
editorial
emergency physician
epidemic
heroin dependence
human
intoxication
opiate addiction
pain (drug therapy)
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160203174
MEDLINE PMID
26973177 (http://www.ncbi.nlm.nih.gov/pubmed/26973177)
PUI
L608922669
DOI
10.1016/j.annemergmed.2016.01.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2016.01.026
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 297
TITLE
Trends in the Concomitant Prescribing of Opioids and Benzodiazepines,
2002−2014
AUTHOR NAMES
Hwang C.S.
Kang E.M.
Kornegay C.J.
Staffa J.A.
Jones C.M.
McAninch J.K.
AUTHOR ADDRESSES
(Hwang C.S.; Kang E.M.; Kornegay C.J.; Staffa J.A.; McAninch J.K.,
jana.mcaninch@fda.hhs.gov) Division of Science Policy, Office of the
Assistant Secretary for Planning and Evaluation, U.S. Department of Health
and Human Services, Washington, United States.
(Jones C.M.) Office of Public Health Strategy and Analysis, Office of the
Commissioner, U.S. Food and Drug Administration, Silver Spring, United
States.
CORRESPONDENCE ADDRESS
J.K. McAninch, U.S. Food and Drug Administration, 10903 New Hampshire
Avenue, , United States. Email: jana.mcaninch@fda.hhs.gov
SOURCE
American Journal of Preventive Medicine (2016) 51:2 (151-160). Date of
Publication: 1 Aug 2016
ISSN
1873-2607 (electronic)
0749-3797
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Introduction Although many clinical guidelines caution against the combined
use of opioids and benzodiazepines, overdose deaths and emergency department
visits involving the co-ingestion of these drugs are increasing. Methods In
this ecologic time series study, the IMS Health Total Patient Tracker was
used to describe nationally projected trends of patients receiving opioids
and benzodiazepines in the U.S. outpatient retail setting between January
2002 and December 2014. The IMS Health Data Extract Tool was used to examine
trends in the concomitant prescribing of these two medication classes among
177 million individuals receiving opioids during this period. The annual
proportion of opioid recipients who were prescribed benzodiazepines
concomitantly was calculated and stratified by gender, age, duration of
opioid use, immediate-release versus extended-release/long-acting opioids,
and benzodiazepine molecule. The proportion of patients with concomitancy
receiving opioids and benzodiazepines from the same prescriber was also
analyzed. Analyses were conducted from April to June 2015. Results The
nationally projected number of patients receiving opioids and
benzodiazepines increased by 8% and 31%, respectively, from 2002 to 2014.
During this period, the annual proportion of opioid recipients dispensed a
benzodiazepine concomitantly increased from 6.8% to 9.6%, which corresponded
to a relative increase of 41%. Approximately half of these patients received
both prescriptions from the same prescriber on the same day. Concomitancy
was more common in patients receiving opioids for ≥90 days, women, and the
elderly. Conclusions Concomitant prescribing of opioids and benzodiazepines
is increasing and may play a growing role in adverse patient outcomes
related to these medications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug combination)
opiate (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
child
drug release
drug utilization
emergency ward
extended release
female
human
immediate release
major clinical study
male
medicaid
medicare
practice guideline
recipient
sex difference
treatment duration
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160292146
MEDLINE PMID
27079639 (http://www.ncbi.nlm.nih.gov/pubmed/27079639)
PUI
L609745648
DOI
10.1016/j.amepre.2016.02.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amepre.2016.02.014
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 298
TITLE
A Promising Screening Tool for Prescription Opioid Use Disorders in Older
Adults?
AUTHOR NAMES
Douaihy A.
AUTHOR ADDRESSES
(Douaihy A., douaihya@upmc.edu) Department of Psychiatry, University of
Pittsburgh School of Medicine, Pittsburgh, United States.
CORRESPONDENCE ADDRESS
A. Douaihy, Western Psychiatric Institute and Clinic, 3811 O'Hara St,
Pittsburgh, United States. Email: douaihya@upmc.edu
SOURCE
American Journal of Geriatric Psychiatry (2016) 24:8 (637-638). Date of
Publication: 1 Aug 2016
ISSN
1545-7214 (electronic)
1064-7481
BOOK PUBLISHER
Elsevier B.V., agents@lww.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
geriatric assessment
geriatric disorder (diagnosis)
mental disease assessment
opiate addiction (side effect, diagnosis, side effect)
prescription
Prescription Drug Use Questionnaire
EMTREE MEDICAL INDEX TERMS
chronic pain (drug therapy)
drug abuse
drug misuse
editorial
emergency ward
groups by age
human
interrater reliability
receiver operating characteristic
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Gerontology and Geriatrics (20)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160729399
PUI
L612647296
DOI
10.1016/j.jagp.2016.05.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jagp.2016.05.006
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 299
TITLE
Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid
Expenditures and Health Services Utilization Rates in Vermont
AUTHOR NAMES
Mohlman M.K.
Tanzman B.
Finison K.
Pinette M.
Jones C.
AUTHOR ADDRESSES
(Mohlman M.K., marykate.mohlman@vermont.gov; Tanzman B.; Jones C.) Vermont
Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, United
States.
(Finison K.; Pinette M.) Onpoint Health Data, 254 Commercial Street, Suite
257, Portland, United States.
CORRESPONDENCE ADDRESS
M.K. Mohlman, Vermont Blueprint for Health, NOB 1 South, 280 State Drive,
Waterbury, United States. Email: marykate.mohlman@vermont.gov
SOURCE
Journal of Substance Abuse Treatment (2016) 67 (9-14). Date of Publication:
1 Aug 2016
ISSN
1873-6483 (electronic)
0740-5472
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
In the face of increasing rates of overdose deaths, escalating health care
costs, and the tremendous social costs of opioid addiction, policy makers
are asked to address the questions of whether and how to expand access to
treatment services. In response to an upward trend in opioid abuse and
adverse outcomes, Vermont is investing in statewide expansion of a
medication-assisted therapy program delivered in a network of community
practices and specialized treatment centers (Hub & Spoke Program). This
study was conducted to test the rationale for these investments and to
establish a pre-Hub & Spoke baseline for evaluating the additive impact of
the program. Using a serial cross-sectional design from 2008 to 2013 to
evaluate medical claims for Vermont Medicaid beneficiaries with opioid
dependence or addiction (6158 in the intervention group, 2494 in the control
group), this study assesses the treatment and medical service expenditures
for those receiving medication-assisted treatment compared to those
receiving substance abuse treatment without medication. Results suggest that
medication-assisted therapy is associated with reduced general health care
expenditures and utilization, such as inpatient hospital admissions and
outpatient emergency department visits, for Medicaid beneficiaries with
opioid addiction. For state Medicaid leaders facing similar decisions on
approaches to opioid addiction, these results provide early support for
expanding medication-assisted treatment services rather than relying only on
psychosocial, abstinence, or detoxification interventions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy, pharmacoeconomics)
methadone (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health care utilization
medicaid
opiate addiction (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
cost effectiveness analysis
cross-sectional study
emergency ward
female
hospital admission
human
major clinical study
male
methadone treatment
priority journal
residential care
treatment outcome
Vermont
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160380189
MEDLINE PMID
27296656 (http://www.ncbi.nlm.nih.gov/pubmed/27296656)
PUI
L610391156
DOI
10.1016/j.jsat.2016.05.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jsat.2016.05.002
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 300
TITLE
Non-accidental non-fatal poisonings attended by emergency ambulance crews:
An observational study of data sources and epidemiology
AUTHOR NAMES
John A.
Okolie C.
Porter A.
Moore C.
Thomas G.
Whitfield R.
Oretti R.
Snooks H.
AUTHOR ADDRESSES
(John A., a.john@swansea.ac.uk; Okolie C.; Porter A.; Thomas G.; Snooks H.)
Swansea University Medical School, Swansea, United Kingdom.
(Moore C.; Whitfield R.) Welsh Ambulance Services NHS Trust, H.M.Stanley
Hospital, St Asaph, Denbighshire, United Kingdom.
(Oretti R.) Community Addiction Unit, Cardiff and Vale University Health
Board, Cardiff, United Kingdom.
CORRESPONDENCE ADDRESS
A. John, Swansea University Medical School, Swansea, United Kingdom. Email:
a.john@swansea.ac.uk
SOURCE
BMJ Open (2016) 6:8 Article Number: 011049. Date of Publication: 1 Aug 2016
ISSN
2044-6055 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Background: Non-accidental non-fatal poisoning (NANFP) is associated with
high risk of repeat episodes and fatality. This cross-sectional study aims
to describe the data sources and epidemiology of non-fatal poisonings (NFPs)
presenting to the emergency ambulance service. Methods: We assessed
incidents of NFP across Wales from electronic ambulance call centre records
and paper records completed by attending ambulance crews, December 2007 to
February 2008. We descriptively analysed data completed by attending crews.
Results: 92 331 calls were made to the ambulance call centre, of which 3923
(4.2%) were coded as 'overdose' or 'poisoning'. During the same period,
ambulance crews recorded 1827 attended NANFP incidents in those categories,
of which 1287 (70.4%) had been identified in the call centre. 76.1% (1356/
1782) were aged 1544 years and 54.2% (991/1827) were female. 75.0%
(1302/1753) of incidents occurred in areas from the lower 2 quintiles of
deprivation in Wales. Substance taken was reported in 90% of cases (n=1639).
Multiple ingestion was common (n=886, 54.1%). Psychotropic was the most
frequently taken group of substances (n=585, 32.0%) and paracetamol (n=484,
26.5%) was the most frequently taken substance prehospital. Almost half of
patients had taken alcohol alongside other substances (n=844, 46.2%).
Naloxone was the most frequently administered treatment (n=137, 7.5%). Only
142/1827 (7.8%) patients were not transported to hospital, of whom 4 were
recorded to have been given naloxone. Conclusions: We report new data on the
epidemiology of NFP across substance types at national level, highlighting
deficiencies in information systems and high levels of multiple ingestion.
In order to develop policy and practice for this patient group prehospital
and further along the care pathway, information systems need to be developed
to allow accurate routine monitoring of volume, presentation and outcomes.
EMTREE DRUG INDEX TERMS
amphetamine (drug toxicity)
anticonvulsive agent (drug toxicity)
antidepressant agent (drug toxicity)
antiinfective agent (drug toxicity)
atropine (drug therapy)
benzodiazepine derivative (drug toxicity)
buprenorphine (drug toxicity)
cannabis (drug toxicity)
cardiovascular agent (drug toxicity)
cocaine (drug toxicity)
codeine (drug toxicity)
diamorphine (drug toxicity)
diazepam (drug therapy)
diclofenac (drug toxicity)
epinephrine (drug therapy)
furosemide (drug therapy)
glucagon (drug therapy)
ibuprofen (drug toxicity)
methadone (drug toxicity)
metoclopramide (drug therapy)
midomafetamine (drug toxicity)
morphine (drug toxicity)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
nonsteroid antiinflammatory agent (drug toxicity)
opiate (drug toxicity)
paracetamol (drug toxicity)
psychotropic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol consumption
ambulance
consciousness level
demography
drug intoxication (drug therapy, drug therapy, epidemiology)
non accidental non fatal poisoning (drug therapy, drug therapy,
epidemiology)
violence
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
aggression
article
breathing disorder
child
clinical feature
cross-sectional study
descriptive research
faintness
female
human
major clinical study
male
mental disease
observational study
respiratory distress
suicidal ideation
unconsciousness
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
buprenorphine (52485-79-7, 53152-21-9)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
epinephrine (51-43-4, 55-31-2, 6912-68-1)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160628812
MEDLINE PMID
27540098 (http://www.ncbi.nlm.nih.gov/pubmed/27540098)
PUI
L611819041
DOI
10.1136/bmjopen-2016-011049
FULL TEXT LINK
http://dx.doi.org/10.1136/bmjopen-2016-011049
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 301
TITLE
Addressing the Challenge of Emergency Department Analgesia: Innovation in
the Use of Opioid Alternatives
AUTHOR NAMES
Goett R.
Todd K.H.
Nelson L.S.
AUTHOR ADDRESSES
(Goett R., rg739@njms.rutgers.edu; Todd K.H.; Nelson L.S.)
CORRESPONDENCE ADDRESS
R. Goett, Department of Emergency Medicine, New Jersey Medical School,
Rutgers University, 185 South Orange Avenue, Newark, United States. Email:
rg739@njms.rutgers.edu
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2016) 30:3 (225-227).
Date of Publication: 2 Jul 2016
ISSN
1536-0539 (electronic)
1536-0288
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
The current epidemic of opioid toxicity and deaths has led clinicians and
policy-makers to explore alternatives to opioids for management of moderate
to severe pain. One environment in which opioid use has been questioned is
the emergency department (ED). This commentary addresses the proposal for
“opioid-free EDs” and discusses the risk-to-benefit ratios of opioid and
alternative pharmacotherapy for acutely injured patients requiring
analgesia. The authors recognize that a truly opioid-free ED is not
practical and that alternative analgesic approaches also carry risks.
Innovations in managing pain in the ED are needed. But excessive restriction
on opioid pharmacotherapy in emergency medicine carries the risk of
replacing overprescribing with underprescribing of opioids. The commentary
supports the need to establish a core of evidence to support efforts to
increase the use of nonopioid and nonpharmacologic modalities for those
suffering from pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
ketamine
lidocaine
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
pain
EMTREE MEDICAL INDEX TERMS
acupuncture
drug monitoring
government regulation
health care utilization
hospital policy
human
massage
meditation
note
opiate addiction
practice guideline
prescription
primary prevention
CAS REGISTRY NUMBERS
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160607497
MEDLINE PMID
27541623 (http://www.ncbi.nlm.nih.gov/pubmed/27541623)
PUI
L611750181
DOI
10.1080/15360288.2016.1209612
FULL TEXT LINK
http://dx.doi.org/10.1080/15360288.2016.1209612
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 302
TITLE
Primary care naloxone and opioid co-prescribing reduces emergency visits
AUTHOR ADDRESSES
SOURCE
Clinical Pharmacist (2016) 8:7. Date of Publication: 1 Jul 2016
ISSN
1758-9061
BOOK PUBLISHER
Royal Pharmaceutical Society, pharmpress@rpsgb.org.uk
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
prescription
primary medical care
EMTREE MEDICAL INDEX TERMS
emergency ward
human
risk reduction
short survey
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160687771
PUI
L612328645
DOI
10.1211/CP.2016.20201370
FULL TEXT LINK
http://dx.doi.org/10.1211/CP.2016.20201370
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 303
TITLE
ED-based Counseling Sessions Reduce Risky Opioid Use Among Certain Patients
AUTHOR ADDRESSES
SOURCE
ED management : the monthly update on emergency department management (2016)
28:7 (81-83). Date of Publication: 1 Jul 2016
ISSN
1044-9167
ABSTRACT
Investigators at the University of Michigan have shown promising results
from an ED-based intervention designed to curb risky opioid use among
patients who have reported opioid misuse within the previous three months.
The intervention includes a 30-minute counseling session with a therapist
who utilizes motivational interviewing techniques to strengthen their desire
to move away from opioid use behaviors. The randomized clinical trial
included 204 emergency patients, divided between patients receiving printed
educational materials and patients receiving printed materials as well as
counseling sessions. Researchers followed up with all patients after six
months, finding that those who received the counseling intervention
demonstrated a substantially higher reduction in behaviors that heighten the
risk of an overdose than patients who received only printed materials.
Investigators are working now to adapt the counseling intervention so that
it can be delivered by more cost-efficient,means, such as via interactive
voice response messages or computer.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital emergency service
EMTREE MEDICAL INDEX TERMS
controlled study
counseling
drug overdose
human
motivation
opiate addiction
randomized controlled trial
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27439227 (http://www.ncbi.nlm.nih.gov/pubmed/27439227)
PUI
L618142843
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 304
TITLE
Opioid Use Disorders
AUTHOR NAMES
Sharma B.
Bruner A.
Barnett G.
Fishman M.
AUTHOR ADDRESSES
(Sharma B.; Bruner A.; Barnett G.; Fishman M., mjfishman@comcast.net)
Mountain Manor Treatment Center, Baltimore, United States.
(Bruner A.) Department of Pediatrics, Johns Hopkins University, Baltimore,
United States.
(Fishman M., mjfishman@comcast.net) Department of Psychiatry, Johns Hopkins
University, Baltimore, United States.
CORRESPONDENCE ADDRESS
M. Fishman, 3800 Frederick Avenue, Baltimore, United States. Email:
mjfishman@comcast.net
SOURCE
Child and Adolescent Psychiatric Clinics of North America (2016) 25:3
(473-487). Date of Publication: 1 Jul 2016
ISSN
1558-0490 (electronic)
1056-4993
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Opioid use and addiction in adolescents and young adults is a health problem
of epidemic proportions, with devastating consequences for youth and their
families. Opioid overdose is a life-threatening emergency that should be
treated with naloxone, and respiratory support if necessary. Overdose should
always be an opportunity to initiate addiction treatment. Detoxification is
often a necessary, but never sufficient, component of treatment for OUDs.
Treatment for OUDs is effective but treatment capacity is alarmingly limited
and under-developed. Emerging consensus supports the incorporation of
relapse prevention medications such as buprenorphine and extended release
naltrexone into comprehensive psychosocial treatment including counseling
and family involvement.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
clonidine (drug therapy)
drugs used in the treatment of addiction (drug therapy)
illicit drug
naloxone (drug therapy)
naltrexone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, diagnosis, drug therapy, epidemiology,
etiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent disease (epidemiology)
age
assisted ventilation
clinical feature
comorbidity
consensus
diagnostic test
disease course
disease exacerbation
disease severity
drug detoxification
drug misuse
drug overdose
emergency treatment
epidemic (diagnosis, epidemiology, etiology, therapy)
evidence based medicine
family attitude
family therapy
gender
hepatitis C
heroin dependence
human
Human immunodeficiency virus
Human immunodeficiency virus infection
injection
mortality
nonhuman
patient assessment
patient counseling
prescription
prevalence
priority journal
psychosocial care
psychosocial disorder
race
relapse (prevention)
respiration depression (drug therapy, therapy)
review
risk factor
substance abuse
symptom
virus transmission
withdrawal syndrome (drug therapy)
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160306076
MEDLINE PMID
27338968 (http://www.ncbi.nlm.nih.gov/pubmed/27338968)
PUI
L609943499
DOI
10.1016/j.chc.2016.03.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.chc.2016.03.002
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 305
TITLE
Prevalence and correlates of coprescribing anxiolytic medications with
extensive prescription opioid use in Veterans Health Administration patients
with metastatic cancer
AUTHOR NAMES
Barry D.T.
Sofuoglu M.
Kerns R.D.
Wiechers I.R.
Rosenheck R.A.
AUTHOR ADDRESSES
(Barry D.T.; Sofuoglu M.; Kerns R.D.; Rosenheck R.A.) Department of
Psychiatry, Yale University School of Medicine, New Haven, United States.
(Barry D.T.) APT Foundation Pain Treatment Services, New Haven, United
States.
(Sofuoglu M.; Rosenheck R.A.) Veterans Health Administration Mental Illness
Research, Education and Clinical Center, West Haven, United States.
(Kerns R.D.) Pain Res., Info., Multimorbidities and Educ. Center of
Innovation VA Connecticut Healthcare System, West Haven, United States.
(Wiechers I.R.) Robert Wood Johnson Foundation Clinical Scholars Program,
Yale University School of Medicine, New Haven, United States.
SOURCE
Journal of Opioid Management (2016) 12:4 (259-268). Date of Publication: 1
Jul 2016
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Objective: To examine the prevalence and correlates of concomitant
anxiolytic prescription fills in Veterans Health Administration (VHA)
patients with metastatic cancer who have extensive prescription opioid use.
Design, Setting, and Participants: National VHA data for fiscal year 2012
were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes
196-199) who also had extensive prescription opioid use (at least 10 opioid
prescriptions during the year, comprising the highest 29 percent of opioid
users). Bivariate and multivariate analyses were used to examine correlates
of receiving anxiolytic medication among veterans with metastatic cancer and
extensive prescription opioid use. Results: Of the 5,950 veterans with
metastatic cancer and extensive prescription opioid use, 51 percent also
received anxiolytic medication, of whom 64 percent had a medical indication
and 85 percent had a psychiatric or medical indication for psychotropics. Of
those with extensive prescription opioid use who filled an anxiolytic, 64
percent also received antidepressants and 38 percent received three or more
classes of psychotropic medication (ie, polypharmacy). In multivariate
analyses, factors associated with receipt of an anxiolytic included any
anxiety disorder, insomnia, the prescription of antidepressants or
antipsychotics, bipolar disorder, younger age, more emergency department
visits, and greater number of opioid prescriptions. Conclusions: VHA
patients with metastatic cancer and extensive prescription opioid use who
are prescribed anxiolytics are likely to have a Food and Drug
Administration-approved indication for psychotropics, and anxiolytics in
particular, but represent a clinically vulnerable group which merits careful
monitoring.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anxiolytic agent (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
amfebutamone (drug therapy)
amoxapine (drug therapy)
chlorpromazine (drug therapy)
citalopram (drug therapy)
clomipramine (drug therapy)
desipramine (drug therapy)
desvenlafaxine (drug therapy)
doxepin (drug therapy)
duloxetine (drug therapy)
escitalopram (drug therapy)
fluoxetine (drug therapy)
fluvoxamine (drug therapy)
imipramine (drug therapy)
isocarboxazid (drug therapy)
maprotiline (drug therapy)
mirtazapine (drug therapy)
nefazodone (drug therapy)
nortriptyline (drug therapy)
paroxetine (drug therapy)
phenelzine (drug therapy)
protriptyline (drug therapy)
selegiline (drug therapy)
sertraline (drug therapy)
tranylcypromine (drug therapy)
trazodone (drug therapy)
trimipramine (drug therapy)
unindexed drug
venlafaxine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy, drug therapy)
metastasis (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
anxiety disorder (drug therapy)
article
bipolar disorder (drug therapy)
bivariate analysis
cancer patient
controlled study
depression (drug therapy)
drug indication
drug use
dysthymia (drug therapy)
emergency ward
female
fibromyalgia (drug therapy)
headache (drug therapy)
human
ICD-9
insomnia (drug therapy)
long term care
major clinical study
major depression (drug therapy)
male
mental disease (drug therapy)
mental patient
middle aged
migraine (drug therapy)
multivariate analysis
musculoskeletal pain (drug therapy)
narcolepsy (drug therapy)
nausea and vomiting (drug therapy)
neuropathic pain (drug therapy)
neuropathy (drug therapy)
organic brain syndrome (drug therapy)
pain (drug therapy)
paraplegia
polypharmacy
postherpetic neuralgia (drug therapy)
posttraumatic stress disorder (drug therapy)
prescription
prevalence
pruritus (drug therapy)
risk factor
schizophrenia (drug therapy)
seizure (drug therapy)
veteran
veterans health
CAS REGISTRY NUMBERS
amfebutamone (31677-93-7, 34911-55-2)
amoxapine (14028-44-5)
chlorpromazine (50-53-3, 69-09-0)
citalopram (59729-33-8)
clomipramine (17321-77-6, 303-49-1)
desipramine (50-47-5, 58-28-6)
desvenlafaxine (386750-22-7)
doxepin (1229-29-4, 1668-19-5)
duloxetine (116539-59-4, 136434-34-9)
escitalopram (128196-01-0, 219861-08-2)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
fluvoxamine (54739-18-3)
imipramine (113-52-0, 50-49-7)
isocarboxazid (59-63-2)
maprotiline (10262-69-8, 10347-81-6)
mirtazapine (61337-67-5)
nefazodone (82752-99-6, 83366-66-9)
nortriptyline (72-69-5, 894-71-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paroxetine (61869-08-7)
phenelzine (156-51-4, 51-71-8)
protriptyline (1225-55-4, 438-60-8)
selegiline (14611-51-9, 14611-52-0, 2079-54-1, 2323-36-6)
sertraline (79617-96-2)
tranylcypromine (13492-01-8, 155-09-9, 54-97-7)
trazodone (19794-93-5, 25332-39-2)
trimipramine (25332-13-2, 521-78-8, 739-71-9)
venlafaxine (93413-69-5, 99300-78-4)
EMBASE CLASSIFICATIONS
Cancer (16)
Psychiatry (32)
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160849274
PUI
L613320564
DOI
10.5055/jom.2016.0341
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2016.0341
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 306
TITLE
A comparison of automated dispensing cabinet optimization methods
AUTHOR NAMES
O'Neil D.P.
Miller A.
Cronin D.
Hatfield C.J.
AUTHOR ADDRESSES
(O'Neil D.P., oneild@wvuhealthcare.com) Department of Pharmacy, West
Virginia University Hospitals, Morgantown, United States.
(Miller A.; Cronin D.; Hatfield C.J.) Department of Pharmacy, University of
North Carolina, Medical Center, Chapel Hill, United States.
CORRESPONDENCE ADDRESS
D.P. O'Neil, Department of Pharmacy, West Virginia University Hospitals,
Morgantown, United States. Email: oneild@wvuhealthcare.com
SOURCE
American Journal of Health-System Pharmacy (2016) 73:13 (975-980). Date of
Publication: 1 Jul 2016
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
ABSTRACT
Results of a study comparing two methods of optimizing automated dispensing
cabinets (ADCs) are reported. Methods. Eight nonprofiled ADCs were optimized
over six months. Optimization of each cabinet involved three steps: (1)
removal of medications that had not been dispensed for at least 180 days,
(2) movement of ADC stock to better suit end-user needs and available space,
and (3) adjustment of par levels (desired on-hand inventory levels). The par
levels of four ADCs (the Day Supply group) were adjusted according to
average daily usage; the par levels of the other four ADCs (the Formula
group) were adjusted using a standard inventory formula. The primary outcome
was the vend:fill ratio, while secondary outcomes included total inventory,
inventory cost, quantity of expired medications, and ADC stockout
percentage. Results. The total number of medications stocked in the eight
machines was reduced from 1,273 in a designated two-month preoptimization
period to 1,182 in a designated two-month postoptimization period, yielding
a carrying cost savings of $44,981. The mean vend:fill ratios before and
after optimization were 4.43 and 4.46, respectively. The vend:fill ratio for
ADCs in the Formula group increased from 4.33 before optimization to 5.2
after optimization; in the Day Supply group, the ratio declined (from 4.52
to 3.90). The postoptimization interaction difference between the Formula
and Day Supply groups was found to be significant (p = 0.0477). Conclusion.
ADC optimization via a standard inventory formula had a positive impact on
inventory costs, refills, vend:fill ratios, and stockout percentages.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
atropine
bicarbonate
calcium chloride
digoxin
dopamine
epinephrine
flumazenil
furosemide
glyceryl trinitrate
labetalol
lipid emulsion
metoprolol tartrate
morphine sulfate
naloxone
phenylephrine
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
automated dispensing cabinet
hospital department
medical device
EMTREE MEDICAL INDEX TERMS
article
automation
comparative study
cost control
emergency health service
health care delivery
machine
pharmacy
pharmacy technician
priority journal
process optimization
DEVICE TRADE NAMES
Pyxis , United StatesCareFusion
DEVICE MANUFACTURERS
(United States)CareFusion
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
digoxin (20830-75-5, 57285-89-9)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0, 80738-44-9)
labetalol (32780-64-6, 36894-69-6)
metoprolol tartrate (56392-17-7)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160483440
MEDLINE PMID
27217517 (http://www.ncbi.nlm.nih.gov/pubmed/27217517)
PUI
L611009232
DOI
10.2146/ajhp150423
FULL TEXT LINK
http://dx.doi.org/10.2146/ajhp150423
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 307
TITLE
Out of crisis comes hope for patients and opportunity for pharmacists
AUTHOR NAMES
Trygstad T.
AUTHOR ADDRESSES
(Trygstad T.) Drake University, United States.
(Trygstad T.) University of North Carolina, United States.
CORRESPONDENCE ADDRESS
T. Trygstad, Drake University, United States.
SOURCE
Pharmacy Times (2016) 82:7. Date of Publication: 1 Jul 2016
ISSN
0003-0627
BOOK PUBLISHER
Intellisphere LLC, jburke@mdng.com
EMTREE DRUG INDEX TERMS
diamorphine
hydrocodone
methadone
naloxone
oxycodone
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hope
patient
pharmacist
EMTREE MEDICAL INDEX TERMS
editorial
emergency health service
human
pharmacy
physician
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160562788
PUI
L611435953
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 308
TITLE
The opioid pendulum and the need for better pain care
AUTHOR NAMES
Lynch M.
AUTHOR ADDRESSES
(Lynch M.) Department of Anesthesia Pain Medicine, Perioperative Care and
Psychiatry and Pharmacology, Dalhousie University, Halifax, Canada.
CORRESPONDENCE ADDRESS
M. Lynch, Department of Anesthesia Pain Medicine, Perioperative Care and
Psychiatry and Pharmacology, Dalhousie University, Halifax, Canada.
SOURCE
Pain Medicine (United States) (2016) 17:7 (1215-1219). Date of Publication:
1 Jul 2016
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Oxford University Press, jnl.info@oup.co.uk
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain
patient care
EMTREE MEDICAL INDEX TERMS
analgesia
cancer survival
cohort analysis
comorbidity
counseling
drug misuse
emergency ward
health care personnel
health service
health survey
hospital admission
human
neuropathy
North America
Norway
note
opiate addiction
physiotherapy
postoperative pain
postoperative period
prescription
psychological well-being
quality of life
resuscitation
risk factor
United Kingdom
yoga
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20170173147
PUI
L614693281
DOI
10.1093/pm/pnw085
FULL TEXT LINK
http://dx.doi.org/10.1093/pm/pnw085
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 309
TITLE
Opioid prescription fill rates after emergency department discharge
AUTHOR NAMES
Kim H.S.
Heard K.J.
Heard S.
Hoppe J.A.
AUTHOR ADDRESSES
(Kim H.S., howard.kim@northwestern.edu) Department of Emergency Medicine,
Center for Education in Health Sciences, Northwestern University, Chicago,
United States.
(Heard K.J.) Section of Medical Pharmacology and Toxicology, Department of
Emergency Medicine, University of Colorado, School of Medicine, Aurora,
United States.
(Heard K.J.; Heard S.; Hoppe J.A.) Rocky Mountain Poison and Drug Center,
Denver, United States.
(Hoppe J.A.) Department of Emergency Medicine, School of Medicine,
University of Colorado, Aurora, United States.
CORRESPONDENCE ADDRESS
H.S. Kim, Department of Emergency Medicine, Center for Education in Health
Sciences, Northwestern University, Chicago, United States. Email:
howard.kim@northwestern.edu
SOURCE
American Journal of Health-System Pharmacy (2016) 73:12 (902-907). Date of
Publication: 15 Jun 2016
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
ABSTRACT
Purpose: Opioid prescription fill rates and the time to fill after emergency
department (ED) discharge were studied. Methods: Data were evaluated for all
patients discharged from the ED between September 1, 2011, who were February
1, 2012, who were diagnosed with one of the following: dental pain, jaw
pain, fank pain, abdominal pain, pelvic pain, back pain, neck pain, knee
pain, headache, fracture, or sprain. Clinical information was abstracted via
computer algorithm, and prescription filling within 100 days of prescription
writing was determined by cross-referencing patient demographics with the
state prescription drug monitoring program. Logistic regression analysis and
a Cox proportional hazards model were used to determine if any clinical and
demographic characteristics were associated with fill rates or the time to
fill, respectively. Results: Of the 2243 patients who received an opioid
prescription at ED discharge, 1775 (79%) filled it, with a median time to
fill of 0 days. On adjusted analysis, characteristics associated with
filling the opioid prescriptions included Caucasian race, being insured by
the federal government or through a state indigent assistance program, a
chief complaint of back pain, and a history of filling an opioid
prescription within the past year. No characteristics were predictive of a
prolonged time to filling. Conclusion: One in five patients who received an
opioid prescription at discharge from an urban academic ED did not fill it.
Several factors may be associated with a greater likelihood of filling, such
as insurance status and history of filling an opioid prescription within the
past year.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2 decanoylamino 3 morpholino 1 phenyl 1 propanol
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital discharge
pain (drug therapy, diagnosis, disease management, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
abdominal pain (diagnosis, disease management)
adult
algorithm
article
backache (diagnosis, disease management)
Caucasian
Colorado
demography
emergency ward
female
flank pain (diagnosis, disease management)
fracture (diagnosis, disease management)
headache (diagnosis, disease management)
human
jaw pain (diagnosis, disease management)
knee pain (diagnosis, disease management)
major clinical study
male
neck pain (diagnosis, disease management)
pelvic pain (diagnosis, disease management)
priority journal
sprain (diagnosis, disease management)
tooth pain (diagnosis, disease management)
CAS REGISTRY NUMBERS
2 decanoylamino 3 morpholino 1 phenyl 1 propanol (109836-82-0, 73257-80-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160452979
MEDLINE PMID
27261241 (http://www.ncbi.nlm.nih.gov/pubmed/27261241)
PUI
L610837129
DOI
10.2146/ajhp150528
FULL TEXT LINK
http://dx.doi.org/10.2146/ajhp150528
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 310
TITLE
A pilot randomized clinical trial of an intervention to reduce overdose risk
behaviors among emergency department patients at risk for prescription
opioid overdose
AUTHOR NAMES
Bohnert A.S.B.
Bonar E.E.
Cunningham R.
Greenwald M.K.
Thomas L.
Chermack S.
Blow F.C.
Walton M.
AUTHOR ADDRESSES
(Bohnert A.S.B., amybohne@med.umich.edu; Bonar E.E.; Thomas L.; Chermack S.;
Blow F.C.; Walton M.) Department of Psychiatry, University of Michigan
Medical School, 4250 Plymouth Rd., Ann Arbor, United States.
(Bohnert A.S.B., amybohne@med.umich.edu; Thomas L.; Chermack S.; Blow F.C.)
VA Center for Clinical Management Research (CCMR), Department of Veterans
Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, United
States.
(Bohnert A.S.B., amybohne@med.umich.edu; Cunningham R.; Walton M.)
University of Michigan Injury Center, University of Michigan Medical School,
2800 Plymouth Rd., Bldg. 10, Ann Arbor, United States.
(Bohnert A.S.B., amybohne@med.umich.edu; Cunningham R.) Institute for
Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd.,
Bldg. 16, Ann Arbor, United States.
(Cunningham R.) Department of Emergency Medicine, University of Michigan
Medical School, 1500 East Medical Center Drive, Ann Arbor, United States.
(Cunningham R.) Department of Health Behavior and Health Education,
University of Michigan School of Public Health, 1415 Washington Heights, Ann
Arbor, United States.
(Greenwald M.K.) Department of Psychiatry and Behavioral Neurosciences,
Department of Pharmacy Practice, Wayne State University, 3901Chrysler
Service Drive, Suite 2A, Detroit, United States.
CORRESPONDENCE ADDRESS
A.S.B. Bohnert, University of Michigan, North Campus Research Complex 2800
Plymouth Rd, Bldg 16, Ann Arbor, United States. Email:
amybohne@med.umich.edu
SOURCE
Drug and Alcohol Dependence (2016) 163 (40-47). Date of Publication: 1 Jun
2016
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background and aims: Prescription opioid overdose is a significant public
health problem. Interventions to prevent overdose risk behaviors among
high-risk patients are lacking. This study examined the impact of a
motivational intervention to reduce opioid misuse and overdose risk
behaviors. Methods: This study was a pilot randomized controlled trial set
in a single emergency department (ED) in which, 204 adult, English-speaking
patients seeking care who reported prescription opioid misuse during the
prior 3 months were recruited. Patients were randomized to either the
intervention, a 30-minute motivational interviewing-based session delivered
by a therapist plus educational enhanced usual care (EUC), or EUC alone.
Participants completed self-reported surveys at baseline and 6 months
post-baseline (87% retention rate) to measure the primary outcomes of
overdose risk behaviors and the secondary outcome of non-medical opioid use.
Findings: Participants in the intervention condition reported significantly
lower levels of overdose risk behaviors (incidence rate ratio [IRR] = 0.72,
95% CI: 0.59-0.87; 40.5% reduction in mean vs. 14.7%) and lower levels of
non-medical opioid use (IRR = 0.81, 95% CI: 0.70-0.92; 50.0% reduction in
mean vs. 39.5%) at follow-up compared to the EUC condition. Conclusions:
This study represents the first clinical trial of a behavioral intervention
to reduce overdose risk. Results indicate that this single motivational
enhancement session reduced prescription opioid overdose risk behaviors,
including opioid misuse, among adult patients in the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (therapy)
motivational interviewing
social behavior
EMTREE MEDICAL INDEX TERMS
adult
article
behavior assessment
controlled study
drug misuse (therapy)
emergency ward
female
follow up
help seeking behavior
human
major clinical study
male
patient assessment
patient education
prescription
priority journal
randomized controlled trial
risk assessment
risk factor
risk reduction
social interaction
treatment response
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160281001
MEDLINE PMID
27062245 (http://www.ncbi.nlm.nih.gov/pubmed/27062245)
PUI
L609645250
DOI
10.1016/j.drugalcdep.2016.03.018
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2016.03.018
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 311
TITLE
Predictors of seeking emergency medical help during overdose events in a
provincial naloxone distribution programme: A retrospective analysis
AUTHOR NAMES
Ambrose G.
Amlani A.
Buxton J.A.
AUTHOR ADDRESSES
(Ambrose G.; Amlani A.; Buxton J.A., Jane.Buxton@bccdc.ca) Communicable
Disease Prevention and Control Services, British Columbia Centre for Disease
Control, Vancouver, Canada.
(Buxton J.A., Jane.Buxton@bccdc.ca) School of Population and Public Health,
University of British Columbia, Vancouver, Canada.
CORRESPONDENCE ADDRESS
J.A. Buxton, Communicable Disease Prevention and Control Services, British
Columbia Centre for Disease Control, Vancouver, Canada. Email:
Jane.Buxton@bccdc.ca
SOURCE
BMJ Open (2016) 6:6 Article Number: e011224. Date of Publication: 1 Jun 2016
ISSN
2044-6055 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Objectives: This study sought to identify factors that may be associated
with help-seeking by witnesses during overdoses where naloxone is
administered. Setting: Overdose events occurred in and were reported from
the five regional health authorities across British Columbia, Canada.
Naloxone administration forms completed following overdose events were
submitted to the British Columbia Take Home Naloxone programme.
Participants: All 182 reported naloxone administration events, reported by
adult men and women and occurring between 31 August 2012 and 31 March 2015,
were considered for inclusion in the analysis. Of these, 18 were excluded:
10 events which were reported by the person who overdosed, and 8 events for
which completed forms did not indicate whether or not emergency medical help
was sought. Primary and secondary outcome measures: Seeking emergency
medical help (calling 911), as reported by participants, was the sole
outcome measure of this analysis. Results: Medical help was sought
(emergency services-911 called) in 89 (54.3%) of 164 overdoses where
naloxone was administered. The majority of administration events occurred in
private residences (50.6%) and on the street (23.4%), where reported rates
of calling 911 were 27.5% and 81.1%, respectively. Overdoses occurring on
the street (compared to private residence) were significantly associated
with higher odds of calling 911 in multivariate analysis (OR=10.68; 95% CI
2.83 to 51.87; p<0.01), after adjusting for other variables. Conclusions:
Overdoses occurring on the street were associated with higher odds of
seeking emergency medical help by responders. Further research is needed to
determine if sex and stimulant use by the person who overdosed are
associated with seeking emergency medical help. The results of this study
will inform interventions within the British Columbia Take Home Naloxone
programme and other jurisdictions to encourage seeking emergency medical
help.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
aged
article
female
help seeking behavior
human
major clinical study
male
prediction
retrospective study
sensitivity analysis
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160486127
MEDLINE PMID
27329442 (http://www.ncbi.nlm.nih.gov/pubmed/27329442)
PUI
L610960010
DOI
10.1136/bmjopen-2016-011224
FULL TEXT LINK
http://dx.doi.org/10.1136/bmjopen-2016-011224
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 312
TITLE
Naloxone Administration in US Emergency Departments, 2000–2011
AUTHOR NAMES
Frank J.W.
Levy C.
Calcaterra S.L.
Hoppe J.A.
Binswanger I.A.
AUTHOR ADDRESSES
(Frank J.W., joseph.frank@ucdenver.edu; Calcaterra S.L.; Binswanger I.A.)
Division of General Internal Medicine, University of Colorado School of
Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, United States.
(Frank J.W., joseph.frank@ucdenver.edu; Levy C.) VA Eastern Colorado Health
Care System, 1055 Clermont Street, Denver, United States.
(Levy C.) Division of Health Care Policy and Research, University of
Colorado, Mailstop F-480, 13199 E. Montview Blvd., Suite 400, Aurora, United
States.
(Calcaterra S.L.) Denver Health Medical Center, 777 Bannock Street, Denver,
United States.
(Hoppe J.A.) Department of Emergency Medicine, University of Colorado School
of Medicine, 12401 E. 17th Avenue, Aurora, United States.
(Hoppe J.A.) Rocky Mountain Poison and Drug Center, 777 Bannock Street,
Denver, United States.
(Binswanger I.A.) Institute for Health Research, Kaiser Permanente Colorado,
10065 East Harvard Avenue, Suite 300, Denver, United States.
CORRESPONDENCE ADDRESS
J.W. Frank, Division of General Internal Medicine, University of Colorado
School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, United
States. Email: joseph.frank@ucdenver.edu
SOURCE
Journal of Medical Toxicology (2016) 12:2 (148-156). Date of Publication: 1
Jun 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Rates of opioid overdose and opioid-related emergency department (ED) visits
have increased dramatically. Naloxone is an effective antidote to
potentially fatal opioid overdose, but little is known about naloxone
administration in ED settings. We examined trends and correlates of naloxone
administration in ED visits nationally from 2000 to 2011. Using data from
the National Hospital Ambulatory Medical Care Survey, we examined ED visits
involving (1) the administration of naloxone or (2) a diagnosis of opioid
overdose, abuse, or dependence. We assessed patient characteristics in these
visits, including concomitant administration of prescription opioid
medications. We used logistic regression to identify correlates of naloxone
administration. From 2000 to 2011, naloxone was administered in an estimated
1.7 million adult ED visits nationally; 19 % of these visits recorded a
diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million
adult ED visits were related to opioid overdose, abuse, or dependence; 11 %
of these visits involved naloxone administration. In multivariable logistic
regression models, patient age, race, and insurance and non-rural facility
location were independently associated with naloxone administration. An
opioid medication was provided in 14 % of visits involving naloxone
administration. Naloxone was administered in a minority of ED visits related
to opioid overdose, abuse, or dependence. Among all ED visits involving
naloxone administration, prescription opioids were also provided in one in
seven visits. Further work should explore the provider decision-making in
the management of opioid overdose in ED settings and examine patient
outcomes following these visits.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (pharmacoeconomics)
EMTREE DRUG INDEX TERMS
codeine
dextropropoxyphene
fentanyl
hydrocodone
hydromorphone
morphine
oxycodone
pethidine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
decision making
female
health care survey
human
ICD-9-CM
male
medicare
opiate addiction
prescription
socioeconomics
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151003348
MEDLINE PMID
26621354 (http://www.ncbi.nlm.nih.gov/pubmed/26621354)
PUI
L607151056
DOI
10.1007/s13181-015-0525-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-015-0525-5
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 313
TITLE
Small state takes big steps in opioid-overdose reversal
AUTHOR NAMES
Traynor K.
AUTHOR ADDRESSES
(Traynor K.)
SOURCE
American journal of health-system pharmacy : AJHP : official journal of the
American Society of Health-System Pharmacists (2016) 73:11 (734-738). Date
of Publication: 1 Jun 2016
ISSN
1535-2900 (electronic)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy, epidemiology)
emergency health service
health care planning
human
legislation and jurisprudence
procedures
Vermont
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
27208051 (http://www.ncbi.nlm.nih.gov/pubmed/27208051)
PUI
L616638141
DOI
10.2146/news160033
FULL TEXT LINK
http://dx.doi.org/10.2146/news160033
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 314
TITLE
Optimising health and safety of people who inject drugs during transition
from acute to outpatient care: Narrative review with clinical checklist
AUTHOR NAMES
Thakarar K.
Weinstein Z.M.
Walley A.Y.
AUTHOR ADDRESSES
(Thakarar K., kthakarar@mmc.org) Department of Medicine/Infectious Diseases,
Maine Medical Center, Portland, United States.
(Weinstein Z.M.; Walley A.Y.) Clinical Addiction Research and Education
Unit, Section of General Internal Medicine, Department of Medicine, Boston
University School of Medicine/Boston Medical Center, Boston, United States.
CORRESPONDENCE ADDRESS
K. Thakarar, Department of Medicine/Infectious Diseases, Maine Medical
Center, 84 Marginal Way, Suite 800, Portland, United States. Email:
kthakarar@mmc.org
SOURCE
Postgraduate Medical Journal (2016) 92:1088 (356-363). Date of Publication:
1 Jun 2016
ISSN
1469-0756 (electronic)
0032-5473
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
The opioid epidemic in the USA continues to worsen. Medical providers are
faced with the challenge of addressing complications from opioid use
disorders and associated injection drug use. Unsafe injection practices
among people who inject drugs (PWID) can lead to several complications
requiring acute care encounters in the emergency department and inpatient
hospital. Our objective is to provide a narrative review to help medical
providers recognise and address key health issues in PWID, who are being
released from the emergency department and inpatient hospital. In the midst
of rises in overdose deaths and infections such as hepatitis C, we highlight
several health issues for PWID, including overdose and infection prevention.
We provide a clinical checklist of actions to help guide providers in the
care of these complex patients. The clinical checklist includes strategies
also applicable to low-resource settings, which may lack addiction treatment
options. Our review and clinical checklist highlight key aspects of
optimising the health and safety of PWID.
EMTREE DRUG INDEX TERMS
buprenorphine
diamorphine
methadone
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
outpatient care
patient safety
transitional care
EMTREE MEDICAL INDEX TERMS
adult
bacteremia
case report
checklist
clinical evaluation
complete heart block
counseling
drug monitoring
drug overdose
drug storage
dual chamber pacemaker
dyspnea
embolism
endocarditis
fever
follow up
hepatitis C (prevention)
human
Human immunodeficiency virus
male
mass fragmentography
mental health
methicillin susceptible Staphylococcus aureus
prescription
QT prolongation
quality of life
review
sexually transmitted disease
substance use
tricuspid valve
tricuspid valve replacement
tuberculosis
vaccination
waste disposal
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160297430
MEDLINE PMID
27004476 (http://www.ncbi.nlm.nih.gov/pubmed/27004476)
PUI
L609864805
DOI
10.1136/postgradmedj-2015-133720
FULL TEXT LINK
http://dx.doi.org/10.1136/postgradmedj-2015-133720
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 315
TITLE
Co-ingestion of tricyclic antidepressants with selective norepinephrine
reuptake inhibitors: Overdose in the emergency department
AUTHOR NAMES
Kaicker J.
Bostwick J.
AUTHOR ADDRESSES
(Kaicker J.) Emergency Medicine Program, Western University, London, Canada.
(Bostwick J., Jo.bostwick@gmail.com) Montfort Hospital, Ottawa, Canada.
(Bostwick J., Jo.bostwick@gmail.com) University of Ottawa, Canada.
CORRESPONDENCE ADDRESS
J. Bostwick, Montfort Hospital, Ottawa, Canada. Email: Jo.bostwick@gmail.com
SOURCE
Canadian Family Physician (2016) 62:6 (485 and 487-489). Date of
Publication: 1 Jun 2016
ISSN
0008-350X
BOOK PUBLISHER
College of Family Physicians of Canada
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amitriptyline (drug therapy, oral drug administration)
desvenlafaxine (drug therapy, oral drug administration)
EMTREE DRUG INDEX TERMS
bicarbonate
glucose (endogenous compound)
ketamine
naloxone
rocuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
bedtime dosage
blood pressure measurement
body temperature
breathing rate
case report
consciousness level
depression (drug therapy)
dry skin
electrocardiogram
female
Glasgow coma scale
glucose blood level
heart rate
human
intubation
medical history
oxygen saturation
QRS complex
young adult
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
bicarbonate (144-55-8, 71-52-3)
desvenlafaxine (386750-22-7)
glucose (50-99-7, 84778-64-3)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naloxone (357-08-4, 465-65-6)
rocuronium (119302-91-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160462750
MEDLINE PMID
27303005 (http://www.ncbi.nlm.nih.gov/pubmed/27303005)
PUI
L610886201
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 316
TITLE
Innovative Program Targets Five Common Pain Syndromes With Non-opioid
Alternatives
AUTHOR ADDRESSES
SOURCE
ED management : the monthly update on emergency department management (2016)
28:6 (61-66). Date of Publication: 1 Jun 2016
ISSN
1044-9167
ABSTRACT
To combat the prescription opioid problem, St. Joseph's Healthcare System in
Paterson, NJ, has developed a new program that gives providers options they
can use to effectively alleviate pain without resorting to highly addictive
medication. Launched in January 2016 in the ED at St. Joseph's Regional
Medical Center (SJRMC), the Alternatives to Opioids (ALTO) program utilizes
protocols that primarily target five common conditions: renal colic,
sciatica, headaches, musculoskeletal pain, and extremity fractures.
Administrators say they have successfully treated more than 300 patients
under the new program, and they see ALTO as a model other hospitals can
duplicate. Among the alternative therapies called for in the ALTO program
are trigger point injections, nitrous oxide, and ultrasound-guided nerve
blocks. ALTO medications are specifically chosen because of how they affect
the pain receptor sites for each different pain syndrome. While the primary
goal of the program is to use alternatives to opioids when-ever possible,
another important underlying goal is to stop acute pain from becoming
chronic. While ALTO therapies typically take a bit longer to deliver than
prescribing opioids, administrators note that this has not adversely
affected patient flow in the ED.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain (drug therapy)
emergency health service
human
opiate addiction (prevention)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27295817 (http://www.ncbi.nlm.nih.gov/pubmed/27295817)
PUI
L611382770
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 317
TITLE
Emergency medicine providers' opioid prescribing practices stratified by
gender, age, and years in practice
AUTHOR NAMES
Varney S.M.
Bebarta V.S.
Mannina L.M.
Ramos R.G.
Ganem V.J.
Carey K.R.
AUTHOR ADDRESSES
(Varney S.M.; Ramos R.G.) Department of Emergency Medicine, University of
Texas, Health Science Center, San Antonio, United States.
(Bebarta V.S., Vikhyat.bebarta@ucdenver.edu) Department of Emergency
Medicine, University of Colorado, School of Medicine, Aurora, United States.
(Mannina L.M.) Department of Emergency Medicine, Mike O'Callaghan Federal
Medical Center, Nellis, United States.
(Ganem V.J.) Air Force Enroute Care Research Center, Fort Sam Houston,
United States.
(Ganem V.J.; Carey K.R.) Geneva Foundation, Tacoma, United States.
CORRESPONDENCE ADDRESS
V.S. Bebarta, Department of Emergency Medicine, University of Colorado,
School of Medicine, Aurora, United States. Email:
Vikhyat.bebarta@ucdenver.edu
SOURCE
World Journal of Emergency Medicine (2016) 7:2 (106-110). Date of
Publication: 1 Jun 2016
ISSN
1920-8642
BOOK PUBLISHER
Second Affiliated Hospital, Zhejiang University School of Medicine,
em_nancy@zju.edu.cn
ABSTRACT
BACKGROUND: Emergency medicine providers (EMPs) prescribe about 25% of
opioids, but the effect of EMP risk perception on decisions to prescribe
opioids is unknown. This study was undertaken to identify factors that
influence EMP risk and opioid prescribing practices. METHODS: We distributed
an anonymous questionnaire to EMPs at a military trauma and referral center.
Response frequencies and distributions were assessed for independence using
the Chi-square test. RESULTS: Eighty-nine EMPs completed the questionnaire
(100% response). Respondents were primarily younger male physicians (80%) in
practice under five years (55%). Male EMPs were more likely to prescribe
more opioid tablets than female ones both when and when not concerned for
opioid misuse (P<0.001, P<0.007, respectively). Of the providers, 70% stated
that patient age would influence their prescribing decisions. Hydrocodone
and oxycodone were the opioids prescribed most frequently. About 60% of the
providers reported changing their prescribing behavior would not prevent
opioid misuse. Additionally, 40% of the providers believed at least 10% of
patients seen at this military ED misused opioids. CONCLUSION: Female EM
providers reported prescribing fewer opioid tablets. Patient age influenced
prescribing behavior, but the effect is unknown. Finally, EM providers
reported that altering their prescribing behavior would not prevent
prescription opioid misuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
emergency nurse practitioner
emergency physician
physician assistant
prescription
EMTREE MEDICAL INDEX TERMS
adult
age
article
controlled study
drug misuse
female
human
male
questionnaire
risk factor
sex difference
tablet
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160438383
PUI
L610762134
DOI
10.5847/wjem.j.1920-8642.2016.02.004
FULL TEXT LINK
http://dx.doi.org/10.5847/wjem.j.1920-8642.2016.02.004
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 318
TITLE
A cross sectional study on pediatric methadone poisoning in northeast of
Iran
AUTHOR NAMES
Hamedi A.
Ghahremani S.
Nakhaei A.A.
Balali M.R.
Ghahremani S.
AUTHOR ADDRESSES
(Hamedi A.) Infection Control and Hand Hygiene Research Center, Mashhad
University of Medical Sciences, Mashhad, Iran.
(Ghahremani S., Gahremanis@mums.ac.ir; Nakhaei A.A.; Balali M.R.) Imam Reza
Hospital, Mashhad University of Medical Science, Mashhad, Iran.
(Ghahremani S.) Nuclear Medicine Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran.
CORRESPONDENCE ADDRESS
S. Ghahremani, Imam Reza Hospital, Mashhad University of Medical Science,
Mashhad, Iran. Email: Gahremanis@mums.ac.ir
SOURCE
Asia Pacific Journal of Medical Toxicology (2016) 5:3 (75-78). Date of
Publication: 1 Jun 2016
ISSN
2322-4320 (electronic)
2322-2611
BOOK PUBLISHER
Mashhad University of Medical Sciences, P.O. Box: 445, Daneshgah Avenue,
Mashhad, Iran. ijp@mums.ac.ir
ABSTRACT
Introduction: Methadone is a product derived from heroin that is available
in drug stores as a 1mg/ml syrup. Methadone is a long acting drug with a
roughly 24-hour half-life .Poisoning from opiates is one of the most
dangerous and prevalent causes of poisoning in Imam Reza hospital (North-
East of Iran), and its pattern has changed in the form of increased
poisoning from methadone in recent years. The goal of this study is to
evaluate why methadone poisoning in children under 6 years old have been
increasing in recent years Methods: This cross-sectional study was done on
all children referred to Imam Reza Hospital's pediatric emergency room for
cause and agent of poisoning during 2015, to identify the number and the
most common cause of poisoning; evaluated demographic data showed methadone
poisoning as the most common cause of accidental poisoning in children.
Results: In one year 3395 child admitted in the pediatric emergency room,
including 409 cases (12%) of intoxication; 256 of these cases had different
opium poisoning (62.5%) and 69 cases (16.8%) had methadone poisoning. In
methadone poisoning 39 cases were male and 30 female. 25-48 months and 4-24
months age groups had the most cases of methadone poisoning, respectively.
Conclusion: In the emergency center the most common poisoning is opioid
compounds especially methadone, likely due to the availability of methadone
syrup in pharmacies. Parents use methadone to give up addiction. Poisoning
occurred because children like to open bottles and accidentally consume its
contents.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
EMTREE DRUG INDEX TERMS
naloxone
opiate
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
methadone poisoning
EMTREE MEDICAL INDEX TERMS
article
artificial ventilation
aspiration pneumonia
bradypnea
child
cross-sectional study
drowsiness
female
human
ingestion
Iran
major clinical study
male
nausea and vomiting
oxygen saturation
pruritus
questionnaire
seizure
stomach lavage
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170075869
PUI
L614215074
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 319
TITLE
Opioid Prescribing Laws and Emergency Department Guidelines for Chronic
Non-Cancer Pain in Washington State
AUTHOR NAMES
Skaer T.L.
Nwude A.C.
AUTHOR ADDRESSES
(Skaer T.L., tskaer@wsu.edu; Nwude A.C.) Department of Pharmacotherapy,
College of Pharmacy, Washington State University, Spokane, United States.
CORRESPONDENCE ADDRESS
T.L. Skaer, Department of Pharmacotherapy, College of Pharmacy, Washington
State University, Spokane, United States. Email: tskaer@wsu.edu
SOURCE
Pain Practice (2016) 16:5 (642-647). Date of Publication: 1 Jun 2016
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Rising mortality rates, increased opioid prescription abuse, and a perceived
need to provide practitioners with structured guidance in opioid prescribing
have prompted the Washington State Legislature to establish new legal
standards of practice regarding chronic non-cancer pain management.
Clinicians are required to conduct a detailed physical examination and
health history prior to treatment. Risk assessments for abuse and detailed
periodic reviews of treatment are required at least every 6 months. Those
considered “high risk” or who have significant psychiatric comorbidities
will be required to sign and follow a written agreement or pain contract,
obtain their pain prescriptions from a single provider, and submit to
biological drug screening. Unless an exemption exists, patients prescribed >
120 mg of morphine-equivalents daily, considered severe pain nonresponders,
necessitating dosage escalation, diagnosed with multifaceted mental
health-related comorbidities, demonstrating diagnostic ambiguity, and/or
requiring significant treatment individualization are referred to a pain
specialist. Episodic care settings should refrain from supplying opioids to
chronic pain patients whenever possible. The ER is for Emergencies coalition
instituted the Seven Best Practices program throughout the state to reduce
unnecessary visits, coordinate prescribing practice, reduce Medicaid
expenditures, and improve overall patient care. The state reported
approximately $33.65 million in savings in 2013 through the use of these
practices and converting Medicaid participants from fee-for-service to
managed care plans. Similar legislation to complement clinical practice
guidelines is expected to be enacted in other states. It is vital that
practitioners comprehend the new guidelines and make appropriate adjustments
in their opioid prescribing habits.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain
drug legislation
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
clinical practice
consultation
cost control
emergency ward
health care cost
human
managed care
medicaid
medical specialist
patient care
patient monitoring
review
risk assessment
treatment planning
United States
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160474935
MEDLINE PMID
26369588 (http://www.ncbi.nlm.nih.gov/pubmed/26369588)
PUI
L610950185
DOI
10.1111/papr.12359
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12359
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 320
TITLE
An unusual presentation of opioid induced cerebral infarction
AUTHOR NAMES
Butt M.-U.-R.A.
Nadir R.
AUTHOR ADDRESSES
(Butt M.-U.-R.A., mujeeb_b@yahoo.com) Department of Medicine, Shalamar
Medical and Dental College, Shalamar Hospital, Lahore, Pakistan.
(Nadir R.) Clinical Dietition, Shalamar Medical and Dental College, Shalamar
Hospital, Lahore, Pakistan.
CORRESPONDENCE ADDRESS
M.-U.-R.A. Butt, Department of Medicine, Shalamar Medical and Dental
College, Shalamar Hospital, Lahore, Pakistan. Email: mujeeb_b@yahoo.com
SOURCE
Journal of the College of Physicians and Surgeons Pakistan (2016) 26
Supplement1 (S76-S78). Date of Publication: 1 Jun 2016
ISSN
1681-7168 (electronic)
1022-386X
BOOK PUBLISHER
College of Physicians and Surgeons Pakistan, 7th Central Street, Karachi,
Pakistan.
ABSTRACT
Opioid induced cerebral infarction is one of the most dreadful complications
encountered in clinical practice. A 30-year known hypertensive male
presented to the emergency department of Shalamar Hospital, Lahore,
Pakistan, with altered state of consciousness. He had been in his usual
state of health a day before the presentation. On examination he was
afebrile, his GCS was 3/15 having pinpoint pupils with absent doll's eye
movements. His blood pressure was 90/60 mmHg, pulse rate was 62/minute, and
respiratory rate was 10/minute. His right plantar was upgoing. He was
resuscitated in emergency and was placed on ventilator due to hypoxemia.
Computed tomography (CT) of brain revealed bilateral internal capsule
hypolucencies and bilateral frontal lobe infarction. His urinary
toxicological screening revealed extremely high concentrations of opioids
and benzodiazepine. Patient made an uneventful recovery with antidote and
supportive care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
amlodipine
benzodiazepine
bromazepam (drug therapy)
diazepam
enoxaparin (subcutaneous drug administration)
glucose (endogenous compound)
midazolam maleate
naloxone (drug dose)
rosuvastatin
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain infarction
capsula interna
frontal lobe
EMTREE MEDICAL INDEX TERMS
adult
arterial gas
article
blood pressure
bradykinesia
breathing rate
case report
computer assisted tomography
consciousness
cranial nerve
diastolic dysfunction
drug intoxication
emergency ward
extubation
eye movement
follow up
glucose blood level
heart left ventricle hypertrophy
hospital admission
human
hypertension
hypoxemia
insomnia (drug therapy)
intensive care unit
long term memory
lung auscultation
male
Mini Mental State Examination
neuroimaging
oxygen saturation
Pakistan
pH
physical examination
protein cerebrospinal fluid level
pulse oximeter
pulse oximetry
pulse rate
pupil
repeated drug dose
respiration depression
resuscitation
shoulder pain
smoking
ST segment elevation
tendon reflex
traffic accident
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
amlodipine (88150-42-9, 103129-82-4, 736178-83-9)
benzodiazepine (12794-10-4)
bromazepam (1812-30-2)
diazepam (439-14-5)
enoxaparin (679809-58-6)
glucose (50-99-7, 84778-64-3)
midazolam maleate (59467-94-6, 65506-68-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
rosuvastatin (147098-18-8, 147098-20-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Radiology (14)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170342573
MEDLINE PMID
27376233 (http://www.ncbi.nlm.nih.gov/pubmed/27376233)
PUI
L616132079
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 321
TITLE
A curious cause of positive PCP test results: Dextromethorphan intoxication
AUTHOR NAMES
LaRocca T.
AUTHOR ADDRESSES
(LaRocca T.) Department of Medicine, University of Miami Miller School of
Medicine, Palm Beach Regional Campus, Atlantis, United States.
CORRESPONDENCE ADDRESS
T. LaRocca, Department of Medicine, University of Miami Miller School of
Medicine, Palm Beach Regional Campus, Atlantis, United States.
SOURCE
Consultant (2016) 56:6 (540 and 543). Date of Publication: 1 Jun 2016
ISSN
0010-7069
BOOK PUBLISHER
Cliggott Publishing Co.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabis
dextromethorphan
phencyclidine
EMTREE DRUG INDEX TERMS
antihypertensive agent
benzodiazepine derivative (drug therapy)
creatine kinase (endogenous compound)
electrolyte
infusion fluid (drug therapy)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
acute kidney failure
adult
agitation
article
case report
computer assisted tomography
creatinine clearance
diaphoresis
dissociative disorder
electrocardiography
emergency ward
Glasgow coma scale
hallucination
human
hypertension
hypokalemia
kidney function
laughter
male
neurologic disease
nystagmus
physical examination
priority journal
sinus tachycardia
thorax radiography
young adult
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
creatine kinase (9001-15-4)
dextromethorphan (125-69-9, 125-71-3)
naloxone (357-08-4, 465-65-6)
phencyclidine (77-10-1, 956-90-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160482104
PUI
L610990371
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 322
TITLE
Carbamazepine and carbamazepine-10,11-epoxide clearance measurements during
continuous venovenous hemofiltration in a massive overdose
AUTHOR NAMES
Smollin C.G.
Petrie M.S.
Kearney T.
AUTHOR ADDRESSES
(Smollin C.G., craig.smollin@emergency.ucsf.edu) Department of Emergency
Medicine, University of California San Francisco, 1001 Potrero Ave, San
Francisco, United States.
(Petrie M.S.) TPMG Regional Laboratories, Berkeley, United States.
(Kearney T.) School of Pharmacy, University of California San Francisco, San
Francisco, United States.
CORRESPONDENCE ADDRESS
C.G. Smollin, Department of Emergency Medicine, University of California San
Francisco, 1001 Potrero Ave, San Francisco, United States. Email:
craig.smollin@emergency.ucsf.edu
SOURCE
Clinical Toxicology (2016) 54:5 (424-427). Date of Publication: 27 May 2016
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Introduction: Carbamazepine (CBZ) overdose can result in significant
neurologic and cardiovascular toxicity, and is compounded by the presence of
an active metabolite, carbamazepine-10,11-epoxide (CBZE). Existing
publications describing continuous venovenous hemofiltration (CVVH) in CBZ
overdose are limited in their ability to calculate accurate clearances. We
report a case of CBZ overdose treated with CVVH with detailed measurement of
CBZ, CBZE and their respective clearances calculated utilizing serial
effluent measurements. This was coupled with serum level determinations
comparing two analytical methodologies, time-of-flight mass spectroscopy and
an immunoassay. Case details: A 41-year-old woman presented unresponsive
after an overdose of CBZ. Initial CBZ serum levels were markedly elevated
(57.8 g/mL) and continued to rise. Due to continued hemodynamic instability,
extracorporeal removal was initiated using CVVH. Materials and methods:
During the first 30 h of CVVH, interval serum samples and all ultrafiltrate
bags were collected and analyzed. Serum and effluent levels of CBZ and CBZE
were measured using an Agilent 6230 time-of-flight high-resolution mass
spectrometer (TOF-MS). CBZ levels were also obtained utilizing the
Microgenics CEDIA Carbamazepine Immunoassay (Thermo Fisher, Waltham, MA) for
serum and effluent samples. Immunoassay analysis was performed using Siemens
ADVIA 1800 instrument. Results: The clearances achieved for CBZE (mean =
25.2, range 17.7-42.6 mL/min) exceeded that for CBZ (mean = 18.1, range
12.7-28.7 mL/min). CVVH removed a total of 1293 and 1261 mg of CBZ and CBZE,
respectively. Serum levels of CBZ measured by immunoassay when compared with
TOF-MS indicated cross reactivity of CBZE with the immunoassay. Conclusions:
CVVH removed CBZE with higher clearances than CBZ. However, CVVH clearance
rates for both CBZ and CBZE were lower than published clearances of CBZ and
CBZE by intermittent hemodialysis. Our methodology allowed for a precise
pharmacokinetic assessment of clearance based on total quantity of parent
drug and active metabolite removed. Use of an immunoassay to determine CBZ
serum levels reflects both parent compound and active metabolite due to
cross-reactivity with CBZE.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carbamazepine (drug toxicity)
carbamazepine 10,11 oxide (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
bicarbonate
creatinine (endogenous compound)
epinephrine
glucagon
methamphetamine
naloxone
phenylephrine
valproic acid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
continuous hemofiltration
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
acidosis
adult
article
blood clotting disorder
brain injury
case report
compartment syndrome
creatinine blood level
drug clearance
electrocardiogram
emergency ward
fasciotomy
female
fluid balance
Glasgow coma scale
heart arrest
heart right bundle branch block
hemodynamics
human
hypertransaminasemia
hypotension
immunoassay
intensive care unit
measurement accuracy
mortality
neurologic examination
resuscitation
return of spontaneous circulation
telemetry
time of flight mass spectrometry
urinalysis
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
carbamazepine (298-46-4, 8047-84-5)
carbamazepine 10,11 oxide (36507-30-9)
creatinine (19230-81-0, 60-27-5)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Urology and Nephrology (28)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160232755
MEDLINE PMID
26942940 (http://www.ncbi.nlm.nih.gov/pubmed/26942940)
PUI
L609149067
DOI
10.3109/15563650.2016.1148721
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2016.1148721
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 323
TITLE
Qualitative assessment of take-home naloxone program participant and law
enforcement interactions in British Columbia
AUTHOR NAMES
Deonarine A.
Amlani A.
Ambrose G.
Buxton J.A.
AUTHOR ADDRESSES
(Deonarine A.; Amlani A.; Ambrose G.; Buxton J.A., jane.buxton@bccdc.ca)
University of British Columbia, School of Population and Public Health, 2206
East Mall, Vancouver, Canada.
(Ambrose G.; Buxton J.A., jane.buxton@bccdc.ca) BC Centre for Disease
Control, 655 West 12th Avenue, Vancouver, Canada.
CORRESPONDENCE ADDRESS
J.A. Buxton, University of British Columbia, School of Population and Public
Health, 2206 East Mall, Vancouver, Canada. Email: jane.buxton@bccdc.ca
SOURCE
Harm Reduction Journal (2016) 13:1 Article Number: 17. Date of Publication:
21 May 2016
ISSN
1477-7517 (electronic)
BOOK PUBLISHER
BioMed Central Ltd., info@biomedcentral.com
ABSTRACT
Background: The British Columbia take-home naloxone (BCTHN) program has been
in operation since 2012 and has resulted in the successful reversal of over
581 opioid overdoses. The study aims to explore BCTHN program participant
perspectives about the program, barriers to participants contacting
emergency services (calling "911") during an overdose, and perspectives of
law enforcement officials on naloxone administration by police officers.
Methods: Two focus groups and four individual interviews were conducted with
BCTHN program participants; interviews with two law enforcement officials
were also conducted. Qualitative analysis of all transcripts was performed.
Results: Positive themes about the BCTHN program from participants included
easy to understand training, correcting misperceptions in the community, and
positive interactions with emergency services. Potential barriers to
contacting emergency services during an overdose include concerns about
being arrested for outstanding warrants or for other illegal activities
(such as drug possession) and confiscation of kits. Law enforcement
officials noted that warrants were complex situational issues, kits would
normally not be confiscated, and admitted arrests for drug possession or
other activities may not serve the public good in an overdose situation. Law
enforcement officials were concerned about legal liability and
jurisdictional/authorization issues if naloxone administration privileges
were expanded to police. Conclusions: Program participants and law
enforcement officials expressed differing perspectives about warrants, kit
confiscation, and arrests. Facilitating communication between BCTHN program
participants and other stakeholders may address some of the confusion and
remove potential barriers to further improving program outcomes. Naloxone
administration by law enforcement would require policies to address
jurisdiction/authorization and liability issues.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health program
law enforcement
take home naloxone program
EMTREE MEDICAL INDEX TERMS
adult
article
British Columbia
community integration
detention
emergency health service
female
human
in service training
intoxication
legal liability
male
opiate addiction
police
public opinion
qualitative research
reading
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160384977
MEDLINE PMID
27206486 (http://www.ncbi.nlm.nih.gov/pubmed/27206486)
PUI
L610404485
DOI
10.1186/s12954-016-0106-1
FULL TEXT LINK
http://dx.doi.org/10.1186/s12954-016-0106-1
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 324
TITLE
Amorphous Formulation and in Vitro Performance Testing of Instantly
Disintegrating Buccal Tablets for the Emergency Delivery of Naloxone
AUTHOR NAMES
Alqurshi A.
Kumar Z.
McDonald R.
Strang J.
Buanz A.
Ahmed S.
Allen E.
Cameron P.
Rickard J.A.
Sandhu V.
Holt C.
Stansfield R.
Taylor D.
Forbes B.
Royall P.G.
AUTHOR ADDRESSES
(Alqurshi A.; Kumar Z.; Taylor D.; Forbes B.; Royall P.G.,
paul.royall@kcl.ac.uk) Institute of Pharmaceutical Science, King's College
London, Franklin-Wilkins Building, 150 Stamford Street, London, United
Kingdom.
(McDonald R.; Strang J.) Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, National Addiction Centre,
Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, United
Kingdom.
(Buanz A.) UCL School of Pharmacy, University College London, 29-39
Brunswick Square, London, United Kingdom.
(Ahmed S.; Allen E.) Quintiles Ltd, Quintiles Drug Research Unit at Guy's
Hospital, 6 Newcomen Street, London, United Kingdom.
(Cameron P.; Rickard J.A.; Sandhu V.; Holt C.; Stansfield R.) Guy's and St
Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital,
Great Maze Pond, London, United Kingdom.
CORRESPONDENCE ADDRESS
P.G. Royall, Institute of Pharmaceutical Science, King's College London,
Franklin-Wilkins Building, 150 Stamford Street, London, United Kingdom.
Email: paul.royall@kcl.ac.uk
SOURCE
Molecular Pharmaceutics (2016) 13:5 (1688-1698). Date of Publication: 2 May
2016
ISSN
1543-8392 (electronic)
1543-8384
BOOK PUBLISHER
American Chemical Society, service@acs.org
ABSTRACT
The aim of this study was to develop a freeze-dried buccal tablet for the
rapid delivery of naloxone in opioid overdose. The tablet composition was
optimized to produce an amorphous matrix, which was confirmed by the absence
of peaks associated with crystallinity observed by differential scanning
calorimetry and powder X-ray diffraction. Tablets with high gelatin content
lacked adequate porosity. Mannitol was added to the formulation to bridge
and intercalate gelatin's tight polymer aggregates, however sodium
bicarbonate was also required to prevent crystallization within the tablets.
A linear reduction in mannitol's recrystallization enthalpy was observed
with increasing sodium bicarbonate concentration (δ(recry)H =
-20.3[NaHCO(3)] + 220.9; r(2) = 0.9, n = 18). The minimum sodium bicarbonate
concentration for full inhibition of mannitol crystallization was 10.9% w/w.
Freeze-dried tablets with lower amounts of sodium bicarbonate possessed a
crystalline fraction that PXRD identified as mannitol hemihydrate from the
unique peak at 9.7° 2θ. Mannitol's greater affinity for both ions and
residual water rather than its affinity for self-association was the
mechanism for the inhibition of crystallization observed here. The optimized
tablet (composition mannitol 24% w/w (4.26 mg), gelatin 65% w/w (11.7 mg),
sodium bicarbonate 11% w/w (1.98 mg), and naloxone 800 μg) formed
predominantly amorphous tablets that disintegrated in less than 10 s.
Optimized tablets were chemically and physically stable over 9 months
storage at 25 °C. As speed of drug liberation is the critical performance
attribute for a solid dosage form designed to deliver drug in an emergency,
a novel imaging based in vitro disintegration assay for buccal tablets was
developed. The assay was optimized with regard to conditions in the buccal
cavity: i.e., temperature 33-37 °C, volume of medium (0.1-0.7 mL), and use
of mucin-containing biorelevant medium. The disintegration assay was
sensitive to temperature, medium volume, and medium composition; naloxone
tablet disintegration was extremely rapid, with full disintegration ranging
from 5 to 20 s. In conclusion, rapidly disintegrating tablets have been
developed which are suitable for proof-of-concept clinical trial in humans
to determine the pharmacokinetics of naloxone delivered via the buccal
route.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (pharmaceutics)
EMTREE DRUG INDEX TERMS
bicarbonate
gelatin
mannitol
mucin
water
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug delivery system
tablet disintegration
tablet formulation
EMTREE MEDICAL INDEX TERMS
article
crystallization
differential scanning calorimetry
drug release
drug stability
freeze drying
glass transition temperature
in vitro study
mouth cavity
physical chemistry
porosity
priority journal
X ray powder diffraction
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
gelatin (9000-70-8)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
water (7732-18-5)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160375937
MEDLINE PMID
26977787 (http://www.ncbi.nlm.nih.gov/pubmed/26977787)
PUI
L610312557
DOI
10.1021/acs.molpharmaceut.6b00096
FULL TEXT LINK
http://dx.doi.org/10.1021/acs.molpharmaceut.6b00096
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 325
TITLE
Overlapping mechanisms of stress-induced relapse to opioid use disorder and
chronic pain: Clinical implications
AUTHOR NAMES
Ghitza U.E.
AUTHOR ADDRESSES
(Ghitza U.E., ghitzau@nida.nih.gov) U.S. Department of Health and Human
Services (HHS), Center for the Clinical Trials Network (CCTN), National
Institute on Drug Abuse (NIDA), National Institutes of Health (NIH),
Bethesda, United States.
CORRESPONDENCE ADDRESS
U.E. Ghitza, U.S. Department of Health and Human Services (HHS), Center for
the Clinical Trials Network (CCTN), National Institute on Drug Abuse (NIDA),
National Institutes of Health (NIH), Bethesda, United States. Email:
ghitzau@nida.nih.gov
SOURCE
Frontiers in Psychiatry (2016) 7:MAY Article Number: 80. Date of
Publication: 2 May 2016
ISSN
1664-0640 (electronic)
BOOK PUBLISHER
Frontiers Research Foundation, info@frontiersin.org
ABSTRACT
Over the past two decades, a steeply growing number of persons with chronic
non-cancer pain have been using opioid analgesics chronically to treat it,
accompanied by a markedly increased prevalence of individuals with
opioid-related misuse, opioid use disorders, emergency department visits,
hospitalizations, admissions to drug treatment programs, and drug overdose
deaths. This opioid misuse and overdose epidemic calls for well-designed
randomized-controlled clinical trials into more skillful and appropriate
pain management and for developing effective analgesics that have lower
abuse liability and are protective against stress induced by chronic
non-cancer pain. However, incomplete knowledge regarding effective
approaches to treat various types of pain has been worsened by an
under-appreciation of overlapping neurobiological mechanisms of stress,
stress-induced relapse to opioid use, and chronic non-cancer pain in
patients presenting for care for these conditions. This insufficient
knowledge base has unfortunately encouraged common prescription of
conveniently available opioid pain-relieving drugs with abuse liability, as
opposed to treating underlying problems using team-based multidisciplinary,
patient-centered, collaborative-care approaches for addressing pain and
co-occurring stress and risk for opioid use disorder. This paper reviews
recent neurobiological findings regarding overlapping mechanisms of
stress-induced relapse to opioid misuse and chronic non-cancer pain, and
then discusses these in the context of key outstanding evidence gaps and
clinical-treatment research directions that may be pursued to fill these
gaps. Such research directions, if conducted through well-designed
randomized-controlled trials, may substantively inform clinical practice in
general medical settings on how to effectively care for patients presenting
with pain-related distress and these common co-occurring conditions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
opiate addiction
relapse
stress
EMTREE MEDICAL INDEX TERMS
clinical effectiveness
comorbidity
correlational study
drug seeking behavior
human
neurobiology
patient care
personalized medicine
short survey
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160475883
PUI
L610905815
DOI
10.3389/fpsyt.2016.00080
FULL TEXT LINK
http://dx.doi.org/10.3389/fpsyt.2016.00080
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 326
TITLE
Characteristics of heroin-dependent patients seeking asthma care in the ED
AUTHOR NAMES
Weeks M.A.
Clark E.P.
Mycyk M.B.
AUTHOR ADDRESSES
(Weeks M.A.; Clark E.P.; Mycyk M.B., mmycyk@cookcountyhhs.org) Cook County
Health, And Hospitals System, Department of Emergency Medicine, 1900 West
Polk Street, Chicago, United States.
CORRESPONDENCE ADDRESS
M.B. Mycyk, Cook County Health, And Hospitals System, Department of
Emergency Medicine, 1900 West Polk Street, Chicago, United States. Email:
mmycyk@cookcountyhhs.org
SOURCE
American Journal of Emergency Medicine (2016) 34:5 (895-898). Date of
Publication: 1 May 2016
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Background Limited data suggest that heroin worsens asthma severity, but
little is known about heroin-dependent patients who seek emergency
department (ED) care for asthma. Objectives To describe what
heroin-dependent patients know about their asthma and how they use health
care resources. Methods A prospective study of heroin-dependent patients
seeking care for "asthma" at an urban ED with 130 000 annual visits was
conducted. Eligible subjects were English-speaking heroin-dependent adults
seeking care for mild to moderate asthma symptoms. A closed-format survey
instrument to assess opioid use, asthma knowledge, and health care use was
developed by content experts, piloted for study performance, revised, and
then administered to eligible patients prior to ED discharge. Descriptive
analysis was done. Results Thirty subjects participated. Mean age was 47.5
years; 21 (70%) were male. Most used heroin several times weekly. Intranasal
was the most common route (93%). Almost half (47%) stated that their asthma
was diagnosed in the ED, 13% by a primary care physician, 13% by a lung
specialist, and 27% did not know how diagnosed. The ED was used as the
primary source for asthma medications in 73% cases; 43% used the ED for
breathing issues at least once per month. Most subjects (77%) felt that
heroin worsened their asthma symptoms. Only 7 (23%) also abused prescription
opioids, and only 7 (23%) knew about prescription naloxone. Conclusion
Patients with heroin dependence frequently use the ED for their health care
needs related to asthma. Most do not have other health care providers, most
have limited health literacy, and all would benefit from referral to a
primary care provider and substance abuse resources.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
EMTREE DRUG INDEX TERMS
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
asthma
emergency ward
heroin dependence
EMTREE MEDICAL INDEX TERMS
adult
article
breathing disorder
clinical article
disease severity
female
health care need
human
male
pilot study
prescription
priority journal
prospective study
substance abuse
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160227597
MEDLINE PMID
26947370 (http://www.ncbi.nlm.nih.gov/pubmed/26947370)
PUI
L609111661
DOI
10.1016/j.ajem.2016.02.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2016.02.005
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 327
TITLE
Increased burden of healthcare utilization and cost associated with
opioid-related constipation among patients with noncancer pain
AUTHOR NAMES
Fernandes A.W.
Kern D.M.
Datto C.
Chen Y.-W.
McLeskey C.
Tunceli O.
AUTHOR ADDRESSES
(Fernandes A.W.) Health Outcomes and Pharmacoeconomics, AstraZeneca
Pharmaceuticals LP, Gaithersburg, United States.
(Kern D.M.) HealthCore, Inc, United States.
(Datto C.) AstraZeneca Pharmaceuticals LP, United States.
(Chen Y.-W.; McLeskey C.) AstraZeneca Pharmaceuticals LP, United States.
(Tunceli O.) HealthCore, Inc, Wilmington, United States.
SOURCE
American Health and Drug Benefits (2016) 9:3 (160-169). Date of Publication:
1 May 2016
ISSN
1942-2970 (electronic)
1942-2962
BOOK PUBLISHER
Engage Healthcare Communications, Inc., nick@engagehc.com
ABSTRACT
BACKGROUND: Opioids are widely accepted as treatment for moderate to severe
pain, and opioid-induced constipation is one of the most common side effects
of opioids. This side effect negatively affects pain management and
patients’ quality of life, which could result in increased healthcare
utilization and costs. OBJECTIVE: To assess healthcare utilization and costs
(all-cause, constipation-related, and pain-related) for individuals with and
without opioid-induced constipation during the 12 months after initiation of
opioid therapy for noncancer pain. METHODS: This retrospective cohort study
was conducted using administrative claims data from HealthCore Integrated
Research Environment between January 1, 2006, and June 30, 2014. The
analysis was limited to patients aged ≥18 years who filled a prescription
for continuous opioid treatment (≥28 days) for noncancer pain. Propensity
scores were used to match opioid users with constipation (cohort 1) and
opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized
linear models were used to estimate all-cause, constipation-related, and
pain-related healthcare utilization and costs during the 12 months after the
initiation of opioid therapy. RESULTS: After matching and balancing for all
prespecified variables, 17,384 patients were retained in each cohort (mean
age, 56 years; 63% female). Opioid users with constipation were twice as
likely as those without constipation to have ≥1 inpatient hospitalizations
(odds ratio, 2.28; 95% confidence interval [CI], 2.17-2.39) during the 12
months. The total mean adjusted overall costs per patient during the study
period were $12,413 higher for patients with constipation versus those
without it (95% CI, $11,726-$13,116). The total mean adjusted overall
pain-related costs per patient were $6778 (95% CI, $6293-$7279) higher for
the patients with constipation than those without. Among patients using
opioids for noncancer pain, the annual mean constipation-related costs per
patient totaled $4646 (total average plan-paid costs, $4424; total
patient-paid costs, $222). CONCLUSIONS: Patients using opioids with newly
diagnosed constipation had significantly greater healthcare utilization and
costs than patients without constipation; these costs accounted for
approximately 16% of the total healthcare costs per patient during the
12-month study period. Recognition and effective treatment of opioid-induced
constipation may decrease healthcare utilization for patients with chronic
noncancer pain and may reduce the economic burden of pain therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacoeconomics)
EMTREE DRUG INDEX TERMS
dextropropoxyphene
methadone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic noncancer pain
chronic pain
constipation
health care utilization
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
cohort analysis
diabetes mellitus
emergency ward
female
health care cost
hospitalization
human
hypertension
major clinical study
male
opiate addiction
quality of life
retrospective study
sensitivity analysis
CAS REGISTRY NUMBERS
dextropropoxyphene (1639-60-7, 469-62-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160424300
PUI
L610638995
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 328
TITLE
AHA updates guidelines for CPR and emergency cardiovascular care
AUTHOR NAMES
Hauk L.
AUTHOR ADDRESSES
(Hauk L.)
SOURCE
American Family Physician (2016) 93:9 (796-797). Date of Publication: 1 May
2016
ISSN
1532-0650 (electronic)
0002-838X
BOOK PUBLISHER
American Academy of Family Physicians, foundation@aafp.org
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
acute coronary syndrome
artificial ventilation
cardiovascular procedure
electrocardiography
emergency health service
heart arrest
human
medical society
note
opiate addiction
oxygen therapy
positive end expiratory pressure
respiratory arrest
resuscitation
spine injury
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160342531
MEDLINE PMID
27175962 (http://www.ncbi.nlm.nih.gov/pubmed/27175962)
PUI
L610200768
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 329
TITLE
Resident Decision Making: Opioids in the Outpatient Setting
AUTHOR NAMES
Siegler J.E.
Kable J.W.
Chatterjee A.
AUTHOR ADDRESSES
(Siegler J.E.; Kable J.W.; Chatterjee A.)
SOURCE
Journal of graduate medical education (2016) 8:2 (138-141). Date of
Publication: 1 May 2016
ISSN
1949-8357 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
decision making
medical education
EMTREE MEDICAL INDEX TERMS
chronic pain (diagnosis, drug therapy)
health personnel attitude
hospital emergency service
human
opiate addiction (prevention)
outpatient
psychology
LANGUAGE OF ARTICLE
English
MEDLINE PMID
27168876 (http://www.ncbi.nlm.nih.gov/pubmed/27168876)
PUI
L615866563
DOI
10.4300/JGME-D-15-00186.1
FULL TEXT LINK
http://dx.doi.org/10.4300/JGME-D-15-00186.1
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 330
TITLE
New opioid prescribing guidelines favor non-opioid alternatives
AUTHOR ADDRESSES
SOURCE
ED management : the monthly update on emergency department management (2016)
28:5 (54-57). Date of Publication: 1 May 2016
ISSN
1044-9167
ABSTRACT
Determined to make a dent in the growing problem of opioid addiction, the
CDC has unveiled new guidelines for opioid prescribing for chronic pain. The
recommendations urge providers to be more judicious in their prescribing,
opting for opioids only after carefully weighing substantial risks and
benefits. Public health authorities note the rampant use and misuse of
opioids have "blurred the lines" between prescription opioids and illicit
opioids. The new guidelines are designed to help frontline providers balance
the need to manage their patients' chronic pain with the duty to curb
dangerous prescribing practices. The recommendations are built around three
principles: favor non-opioid alternatives for most cases of chronic pain,
use the lowest effective dose when prescribing opioids, and exercise
caution/monitor patients who are treated with opioids.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
practice guideline
EMTREE MEDICAL INDEX TERMS
drug overdose (prevention)
emergency health service
human
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27266000 (http://www.ncbi.nlm.nih.gov/pubmed/27266000)
PUI
L611382646
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 331
TITLE
The Opioid Epidemic in the United States
AUTHOR NAMES
Wilkerson R.G.
Kim H.K.
Windsor T.A.
Mareiniss D.P.
AUTHOR ADDRESSES
(Wilkerson R.G., gwilkerson@em.umaryland.edu; Kim H.K.; Windsor T.A.;
Mareiniss D.P.) Department of Emergency Medicine, University of Maryland
School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore,
United States.
CORRESPONDENCE ADDRESS
R.G. Wilkerson, Department of Emergency Medicine, University of Maryland
School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore,
United States. Email: gwilkerson@em.umaryland.edu
SOURCE
Emergency Medicine Clinics of North America (2016) 34:2 (e1-e23). Date of
Publication: 1 May 2016
ISSN
0733-8627
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
naloxone (adverse drug reaction, drug therapy, inhalational drug
administration, intramuscular drug administration, intranasal drug
administration, intraosseous drug administration, pharmacology, subcutaneous
drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, disease management, drug therapy,
epidemiology)
EMTREE MEDICAL INDEX TERMS
analgesia
chronic constipation (side effect)
clinical practice
cost of illness
criminal justice
delirium (side effect)
drug intoxication (drug therapy)
drug misuse
drug overdose
drug safety
emergency care
emergency health service
health hazard
heart arrhythmia (side effect)
heroin dependence (disease management, epidemiology)
home care
human
intravenous drug abuse
medicolegal aspect
pain (drug therapy)
patient education
prescription
priority journal
public health service
respiratory distress (side effect)
review
risk factor
seizure (side effect)
short bowel syndrome (side effect)
trend study
United States
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160134899
MEDLINE PMID
27133253 (http://www.ncbi.nlm.nih.gov/pubmed/27133253)
PUI
L608400227
DOI
10.1016/j.emc.2015.11.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2015.11.002
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 332
TITLE
Intoxications involving the fentanyl analogs acetylfentanyl,
4-methoxybutyrfentanyl and furanylfentanyl: Results from the Swedish STRIDA
project
AUTHOR NAMES
Helander A.
Bäckberg M.
Beck O.
AUTHOR ADDRESSES
(Helander A., anders.helander@ki.se; Beck O.) Department of Laboratory
Medicine, Karolinska Institutet, Stockholm, Sweden.
(Helander A., anders.helander@ki.se; Beck O.) Department of Clinical
Pharmacology, C1:74, Karolinska University Laboratory, Huddinge, Stockholm,
Sweden.
(Bäckberg M.) Swedish Poisons Information Centre, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A. Helander, Department of Clinical Pharmacology, C1:74, Karolinska
University Laboratory, Huddinge, Stockholm, Sweden. Email:
anders.helander@ki.se
SOURCE
Clinical Toxicology (2016) 54:4 (324-332). Date of Publication: 20 Apr 2016
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Background: Potent and potentially harmful new psychoactive substances (NPS)
are continuously introduced on the recreational drugs market. This report
from the Swedish STRIDA project describes analytically confirmed cases of
intoxication involving the fentanyl analogs acetylfentanyl,
4-methoxybutyrfentanyl, and furanylfentanyl. Methods: Patients with
suspected NPS exposure presenting in emergency departments and intensive
care units in Sweden and requiring hospital care are invited to the STRIDA
project. Toxicological analysis of serum and urine samples was performed by
multi-component liquid chromatographic-mass spectrometric methods. Data on
clinical features were retrieved from telephone consultations with the
Swedish Poisons Information Centre and from medical records. Results:
Between April and November 2015, 14 analytically confirmed intoxications
involving acetylfentanyl (nine cases), 4-methoxybutyrfentanyl (3),
furanylfentanyl (1), and 4-methoxybutyrfentanyl together with
furanylfentanyl (1) were identified. The patients were aged 20-40 (mean
28.5) years and 86% were men. Twelve patients (86%) were admitted to
intensive care, where two required intubation and mechanical ventilation.
Typical clinical features were decreased consciousness, respiratory
depression, and miosis. In eight cases, the antidote naloxone was
administered to counter the effects. The serum acetylfentanyl concentration
(N = 7) was 0.6-51.6 (mean 18.3 and median 14.8) ng/mL, and in urine (N = 8)
0.1-686 (mean 155 and median 66.6) ng/mmol creatinine. The serum
4-methoxybutyrfentanyl concentration (N = 2) was 1.3 and 3.1 ng/mL, and
5.1-51.3 ng/mmol creatinine in urine (N = 3). For furanylfentanyl, the serum
concentrations were 4.4 and 148 ng/mL and in urine 9.2 and 85 ng/mmol
creatinine, respectively. In 13 cases (93%), other NPS and/or classical
drugs were also detected. Drug products brought to hospital by patients
contained acetylfentanyl (nasal spray and pink tablet),
4-methoxybutyrfentanyl (green tablet), furanylfentanyl/traces of
4-methoxybutyrfentanyl (nasal spray), and 4-fluorobutyrfentanyl (purple
tablet). Conclusion: Potentially life-threatening opioid toxicity was seen
in acute intoxications involving acetylfentanyl, 4-methoxybutyrfentanyl, and
furanylfentanyl. Intensive care treatment for one month was necessary in one
acetylfentanyl case and one acetylfentanyl patient died from cerebral
hemorrhage.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 methoxybutyrfentanyl (drug concentration, drug toxicity)
acetylfentanyl (drug concentration, drug toxicity)
fentanyl derivative (drug concentration, drug toxicity)
furanylfentanyl (drug concentration, drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical article
clinical feature
consciousness
drug blood level
emergency ward
female
human
intensive care unit
liquid chromatography
male
mass spectrometry
miosis
respiration depression
Sweden
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160147416
MEDLINE PMID
26850293 (http://www.ncbi.nlm.nih.gov/pubmed/26850293)
PUI
L608510898
DOI
10.3109/15563650.2016.1139715
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2016.1139715
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 333
TITLE
Traditional and new drugs of abuse - Management of acute emergency cases
ORIGINAL (NON-ENGLISH) TITLE
Alte und neue Drogen - Vorgehen im Notfall
AUTHOR NAMES
Desel H.
Müller D.
AUTHOR ADDRESSES
(Desel H.; Müller D., d.mueller@med.uni-goettingen.de)
Klinisch-toxikologisches Labor, Giftinformationszentrum- Nord der Länder
Bremen, Hamburg, Niedersachsen und Schleswig-Holstein, Universitätsmedizin
Göttingen, Robert-Koch-Straße 40, Göttingen, Germany.
CORRESPONDENCE ADDRESS
D. Müller, Klinisch-toxikologisches Labor, Giftinformationszentrum- Nord der
Länder Bremen, Hamburg, Niedersachsen und Schleswig-Holstein,
Universitätsmedizin Göttingen, Robert-Koch-Straße 40, Göttingen, Germany.
Email: d.mueller@med.uni-goettingen.de
SOURCE
Anasthesiologie und Intensivmedizin (2016) 57:4 (182-194). Date of
Publication: 1 Apr 2016
ISSN
1439-0256 (electronic)
0170-5334
BOOK PUBLISHER
DIOmed Verlags GmbH, info@diomed.de
ABSTRACT
Emergency incidences caused by drugs of abuse are frequent events. The
majority of cases treated by medical services in Germany are ethanol
poisonings, whereas severe methanol poisoning is rare. Many analgesics can
cause an opioid toxidrome characterised by sedation and high risk for
respiratory depression, while overdosing of gammahydroxybutyrate or
benzodiazepines cause sedation, but rarely lead to respiratory failure.
Cocaine, amphetamines, and the withdrawal of alcohol or opioids stimulate
the central and the peripheral nervous system. Treatment of acute drug
poisonings is symptomatic in most cases. Excitation states and generalised
seizures are even treated with high doses of a benzodiazepine. Specifically
acting antidotes are available for methanol poisoning (fomepizole), opioid
poisoning (naloxone) and benzodiazepine overdose (flumazenil). However,
treatment with naloxone or flumazenil may induce severe withdrawal symptoms
in patients adapted to the drug.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
new drug
EMTREE DRUG INDEX TERMS
4 methylpyrazole
amphetamine derivative
analgesic agent
benzodiazepine
benzodiazepine derivative
cocaine
flumazenil
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
alcohol intoxication
alcohol withdrawal syndrome
central nervous system
drug intoxication
drug megadose
emergency care
emergency patient
Germany
human
methanol poisoning
peripheral nervous system
respiration depression
respiratory failure
review
sedation
tonic clonic seizure
withdrawal syndrome
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
20160388369
PUI
L610465418
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 334
TITLE
Development and initial testing of a tailored telephone intervention
delivered by peers to prevent recurring opioid-overdoses (TTIP-PRO)
AUTHOR NAMES
Winhusen T.
Theobald J.
Lewis D.
Wilder C.M.
Lyons M.S.
AUTHOR ADDRESSES
(Winhusen T., winhusen@carc.uc.edu) Addiction Sciences Division, Department
of Psychiatry and Behavioral Neuroscience, University of Cincinnati College
of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA,
(Theobald J.; Lewis D.) Addiction Sciences Division, Department of
Psychiatry and Behavioral Neuroscience, University of Cincinnati College of
Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA
(Wilder C.M.) Addiction Sciences Division, Department of Psychiatry and
Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131
Harvey Avenue, Cincinnati, OH 45229, USA, Cincinnati Veterans Affairs
Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA and
(Lyons M.S.) Department of Emergency Medicine, University of Cincinnati
College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA
SOURCE
Health education research (2016) 31:2 (146-160). Date of Publication: 1 Apr
2016
ISSN
1465-3648 (electronic)
ABSTRACT
Individuals with opioid use disorder experiencing a non-fatal
opioid-overdose (OOD) are at heightened risk for future OODs; there are no
interventions to facilitate treatment enrollment for these patients. Our
goal was to develop and initially test the 'tailored telephone intervention
delivered by peers to prevent recurring opioid-overdoses' (TTIP-PRO), a
computer-facilitated, peer-delivered, individually tailored secondary
prevention intervention designed to: (i) encourage patients to initiate
medication-assisted treatment (MAT) and (ii) increase OOD knowledge. A
pre-post-study assessed TTIP-PRO-content acceptability and software
performance. Two Peer Interventionists, who were abstinent from illicit
opioids, enrolled in MAT and had experience with OOD, were recruited from a
MAT clinic. Recruitment letters were sent to patients treated for OOD in a
hospital emergency department within the prior 8 months. Eight patients
received TTIP-PRO and completed pre-/post-assessment. Peer Interventionists
completed training within 4 h and reported high satisfaction with TTIP-PRO.
There were no performance issues with the software. All participants rated
TTIP-PRO as 'very helpful'. Participants' OOD knowledge increased
significantly, with 69.9% correct responses pre-TTIP-PRO and 93.6%
post-TTIP-PRO. Interest in receiving MAT, measured on a 10-point scale,
increased from 8.1 to 9.5, but this change was not statistically
significant. Further development and testing of TTIP-PRO appears warranted.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
peer group
procedures
telephone
EMTREE MEDICAL INDEX TERMS
adult
attitude to health
comorbidity
drug dependence (drug therapy)
drug overdose (prevention)
female
health education
health status
human
male
opiate addiction (drug therapy)
opiate substitution treatment
organization and management
risk factor
secondary prevention
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT02282306)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
27004905 (http://www.ncbi.nlm.nih.gov/pubmed/27004905)
PUI
L614892784
DOI
10.1093/her/cyw010
FULL TEXT LINK
http://dx.doi.org/10.1093/her/cyw010
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 335
TITLE
Probable tapentadol-associated serotonin syndrome after overdose
AUTHOR NAMES
Walczyk H.
Liu C.H.
Alafris A.
Cohen H.
AUTHOR ADDRESSES
(Walczyk H.) SeaView Research, Miami, United States.
(Liu C.H., cheukheimichael.liu@ynhh.org) Department of Pharmacy, Yale-New
Haven Hospital, New Haven, United States.
(Alafris A.) Department of Pharmacy, St. Barnabas Hospital, Bronx, United
States.
(Cohen H.) Department of Pharmacy Services, Kingsbrook Jewish Medical
Center, Arnold and Marie Schwartz College of Pharmacy and Health Sciences,
Long Island University, Division of Pharmacy Practice, Brooklyn, United
States.
CORRESPONDENCE ADDRESS
C.H. Liu, Department of Pharmacy, Yale-New Haven Hospital, 20 York Street,
New Haven, United States. Email: cheukheimichael.liu@ynhh.org
SOURCE
Hospital Pharmacy (2016) 51:4 (320-327). Date of Publication: 1 Apr 2016
ISSN
1945-1253 (electronic)
0018-5787
BOOK PUBLISHER
Thomas Land Publishers Inc.
ABSTRACT
Purpose: Drug-induced serotonin syndrome is a potentially life-threatening
condition. An Ovid MEDLINE, and PubMed search from 1950 to October 2015
revealed one published case report of suspected tapentadol-induced serotonin
syndrome. We report a probable case of tapentadol-induced serotonin syndrome
after overdose. Case Summary: A 48-year-old male was found unresponsive
after a witnessed overdose of medications including tapentadol. After
administration of naloxone by emergency medical services, the patient became
combative and presented with altered mental status. He was managed with
physical and pharmacologic restraints in the emergency department. Other
medications that could be implicated in the patient's presentation include
duloxetine and amitriptyline. It was suspected that the opioid properties of
tapentadol were masking the patient's signs and symptoms of serotonin
syndrome. The patient was admitted to the medical intensive care unit,
remained stable, and was discharged 2 days later. Currently, there is one
published case report of suspected tapentadol-induced serotonin syndrome
after an overdose. The manufacturer of tapentadol reported no cases of
serotonin syndrome during clinical trials, but there have been postmarketing
cases reported with co-administration of other serotonergic drugs.
Conclusion: We report a probable case of tapentadol-induced serotonin
syndrome after overdose. Further research is needed to better understand the
pharmacology and incidence behind this adverse event.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
tapentadol (drug therapy, drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
amitriptyline (drug therapy, oral drug administration)
atenolol (drug therapy, oral drug administration)
duloxetine (drug therapy, oral drug administration)
enalapril (drug therapy, oral drug administration)
esomeprazole (drug therapy, oral drug administration)
methadone (drug therapy, oral drug administration)
naloxone (drug therapy, intramuscular drug administration)
oxycodone
simvastatin (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
serotonin syndrome (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
backache (drug therapy)
case report
chronic pain (drug therapy)
drug overdose
emergency health service
emergency ward
gastroesophageal reflux (drug therapy)
Glasgow coma scale
human
hyperlipidemia (drug therapy)
hypertension (drug therapy)
incidence
major depression (drug therapy)
male
medical intensive care unit
mental health
middle aged
postmarketing surveillance
symptomatology
DRUG TRADE NAMES
cymbalta
elavil
methadose
nexium
nucynta
oxycontin
tenormin
vasotec
zocor
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
atenolol (29122-68-7, 93379-54-5)
duloxetine (116539-59-4, 136434-34-9)
enalapril (75847-73-3)
esomeprazole (119141-88-7, 202742-32-3, 217087-09-7, 217087-10-0,
161796-84-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
simvastatin (79902-63-9)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170422270
PUI
L616750942
DOI
10.1310/hpj5104-320
FULL TEXT LINK
http://dx.doi.org/10.1310/hpj5104-320
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 336
TITLE
Author response to "Impact of survival bias on opioid-related outcomes when
using death as an exclusion criterion"
AUTHOR NAMES
Martin B.C.
Hayes C.
Austen M.
Hudson T.
AUTHOR ADDRESSES
(Martin B.C., bmartin@uams.edu1) Pharmacy Practice University of Arkansas
for Medical Sciences Little Roc, United States.
(Hayes C.) Department of Pharmacy Baptist Health Medical Center Little Rock,
United States.
(Martin B.C., bmartin@uams.edu1; Hayes C.) Division of Pharmaceutical
Evaluation and Policy, College of Pharmacy University of Arkansas, Medical
Sciences Little Rock, United States.
(Austen M.; Hudson T.) Center for Mental Healthcare and Outcomes Research,
Central Arkansas Veterans Healthcare System Little Rock, United States.
(Hudson T.) Psychiatric Research Institute University of Arkansas, Medical
Sciences Little Rock, United States.
CORRESPONDENCE ADDRESS
B.C. Martin, Pharmacy Practice University of Arkansas for Medical Sciences
Little Roc, United States. Email: bmartin@uams.edu1
SOURCE
Pharmacoepidemiology and Drug Safety (2016) 25:4 (477-478). Date of
Publication: 1 Apr 2016
ISSN
1099-1557 (electronic)
1053-8569
BOOK PUBLISHER
John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United
Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
dextropropoxyphene
oxycodone
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
death
outcomes research
survival
EMTREE MEDICAL INDEX TERMS
drug overdose
emergency ward
health care policy
human
letter
outpatient
priority journal
sample size
veteran
CAS REGISTRY NUMBERS
dextropropoxyphene (1639-60-7, 469-62-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160286912
MEDLINE PMID
27059545 (http://www.ncbi.nlm.nih.gov/pubmed/27059545)
PUI
L609701581
DOI
10.1002/pds.3972
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.3972
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 337
TITLE
Risk factors of prescription opioid overdose among Colorado medicaid
beneficiaries
AUTHOR NAMES
Dilokthornsakul P.
Moore G.
Campbell J.D.
Lodge R.
Traugott C.
Zerzan J.
Allen R.
Page R.L.
AUTHOR ADDRESSES
(Dilokthornsakul P., piyamethd@gmail.com; Moore G.; Campbell J.D.; Page
R.L.) Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy
and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus,
Aurora, United States.
(Dilokthornsakul P., piyamethd@gmail.com) Center of Pharmaceutical Outcomes
Research, Department of Pharmacy Practice, Faculty of Pharmaceutical
Sciences, Naresuan University, Phitsanulok, Thailand.
(Lodge R.; Traugott C.; Zerzan J.) Department of Health Care Policy and
Financing, State of Colorado, Denver, United States.
(Allen R.) Peak Statistical Services, Evergreen, United States.
CORRESPONDENCE ADDRESS
P. Dilokthornsakul, Center for Pharmaceutical Outcomes Research, Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of Colorado
Anschutz Medical Campus, Aurora, United States. Email: piyamethd@gmail.com
SOURCE
Journal of Pain (2016) 17:4 (436-443). Date of Publication: 1 Apr 2016
ISSN
1528-8447 (electronic)
1526-5900
BOOK PUBLISHER
Churchill Livingstone Inc.
ABSTRACT
This study aims to determine risk factors of opioid overdose among the
Colorado Medicaid population. A retrospective nested case-control study was
undertaken. Medicaid beneficiaries who had ≥1 medical claim for an emergency
department visit or a hospitalization associated with an opioid overdose
from July 2009 to June 2014 were defined as cases. Controls were selected
using a nearest neighbor matching without replacement. The matched controls
were selected on the basis of age, sex, and opioid prescription. One case
was matched with three controls. Multivariate conditional logistic
regression was used to compare risk factors. A total of 816 cases with 2,448
controls were included. Six factors were associated with opioid overdose:
mean morphine dose equivalent (>50 mg/d; odds ratio [OR] = 1.986 [95%
confidence interval [CI], 1.509-2.614]), methadone use (switching opioid to
methadone vs. no methadone use; OR = 7.230 [95% CI, 2.346-22.286]),
drug/alcohol abuse (OR = 3.104 [95% CI, 2.195-4.388]), other psychiatric
illness (OR = 1.730 [95% CI, 1.307-2.291]), benzodiazepine use (OR = 2.005
[95% CI, 1.516-2.652]), and the number of pharmacies used by the beneficiary
(≥4 pharmacies vs. 1 pharmacy; OR = 1.514 [95% CI, 1.003-2.286]). In
conclusion, several factors are associated with opioid overdose. States and
communities should ensure the availability of at-home intranasal naloxone
for overdose rescue on the basis of the presence of risk factors.
Perspective This article presents the risk factors of opioid overdose among
the Colorado Medicaid population. On the basis of study findings, Colorado
Medicaid is currently working with physicians, hospitals, and other health
system stakeholders to continue to develop policies to identify and assist
this subset of our population. One such policy will be to provide at-home
intranasal naloxone for overdose rescue.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine
methadone
morphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medicaid
prescription
EMTREE MEDICAL INDEX TERMS
adult
aged
alcohol abuse
article
controlled study
drug abuse
drug overdose
emergency ward
female
hospitalization
human
major clinical study
male
mental disease
middle aged
pharmacy
population based case control study
retrospective study
risk factor
United States
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160120485
MEDLINE PMID
26721613 (http://www.ncbi.nlm.nih.gov/pubmed/26721613)
PUI
L608276524
DOI
10.1016/j.jpain.2015.12.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2015.12.006
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 338
TITLE
Take-home naloxone programs and calls to emergency services
AUTHOR NAMES
Kirwan A.
Curtis M.
van Beek I.A.
Cantwell K.
Dietze P.M.
AUTHOR ADDRESSES
(Kirwan A.) Burnet Institute, Melbourne, VIC michael.curtis@burnet.edu.au
(Curtis M.) Burnet Institute, Melbourne, VIC
(van Beek I.A.) Kirketon Road Centre, Sydney, NSW
(Cantwell K.) Burnet Institute, Melbourne, VIC
(Dietze P.M.) Burnet Institute, Melbourne, VIC
SOURCE
The Medical journal of Australia (2016) 204:4 (143). Date of Publication: 7
Mar 2016
ISSN
1326-5377 (electronic)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
drug overdose (prevention)
emergency health service
home care
human
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
26937662 (http://www.ncbi.nlm.nih.gov/pubmed/26937662)
PUI
L611229255
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 339
TITLE
Patient-reported Outcomes from A National, Prospective, Observational Study
of Emergency Department Acute Pain Management with an Intranasal
Nonsteroidal Anti-inflammatory Drug, Opioids, or Both
AUTHOR NAMES
Pollack C.V.
Diercks D.B.
Thomas S.H.
Shapiro N.I.
Fanikos J.
Mace S.E.
Rafique Z.
Todd K.H.
AUTHOR ADDRESSES
(Pollack C.V., cvpollack@gmail.com) Department of Emergency Medicine, Thomas
Jefferson University, Philadelphia, United States.
(Diercks D.B.) Department of Emergency Medicine, University of California
Davis Medical Center, Sacramento, United States.
(Shapiro N.I.) Department of Emergency Medicine, Beth Israel Deaconess
Medical Center, Boston, United States.
(Fanikos J.) Department of Pharmacy, Brigham and Women's Hospital, Boston,
United States.
(Mace S.E.) Department of Emergency Medicine, Cleveland Clinic, Lerner
College of Medicine, Western Reserve University, Cleveland, United States.
(Rafique Z.) Section of Emergency Medicine, Department of Medicine, Baylor
College of Medicine, Houston, United States.
(Todd K.H.) Department of Emergency Medicine, University of Texas, MD
Anderson Cancer Center, Houston, United States.
(Thomas S.H.) Department of Emergency Medicine, Hamad Medical Corporation,
Department of Medicine, Weill Cornell Medical College, Doha, Qatar.
CORRESPONDENCE ADDRESS
C.V. Pollack, Department of Emergency Medicine, Thomas Jefferson University,
Philadelphia, United States. Email: cvpollack@gmail.com
SOURCE
Academic Emergency Medicine (2016) 23:3 (331-341). Date of Publication: 1
Mar 2016
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives Patient compliance and satisfaction with analgesics prescribed
after emergency department (ED) care for acute pain are poorly understood,
largely because of the lack of direct patient follow-up with the ED
provider. Our objective was to compare patient satisfaction with three
analgesia regimens prescribed for post-ED care - a nasally administered
nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination
therapy - by collecting granular follow-up on analgesic use, pain scores,
side effects, work activity levels, and overall satisfaction directly from
patients. Methods We designed a prospective registry linking ED assessment
and analgesic management for acute pain of specific musculoskeletal or
visceral etiologies with self-reported automated telephonic follow-up daily
for the 4 days post-ED discharge. Patients were prescribed a specific NSAID
(SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid
only, or both with the opioid clearly defined as rescue therapy, at the ED
provider's discretion. Results There were 824 evaluable subjects. Maximum
pain scores improved day to day more effectively with a ketorolac-based
approach. Self-reported rates of return to work and work effectiveness were
higher with SPRIX than with opioids or combination therapy. Adverse effects
of nausea, constipation, drowsiness, and abdominal pain were higher each day
among patients taking an opioid; nasal irritation was more common with
SPRIX. Overall satisfaction at the end of the follow-up period was higher
with SPRIX-based treatment than with opioid monotherapy. Conclusions
Automated telephonic follow-up of ED patients prescribed short-term
analgesia is feasible. Ketorolac-based analgesia after an ED visit for many
acute pain syndromes was associated with favorable patient outcomes and
higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not
available over the counter and has a novel delivery approach, may be useful
for short-term post-ED outpatient analgesia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketorolac trometamol (adverse drug reaction, drug combination, drug therapy,
intranasal drug administration)
opiate (adverse drug reaction, drug combination, drug therapy, oral drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
adult
article
cohort analysis
constipation (side effect)
controlled study
drowsiness (side effect)
female
follow up
human
major clinical study
male
monotherapy
nausea (side effect)
nose irritation (side effect)
observational study
patient satisfaction
priority journal
prospective study
treatment outcome
CAS REGISTRY NUMBERS
ketorolac trometamol (74103-07-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT01626235)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160212730
MEDLINE PMID
26782787 (http://www.ncbi.nlm.nih.gov/pubmed/26782787)
PUI
L608981642
DOI
10.1111/acem.12902
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12902
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 340
TITLE
OPIOID CRISIS. Prehospital naloxone administration for opioid-related
emergencies
AUTHOR NAMES
Drennan I.R.
Orkin A.M.
AUTHOR ADDRESSES
(Drennan I.R.; Orkin A.M.)
SOURCE
JEMS : a journal of emergency medical services (2016) 41:3 (36-39). Date of
Publication: 1 Mar 2016
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug administration, pharmacology)
narcotic antagonist (drug administration, pharmacology)
EMTREE MEDICAL INDEX TERMS
emergency health service
human
opiate addiction (drug therapy)
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
27120853 (http://www.ncbi.nlm.nih.gov/pubmed/27120853)
PUI
L613587644
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 341
TITLE
Extent and Impact of Opioid Prescribing for Acute Occupational Low Back Pain
in the Emergency Department
AUTHOR NAMES
Lee S.S.
Choi Y.
Pransky G.S.
AUTHOR ADDRESSES
(Lee S.S.; Choi Y.; Pransky G.S.) Liberty Mutual Research, Institute for
Safety, 71 Frankland Road, Hopkinton, United States.
CORRESPONDENCE ADDRESS
G.S. Pransky, Liberty Mutual Research, Institute for Safety, 71 Frankland
Road, Hopkinton, United States.
SOURCE
Journal of Emergency Medicine (2016) 50:3 (376-384). Date of Publication: 1
Mar 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Initial management of acute occupational low back pain (AOLBP)
commonly occurs in the emergency department (ED), where opioid prescribing
can vary from the clinical guidelines that recommend limited use. Objective
The objective of this study was to explore how opioids are prescribed in the
ED and the impact on work disability and other outcomes in AOLBP. Methods A
retrospective cohort study was conducted. All acute compensable lost-time
LBP cases seen initially in the ED with a date of injury from January 1,
2009 to December 31, 2011 were identified within a nationally representative
Workers' Compensation dataset. Multivariate models estimated the effect of
early opioids (received within 2 days of ED visit) on disability duration,
long-term opioid use, total medical costs, and subsequent surgeries. Results
Of the cohort (N = 2887), 12% received early opioids; controlling for
severity, this was significantly associated with long-term opioid use
(adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and
increased total medical costs for those in the highest opioid dosage
quartile, but not associated with disability duration or subsequent low back
surgery. Conclusions Early opioid prescribing in the ED for uncomplicated
AOLBP increased long-term opioid use and medical costs, and should be
discouraged, as opioid use for low back pain has been associated with a
variety of adverse outcomes. However, ED providers may be becoming more
compliant with current LBP treatment guidelines.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute occupational low back pain (drug therapy, drug therapy)
backache (drug therapy, drug therapy)
emergency ward
prescription
work disability (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
adverse outcome
article
drug cost
female
human
injury severity
major clinical study
male
nuclear magnetic resonance imaging
practice guideline
priority journal
private health insurance
return to work
workman compensation
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160005613
MEDLINE PMID
26754559 (http://www.ncbi.nlm.nih.gov/pubmed/26754559)
PUI
L607456333
DOI
10.1016/j.jemermed.2015.10.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.10.015
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 342
TITLE
Reversal of Opioid-Induced Ventilatory Depression Using Low-Dose Naloxone
(0.04 mg): a Case Series
AUTHOR NAMES
Kim H.K.
Nelson L.S.
AUTHOR ADDRESSES
(Kim H.K., hongkimmd@gmail.com) Department of Emergency Medicine, University
of Maryland Emergency Medicine Network, University of Maryland School of
Medicine, 110 South Paca Street 6th floor, Suite 200, Baltimore, United
States.
(Nelson L.S.) Department of Emergency Medicine, New York University School
of Medicine/Bellevue Hospital Center, 462 First Ave. Room A345, New York,
United States.
CORRESPONDENCE ADDRESS
H.K. Kim, Department of Emergency Medicine, University of Maryland Emergency
Medicine Network, University of Maryland School of Medicine, 110 South Paca
Street 6th floor, Suite 200, Baltimore, United States. Email:
hongkimmd@gmail.com
SOURCE
Journal of Medical Toxicology (2016) 12:1 (107-110). Date of Publication: 1
Mar 2016
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, barbara.b.bertram@gsk.com
ABSTRACT
Introduction: Naloxone is commonly administered in emergency department (ED)
to reverse opioid intoxication. Several naloxone dose recommendations exist
for acute management of opioid intoxication based on limited published
clinical data. A case series of ED patients with opioid-induced ventilatory
depression that was reversed using a low-dose naloxone (0.04 mg with
titration) is presented. Methods: ED patients with opioid-induced
ventilatory depression requiring naloxone administration were identified
through medical toxicology consultation. Retrospective review of medical
records was performed. Collected data included history, and pre- and
post-naloxone data, including respiratory rate (RR), pulse oximetry (pulse
ox), end-tidal CO(2) level (ET-CO(2)), and Richmond Agitation Sedation Scale
(RASS). Results: Fifteen ED patients with moderate to severe opioid-induced
ventilatory depression (median RR, 6 breaths/min) who were managed using
low-dose naloxone strategy were identified. Twelve of 15 patients reported
ingestion of methadone (range, 30 to 180 mg). The median naloxone dose of
0.08 mg (range, 0.04 to 0.12 mg) reversed opioid-induced ventilatory and CNS
depression. Two patients experienced acute opioid withdrawal after receiving
0.08 mg. Conclusion: ED patients with moderate to severe opioid-induced
ventilatory depression can be reversed using 0.04 mg IV naloxone with
appropriate dose titration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hypoventilation (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
breathing rate
central nervous system depression
clinical article
drug induced disease
emergency ward
end tidal carbon dioxide tension
female
human
low drug dose
male
nausea and vomiting
pulse oximetry
Richmond Agitation Sedation Scale
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015316922
MEDLINE PMID
26289651 (http://www.ncbi.nlm.nih.gov/pubmed/26289651)
PUI
L605718342
DOI
10.1007/s13181-015-0499-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-015-0499-3
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 343
TITLE
Streptococcus gallolyticus (bovis): A rare presentation of meningitis in the
ED
AUTHOR NAMES
Gray J.D.
Wilson C.J.
AUTHOR ADDRESSES
(Gray J.D.; Wilson C.J.) Department of Emergency Medicine, Geisinger Medical
Center, 100 N. Academy Ave, Danville, United States.
SOURCE
American Journal of Emergency Medicine (2016) 34:3 (677e1). Date of
Publication: 1 Mar 2016
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Bacterial meningitis is a fairly common and often deadly manifestation of
altered mental status in the elderly, carrying a mortality rate of greater
than 20% despite antibiotic therapy [1]. Most commonly caused by
Streptococcus pneumoniae, Listeria monocytogenes, Escherichia coli, and
Klebsiella pneumoniae. We present a case of meningitis caused by
Streptococcus gallolyticus in an elderly, otherwise healthy woman. There
have been no reports in the emergency medicine literature and only a few
reports in the literature of S gallolyticus as a cause of altered mental
status and meningitis, specifically of immunocompetent patients.
EMTREE DRUG INDEX TERMS
aciclovir (drug therapy)
ampicillin (drug therapy)
ceftriaxone (drug therapy)
glucose (endogenous compound)
lactic acid (endogenous compound)
naloxone
protein (endogenous compound)
vancomycin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterial meningitis (drug therapy, drug therapy, etiology)
emergency ward
Streptococcus gallolyticus
EMTREE MEDICAL INDEX TERMS
adenomatous polyp
aged
antibiotic therapy
article
case report
cerebrospinal fluid
colon adenoma
colonoscopy
computer assisted tomography
confusion
emergency health service
feces
female
human
hyperlipidemia
hypertension
intensive care unit
lactate blood level
lactic acidosis
leukocytosis
lumbar puncture
medical history
neutrophil
nuclear magnetic resonance imaging
priority journal
protein cerebrospinal fluid level
respiratory tract intubation
septic shock
transesophageal echocardiography
ventilator
vomiting
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
ceftriaxone (73384-59-5, 74578-69-1)
glucose (50-99-7, 84778-64-3)
lactic acid (113-21-3, 50-21-5)
naloxone (357-08-4, 465-65-6)
protein (67254-75-5)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015285231
MEDLINE PMID
26259921 (http://www.ncbi.nlm.nih.gov/pubmed/26259921)
PUI
L605554021
DOI
10.1016/j.ajem.2015.06.055
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2015.06.055
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 344
TITLE
A 17-year-old girl with cough - Pulseless after drug overdose
AUTHOR NAMES
Yoshioka I.
Surmaitis R.
Katz K.D.
AUTHOR ADDRESSES
(Yoshioka I., Katzkd1@gmail.com; Surmaitis R.; Katz K.D., Katzkd1@gmail.com)
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown,
United States.
CORRESPONDENCE ADDRESS
I. Yoshioka, Department of Emergency Medicine, Lehigh Valley Health Network,
Allentown, United States. Email: Katzkd1@gmail.com
SOURCE
Pediatric Emergency Care (2016) 32:3 (197-199). Date of Publication: 1 Mar
2016
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS
bicarbonate (intravenous drug administration)
calcium chloride (intravenous drug administration)
epinephrine (intravenous drug administration)
etomidate (intravenous drug administration)
glucose (endogenous compound)
naloxone (intravenous drug administration)
propofol
suxamethonium (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coughing
drug overdose
EMTREE MEDICAL INDEX TERMS
adolescent
apnea
assisted ventilation
case report
convulsion
defibrillation
defibrillator
depression
dizziness
electrocardiogram
emergency ward
female
Glasgow coma scale
glucose blood level
heart arrest
heart ventricle fibrillation
human
immunoassay
ingestion
nausea
note
resuscitation
return of spontaneous circulation
sedation
sinus tachycardia
tablet
vital sign
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160220503
MEDLINE PMID
26928103 (http://www.ncbi.nlm.nih.gov/pubmed/26928103)
PUI
L609068929
DOI
10.1097/PEC.0000000000000733
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000733
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 345
TITLE
Association between opioid abuse/dependence and outcomes in hospitalized
heart failure patients
AUTHOR NAMES
Gupta T.
Mujib M.
Agarwal P.
Prakash P.
Garg A.
Sharma N.
Aronow W.S.
Nabors C.
AUTHOR ADDRESSES
(Gupta T.; Mujib M.; Agarwal P.; Prakash P.; Garg A.; Sharma N.; Aronow
W.S.; Nabors C., naborsc@wcmc.com) Department of Medicine, Westchester
Medical Center, New York Medical College, Valhalla, United States.
CORRESPONDENCE ADDRESS
C. Nabors, Department of Medicine, Westchester Medical Center, New York
Medical College, Valhalla, United States. Email: naborsc@wcmc.com
SOURCE
American Journal of Therapeutics (2016) 23:2 (e350-e356). Date of
Publication: 1 Mar 2016
ISSN
1536-3686 (electronic)
1075-2765
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Opioid use is associated with unintentional and intentional overdose and is
one of the leading causes of emergency room visits and accidental deaths.
However, the association between opioid abuse/dependence and outcomes in
hospitalized patients has not been well studied. Congestive heart failure
(HF) is the fourth most common cause of hospitalization in the United
States. The purpose of this study was to examine the effect of opioid
abuse/dependence on outcomes in patients hospitalized with HF. We queried
the 2002-2010 Nationwide Inpatient Sample databases to identify all patients
aged 18 years and older admitted with the primary diagnosis of HF.
Multivariate logistic regression analysis was used to compare the frequency
of hospital-acquired conditions (HACs) and in-hospital mortality between
patients with and without a history of opioid abuse/dependence. Of 9,993,240
patients with HF, 29,014 had a history of opioid abuse or dependence. Opioid
abusers/dependents were likely to be younger men of poor socioeconomic
background with self pay or Medicaid as their primary payer. They had a
lower prevalence of dyslipidemia, diabetes mellitus, coronary artery
disease, prior myocardial infarction, and peripheral vascular disease (P <
0.001 for all). They were more likely to be smokers and have chronic
pulmonary disease, depression, liver disease, and obesity (P < 0.001 for
all). Patients with a history of opioid abuse/dependence had lower incidence
of HACs (14.8% vs. 16.5%, adjusted odds ratio: 0.71, P < 0.001) and lower
in-hospital mortality (1.3% vs. 3.6%, adjusted odds ratio: 0.64, P < 0.001)
as compared with patients without prior opioid abuse/dependence. In
conclusion, among adult patients aged 18 years and older hospitalized with
HF, opioid abuse/dependence was associated with lower frequency of HACs and
lower in-hospital mortality.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart failure
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
aged
article
chronic lung disease
controlled study
coronary artery disease
depression
diabetes mellitus
disease association
dyslipidemia
female
heart infarction
hospital patient
human
incidence
liver disease
major clinical study
male
medicaid
mortality
obesity
outcome assessment
peripheral vascular disease
prevalence
priority journal
smoking
socioeconomics
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015704484
MEDLINE PMID
25611362 (http://www.ncbi.nlm.nih.gov/pubmed/25611362)
PUI
L601889364
DOI
10.1097/MJT.0000000000000190
FULL TEXT LINK
http://dx.doi.org/10.1097/MJT.0000000000000190
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 346
TITLE
Examining Rural/Urban Differences in Prescription Opioid Misuse Among US
Adolescents
AUTHOR NAMES
Monnat S.M.
Rigg K.K.
AUTHOR ADDRESSES
(Monnat S.M.) Department of Agricultural Economics, Sociology, and Education
and The Population Research Institute, The Pennsylvania State University,
University Park, Pennsylvania
(Rigg K.K.) Department of Mental Health Law & Policy, Louis de la Parte
Florida Mental Health Institute, University of South Florida, Tampa, Florida
SOURCE
The Journal of rural health : official journal of the American Rural Health
Association and the National Rural Health Care Association (2016) 32:2
(204-218). Date of Publication: 1 Mar 2016
ISSN
1748-0361 (electronic)
ABSTRACT
CONCLUSIONS: Researchers, policy makers, and treatment providers must
consider the complex array of individual, social, and community risk and
protective factors to understand rural/urban differences in adolescent POM.
Potential points of intervention to prevent POM in general and reduce rural
disparities include early education about addiction risks, use of family
drug courts to link criminal offenders to treatment, and access to
nonemergency medical services to reduce rural residents' reliance on
emergency departments where opioid prescribing is more likely.RESULTS: Among
adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban
engaged in past-year POM. Net of multiple risk and protective factors, rural
adolescents have 35% greater odds and small urban adolescents have 21%
greater odds of past-year POM compared to large urban adolescents. The
difference between rural and small urban adolescents was not significant.
Criminal activity, lower perceived substance use risk, and greater use of
emergency medical treatment partially contribute to higher odds among rural
adolescents, but they are also partially buffered by less peer substance
use, less illicit drug access, and stronger religious beliefs.PURPOSE: This
study examines differences in prescription opioid misuse (POM) among
adolescents in rural, small urban, and large urban areas of the United
States and identifies several individual, social, and community risk factors
contributing to those differences.METHODS: We used nationally representative
data from the 2011 and 2012 National Survey on Drug Use and Health and
estimated binary logistic regression and formal mediation models to assess
past-year POM among 32,036 adolescents aged 12-17.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adolescent
child
child parent relation
demography
drug dependence (epidemiology)
female
human
male
opiate addiction (epidemiology)
peer group
psychology
religion
risk assessment
risk factor
rural population
socioeconomics
statistical model
United States
urban population
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26344571 (http://www.ncbi.nlm.nih.gov/pubmed/26344571)
PUI
L614915136
DOI
10.1111/jrh.12141
FULL TEXT LINK
http://dx.doi.org/10.1111/jrh.12141
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 347
TITLE
The Opioid Epidemic
AUTHOR NAMES
Stempniak M.
AUTHOR ADDRESSES
(Stempniak M.)
SOURCE
Hospitals & health networks / AHA (2016) 90:3 (22-4, 26-9). Date of
Publication: 1 Mar 2016
ISSN
1068-8838
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS
awareness
clinical practice
clinical protocol
drug overdose (epidemiology, prevention)
emergency health service
human
mass screening
mortality
opiate addiction (diagnosis, epidemiology, prevention)
organization and management
primary health care
risk factor
LANGUAGE OF ARTICLE
English
MEDLINE PMID
27180399 (http://www.ncbi.nlm.nih.gov/pubmed/27180399)
PUI
L611463504
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 348
TITLE
State-level and system-level opioid prescribing policies: The impact on
provider practices and overdose deaths, a systematic review
AUTHOR NAMES
Beaudoin F.L.
Banerjee G.N.
Mello M.J.
AUTHOR ADDRESSES
(Beaudoin F.L.) Department of Emergency Medicine, Brown University,
Providence, United States.
(Banerjee G.N.) Department of Epidemiology, Brown University, Providence,
United States.
(Mello M.J.) Departments of Emergency Medicine and Health Services, Policy
and Practice, Brown University, Providence, United States.
SOURCE
Journal of Opioid Management (2016) 12:2 (109-118). Date of Publication: 1
Mar 2016
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Objective: In response to persistent public health concerns regarding
prescription opioids, many states and healthcare systems have implemented
legislation and policies intended to regulate or guide opioid prescribing.
The overall impact of these policies is still uncertain. The aim of this
systematic review was to examine the existing evidence of provider-level and
patient-level outcomes preimplementation and postimplementation of policies
and legislation constructed to impact provider prescribing practices around
opioid analgesics. Design: A systematic search of MEDLINE, EMBASE, the Web
of Science, and the Cochrane Database of Systematic Reviews was conducted to
identify studies evaluating the impact of opioid prescribing policies on
provider-level and patient-level outcomes. The systematic review was
conducted in accordance with Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Results: Eleven studies were included
in the review. A meta-analysis was not possible due to between-study
heterogeneity. Six of the studies assessed state-level policies, and five
were at the level of the healthcare system or hospital. Studies showed
temporal associations between policy implementation and reductions in opioid
prescribing, as well as opioid-related overdoses. Results were mixed
regarding the impact of policies on misuse. The majority of the studies were
judged to be of low quality based on the GRADE criteria. Conclusions: There
is low to moderate quality evidence suggesting that the presence of opioid
prescribing policy will reduce the amount and strength of opioid prescribed.
The presence of these policies may impact the number of overdoses, but there
is no clear evidence to suggest that it reduces opioid misuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
controlled substance
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
health care policy
health care system
law
prescription
EMTREE MEDICAL INDEX TERMS
article
California
continuing education
drug overdose
emergency ward
Florida
human
Maine
Minnesota
Ontario
orthopedic surgery
pain clinic
patient counseling
practice guideline
randomized controlled trial (topic)
systematic review
tooth pain
Utah
Washington
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160848814
MEDLINE PMID
27194195 (http://www.ncbi.nlm.nih.gov/pubmed/27194195)
PUI
L613319205
DOI
10.5055/jom.2016.0322
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2016.0322
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 349
TITLE
Substance use disorder in primary care: Which drugs are used and how to
intervene
AUTHOR NAMES
Gyura P.J.
AUTHOR ADDRESSES
(Gyura P.J.) Columbia University School of Nursing, Harlem United, New York,
United States.
CORRESPONDENCE ADDRESS
P.J. Gyura, Columbia University School of Nursing, Harlem United, New York,
United States.
SOURCE
Consultant (2016) 56:3 (234-238). Date of Publication: 1 Mar 2016
ISSN
0010-7069
BOOK PUBLISHER
Cliggott Publishing Co.
ABSTRACT
Substance use is a growing problem in the primary care setting. Screening
and assessing patients for substance use is the first step in addressing
this problem. Screening tools and other interventions can assist in
evaluating which substances are being used in a given geographic area, can
identify patients at risk, and can direct the care of these patients when
help is wanted. Each substance of abuse has its own guidelines, counseling
techniques, and pharmacologic treatments. The goal of substance use disorder
intervention is to build a relationship with patients, to identify the
substance being used, and to employ patientcentered methods to help patients
achieve better health and, potentially, sobriety.
EMTREE DRUG INDEX TERMS
acamprosate (drug therapy)
alcohol
amfebutamone (drug therapy)
amphetamine derivative
anticonvulsive agent (drug therapy)
antidepressant agent (drug therapy)
atomoxetine (drug therapy)
benzodiazepine derivative
buprenorphine (drug therapy)
buspirone (drug therapy)
cannabinoid derivative
cannabis
cathinone
central stimulant agent (drug therapy)
cocaine
diazepam (drug therapy)
midomafetamine
mirtazapine (drug therapy)
naloxone (drug therapy)
naltrexone (drug therapy)
neuroleptic agent (drug therapy)
non prescription drug
opiate
stimulant vaccine (drug therapy)
unclassified drug
vaccine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
patient care
primary medical care
substance abuse
EMTREE MEDICAL INDEX TERMS
alcohol abuse
alcohol consumption
alcoholism (drug therapy)
article
behavior change
benzodiazepine dependence (drug therapy, therapy)
blood brain barrier
cannabis addiction (drug therapy)
clinical evaluation
cocaine dependence (drug therapy)
cognitive therapy
doctor patient relation
drinking behavior
drug efficacy
drug safety
emergency ward
harm reduction
health care personnel
human
memory disorder
methamphetamine dependence (drug therapy)
mortality rate
motivational interviewing
opiate addiction (drug therapy)
outpatient care
patient assessment
patient counseling
patient preference
patient referral
practice guideline
prescription
priority journal
problem solving
screening test
self concept
treatment duration
CAS REGISTRY NUMBERS
acamprosate (77337-73-6)
alcohol (64-17-5)
amfebutamone (31677-93-7, 34911-55-2)
atomoxetine (82248-59-7, 82857-39-4, 82857-40-7, 83015-26-3)
buprenorphine (52485-79-7, 53152-21-9)
buspirone (33386-08-2, 36505-84-7)
cannabis (8001-45-4, 8063-14-7)
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
mirtazapine (61337-67-5)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160266352
PUI
L609433344
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 350
TITLE
Effect of USDrug enforcement administration's rescheduling of hydrocodone
combination analgesic productson opioid analgesic prescribing
AUTHOR NAMES
Jones C.M.
Lurie P.G.
Throckmorton D.C.
AUTHOR ADDRESSES
(Jones C.M., christopher.jones@hhs.gov) Office of the Assistant Secretary
for Planning and Evaluation, US Department of Health and Human Services, 200
Independence Ave. SW, Washington, United States.
(Lurie P.G.; Throckmorton D.C.) Office of the Commissioner, US Food and Drug
Administration, Silver Spring, United States.
CORRESPONDENCE ADDRESS
C.M. Jones, Office of the Assistant Secretary for Planning and Evaluation,
US Department of Health and Human Services, 200 Independence Ave. SW,
Washington, United States. Email: christopher.jones@hhs.gov
SOURCE
JAMA Internal Medicine (2016) 176:3 (399-402). Date of Publication: 1 Mar
2016
ISSN
2168-6106
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydrocodone
opiate
EMTREE DRUG INDEX TERMS
hydrocodone bitartrate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
government
prescription
EMTREE MEDICAL INDEX TERMS
analgesic agent abuse
emergency ward
general practitioner
human
letter
medical society
priority journal
surgeon
treatment duration
United States
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydrocodone bitartrate (143-71-5, 8013-91-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160275818
MEDLINE PMID
26809459 (http://www.ncbi.nlm.nih.gov/pubmed/26809459)
PUI
L609612985
DOI
10.1001/jamainternmed.2015.7799
FULL TEXT LINK
http://dx.doi.org/10.1001/jamainternmed.2015.7799
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 351
TITLE
Availability of antidotes and key emergency drugs in tertiary care hospitals
of Punjab and assessment of the knowledge of health care professionals in
the management of poisoning cases
AUTHOR NAMES
Arslan N.
Khiljee S.
Bakhsh A.
Ashraf M.
Maqsood I.
AUTHOR ADDRESSES
(Arslan N., naheedarslan@yahoo.com; Khiljee S.; Bakhsh A.; Maqsood I.)
Institute of Pharmaceutical Sciences, University of Veterinary and Animal
Sciences, Abdul Qadir Jillani Road, Lahore, Pakistan.
(Ashraf M.) Department of Pharmacology and Toxicology, University of
Veterinary and Animal Sciences, Abdul Qadir Jillani Road, Lahore, Pakistan.
CORRESPONDENCE ADDRESS
N. Arslan, Institute of Pharmaceutical Sciences, University of Veterinary
and Animal Sciences, Abdul Qadir Jillani Road, Lahore, Pakistan. Email:
naheedarslan@yahoo.com
SOURCE
Pakistan Journal of Pharmaceutical Sciences (2016) 29:2 (603-607). Date of
Publication: 1 Mar 2016
ISSN
1011-601X
BOOK PUBLISHER
Pakistan Journal of Pharmaceutical Sciences
ABSTRACT
This study was conducted to evaluate the availability of antidotes / key
emergency drugs in tertiary care hospitals of the Punjab province, and to
assess the knowledge of health care professionals in the stocking and
administration of antidotes in the proper management of poisoning cases.
Seventeen (n=17) tertiary care hospitals of Punjab Pakistan were selected.
Two performas (A and B) were designed for 26 antidotes / key emergency drugs
and given to the hospital pharmacists and physicians respectively. It was
observed that Activated Charcoal, being the universal antidote was found
only in 6 hospitals (41%). Digoxin Immune Fab, Edentate Calcium disodium and
Glucagon were not available in emergency department of any hospital and even
not included in the formulary of any hospital. About 80% pharmacists were
aware of the method of preparation of Activated Charcoal and 85% physicians
were familiar with its route of administration. Data showed that tertiary
care hospitals of Punjab do not stock antidotes according to national drug
policy. Moreover the study strongly suggests the development of health care
centers and professional by organizing antidote awareness programs,
continuous education and record keeping of poisonous cases and availability
of emergency drugs around the clock.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
EMTREE DRUG INDEX TERMS
acetylcysteine
activated carbon
atropine
bicarbonate
deferoxamine
dexamethasone
diazepam
digoxin antibody F(ab) fragment (drug therapy)
edetate calcium disodium
epinephrine
flumazenil
glucagon
hydrocortisone
magnesium sulfate
naloxone
physostigmine
pralidoxime
protamine sulfate
pyridoxine
rabies vaccine
snake venom antiserum
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care personnel
intoxication (drug therapy, drug therapy, therapy)
tertiary care center
EMTREE MEDICAL INDEX TERMS
article
digitalis intoxication (drug therapy)
drug formulary
emergency ward
health care policy
health program
human
India
knowledge
pharmacist
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
deferoxamine (70-51-9)
dexamethasone (50-02-2)
diazepam (439-14-5)
edetate calcium disodium (62-33-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydrocortisone (50-23-7)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
protamine sulfate (9009-65-8)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160314446
MEDLINE PMID
27087082 (http://www.ncbi.nlm.nih.gov/pubmed/27087082)
PUI
L610009205
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 352
TITLE
Science Over Stigma: Saving Lives--Implementation of Naloxone Use in the
School Setting
AUTHOR NAMES
King R.
AUTHOR ADDRESSES
(King R.) School Nurse/Clinical Nursing Instructor, St. George's Technical
High School, New Castle County Vocational School District, Middletown, DE
SOURCE
NASN school nurse (Print) (2016) 31:2 (96-101). Date of Publication: 1 Mar
2016
ISSN
1942-6038 (electronic)
ABSTRACT
Unintentional drug overdose is a leading cause of preventable death in the
United States. Administration of naloxone hydrochloride ("naloxone") can
reverse a potentially fatal opioid overdose and save lives. The school nurse
is an essential part of the school team responsible for developing emergency
response procedures and should facilitate access to naloxone for the
management of opioid-related overdose in the school setting. Delaware has
been leading efforts to provide education, increase awareness, and help
erase the stigma of substance use disorder through school nurse
collaboration with a grassroots organization and state stakeholders. This
article discusses the successful implementation of naloxone use in the
school setting in Delaware public high schools.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
nursing
practice guideline
standards
EMTREE MEDICAL INDEX TERMS
adolescent
child
Delaware
drug misuse
drug overdose (drug therapy)
emergency health service
female
human
male
school health nursing
social stigma
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26929211 (http://www.ncbi.nlm.nih.gov/pubmed/26929211)
PUI
L614628869
DOI
10.1177/1942602X16628890
FULL TEXT LINK
http://dx.doi.org/10.1177/1942602X16628890
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 353
TITLE
Acetylfentanyl: An Emerging Drug of Abuse
AUTHOR NAMES
Rogers J.S.
Rehrer S.J.
Hoot N.R.
AUTHOR ADDRESSES
(Rogers J.S.; Rehrer S.J.; Hoot N.R.) Department of Emergency Medicine,
University of Texas, Health Science Center at Houston, Jesse Jones Library,
6431 Fannin, Houston, United States.
CORRESPONDENCE ADDRESS
N.R. Hoot, Department of Emergency Medicine, University of Texas, Health
Science Center at Houston, Jesse Jones Library, 6431 Fannin, Houston, United
States.
SOURCE
Journal of Emergency Medicine (2016) 50:3 (433-436). Date of Publication: 1
Mar 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Opioid analgesics are widely used in health care, yet have
significant potential for abuse. High doses are associated with potentially
fatal respiratory depression, which caused 21,314 deaths in the United
States in 2011. Acetylfentanyl, a synthetic opioid agonist closely related
to fentanyl, recently emerged as a drug of abuse linked to numerous deaths
in North America. Case Report A 36-year-old male developed the habit of
using a propylene glycol electronic cigarette filled with acetylfentanyl to
aid relaxation. He purchased the drug online in a manner that appeared legal
to him, which compromised his insight about the danger of the substance. He
had been using the e-cigarette with increasing frequency while on medical
leave, and his wife reported finding him weakly responsive on more than one
occasion. At approximately 3 am, the family activated 911 for altered mental
status. His presentation included respiratory depression, pinpoint pupils,
hypoxemia, and a Glasgow Coma Scale score of 6. He responded to serial doses
of intravenous naloxone with improvement in his mental status and
respiratory condition. Due to the need for repeated dosing, he was placed on
a naloxone infusion and recovered uneventfully in intensive care. Why Should
an Emergency Physician Be Aware of This? Complications from emerging drugs
of abuse, like acetylfentanyl, frequently present first to emergency
departments. Prompt recognition and treatment can help avoid morbidity and
mortality. Acetylfentanyl can be managed effectively with naloxone, although
higher than conventional dosing may be required to achieve therapeutic
effect.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylfentanyl
opiate agonist
EMTREE DRUG INDEX TERMS
creatine kinase (endogenous compound)
creatinine (endogenous compound)
glucose (endogenous compound)
naloxone (intravenous drug administration)
propylene glycol
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
acute kidney failure
adult
alcohol consumption
alcoholic beverage
arterial gas
article
blood pH
blood pressure measurement
breathing rate
capnometry
case report
creatine kinase blood level
creatinine blood level
crystalloid
dyspnea
electronic cigarette
gas analysis
Glasgow coma scale
glucose blood level
hospital admission
human
hydration
hyperglycemia
hypoxemia
intensive care
intensive care unit
male
medical leave
mental health
oxygen saturation
patent foramen ovale
physical examination
priority journal
pulse rate
respiration depression
respiratory failure
resuscitation
rhabdomyolysis
smoking
transient ischemic attack
CAS REGISTRY NUMBERS
creatine kinase (9001-15-4)
creatinine (19230-81-0, 60-27-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
propylene glycol (57-55-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151006466
MEDLINE PMID
26589567 (http://www.ncbi.nlm.nih.gov/pubmed/26589567)
PUI
L607165964
DOI
10.1016/j.jemermed.2015.10.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.10.014
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 354
TITLE
Low-back pain at the emergency department: Still not being managed?
AUTHOR NAMES
Rizzardo A.
Miceli L.
Bednarova R.
Guadagnin G.M.
Sbrojavacca R.
Rocca G.D.
AUTHOR ADDRESSES
(Rizzardo A.; Miceli L., miceli.luca@aoud.sanita.fvg.it; Guadagnin G.M.;
Rocca G.D.) Department of Anesthesia and Intensive Care, Academic Hospital
of Udine, University of Udine, Udine, Italy.
(Bednarova R.) Pain Medicine and Palliative Care, Health Company Number 2,
Gorizia, Italy.
(Sbrojavacca R.) Emergency Department, Academic Hospital of Udine, Udine,
Italy.
CORRESPONDENCE ADDRESS
L. Miceli, Department of Anesthesia and Intensive Care, Academic Hospital of
Udine, University of Udine, Piazzale Santa Maria della Misericordia number
10, Udine, Italy. Email: miceli.luca@aoud.sanita.fvg.it
SOURCE
Therapeutics and Clinical Risk Management (2016) 12 (183-187). Date of
Publication: 12 Feb 2016
ISSN
1178-203X (electronic)
1176-6336
BOOK PUBLISHER
Dove Medical Press Ltd., PO Box 300-008, Albany, Auckland, New Zealand.
ABSTRACT
Background: Low-back pain (LBP) affects about 40% of people at some point in
their lives. In the presence of “red flags”, further tests must be done to
rule out underlying problems; however, biomedical imaging is currently
overused. LBP involves large in-hospital and out-of-hospital economic costs,
and it is also the most common musculoskeletal disorder seen in emergency
departments (EDs). Patients and methods: This retrospective observational
study enrolled 1,298 patients admitted to the ED, including all
International Classification of Diseases 10 diagnosis codes for sciatica,
lumbosciatica, and lumbago. We collected patients’ demographic data, medical
history, lab workup and imaging performed at the ED, drugs administered at
the ED, ED length of stay (LOS), numeric rating scale pain score, admission
to ward, and ward LOS data. Thereafter, we performed a cost analysis.
Results: Mean numeric rating scale scores were higher than 7/10. Home
medication consisted of no drug consumption in up to 90% of patients.
Oxycodone–naloxone was the strong opioid most frequently prescribed for the
home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were
administered to up to 72% and 42% of patients, respectively. Imaging was
performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A
total of 43 patients were admitted to a ward. The expense for each
non-ward-admitted patient was approximately €200 in the ED, while the mean
expense for ward-admitted patients was €9,500, with a mean LOS of 15 days.
Conclusion: There is not yet a defined therapeutic care process for the
patient with LBP with clear criteria for an ED visit. It is to this end that
we need a clinical pathway for the prehospital management of LBP syndrome
and consequently for an in-hospital time-saving therapeutic approach to the
patient.
EMTREE DRUG INDEX TERMS
cyclooxygenase 2 inhibitor (drug therapy)
naloxone plus oxycodone (drug therapy)
narcotic analgesic agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
low back pain (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
diagnostic imaging
female
hospital admission
hospitalization cost
human
Italy
length of stay
major clinical study
male
medical leave
observational study
prescription
rating scale
retrospective study
sciatica
CAS REGISTRY NUMBERS
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160149192
PUI
L608354633
DOI
10.2147/TCRM.S91898
FULL TEXT LINK
http://dx.doi.org/10.2147/TCRM.S91898
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 355
TITLE
Use of diagnosis codes for detection of clinically significant opioid
poisoning in the emergency department: A retrospective analysis of a
surveillance case definition
AUTHOR NAMES
Reardon J.M.
Harmon K.J.
Schult G.C.
Staton C.A.
Waller A.E.
AUTHOR ADDRESSES
(Reardon J.M., Joseph.Reardon@alumni.duke.edu; Staton C.A.,
Catherine.Lynch@dm.duke.edu) Duke University, Division of Emergency
Medicine, 2301 Erwin Rd, Box 3935, Durham, United States.
(Harmon K.J., KJHarmon@email.unc.edu; Waller A.E., Anna_Waller@med.unc.edu)
University of North Carolina at Chapel Hill, Carolina Center for Health
Informatics and the Injury Prevention Research Center, 100 Market St, Chapel
Hill, United States.
(Schult G.C., GCSchult@gmail.com; Waller A.E., Anna_Waller@med.unc.edu)
University of North Carolina at Chapel Hill, Department of Emergency
Medicine, 170 Manning Dr, Box 7594, Chapel Hill, United States.
(Staton C.A., Catherine.Lynch@dm.duke.edu) Duke University, Duke Global
Health Institute, 310 Trent Dr, Durham, United States.
CORRESPONDENCE ADDRESS
J.M. Reardon, Duke University, Division of Emergency Medicine, 2301 Erwin
Rd, Box 3935, Durham, United States. Email: Joseph.Reardon@alumni.duke.edu
SOURCE
BMC Emergency Medicine (2016) 16:1 Article Number: 11. Date of Publication:
8 Feb 2016
ISSN
1471-227X (electronic)
BOOK PUBLISHER
BioMed Central Ltd., info@biomedcentral.com
ABSTRACT
Background: Although fatal opioid poisonings tripled from 1999 to 2008, data
describing nonfatal poisonings are rare. Public health authorities are in
need of tools to track opioid poisonings in near real time. Methods: We
determined the utility of ICD-9-CM diagnosis codes for identifying
clinically significant opioid poisonings in a state-wide emergency
department (ED) surveillance system. We sampled visits from four hospitals
from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02
and 965.09 (poisoning by opiates and related narcotics) and/or an external
cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and
related narcotics), and developed a novel case definition to determine in
which cases opioid poisoning prompted the ED visit. We calculated the
percentage of visits coded for opioid poisoning that were clinically
significant and compared it to the percentage of visits coded for poisoning
by non-opioid agents in which there was actually poisoning by an opioid
agent. We created a multivariate regression model to determine if other
collected triage data can improve the positive predictive value of diagnosis
codes alone for detecting clinically significant opioid poisoning. Results:
70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were
primarily prompted by opioid poisoning. The remainder of visits represented
opioid exposure in the setting of other primary diseases. Among non-opioid
poisoning codes reviewed, up to 36 % were reclassified as an opioid
poisoning. In multivariate analysis, only naloxone use improved the positive
predictive value of ICD-9-CM codes for identifying clinically significant
opioid poisoning, but was associated with a high false negative rate.
Conclusions: This surveillance mechanism identifies many clinically
significant opioid overdoses with a high positive predictive value. With
further validation, it may help target control measures such as prescriber
education and pharmacy monitoring.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
naloxone
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
disease surveillance
emergency ward
ICD-9-CM
intoxication
opioid poisoning
EMTREE MEDICAL INDEX TERMS
adult
article
community hospital
false negative result
female
human
major clinical study
male
multivariate analysis
predictive value
university hospital
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160106255
MEDLINE PMID
26856978 (http://www.ncbi.nlm.nih.gov/pubmed/26856978)
PUI
L608143707
DOI
10.1186/s12873-016-0075-4
FULL TEXT LINK
http://dx.doi.org/10.1186/s12873-016-0075-4
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 356
TITLE
Risk for Opioid Misuse among Emergency Department Cancer Patients
AUTHOR NAMES
Reyes-Gibby C.C.
Anderson K.O.
Todd K.H.
AUTHOR ADDRESSES
(Reyes-Gibby C.C., creyes@mdanderson.org; Todd K.H.) Department of Emergency
Medicine, University of Texas, MD Anderson Cancer Center, Houston, United
States.
(Anderson K.O.) Department of Symptom Research, University of Texas, MD
Anderson Cancer Center, Houston, United States.
CORRESPONDENCE ADDRESS
C.C. Reyes-Gibby, Department of Emergency Medicine, University of Texas, MD
Anderson Cancer Center, Houston, United States. Email: creyes@mdanderson.org
SOURCE
Academic Emergency Medicine (2016) 23:2 (151-158). Date of Publication: 1
Feb 2016
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives One of the most challenging areas of emergency medicine practice
is the management and treatment of severe and persistent pain, including
cancer-related pain. Emergency departments (EDs) in the United States
frequently provide care for patients with cancer and an increasing concern
is the potential for opioid misuse in this patient group. The authors
determined the risk for opioid misuse among ED cancer patients with pain and
assessed demographic and clinical factors associated with increased misuse
risk. The Texas state prescription monitoring program was also queried for
evidence of multiple opioid prescriptions for comparing low- and high-risk
groups. Methods The Screener and Opioid Assessment for Patients with
Pain-Revised (SOAPP-R) was administered to assess risk for opioid misuse
among cancer patients presenting to the ED of a comprehensive cancer center
in the United States. Eligibility criteria included: 1) presentation for
treatment of chronic cancer-related pain while taking a prescribed schedule
II opioid for analgesia, 2) age of 18 years or older, 3) ability to speak
English, and 4) ability to understand the study and give written informed
consent. Results Of 934 ED patients screened for the study, 290 were
eligible and 209 participated (72% response rate). On the basis of the
recommended SOAPP-R cutoff score of 18, a total of 71 of the 209 patients
(34%) were categorized as having a high risk of misuse. Of note, 15% and 4%
of all patients reported past or current use of illicit substances,
respectively. The total number of annual opioid prescriptions (17.8 vs.
12.6; p = 0.023) differed between the high- versus low-risk groups.
Multivariable analyses showed that depression (odds ratio [OR] = 3.06, 95%
confidence interval [CI] = 1.45 to 6.48; p = 0.003), poor coping (OR = 1.08,
95% CI = 1.03 to 1.13; p = 0.001), and illicit substance use (OR = 28.30,
95% CI = 2.97 to 269.24; p = 0.029) were significantly associated with high
risk of opioid misuse. Conclusions The risk of opioid misuse among cancer
patients is substantial. Screening for opioid misuse in the ED is feasible.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy, drug therapy)
drug misuse
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
cancer center
cancer patient
chronic pain (drug therapy)
controlled study
cross-sectional study
depression
drug surveillance program
female
high risk population
human
informed consent
low risk population
major clinical study
male
pain assessment
prescription
priority journal
risk factor
Screener and Opioid Assessment for Patients with Pain Revised
substance use
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cancer (16)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160138823
MEDLINE PMID
26824227 (http://www.ncbi.nlm.nih.gov/pubmed/26824227)
PUI
L608438905
DOI
10.1111/acem.12861
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12861
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 357
TITLE
A comparison of an opioid abuse screening tool and prescription drug
monitoring data in the emergency department
AUTHOR NAMES
Weiner S.G.
Horton L.C.
Green T.C.
Butler S.F.
AUTHOR ADDRESSES
(Weiner S.G., sweiner@bwh.harvard.edu) Department of Emergency Medicine,
Brigham and Women's Hospital, Boston, United States.
(Horton L.C., laura.horton@tufts.edu) Tufts University School of Medicine,
Boston, United States.
(Green T.C., traci.c.green@gmail.com) Boston Medical Center, Boston
University Department of Emergency Medicine Providence, RI Inflexxion, Inc.,
Newton, United States.
(Butler S.F., sfbutler@inflexxion.com) Inflexxion, Inc., Newton, United
States.
CORRESPONDENCE ADDRESS
S.G. Weiner, Brigham and Women's Hospital, 75 Francis Street, Boston, United
States. Email: sweiner@bwh.harvard.edu
SOURCE
Drug and Alcohol Dependence (2016) 159 (152-157). Date of Publication: 1 Feb
2016
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Objectives: This study aimed to: (a) determine the percentage of ED patients
receiving prescriptions for opioid pain medications that meet the criteria
for "high-risk for abuse potential" on the Screener and Opioid Assessment
for Patients with Pain (SOAPP®-R), (b) determine the percentage of patients
with high-risk behavior on the state prescription drug monitoring program
(PDMP) database, (c) compare the SOAPP-R with data from the PDMP, and (d)
determine psychometric properties of SOAPP-R for ED patients. Methods:
Convenience sample of ED patients who were being considered for discharge
with a prescription for an opioid pain medication. Subjects completed
SOAPP-R on an electronic tablet and PDMP data was obtained. Scores on
SOAPP-R ≥18 were defined as "at-risk", and PDMP data showing both ≥4 opioid
prescriptions and ≥4 providers in 12 months was considered the criterion
standard for high-risk behavior. Results: 82 patients (88.2%) provided
consent. 32.9% (n= 27) were determined to be "at-risk" (score ≥18) by
SOAPP-R. 15.9% (n= 13) subjects met PDMP criteria and 53.9% (n= 7) of those
had SOAPP-R scores ≥18 (sensitivity 54%, specificity 71%, positive
predictive value 26%, negative predictive value 89%). The association of an
at-risk SOAPP-R score and PDMP high-risk criteria was an adjusted odds ratio
of 1.39 (95% confidence interval 0.73-3.68). Conclusions: In our population,
about one-third of patients being considered for discharge with an opioid
prescription scored "at-risk" on SOAPP-R and 15.9% met the PDMP high-risk
criteria. The high negative predictive value of SOAPP-R indicates it may be
a useful screening tool for the ED patient population.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
narcotic dependence (diagnosis)
psychometry
Screener and Opioid Assessment for Patients with Pain Revised
screening test
EMTREE MEDICAL INDEX TERMS
adult
aged
article
comparative study
controlled study
cross-sectional study
data base
diagnostic test accuracy study
drug surveillance program
emergency ward
female
high risk behavior
hospital discharge
human
major clinical study
male
middle aged
predictive value
prescription
priority journal
prospective study
risk assessment
scoring system
sensitivity and specificity
young adult
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160000761
MEDLINE PMID
26743334 (http://www.ncbi.nlm.nih.gov/pubmed/26743334)
PUI
L607428895
DOI
10.1016/j.drugalcdep.2015.12.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2015.12.007
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 358
TITLE
Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to
2012
AUTHOR NAMES
Kuo Y.-F.
Raji M.A.
Chen N.-W.
Hasan H.
Goodwin J.S.
AUTHOR ADDRESSES
(Kuo Y.-F., yokuo@utmb.edu; Raji M.A.; Hasan H.; Goodwin J.S.) Department of
Internal Medicine, The University of Texas Medical Branch, Galveston, United
States.
(Kuo Y.-F., yokuo@utmb.edu; Raji M.A.; Goodwin J.S.) Sealy Center on Aging,
The University of Texas Medical Branch, Galveston, United States.
(Kuo Y.-F., yokuo@utmb.edu; Chen N.-W.; Goodwin J.S.) Department of
Preventive Medicine and Community Health, The University of Texas Medical
Branch, Galveston, United States.
(Kuo Y.-F., yokuo@utmb.edu; Goodwin J.S.) Institute for Translational
Science, The University of Texas Medical Branch, Galveston, United States.
CORRESPONDENCE ADDRESS
Y.-F. Kuo, University of Texas Medical Branch, Department of Preventive
Medicine and Community Health, 301 University Boulevard, Galveston, United
States. Email: yokuo@utmb.edu
SOURCE
American Journal of Medicine (2016) 129:2 (221.e21-221.e30). Date of
Publication: 1 Feb 2016
ISSN
1555-7162 (electronic)
0002-9343
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Background There is growing concern about potential overuse of, and toxicity
from, opioid analgesics. No nationally representative study has examined
inter-state variations in opioid use and impact of policy on opioid use
among older adults. Methods We used national Medicare data from 2007-2012 to
assess temporal and geographic trends in rates of opioid prescription and
relationship to opioid toxicity and different state regulations in Part D
Medicare recipients. We excluded those with a cancer diagnosis. Multilevel,
multivariable regression analyses evaluated rates of prolonged prescriptions
for schedule II, schedule III, and combination II/III opioid for each state,
adjusting for patient characteristics. Results The percent of Part D
recipients receiving prescriptions for combined schedule II/III opioid more
than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large
variations existed among states in rates of opioid prescriptions: from 2.84%
in New York to 10.93% in Utah, in 2012 data. The state variation was larger
for schedule III than schedule II. Individual characteristics independently
associated with prolonged use included older age, female gender, white race,
low income, living in a lower-education area, and comorbidity of drug abuse,
rheumatoid arthritis, and depression. Only state law regulating pain clinic
was associated with reduction of schedule II opioid prescriptions. Prolonged
opioid prescription use increased the odds of opioid overdose-related
emergency room visits or hospitalization by 60%. Conclusions Analyses of
Medicare Part D data demonstrated a substantial growth in opioid
prescriptions from 2007 to 2011 and large variation in opioid prescriptions
across states.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
age
aged
article
Black person
Caucasian
clinical article
comorbidity
depression
District of Columbia
drug abuse
drug intoxication
drug overdose
educational status
emergency care
female
gender
health care policy
hospitalization
human
lowest income group
male
medicare
New Jersey
New York
pain clinic
priority journal
rheumatoid arthritis
social status
Texas
Utah
very elderly
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151018441
MEDLINE PMID
26522794 (http://www.ncbi.nlm.nih.gov/pubmed/26522794)
PUI
L607215590
DOI
10.1016/j.amjmed.2015.10.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amjmed.2015.10.002
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 359
TITLE
μ-Opioid agonists for preventing emergence agitation under sevoflurane
anesthesia in children: A meta-analysis of randomized controlled trials
AUTHOR NAMES
Tan Y.
Shi Y.
Ding H.
Kong X.
Zhou H.
Tian J.
AUTHOR ADDRESSES
(Tan Y.; Shi Y., shiys@lzu.edu.cn; Zhou H.) Department of Anesthesiology,
Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District,
Lanzhou, China.
(Ding H.; Kong X.) Department of Urology, Lanzhou University Second
Hospital, Lanzhou, China.
(Tian J.) Evidence-Based Medicine Center, Lanzhou University, Lanzhou,
China.
CORRESPONDENCE ADDRESS
Y. Shi, Department of Anesthesiology, Lanzhou University Second Hospital,
Cuiyingmen 82, Chengguan District, Lanzhou, China. Email: shiys@lzu.edu.cn
SOURCE
Paediatric Anaesthesia (2016) 26:2 (139-150). Date of Publication: 1 Feb
2016
ISSN
1460-9592 (electronic)
1155-5645
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Summary Background Emergence agitation (EA) is an adverse effect after
sevoflurane anesthesia in pediatric patients. The effectiveness of
prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and
alfentanil in preventing EA is debatable. Methods A literature search was
conducted to identify clinical trials that observed the effect of μ-opioid
agonists fentanyl, remifentanil, sufentanil, and alfentanil on preventing EA
in pediatric patients under sevoflurane anesthesia. The statistical software
RevMan 5.3 was used for meta-analysis. Data from each study were combined
using the relative ratio (RR), weighted mean differences, and their
associated 95% confidence intervals. I(2) was used to evaluate
heterogeneity. Subgroup analysis was conducted to investigate the possible
influences of patient age, adenotonsillectomy, premedication, N(2)O,
propofol, and regional block/local anesthetics on preventing EA with
prophylactic administration of μ-opioid agonists. Publication bias was
checked using funnel plots and Begg's test. Results This meta-analysis
showed the inclusion of 19 randomized controlled trials with 1528 patients
(857 patients received μ-opioid agonists therapy and 671 patients had
placebo). The pooled data indicated that prophylactic μ-opioid agonists
fentanyl, remifentanil, sufentanil, and alfentanil significantly decreased
the incidence of EA [RR = 0.49 (0.38, 0.64), I(2) = 42%, P = 0.04; RR = 0.57
(0.33, 0.99), I(2) = 37%, P = 0.19; RR = 0.18 (0.08, 0.39), I(2) = 0%, P =
0.98; and RR = 0.56 (0.40, 0.78), I(2) = 6%, P = 0.34, respectively]. All
subgroup analyses strengthened the proof for lower incidence of EA under
sevoflurane anesthesia after fentanyl administration. A possibility of
publication bias was detected in the fentanyl group. Conclusions This
meta-analysis suggested that prophylactic μ-opioid agonists fentanyl,
remifentanil, sufentanil, and alfentanil could significantly decrease the
incidence of EA under sevoflurane anesthesia in children compared to
placebo. Considering the limitations of the included studies, more clinical
studies are required.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
mu opiate receptor agonist (clinical trial, drug comparison - placebo, drug
therapy, pharmacology)
sevoflurane (adverse drug reaction)
EMTREE DRUG INDEX TERMS
alfentanil (drug therapy, pharmacology)
fentanyl (adverse drug reaction, drug therapy, pharmacology)
placebo
propofol
remifentanil (drug therapy, pharmacology)
sufentanil (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitation
anesthesia induction
emergence agitation (drug therapy, side effect, drug therapy, side effect)
restlessness (drug therapy, side effect, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
adenotonsillectomy
child care
drug activity
drug efficacy
drug safety
human
incidence
meta analysis (topic)
outcome assessment
postoperative nausea and vomiting (side effect)
postoperative pain (complication, diagnosis)
priority journal
quality control
randomized controlled trial (topic)
review
surgical approach
surgical technique
systematic review
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
fentanyl (437-38-7)
propofol (2078-54-8)
remifentanil (132539-07-2)
sevoflurane (28523-86-6)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160014814
MEDLINE PMID
26614352 (http://www.ncbi.nlm.nih.gov/pubmed/26614352)
PUI
L607551310
DOI
10.1111/pan.12815
FULL TEXT LINK
http://dx.doi.org/10.1111/pan.12815
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 360
TITLE
Methadone overdose causing acute cerebellitis and multi-organ damage
AUTHOR NAMES
Rando J.
Szari S.
Kumar G.
Lingadevaru H.
AUTHOR ADDRESSES
(Rando J., Jessica.rando718@gmail.com) Wright State University, 3640 Colonel
Glenn Hwy, Dayton, United States.
(Szari S., sofia.szari@gmail.com; Kumar G., kumarg@childrensdayton.org;
Lingadevaru H., lingadevaruh@childrensdayton.org) Dayton Children's
Hospital, 1 Childrens Plz, Dayton, United States.
(Szari S., sofia.szari@gmail.com) United States Air Force, 1 Wright
Patterson Afb #A271, Dayton, United States.
CORRESPONDENCE ADDRESS
J. Rando, Wright State University, 3640 Colonel Glenn Hwy, Dayton, United
States. Email: Jessica.rando718@gmail.com
SOURCE
American Journal of Emergency Medicine (2016) 34:2 (343e1-343e3). Date of
Publication: 1 Feb 2016
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
EMTREE DRUG INDEX TERMS
alanine aminotransferase (endogenous compound)
aspartate aminotransferase (endogenous compound)
caffeine
ceftriaxone (drug therapy)
creatinine (endogenous compound)
naloxone
sodium chloride
troponin (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute cerebellitis
cerebellum disease
drug intoxication
multiple organ failure
EMTREE MEDICAL INDEX TERMS
adolescent
aphasia
article
ataxia
case report
computer assisted tomography
electroencephalogram
elevated blood pressure
emergency health service
emergency ward
extubation
fever
heart injury
heart left ventricle hypertrophy
human
intubation
kidney injury
liver injury
lumbar puncture
male
meningitis (drug therapy)
miosis
neuroimaging
nuclear magnetic resonance imaging
occupational therapy
oxygen saturation
physiotherapy
priority journal
respiration depression
resuscitation
sinus tachycardia
ST segment depression
tachycardia
thorax radiography
CAS REGISTRY NUMBERS
alanine aminotransferase (9000-86-6, 9014-30-6)
aspartate aminotransferase (9000-97-9)
caffeine (58-08-2)
ceftriaxone (73384-59-5, 74578-69-1)
creatinine (19230-81-0, 60-27-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Radiology (14)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015182056
MEDLINE PMID
26164407 (http://www.ncbi.nlm.nih.gov/pubmed/26164407)
PUI
L605133628
DOI
10.1016/j.ajem.2015.06.032
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2015.06.032
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 361
TITLE
As opioid overdose deaths reach record highs, call for systematic changes
grows louder
AUTHOR ADDRESSES
SOURCE
ED management : the monthly update on emergency department management (2016)
28:2 (13-19). Date of Publication: 1 Feb 2016
ISSN
1044-9167
ABSTRACT
With deaths from opioid overdoses up sharply, a number of organizations are
calling for systematic changes to curb the prescription of opioids while
also making it easier for patients with addiction problems to access
evidence- based treatment. New data from the National Center for Health
Statistics un- derscore the scope of the problem: Deaths related to
prescription overdoses reached an all-time high in 2014, nearing the 19,000
mark. Deaths linked to heroin reached 10,574, a three-fold increase from
2010. In response to the opioid problem, the CDC has unveiled draft
guidelines directing physicians to consider alternative treatments for pain
before turning to opioids. When opioids must be used, the guidelines
encourage physicians to opt for shorter-acting versions rather than
extended-release forms, and they suggest that physicians incorporate
strategies to mitigate the risk of overdose, such as offering naloxone to
patients in specific high-risk groups. The draft guidelines also call for
physicians to ask patients to take urine tests before prescribing opioids,
and to continue requiring the urine tests at least once per year if patients
continue on the drugs. This is to identify patients who may be supplementing
their prescribed dosages. New research reported in JAMA Internal Medicine
suggests that the over-prescribing of opioids is a problem shared by a broad
cross-section of health professionals, not a small subset, as some have
suggested. A new report, led by researchers at the Johns Hopkins School of
Public Health, recommends significant improvements in the way opioids are
prescribed and dispensed as well as in the way patients with addictions or
overdoses are identified and managed in the healthcare system.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mortality
organization and management
EMTREE MEDICAL INDEX TERMS
clinical practice
drug overdose (prevention)
emergency health service
epidemiology
evidence based medicine
health survey
human
inappropriate prescribing
opiate addiction (prevention)
practice guideline
prescription drug misuse (prevention)
public health service
statistics and numerical data
substance abuse
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26939351 (http://www.ncbi.nlm.nih.gov/pubmed/26939351)
PUI
L610681276
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 362
TITLE
Lesson of the month 1: Artery of Percheron occlusion - An uncommon cause of
coma in a middle-aged man
AUTHOR NAMES
Bailey J.
Khadjooi K.
AUTHOR ADDRESSES
(Bailey J., james.bailey5@nhs.net; Khadjooi K.) Addenbrooke's Hospital,
Cambridge University Hospital NHS Foundation Trust, Cambridge, United
Kingdom.
CORRESPONDENCE ADDRESS
J. Bailey, EAU Office (S612), Ipswich Hospital NHS Trust, Heath Road,
Ipswich, United Kingdom. Email: james.bailey5@nhs.net
SOURCE
Clinical Medicine, Journal of the Royal College of Physicians of London
(2016) 16:1 (86-87). Date of Publication: 1 Feb 2016
ISSN
1473-4893 (electronic)
1470-2118
BOOK PUBLISHER
Royal College of Physicians
ABSTRACT
Bilateral paramedian thalamic infarction resulting from artery of Percheron
occlusion presents with a distinct clinical syndrome comprising impaired
consciousness, often with vertical gaze palsy and memory impairment. This
uncommon anatomical variant arises as a single artery supplying both
paramedian thalami. Early recognition can be challenging in the obtunded
patient, where the differential diagnosis is broad. The acute physician
should consider this diagnosis in a patient presenting with unexplained coma
so that emergent treatments such as thrombolysis can be employed. Early
imaging with computerised tomography can often be normal; therefore the use
of magnetic resonance imaging is essential in confirming the diagnosis.
EMTREE DRUG INDEX TERMS
analgesic agent
antiinflammatory agent (drug combination, drug therapy)
clopidogrel
naloxone
opiate (drug combination, drug therapy)
simvastatin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
artery occlusion
artery of percheron occlusion
coma
EMTREE MEDICAL INDEX TERMS
adult
alertness
amnesia
artery
article
case report
cerebrovascular accident
drowsiness
emergency ward
Glasgow coma scale
hospital admission
human
male
memory disorder
middle aged
neuroimaging
nuclear magnetic resonance imaging
petechia
pupil
rash
recall
short term memory
shoulder pain (drug therapy)
somnolence
thrombophilia
vertigo
CAS REGISTRY NUMBERS
clopidogrel (113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
simvastatin (79902-63-9)
EMBASE CLASSIFICATIONS
Radiology (14)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160100789
MEDLINE PMID
27045503 (http://www.ncbi.nlm.nih.gov/pubmed/27045503)
PUI
L608109369
DOI
10.7861/clinmedicine.16-1-86
FULL TEXT LINK
http://dx.doi.org/10.7861/clinmedicine.16-1-86
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 363
TITLE
Opioid prescribing after nonfatal overdose and association with repeated
overdose: A cohort study
AUTHOR NAMES
Larochelle M.R.
Liebschutz J.M.
Zhang F.
Ross-Degnan D.
Wharam J.F.
AUTHOR ADDRESSES
(Larochelle M.R., marc.larochelle@bmc.org; Liebschutz J.M.) Boston Medical
Center, 801 Massachusetts Avenue, Boston, United States.
(Zhang F.; Ross-Degnan D.; Wharam J.F.) Department of Population Medicine,
Harvard Medical School, 133 Brookline Avenue, Boston, United States.
CORRESPONDENCE ADDRESS
M.R. Larochelle, Boston Medical Center, 801 Massachusetts Avenue, Boston,
United States. Email: marc.larochelle@bmc.org
SOURCE
Annals of Internal Medicine (2016) 164:1 (1-9). Date of Publication: 5 Jan
2016
ISSN
1539-3704 (electronic)
0003-4819
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
ABSTRACT
Background: Nonfatal opioid overdose is an opportunity to identify and treat
substance use disorders, but treatment patterns after the overdose are
unknown. Objective: To determine prescribed opioid dosage after an opioid
overdose and its association with repeated overdose. Design: Retrospective
cohort study. Setting: A large U.S. health insurer. Participants: 2848
commercially insured patients aged 18 to 64 years who had a nonfatal opioid
overdose during long-term opioid therapy for noncancer pain between May 2000
and December 2012. Measurements: Nonfatal opioid overdose was identified
using International Classification of Diseases, Ninth Revision, Clinical
Modification, codes from emergency department or inpatient claims. The
primary outcome was daily morphine-equivalent dosage (MED) of opioids
dispensed from 60 days before to up to 730 days after the index overdose. We
categorized dosages as large (≤100 mg MED), moderate (50 to <100 mg MED),
low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to
repeated overdose stratified by daily dosage as a time-varying covariate.
Results: Over a median follow-up of 299 days, opioids were dispensed to 91%
of patients after an overdose. Seven percent of patients (n = 212) had a
repeated opioid overdose. At 2 years, the cumulative incidence of repeated
overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of
opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving
moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8%
(CI, 6% to 11%) for those receiving no opioids. Limitation: The cohort was
limited to commercially insured adults. Conclusion: Almost all patients
continue to receive prescription opioids after an overdose. Opioid
discontinuation after overdose is associated with lower risk for repeated
overdose. Primary Funding Source: Health Resources and Services
Administration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
buprenorphine
codeine (drug dose, drug therapy)
dextropropoxyphene (drug dose, drug therapy)
dihydrocodeine (drug dose, drug therapy)
fentanyl (drug dose, drug therapy)
hydrocodone (drug dose, drug therapy)
hydromorphone (drug dose, drug therapy)
levorphanol (drug dose, drug therapy)
methadone (drug dose, drug therapy)
morphine (drug dose, drug therapy)
oxycodone (drug dose, drug therapy)
oxymorphone (drug dose, drug therapy)
pethidine (drug dose, drug therapy)
tramadol (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
nonfatal opioid overdose
prescription
repeated opioid overdose
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
drug megadose
emergency ward
follow up
health insurance
hospital patient
human
ICD-9-CM
long term care
low drug dose
major clinical study
outcome assessment
pain (disease management, drug therapy)
priority journal
retrospective study
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
levorphanol (125-72-4, 77-07-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160021514
MEDLINE PMID
26720742 (http://www.ncbi.nlm.nih.gov/pubmed/26720742)
PUI
L607589433
DOI
10.7326/M15-0038
FULL TEXT LINK
http://dx.doi.org/10.7326/M15-0038
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 364
TITLE
Most US patients continue to be prescribed opioids after overdose
AUTHOR NAMES
Wise J.
AUTHOR ADDRESSES
(Wise J.) London, United Kingdom.
CORRESPONDENCE ADDRESS
J. Wise, London, United Kingdom.
SOURCE
BMJ (Online) (2016) 352 Article Number: h7010. Date of Publication: 4 Jan
2016
ISSN
1756-1833 (electronic)
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
chronic pain (drug therapy)
drug megadose
drug overdose
drug seeking behavior
drug withdrawal
emergency ward
follow up
health insurance
hospital patient
human
incidence
low drug dose
note
patient care
practice guideline
priority journal
repeated drug dose
risk assessment
treatment outcome
United States
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160185045
MEDLINE PMID
26729918 (http://www.ncbi.nlm.nih.gov/pubmed/26729918)
PUI
L608676643
DOI
10.1136/bmj.h7010
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.h7010
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 365
TITLE
Emergency department patient perspectives on the risk of addiction to
prescription opioids
AUTHOR NAMES
Conrardy M.
Lank P.
Cameron K.A.
McConnell R.
Chevrier A.
Sears J.
Ahlstrom E.
Wolf M.S.
Courtney D.M.
McCarthy D.M.
AUTHOR ADDRESSES
(Conrardy M., michael.conrardy@northwestern.edu; Ahlstrom E.) Feinberg
School of Medicine, Northwestern University, Chicago, United States.
(Lank P.; McConnell R.; Sears J.; Courtney D.M.; McCarthy D.M.) Department
of Emergency Medicine, Feinberg School of Medicine, Northwestern University,
Chicago, United States.
(Cameron K.A.; Chevrier A.; Wolf M.S.) Division of General Internal Medicine
and Geriatrics, Feinberg School of Medicine, Northwestern University,
Chicago, United States.
(Wolf M.S.; McCarthy D.M.) Division of General Internal Medicine and
Geriatrics, Health Literacy and Learning Program, Feinberg School of
Medicine, Northwestern University, Chicago, United States.
CORRESPONDENCE ADDRESS
M. Conrardy, 211 E Ontario Street, Room 200, Chicago, United States. Email:
michael.conrardy@northwestern.edu
SOURCE
Pain Medicine (United States) (2016) 17:1 (114-121). Date of Publication: 1
Jan 2016
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Oxford University Press, jnl.info@oup.co.uk
ABSTRACT
Objective. To characterize emergency department (ED) patients’ knowledge and
beliefs about the addictive potential of opioids. Design. Mixed methods
analysis of data from a randomized controlled trial. Setting. Urban academic
ED (>88,000 visits). Subjects. One hundred and seventy four discharged ED
patients prescribed hydrocodone-acetaminophen for acute pain. Methods. The
study analyzed data collected from a randomized controlled trial
investigating patients’ knowledge of opioids. ED patients discharged with
hydrocodone-acetaminophen completed an audio-recorded phone interview 4-7
days later. This analysis focuses on responses about addiction. Responses
were categorized using content analysis; thematic analysis identified broad
themes common across different categories. Results. Participants’ mean age
was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had
an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses
were categorized first based on whether the patient believed that opioids
could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%;
or do not know, 4.6%), and second based on whether or not the patient
discussed his/her own experience with the medication (categorized as:
personalized, 35.6%; or not personalized, 64.4%). Cohen’s Kappa was 0.84 for
all categories. Three themes emerged in the thematic analysis: theme 1)
patients expect to “feel” addicted if they are addicted, theme 2) patients
fear addiction, and theme 3) side effects affected patient views of
addiction. Conclusion. In this sample, patients had misconceptions about
opioid addiction. Some patients did not know opioids could be addictive,
others underestimated their personal risk of addiction, and others overtly
feared addiction and, therefore, risked inadequate pain management. Despite
limited data, we recommend providers discuss opioid addiction with their
patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug combination, drug therapy, oral drug
administration)
EMTREE DRUG INDEX TERMS
hydrocodone (drug combination, drug therapy)
hydrocodone plus acetaminophen (drug combination, drug therapy)
paracetamol (drug combination, drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
patient attitude
prescription
risk factor
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
article
backache
bone injury
content analysis
disease association
drug effect
drug use
fear
female
human
intercoder reliability
major clinical study
male
medical record review
pain (drug therapy)
patient education
personal experience
qualitative analysis
randomized controlled trial (topic)
reliability
telephone interview
thematic analysis
therapeutic misconception
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015356020
MEDLINE PMID
26332701 (http://www.ncbi.nlm.nih.gov/pubmed/26332701)
PUI
L605914651
DOI
10.1111/pme.12862
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12862
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 366
TITLE
Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose
Resuscitation Efforts
AUTHOR NAMES
Sumner S.A.
Mercado-Crespo M.C.
Spelke M.B.
Paulozzi L.
Sugerman D.E.
Hillis S.D.
Stanley C.
AUTHOR ADDRESSES
(Sumner S.A.; Mercado-Crespo M.C.; Spelke M.B.; Paulozzi L.; Sugerman D.E.;
Hillis S.D.; Stanley C.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2016)
20:2 (220-225). Date of Publication: 2016
ISSN
1545-0066 (electronic)
ABSTRACT
Naloxone administration is an important component of resuscitation attempts
by emergency medical services (EMS) for opioid drug overdoses. However, EMS
providers must first recognize the possibility of opioid overdose in
clinical encounters. As part of a public health response to an outbreak of
opioid overdoses in Rhode Island, we examined missed opportunities for
naloxone administration and factors potentially influencing EMS providers'
decision to administer naloxone. We reviewed medical examiner files on all
individuals who died of an opioid-related drug overdose in Rhode Island from
January 1, 2012 through March 31, 2014, underwent attempted resuscitation by
EMS providers, and had records available to assess for naloxone
administration. We evaluated whether these individuals received naloxone as
part of their resuscitation efforts and compared patient and scene
characteristics of those who received naloxone to those who did not receive
naloxone via chi-square, t-test, and logistic regression analyses. One
hundred and twenty-four individuals who underwent attempted EMS
resuscitation died due to opioid overdose. Naloxone was administered during
EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly
three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI
1.2-7.0; p-value 0.02). Additionally, patients without signs of potential
drug abuse also had a greater than three-fold odds of not receiving naloxone
(OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly
those over age 50, were more likely not to receive naloxone than victims
younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older
individuals, and those patients without clear signs of illicit drug abuse,
were less likely to receive naloxone in EMS resuscitation attempts.
Heightened clinical suspicion for opioid overdose is important given the
recent increase in overdoses among patients due to prescription opioids.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
cross-sectional study
drug overdose (drug therapy)
emergency health service
female
human
male
middle aged
opiate addiction (drug therapy)
resuscitation
statistics and numerical data
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26383533 (http://www.ncbi.nlm.nih.gov/pubmed/26383533)
PUI
L614820988
DOI
10.3109/10903127.2015.1076096
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2015.1076096
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 367
TITLE
Randomized controlled trial of electronic care plan alerts and resource
utilization by high frequency emergency department users with opioid use
disorder
AUTHOR NAMES
Rathlev N.
Almomen R.
Deutsch A.
Smithline H.
Li H.
Visintainer P.
AUTHOR ADDRESSES
(Rathlev N., niels.rathlev@baystatehealth.org; Smithline H.) Baystate
Medical Center, Tufts University School of Medicine, Department of Emergency
Medicine, 759 Chestnut St., Springfield, United States.
(Almomen R.) ARAMCO, Department of Emergency Medicine, Dharan, Saudi Arabia.
(Deutsch A.; Li H.) Baystate Medical Center, Department of Emergency
Medicine, Springfield, United States.
(Visintainer P.) Baystate Medical Center, Department of Academic Affairs
Administration, Springfield, United States.
CORRESPONDENCE ADDRESS
N. Rathlev, Baystate Medical Center, Tufts University School of Medicine,
Department of Emergency Medicine, 759 Chestnut St., Springfield, United
States. Email: niels.rathlev@baystatehealth.org
SOURCE
Western Journal of Emergency Medicine (2016) 17:1 (28-34). Date of
Publication: 1 Jan 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: There is a paucity of literature supporting the use of
electronic alerts for patients with high frequency emergency department (ED)
use. We sought to measure changes in opioid prescribing and administration
practices, total charges and other resource utilization using electronic
alerts to notify providers of an opioid-use care plan for high frequency ED
patients. Methods: This was a randomized, non-blinded, two-group parallel
design study of patients who had 1) opioid use disorder and 2) high
frequency ED use. Three affiliated hospitals with identical electronic
health records participated. Patients were randomized into "Care Plan"
versus "Usual Care groups". Between the years before and after
randomization, we compared as primary outcomes the following: 1) opioids
(morphine mg equivalents) prescribed to patients upon discharge and
administered to ED and inpatients; 2) total medical charges, and the numbers
of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed
tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5)
inpatient admissions. Results: A total of 40 patients were enrolled. For ED
and inpatients in the "Usual Care" group, the proportion of morphine mg
equivalents received in the post-period compared with the pre-period was
15.7%, while in the "Care Plan" group the proportion received in the
post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI
[0.07-1.12]; p=0.07). For discharged patients in the "Usual Care" group, the
proportion of morphine mg equivalents prescribed in the post-period compared
with the pre-period was 25.7% while in the "Care Plan" group, the proportion
prescribed in the post-period compared to the pre-period was 2.9%. The "Care
Plan" group showed an 89% greater proportional change over the periods
compared with the "Usual Care" group (ratio=0.11, 95% CI [0.01-0.092];
p=0.04). Care plans did not change the total charges, or, the numbers of ED
visits, ED visits with CT or MRI or inpatient admissions. Conclusion:
Electronic care plans were associated with an incremental decrease in
opioids (in morphine mg equivalents) prescribed to patients with opioid use
disorder and high frequency ED use.
EMTREE DRUG INDEX TERMS
morphine
opiate
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
electronic alert care plan
electronic medical record
opiate addiction (disease management)
patient care planning
resource allocation
EMTREE MEDICAL INDEX TERMS
adult
clinical article
computer assisted tomography
controlled study
cost control
emergency patient
emergency ward
female
health care cost
health care utilization
health personnel attitude
hospital admission
hospital charge
hospital discharge
hospital patient
human
intention to treat analysis
intervention study
male
middle aged
morphine addiction (disease management)
multicenter study
nuclear magnetic resonance imaging
outcome assessment
parallel design
prescription
randomized controlled trial
review
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160163388
MEDLINE PMID
26823927 (http://www.ncbi.nlm.nih.gov/pubmed/26823927)
PUI
L608630882
DOI
10.5811/westjem.2015.11.28319
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.11.28319
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 368
TITLE
Quality improvement initiative to decrease variability of emergency
physician opioid analgesic prescribing
AUTHOR NAMES
Burton J.H.
Hoppe J.A.
Echternach J.M.
Rodgers J.M.
Donato M.
AUTHOR ADDRESSES
(Burton J.H., JHBurton@carilionclinic.org; Echternach J.M.; Rodgers J.M.;
Donato M.) Carilion Clinic, Department of Emergency Medicine, 1906 Belleview
Avenue, Roanoke, United States.
(Hoppe J.A.) University of Colorado, Denver School of Medicine, Department
of Emergency Medicine, Aurora, United States.
(Hoppe J.A.) Rocky Mountain Poison and Drug Center, Denver, United States.
CORRESPONDENCE ADDRESS
J.H. Burton, Carilion Clinic, Department of Emergency Medicine, 1906
Belleview Avenue, Roanoke, United States. Email: JHBurton@carilionclinic.org
SOURCE
Western Journal of Emergency Medicine (2016) 17:3 (258-263). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Addressing pain is a crucial aspect of emergency medicine.
Prescription opioids are commonly prescribed for moderate to severe pain in
the emergency department (ED); unfortunately, prescribing practices are
variable. High variability of opioid prescribing decisions suggests a lack
of consensus and an opportunity to improve care. This quality improvement
(QI) initiative aimed to reduce variability in ED opioid analgesic
prescribing. Methods: We evaluated the impact of a three-part QI initiative
on ED opioid prescribing by physicians at seven sites. Stage 1:
Retrospective baseline period (nine months). Stage 2: Physicians were
informed that opioid prescribing information would be prospectively
collected and feedback on their prescribing and that of the group would be
shared at the end of the stage (three months). Stage 3: After physicians
received their individual opioid prescribing data with blinded comparison to
the group means (from Stage 2) they were informed that individual
prescribing data would be unblinded and shared with the group after three
months. The primary outcome was variability of the standard error of the
mean and standard deviation of the opioid prescribing rate (defined as
number of patients discharged with an opioid divided by total number of
discharges for each provider). Secondary observations included mean quantity
of pills per opioid prescription, and overall frequency of opioid
prescribing. Results: The study group included 47 physicians with 149,884 ED
patient encounters. The variability in prescribing decreased through each
stage of the initiative as represented by the distributions for the opioid
prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction,
p<0.01), and Stage 3 mean 8% (60% reduction, p<0.01). The mean quantity of
pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage
2 (18% reduction, p<0.01), and 13 pills in Stage 3 (18% reduction, p<0.01).
The group mean prescribing rate also decreased through each stage: 20% in
Stage 1, 13% in Stage 2 (46% reduction, p<0.01), and 8% in Stage 3 (60%
reduction, p<0.01). Conclusion: ED physician opioid prescribing variability
can be decreased through the systematic application of sharing of peer
prescribing rates and prescriber specific normative feedback.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
prescription
total quality management
EMTREE MEDICAL INDEX TERMS
analgesia
article
emergency ward
human
major clinical study
medical practice
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160431612
MEDLINE PMID
27330656 (http://www.ncbi.nlm.nih.gov/pubmed/27330656)
PUI
L610669224
DOI
10.5811/westjem.2016.3.29692
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.3.29692
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 369
TITLE
Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts
and Their Utility in Preventing Adverse Drug Events in the Emergency
Department
AUTHOR NAMES
Genco E.K.
Forster J.E.
Flaten H.
Goss F.
Heard K.J.
Hoppe J.
Monte A.A.
AUTHOR ADDRESSES
(Genco E.K., emma.genco@ucdenver.edu; Flaten H.; Goss F.; Heard K.J.; Hoppe
J.; Monte A.A.) Department of Emergency Medicine, University of Colorado
School of Medicine, Denver, United States.
(Forster J.E.) Department of Physical Medicine and Rehabilitation,
University of Colorado School of Medicine, Denver, United States.
(Forster J.E.) VA VISN 19 Rocky Mountain Mental Illness Research, Education
and Clinical Center (MIRECC), Denver, United States.
CORRESPONDENCE ADDRESS
E.K. Genco, Department of Emergency Medicine, University of Colorado School
of Medicine, Denver, United States. Email: emma.genco@ucdenver.edu
SOURCE
Annals of Emergency Medicine (2016) 67:2 (240-248.e3). Date of Publication:
1 Feb 2016
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective We examine the characteristics of clinical decision support
alerts triggered when opioids are prescribed, including alert type, override
rates, adverse drug events associated with opioids, and preventable adverse
drug events. Methods This was a retrospective chart review study assessing
adverse drug event occurrences for emergency department (ED) visits in a
large urban academic medical center using a commercial electronic health
record system with clinical decision support. Participants include those
aged 18 to 89 years who arrived to the ED every fifth day between September
2012 and January 2013. The main outcome was characteristics of opioid drug
alerts, including alert type, override rates, opioid-related adverse drug
events, and adverse drug event preventability by clinical decision support.
Results Opioid drug alerts were more likely to be overridden than nonopioid
alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50).
Opioid drug-allergy alerts were twice as likely to be overridden (relative
risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57
times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581
patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%),
and 8 were due to opioids (57.1%). None of the adverse drug events were
preventable by clinical decision support. However, 46 alerts were accepted
for 38 patients that averted a potential adverse drug event. Overall, 98.9%
of opioid alerts did not result in an actual or averted adverse drug event,
and 96.3% of opioid alerts were overridden. Conclusion Overridden opioid
alerts did not result in adverse drug events. Clinical decision support
successfully prevented adverse drug events at the expense of generating a
large volume of inconsequential alerts. To prevent 1 adverse drug event,
providers dealt with more than 123 unnecessary alerts. It is essential to
refine clinical decision support alerting systems to eliminate
inconsequential alerts to prevent alert fatigue and maintain patient safety.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction (side effect, side effect)
decision support system
EMTREE MEDICAL INDEX TERMS
adult
aged
article
clinical assessment
clinical decision making
clinical evaluation
drug hypersensitivity (side effect)
electronic medical record
emergency ward
female
human
major clinical study
male
medical record review
outcome assessment
patient safety
personal experience
prescription
priority journal
retrospective study
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151018871
MEDLINE PMID
26553282 (http://www.ncbi.nlm.nih.gov/pubmed/26553282)
PUI
L607220535
DOI
10.1016/j.annemergmed.2015.09.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2015.09.020
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 370
TITLE
Naloxone Prescriptions by Emergency PhysiciansReferences
AUTHOR ADDRESSES
SOURCE
Annals of Emergency Medicine (2016) 67:1 (149-150). Date of Publication: 1
Jan 2016
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
drug detoxification
drug intoxication
drug legislation
emergency health service
emergency ward
human
note
priority journal
substance abuse
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160215038
MEDLINE PMID
26707531 (http://www.ncbi.nlm.nih.gov/pubmed/26707531)
PUI
L609006806
DOI
10.1016/j.annemergmed.2015.11.023
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2015.11.023
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 371
TITLE
Impact of prior therapeutic opioid use by emergency department providers on
opioid prescribing decisions
AUTHOR NAMES
Pomerleau A.C.
Perrone J.
Hoppe J.A.
Salzman M.
Weiss P.S.
Nelson L.S.
AUTHOR ADDRESSES
(Pomerleau A.C., adam.pomerleau@emory.edu) Emory University School of
Medicine, Department of Emergency Medicine, 50 Hurt Plaza, Atlanta, United
States.
(Perrone J.) University of Pennsylvania, Perelman School of Medicine,
Department of Emergency Medicine, Philadelphia, United States.
(Hoppe J.A.) University of Colorado, Department of Emergency Medicine,
Aurora, United States.
(Hoppe J.A.) Rocky Mountain Poison and Drug Center, Denver, United States.
(Salzman M.) Rowman University, Cooper Medical School, Department of
Emergency Medicine, Camden, United States.
(Weiss P.S.) Emory University, Rollins School of Public Health, Department
of Biostatistics and Bioinformatics, Atlanta, United States.
(Nelson L.S.) New York University School of Medicine, Department of
Emergency Medicine, New York, United States.
CORRESPONDENCE ADDRESS
A.C. Pomerleau, Emory University School of Medicine, Department of Emergency
Medicine, 50 Hurt Plaza, Atlanta, United States. Email:
adam.pomerleau@emory.edu
SOURCE
Western Journal of Emergency Medicine (2016) 17:6 (791-797). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Our study sought to examine the opioid analgesic (OA)
prescribing decisions of emergency department (ED) providers who have
themselves used OA therapeutically and those who have not. A second
objective was to determine if OA prescribing decisions would differ based on
the patient's relationship to the provider. Methods: We distributed an
electronic survey to a random sample of ED providers at participating
centers in a nationwide research consortium. Question topics included
provider attitudes about OA prescribing, prior personal therapeutic use of
OAs (indications, dosing, and disposal of leftover medication), and
hypothetical analgesicprescribing decisions for their patients, family
members, and themselves for different painful conditions. Results: The total
survey population was 957 individuals; 515 responded to the survey, a 54%
response rate. Prior personal therapeutic OA use was reported in 63% (95% CI
= [58-68]). A majority of these providers (82%; 95% CI = [77-87]) took fewer
than half the number of pills prescribed. Regarding provider attitudes
towards OA prescribing, 66% (95% CI = [61-71]) agreed that OA could lead to
addiction even with short-term use. When providers were asked if they would
prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI
= [17-25]) would for an adult patient, 13% (95% CI = [10-16]) would for an
adult family member, and 6% (95% CI = [4-8]) indicated they themselves would
take an opioid for the same pain. When the scenario involved an ankle
fracture, 86% (95% CI = [83-89]) would prescribe OA for an adult patient,
75% (95% CI = [71-79]) for an adult family member, and 52% (95% CI =
[47-57]) would themselves take OA. Providers who have personally used OA to
treat their pain were found to make similar prescribing decisions compared
to those who had not. Conclusion: No consistent differences in prescribing
decisions were found between ED providers based on their prior therapeutic
use of OA. When making OA prescribing decisions, ED providers report that
they are less likely to prescribe opioids to their family members, or
themselves, than to an ED patient with the same painful condition.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency ward
medical decision making
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
ankle sprain
article
attitude
controlled study
cross-sectional study
family
female
human
major clinical study
male
multicenter study
opiate addiction
pill
random sample
treatment indication
very elderly
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160837327
MEDLINE PMID
27833690 (http://www.ncbi.nlm.nih.gov/pubmed/27833690)
PUI
L613257975
DOI
10.5811/westjem.2016.8.30965
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.8.30965
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 372
TITLE
A call for better opioid prescribing training and education
AUTHOR NAMES
Khidir H.
Weiner S.G.
AUTHOR ADDRESSES
(Khidir H.) Harvard Medical School, Boston, United States.
(Weiner S.G., sweiner@bwh.harvard.edu) Harvard Medical School, Brigham and
Women's Hospital, Department of Emergency Medicine, 75 Francis Street,
NH-226, Boston, United States.
CORRESPONDENCE ADDRESS
S.G. Weiner, Harvard Medical School, Brigham and Women's Hospital,
Department of Emergency Medicine, 75 Francis Street, NH-226, Boston, United
States. Email: sweiner@bwh.harvard.edu
SOURCE
Western Journal of Emergency Medicine (2016) 17:6 (686-689). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Pain is the most common complaint in the emergency department (ED), and
emergency physicians face unique challenges in making opioid-related
treatment decisions. Medical students and residents experience significant
variation in the quality of education they receive both about opioid
prescribing as well as substance-use detection and intervention in the ED.
To achieve a better standard of education, clinical educators will need to
(a) develop a clearer understanding of the risk for aberrant opioid
prescribing in the ED, (b) recognize prescribing bias and promote uptake of
evidence-based opioid prescribing guidelines in their EDs, and (c) advocate
for integrated opioid management and addiction medicine training formally
into medical school curricula.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
residency education
EMTREE MEDICAL INDEX TERMS
article
emergency physician
emergency ward
evidence based practice
hospital administrator
human
medical school
medical student
opiate addiction
practice guideline
prospective study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160837310
MEDLINE PMID
27833673 (http://www.ncbi.nlm.nih.gov/pubmed/27833673)
PUI
L613257656
DOI
10.5811/westjem.2016.8.31204
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.8.31204
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 373
TITLE
Emergency visits for prescription opioid overdose
AUTHOR NAMES
Ruan X.
Bydalek K.
Kaye A.D.
AUTHOR ADDRESSES
(Ruan X.; Kaye A.D.) Department of Anesthesiology, Louisiana State
University Health Science Center, New Orleans, United States.
(Bydalek K.) College of Nursing, University of South Alabama, Mobile, United
States.
SOURCE
Clinical Journal of Pain (2016) 32:5 (459). Date of Publication: 2016
ISSN
1536-5409 (electronic)
0749-8047
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency care
EMTREE MEDICAL INDEX TERMS
automutilation
chronic pain (drug therapy)
drug abuse
human
letter
priority journal
suicidal ideation
suicide attempt
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20151003469
MEDLINE PMID
26626300 (http://www.ncbi.nlm.nih.gov/pubmed/26626300)
PUI
L607151256
DOI
10.1097/AJP.0000000000000330
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0000000000000330
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 374
TITLE
Non-cardiogenic pulmonary edema, rhabdomyolysis and myocardial injury
following heroin inhalation: A case report
AUTHOR NAMES
Bazoukis G.
Spiliopoulou A.
Mourouzis K.
Grigoropoulou P.
Yalouris A.
AUTHOR ADDRESSES
(Bazoukis G., gbazoykis@med.uoa.gr; Spiliopoulou A.; Mourouzis K.;
Grigoropoulou P.; Yalouris A.) Department of Internal Medicine, General
Hospital of Athens «Elpis», Athens, Greece.
CORRESPONDENCE ADDRESS
G. Bazoukis, Department of Internal Medicine, General Hospital of Athens
«Elpis», 7 Dimitsanas str., Ambelokipi, Athens, Greece. Email:
gbazoykis@med.uoa.gr
SOURCE
Hippokratia (2016) 20:1 (84-87). Date of Publication: 2016
ISSN
1790-8019 (electronic)
1108-4189
BOOK PUBLISHER
Lithografia Antoniadis I - Psarras Th G.P., 19th Km, Thessaloniki -
Polygyros Str., Nea Redestos, Greece.
ABSTRACT
Background: Heroin use by non-injecting routes of administration (snorting,
swallowing, "chasing the dragon") is considered to be safer but is not
risk-free for fatal overdose or serious side effects. We report the case of
an adolescent who was transferred unconscious to the emergency department
after heroin inhalation. Description of the case: A 17-year-old male was
transferred to the emergency department unconscious (Glasgow coma scale:
6/15) after heroin inhalation. He was treated with non-rebreather mask and
intravenous infusion of naloxone with gradual improvement of consciousness
and arterial blood gasses. The chest computed tomography showed signs of
acute respiratory distress syndrome. Laboratory exams on the second day of
hospitalization showed elevated creatine kinase (CK) and troponin-I levels
while his electrocardiography (ECG) showed J-point elevation in V1, V2, and
V3 precordial leads. On the second day of hospitalization the pulmonary
infiltrates were not present in his chest X-ray while on the eighth day,
troponin- I and CK levels were normalized without dynamic ECG changes and
the patient was discharged uneventfully. Conclusion: Heroin inhalation may
cause severe complications, such as non-cardiogenic pulmonary edema,
rhabdomyolysis or myocardial injury.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
EMTREE DRUG INDEX TERMS
alanine aminotransferase (endogenous compound)
aspartate aminotransferase (endogenous compound)
C reactive protein (endogenous compound)
creatine kinase (endogenous compound)
lactate dehydrogenase (endogenous compound)
linezolid (drug combination, drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
piperacillin plus tazobactam (drug combination, drug therapy, intravenous
drug administration)
troponin I (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart muscle injury (complication, diagnosis)
heroin dependence (drug therapy, drug therapy)
lung edema (complication, diagnosis)
non cardiogenic pulmonary edema (complication, diagnosis)
rhabdomyolysis (complication, diagnosis)
EMTREE MEDICAL INDEX TERMS
adolescent
adult respiratory distress syndrome (complication)
antibiotic therapy
arterial gas
article
blood gas analysis
case report
computer assisted tomography
continuous infusion
electrocardiogram
emergency ward
fever (drug therapy)
Glasgow coma scale
human
lung auscultation
male
myalgia (complication)
sinus tachycardia (complication, diagnosis)
thorax radiography
unconsciousness (complication)
CAS REGISTRY NUMBERS
alanine aminotransferase (9000-86-6, 9014-30-6)
aspartate aminotransferase (9000-97-9)
C reactive protein (9007-41-4)
creatine kinase (9001-15-4)
diamorphine (1502-95-0, 561-27-3)
lactate dehydrogenase (9001-60-9)
linezolid (165800-03-3)
naloxone (357-08-4, 465-65-6)
troponin I (77108-40-8)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Orthopedic Surgery (33)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160691547
PUI
L612347085
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 375
TITLE
Pediatric Care provided at urgent care centers in the United States :
Compliance With recommendations for emergency preparedness
AUTHOR NAMES
Wilkinson R.
Olympia R.P.
Dunnick J.
Brady J.
AUTHOR ADDRESSES
(Wilkinson R.) Penn State Hershey Children's Hospital, Hershey, United
States.
(Olympia R.P., rolympia@hmc.psu.edu) Department of Emergency Medicine, Penn
State Hershey Medical Center, 500 University Drive, Hershey, United States.
(Dunnick J.) Penn State College of Medicine, Hershey, United States.
(Brady J.) Department of Pediatrics, Penn State Hershey Children's Hospital,
Hershey, United States.
CORRESPONDENCE ADDRESS
R.P. Olympia, Department of Emergency Medicine, Penn State Hershey Medical
Center, 500 University Drive, Hershey, United States. Email:
rolympia@hmc.psu.edu
SOURCE
Pediatric Emergency Care (2016) 32:2 (77-81). Date of Publication: 2016
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objectives: To describe the compliance of urgent care centers in the United
States with pediatric care recommendations for emergency preparedness as set
forth by the American Academy of Pediatrics. Methods: An electronic
questionnaire was distributed to urgent care center administrators as
identified by the American Academy of Urgent Care Medicine directory.
Results: A total of 122 questionnaires of the 872 distributed were available
for analysis (14% usable response rate). The most common diagnoses reported
for pediatric patients included otitis media (72%), upper respiratory
illness (69%), strep pharyngitis (61%), bronchiolitis (30%), and extremity
sprain/strain (28%). Seventy-one percent of centers have contacted community
emergency medical services (EMS) to transport a critically ill or injured
child to their local emergency department in the past year. Sixty-two
percent of centers reported having an established written protocol with
community EMS and 54% with their local emergency department or hospital.
Centers reported the availability of the following essential medications and
equipment: oxygen source (75%), nebulized/ inhaled β-agonist (95%),
intravenous epinephrine (88%), oxygen masks/ nasal cannula (89%),
bag-valve-mask resuscitator (81%), suctioning device (60%), and automated
external defibrillator (80%). Centers reported the presence of the following
written emergency plans: respiratory distress (40%), seizures (67%),
dehydration/shock (69%), head injury (59%), neck injury (67%), significant
fracture (69%), and blunt chest or abdominal injury (81%). Forty-seven
percent of centers conduct formal reviews of emergent or difficult cases in
a quality improvement format. Conclusions: Areas for improvement in urgent
care center preparedness were identified, such as increasing the
availability of essentialmedications and equipment, establishing transfer
and transport agreements with local hospitals and community EMS, and
ensuring a structured quality improvement program.
EMTREE DRUG INDEX TERMS
activated carbon
atropine
beta adrenergic receptor stimulating agent
ceftriaxone
diazepam
epinephrine
glucose
lorazepam
methylprednisolone
midazolam
naloxone
oxygen
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
medication compliance
pediatrics
EMTREE MEDICAL INDEX TERMS
abdominal injury
adult
article
automated external defibrillator
bronchiolitis
childhood injury
critically ill patient
dehydration
emergency health service
emergency ward
extremity sprain
female
head injury
human
major clinical study
male
manual emergency ventilator
nasal cannula
nebulization
neck injury
otitis media
oxygen mask
pharyngitis
questionnaire
respiratory distress
respiratory tract disease
seizure
shock
sprain
strep pharyngitis
suction pump
thorax blunt trauma
total quality management
United States
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
ceftriaxone (73384-59-5, 74578-69-1)
diazepam (439-14-5)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160119006
MEDLINE PMID
26835565 (http://www.ncbi.nlm.nih.gov/pubmed/26835565)
PUI
L608269461
DOI
10.1097/PEC.0000000000000698
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000698
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 376
TITLE
Naloxone: New regulations for emergency use
AUTHOR ADDRESSES
SOURCE
Drug and Therapeutics Bulletin (2016) 54:1 (2-3). Date of Publication: 2016
ISSN
1755-5248 (electronic)
0012-6543
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
practice guideline
EMTREE MEDICAL INDEX TERMS
article
drug safety
government regulation
human
medical education
prescription
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160138439
PUI
L608437978
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 377
TITLE
Nalmefene mistakenly prescribed to reduce alcohol consumption in patients
under buprenorphine substitution therapy resulting in acute opioid
withdrawal management in an emergency setting
AUTHOR NAMES
Pélissier F.
Bugat M.-E.R.
Nubukpo P.
Franchitto N.
AUTHOR ADDRESSES
(Pélissier F.; Franchitto N.) Poisons and Substance Abuse Treatment Centre,
Toulouse-Purpan University Hospital, Toulouse, France.
(Bugat M.-E.R.) Department of Primary Care, Toulouse University Hospital,
University of Toulouse III, INSERM U 1027, Toulouse, France.
(Nubukpo P.) Department of Addiction Medicine, Esquirol Hospital, Limoges,
France.
SOURCE
Journal of Clinical Psychopharmacology (2016) 36:1 (100-103). Date of
Publication: 2016
ISSN
1533-712X (electronic)
0271-0749
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (adverse drug reaction, drug interaction, drug therapy)
nalmefene (adverse drug reaction, drug interaction, drug therapy, oral drug
administration)
opiate
EMTREE DRUG INDEX TERMS
alcohol (drug therapy)
baclofen
benzodiazepine derivative
bromazepam (drug therapy)
cyamemazine
diazepam (oral drug administration)
infusion fluid
metopimazine (drug therapy)
oxazepam
paracetamol (drug therapy)
spasmolytic agent (drug therapy)
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism (drug therapy, drug therapy)
opiate substitution treatment
withdrawal syndrome (drug therapy, side effect, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy, side effect)
adult
agitation
alcohol blood level
alcohol consumption
alcoholism
antisocial personality disorder
blood analysis
case report
disease severity
dizziness (side effect)
drug blood level
drug detoxification
drug self administration
drug substitution
drug urine level
drug withdrawal
DSM-5
elevated blood pressure
emergency ward
female
follow up
gastrointestinal symptom (side effect)
general practitioner
heroin dependence (drug therapy)
human
letter
male
middle aged
myalgia (side effect)
nausea (side effect)
patient compliance
physical examination
prescription
priority journal
rhinorrhea (side effect)
side effect (side effect)
single drug dose
smoking
sweating
tremor (side effect)
vomiting
DRUG TRADE NAMES
selincro , DenmarkLundbeck
DRUG MANUFACTURERS
(Denmark)Lundbeck
MP Biomedicals
CAS REGISTRY NUMBERS
alcohol (64-17-5)
baclofen (1134-47-0)
bromazepam (1812-30-2)
buprenorphine (52485-79-7, 53152-21-9)
cyamemazine (3546-03-0)
diazepam (439-14-5)
metopimazine (14008-44-7)
nalmefene (55096-26-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
paracetamol (103-90-2)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20151023920
MEDLINE PMID
26658085 (http://www.ncbi.nlm.nih.gov/pubmed/26658085)
PUI
L607238853
DOI
10.1097/JCP.0000000000000448
FULL TEXT LINK
http://dx.doi.org/10.1097/JCP.0000000000000448
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 378
TITLE
Emergency Physicians as Good Samaritans: Survey of Frequency, Locations,
Supplies and Medications
AUTHOR NAMES
Burkholder T.W.
King R.A.
AUTHOR ADDRESSES
(Burkholder T.W., Taylor.Burkholer@denverem.org) Denver Health and Hospital
Authority, Department of Emergency Medicine, 777 Bannock St, MC 0108,
Denver, United States.
(King R.A.) University of Colorado School of Medicine, Department of
Emergency Medicine, Aurora, United States.
CORRESPONDENCE ADDRESS
T.W. Burkholder, Denver Health and Hospital Authority, Department of
Emergency Medicine, 777 Bannock St, MC 0108, Denver, United States. Email:
Taylor.Burkholer@denverem.org
SOURCE
Western Journal of Emergency Medicine (2016) 17:1 (15-17). Date of
Publication: 1 Jan 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Little is known about the frequency and locations in which
emergency physicians (EPs) are bystanders to an accident or emergency;
equally uncertain is which contents of an "emergency kit" may be useful
during such events. The aim of this study was to describe the frequency and
locations of Good Samaritan acts by EPs and also determine which emergency
kit supplies and medications were most commonly used by Good Samaritans.
Methods: We conducted an electronic survey among a convenience sample of EPs
in Colorado. Results: Respondents reported a median frequency of 2.0 Good
Samaritan acts per five years of practice, with the most common locations
being sports and entertainment events (25%), road traffic accidents (21%),
and wilderness settings (19%). Of those who had acted as Good Samaritans,
86% reported that at least one supply would have been useful during the most
recent event, and 66% reported at least one medication would have been
useful. The most useful supplies were gloves (54%), dressings (34%), and a
stethoscope (20%), while the most useful medications were oxygen (19%),
intravenous fluids (17%), and epinephrine (14%). Conclusion: The majority of
EPs can expect to provide Good Samaritan care during their careers and would
be better prepared by carrying a kit with common supplies and medications
where they are most likely to use them.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
antibiotic agent
antihistaminic agent
atropine
benzodiazepine
bronchodilating agent
epinephrine
glucose
glyceryl trinitrate
infusion fluid
naloxone
oxygen
steroid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
emergency health service
emergency physician
good samaritan acts
health care survey
medical ethics
EMTREE MEDICAL INDEX TERMS
aircraft accident
airway creation device
bandages and dressings
central venous catheter
cervical collar
defibrillator
endotracheal tube
glove
human
major clinical study
manual emergency ventilator
mask
oxygen therapy
review
scalpel
scissors
sport injury
stethoscope
suture
traffic accident
United States
wilderness medicine
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0, 80738-44-9)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160163385
MEDLINE PMID
26823924 (http://www.ncbi.nlm.nih.gov/pubmed/26823924)
PUI
L608630862
DOI
10.5811/westjem.2015.11.28884
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.11.28884
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 379
TITLE
Predictors of Sustained Prescription Opioid Use after Admission for Trauma
in Adolescents
AUTHOR NAMES
Whiteside L.K.
Russo J.
Wang J.
Ranney M.L.
Neam V.
Zatzick D.F.
AUTHOR ADDRESSES
(Whiteside L.K., laurenkw@uw.edu) Department of Medicine, Division of
Emergency Medicine, University of Washington, Seattle, United States.
(Whiteside L.K., laurenkw@uw.edu; Wang J.; Zatzick D.F.) Harborview Injury
Prevention and Research Center, Seattle, United States.
(Russo J.; Neam V.; Zatzick D.F.) Department of Psychiatry and Behavioral
Sciences, University of Washington, Seattle, United States.
(Ranney M.L.) Department of Emergency Medicine, Alpert Medical School, Brown
University, Providence, United States.
CORRESPONDENCE ADDRESS
L.K. Whiteside, Department of Medicine, Division of Emergency Medicine,
University of Washington, Seattle, United States. Email: laurenkw@uw.edu
SOURCE
Journal of Adolescent Health (2016) 58:1 (92-97). Date of Publication: 1 Jan
2016
ISSN
1879-1972 (electronic)
1054-139X
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Purpose The study objectives are to describe the longitudinal trajectory of
prescription opioid use among adolescents requiring a trauma admission and
then identify predictors of sustained opioid use. Methods Randomly sampled
adolescents (12-18 years) admitted to a Level I trauma center were surveyed.
Follow-up assessments were obtained at 2, 5, and 12 months. Self-reported
prescription opioid use, defined as "taking an opioid prescribed by a
physician," was obtained at baseline and every follow-up time point. At the
baseline interview, validated mental health measures and pain scales were
obtained as well as preinjury substance use. A fixed-effects mixed Poisson
regression analysis was performed to predict prescription opioid use over
time. Results A total of 120 adolescents (mean age 15.5 years [1.9 standard
deviation], 75% male) completed the baseline interview with 98% follow-up at
12 months. At baseline, 7% of adolescents reported prescription opioid use
before their trauma, with rates of prescription opioid use of 52% at 2
months, 13.3% at 5 months, and 12.5% at 12 months after discharge. After
adjusting for demographic characteristics and injury severity score, those
with sustained prescription opioid use were more likely to report preinjury
marijuana use and higher baseline pain scores. Conclusions Approximately one
in eight adolescents (12.5%) was using prescription opioids 12 months after
injury hospitalization. Readily identifiable risk factors predicted
sustained prescription opioid use, including preinjury marijuana use and
baseline pain score. Screening for substance use including marijuana at the
time of injury could help identify patients at risk for both substance use
problems and sustained prescription opioid use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adolescent disease (drug therapy, drug therapy)
drug use
hospital admission
injury
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
cannabis use
clinical assessment
demography
emergency health service
female
follow up
health care survey
hospital discharge
human
injury scale
interview
major clinical study
male
mental health
pain (drug therapy)
pain assessment
priority journal
self report
substance use
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151063491
MEDLINE PMID
26476855 (http://www.ncbi.nlm.nih.gov/pubmed/26476855)
PUI
L607408788
DOI
10.1016/j.jadohealth.2015.08.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jadohealth.2015.08.011
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 380
TITLE
Perioperative opioids and public health
AUTHOR NAMES
Kharasch E.D.
Michael Brunt L.
AUTHOR ADDRESSES
(Kharasch E.D., kharasch@wustl.edu) Division of Clinical and Translational
Research, Department of Anesthesiology, Washington University in St. Louis,
St. Louis, United States.
(Kharasch E.D., kharasch@wustl.edu) Department of Biochemistry and Molecular
Biophysics, Washington University in St. Louis, St. Louis, United States.
(Michael Brunt L.) Department of Surgery, Section of Minimally Invasive
Surgery, Washington University in St. Louis, St. Louis, United States.
(Kharasch E.D., kharasch@wustl.edu) Center for Clinical Pharmacology, St.
Louis College of Pharmacy, Washington University in St. Louis, St. Louis,
United States.
CORRESPONDENCE ADDRESS
E.D. Kharasch, Department of Anesthesiology, Washington University in St.
Louis, Campus Box 8054, 660 S Euclid Ave, St. Louis, United States. Email:
kharasch@wustl.edu
SOURCE
Anesthesiology (2016) 124:4 (960-965). Date of Publication: 2016
ISSN
1528-1175 (electronic)
0003-3022
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent
cannabis
cocaine
diamorphine
fentanyl
local anesthetic agent
methadone
naloxone
oxycodone
tramadol
tranquilizer
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
public health
EMTREE MEDICAL INDEX TERMS
analgesia
anesthesist
emergency ward
human
hyperalgesia
morbidity
note
oxygen desaturation
patient controlled analgesia
physician
postoperative analgesia
postoperative pain (complication, drug therapy)
prescription
priority journal
respiration depression (side effect)
risk
risk factor
surgeon
surgical outcome
treatment outcome
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160079465
MEDLINE PMID
26808634 (http://www.ncbi.nlm.nih.gov/pubmed/26808634)
PUI
L607966097
DOI
10.1097/ALN.0000000000001012
FULL TEXT LINK
http://dx.doi.org/10.1097/ALN.0000000000001012
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 381
TITLE
Impact of an Opioid Prescribing Guideline in the Acute Care Setting
AUTHOR NAMES
Del Portal D.A.
Healy M.E.
Satz W.A.
McNamara R.M.
AUTHOR ADDRESSES
(Del Portal D.A.; Healy M.E.; Satz W.A.; McNamara R.M.) Department of
Emergency Medicine, Temple University School of Medicine, 1316 West Ontario
Street, Philadelphia, United States.
CORRESPONDENCE ADDRESS
D.A. Del Portal, Department of Emergency Medicine, Temple University School
of Medicine, 1316 West Ontario Street, Philadelphia, United States.
SOURCE
Journal of Emergency Medicine (2016) 50:1 (21-27). Date of Publication: 1
Jan 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Death from opioid abuse is a major public health issue. The death
rate associated with opioid overdose nearly quadrupled from 1999 to 2008.
Acute care settings are a major source of opioid prescriptions, often for
minor conditions and chronic noncancer pain. Objective Our aim was to
determine whether a voluntary opioid prescribing guideline reduces the
proportion of patients prescribed opioids for minor and chronic conditions.
Methods A retrospective chart review was performed on records of adult
emergency department visits from January 2012 to July 2014 for dental, neck,
back, or unspecified chronic pain, and the proportion of patients receiving
opioid prescriptions at discharge was compared before and after the
guideline. Attending emergency physicians were surveyed on their perceptions
regarding the impact of the guideline on prescribing patterns, patient
satisfaction, and physician-patient interactions. Results In our sample of
13,187 patient visits, there was a significant (p < 0.001) and sustained
decrease in rates of opioid prescriptions for dental, neck, back, or
unspecified chronic pain. The rate of opioid prescribing decreased from
52.7% before the guideline to 29.8% immediately after its introduction, and
to 33.8% at an interval of 12 to 18 months later. The decrease in opioid
prescriptions was observed in all of these diagnosis groups and in all age
groups. All 31 eligible prescribing physicians completed a survey. The
opioid prescribing guideline was supported by 100% of survey respondents.
Conclusions An opioid prescribing guideline significantly decreased the
rates at which opioids were prescribed for minor and chronic complaints in
an acute care setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
backache (drug therapy)
chronic pain (drug therapy)
doctor patient relation
emergency physician
emergency ward
female
health survey
hospital discharge
human
major clinical study
male
medical record review
neck pain (drug therapy)
patient satisfaction
perception
practice guideline
priority journal
retrospective study
tooth pain (drug therapy)
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015299605
MEDLINE PMID
26281819 (http://www.ncbi.nlm.nih.gov/pubmed/26281819)
PUI
L605636370
DOI
10.1016/j.jemermed.2015.06.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.06.014
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 382
TITLE
Acute Basilar Artery Thrombosis
AUTHOR NAMES
Jackson J.S.
Colibao L.
AUTHOR ADDRESSES
(Jackson J.S.; Colibao L.) Department of Medicine, Division of Emergency
Medicine, University of Miami Miller School of Medicine, 1120 NW 14th
Street, Miami, United States.
CORRESPONDENCE ADDRESS
J.S. Jackson, Department of Medicine, Division of Emergency Medicine,
University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami,
United States.
SOURCE
Journal of Emergency Medicine (2016) 50:1 (e41-e42). Date of Publication: 1
Jan 2016
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
EMTREE DRUG INDEX TERMS
alteplase (drug therapy, intravenous drug administration)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
artery disease (drug therapy, drug therapy, surgery)
artery thrombosis (drug therapy, drug therapy, surgery)
basilar artery
basilar artery thrombosis (drug therapy, drug therapy, surgery)
EMTREE MEDICAL INDEX TERMS
adult
case report
dysarthria
emergency ward
hemiparesis
human
magnetic resonance angiography
male
mechanical thrombectomy
mental health
neurologic examination
nuclear magnetic resonance imaging
priority journal
ptosis
short survey
CAS REGISTRY NUMBERS
alteplase (105857-23-6)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015485079
MEDLINE PMID
26437805 (http://www.ncbi.nlm.nih.gov/pubmed/26437805)
PUI
L606698734
DOI
10.1016/j.jemermed.2015.07.037
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.07.037
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 383
TITLE
Effect of opioid prescribing guidelines in primary care
AUTHOR NAMES
Chen J.H.
Hom J.
Richman I.
Asch S.M.
Podchiyska T.
Johansen N.A.
AUTHOR ADDRESSES
(Chen J.H., jonc101@stanford.edu; Hom J.; Asch S.M.; Johansen N.A.) Division
of General Medical Disciplines, Department of Medicine, Stanford University,
1265 Welch Road, Stanford, United States.
(Richman I.; Asch S.M.) Center for Innovation to Implementation (Ci2i),
Veteran Affairs Palo Alto Health Care System, Palo Alto, United States.
(Richman I.) Center for Primary Care and Outcomes Research (PCOR), United
States.
(Podchiyska T.) Department of Health Research and Policy-Epidemiology,
Stanford University, Stanford, United States.
CORRESPONDENCE ADDRESS
J.H. Chen, Division of General Medical Disciplines, Department of Medicine,
Stanford University, 1265 Welch Road, Stanford, United States. Email:
jonc101@stanford.edu
SOURCE
Medicine (United States) (2016) 95:35 Article Number: e4760. Date of
Publication: 2016
ISSN
1536-5964 (electronic)
0025-7974
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Long-term opioid use for noncancer pain is increasingly prevalent yet
controversial given the risks of addiction, diversion, and overdose. Prior
literature has identified the problem and proposed management guidelines,
but limited evidence exists on the actual effectiveness of implementing such
guidelines in a primary care setting. A multidisciplinary working group of
institutional experts assembled comprehensive guidelines for chronic opioid
prescribing, including monitoring and referral recommendations. The
guidelines were disseminated in September 2013 to our medical center's
primary care clinics via in person and electronic education. We extracted
electronic medical records for patients with noncancer pain receiving opioid
prescriptions (Rxs) in seasonally matched preintervention
(11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For
patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of
drug screening, specialty referrals, clinic visits, emergency room visits,
and quantity of opioids prescribed. After disseminating guidelines, the
percentage of noncancer clinic patients receiving any opioid Rxs dropped
from 3.9% to 3.4% (P=0.02). The percentage of noncancer patients receiving
chronic opioid Rxs decreased from 2.0% to 1.6% (P=0.03). The rate of urine
drug screening increased from 9.2% to 17.3% (P=0.005) amongst noncancer
chronic opioid patients. No significant differences were detected for other
metrics or demographics assessed. An educational intervention for primary
care opioid prescribing is feasible and was temporally associated with a
modest reduction in overall opioid Rx rates. Provider use of routine drug
screening increased, but overall rates of screening and specialty referral
remained low despite the intervention. Despite national pressures to
introduce opioid prescribing guidelines for chronic pain, doing so alone
does not necessarily yield substantial changes in clinical practice.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain (disease management, drug therapy)
clinical practice
drug screening
drug urine level
electronic medical record
female
human
major clinical study
male
medicaid
medicare
patient referral
primary medical care
priority journal
quantitative analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160668453
MEDLINE PMID
27583928 (http://www.ncbi.nlm.nih.gov/pubmed/27583928)
PUI
L612209551
DOI
10.1097/MD.0000000000004760
FULL TEXT LINK
http://dx.doi.org/10.1097/MD.0000000000004760
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 384
TITLE
Gender differences in emergency department visits and detox referrals for
illicit and nonmedical use of opioids
AUTHOR NAMES
Ryoo H.-J.
Choo E.K.
AUTHOR ADDRESSES
(Ryoo H.-J., hyeon-ju-ryoo@brown.edu) Warren Alpert Medical School, Brown
University, 222 Richmond Street, Providence, United States.
(Choo E.K.) Warren Alpert Medical School, Brown University, Department of
Emergency Medicine, Providence, United States.
CORRESPONDENCE ADDRESS
H.-J. Ryoo, Warren Alpert Medical School, Brown University, 222 Richmond
Street, Providence, United States. Email: hyeon-ju-ryoo@brown.edu
SOURCE
Western Journal of Emergency Medicine (2016) 17:3 (295-301). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Visits to the emergency department (ED) for use of illicit
drugs and opioids have increased in the past decade. In the ED, little is
known about how gender may play a role in drugrelated visits and referrals
to treatment. This study performs gender-based comparison analyses of
drug-related ED visits nationwide. Methods: We performed a cross-sectional
analysis with data collected from 2004 to 2011 by the Drug Abuse Warning
Network (DAWN). All data were coded to capture major drug categories and
opioids. We used logistic regression models to find associations between
gender and odds of referral to treatment programs. A second set of models
were controlled for patient "seeking detox," or patient explicitly
requesting for detox referral. Results: Of the 27.9 million ED visits
related to drug use in the DAWN database, visits by men were 2.69 times more
likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]).
Men were more likely than women to be referred to detox programs for any
illicit drugs (OR 1.12, 95% CI [1.02-1.22]), for each of the major illicit
drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40]), and for prescription
opioids (OR 1.30, 95% CI [1.17-1.43]). This significant association
prevailed after controlling for "seeking detox." Conclusion: Women are less
likely to receive referrals to detox programs than men when presenting to
the ED regardless of whether they are "seeking detox." Future research may
help determine the cause for this gender-based difference and its
significance for healthcare costs and health outcomes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
illicit drug (drug toxicity)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
cannabis (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
methamphetamine (drug toxicity)
prescription drug (drug toxicity)
psychedelic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug detoxification
emergency ward
patient referral
sex difference
EMTREE MEDICAL INDEX TERMS
adult
article
cross-sectional study
data base
drug abuse
female
help seeking behavior
human
logistic regression analysis
major clinical study
male
middle aged
young adult
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160431618
MEDLINE PMID
27330662 (http://www.ncbi.nlm.nih.gov/pubmed/27330662)
PUI
L610669239
DOI
10.5811/westjem.2016.2.29425
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.2.29425
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 385
TITLE
A 15-Year-Old BoyWith Trisomy 21 and PostoperativeWeakness
AUTHOR NAMES
Schwarz A.C.
Amlie-Lefond C.
AUTHOR ADDRESSES
(Schwarz A.C., anisha.schwarz@seattlechildrens.org; Amlie-Lefond C.)
Department of Neurology, Seattle Children's Hospital, University of
Washington, Pediatric Neurology, 4800 Sand PointWay NE, OC.7.830, Seattle,
United States.
CORRESPONDENCE ADDRESS
A.C. Schwarz, Department of Neurology, Seattle Children's Hospital,
University of Washington, Pediatric Neurology, 4800 Sand PointWay NE,
OC.7.830, Seattle, United States. Email: anisha.schwarz@seattlechildrens.org
SOURCE
JAMA Pediatrics (2016) 170:1 (85-86). Date of Publication: 1 Jan 2016
ISSN
2168-6203
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS
naloxone
oxycodone
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
arm weakness (complication)
face disorder (complication)
face weakness (complication)
postoperative complication (complication)
trisomy 21
weakness (complication)
EMTREE MEDICAL INDEX TERMS
adolescent
case report
emergency ward
general anesthesia
human
hyperreflexia
lipoma (surgery)
male
mutism
nuclear magnetic resonance imaging
priority journal
scrotal lipoma (surgery)
scrotal pain
scrotal swelling
scrotum disorder (surgery)
short survey
sign language
somnolence
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Human Genetics (22)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160038372
MEDLINE PMID
26747074 (http://www.ncbi.nlm.nih.gov/pubmed/26747074)
PUI
L607730360
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 386
TITLE
Assessment of provider attitudes toward #naloxone on Twitter
AUTHOR NAMES
Haug N.A.
Bielenberg J.
Linder S.H.
Lembke A.
AUTHOR ADDRESSES
(Haug N.A.; Bielenberg J.) a PGSP-Stanford University PsyD Consortium , Palo
Alto University , Palo Alto , California , USA
(Haug N.A.; Lembke A.) b Department of Psychiatry and Behavioral Sciences ,
Stanford University School of Medicine , Stanford , California , USA
(Linder S.H.) c VA Palo Alto Health Care System , Palo Alto , California ,
USA
SOURCE
Substance abuse (2016) 37:1 (35-41). Date of Publication: 2016
ISSN
1547-0164 (electronic)
ABSTRACT
RESULTS: A total of 368 individuals posted 467 naloxone-related tweets.
Occupations consisted of professional first responders such as emergency
medical technicians (EMTs), firefighters, and paramedics (n = 122); law
enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other
health professionals including pharmacists, pharmacy technicians,
counselors, and social workers (n = 31); naloxone-trained individuals (n =
12); and students (n = 23). Primary themes included burnout, education and
training, information seeking, news updates, optimism, policy and economics,
stigma, and treatment. The highest levels of burnout, fatigue, and stigma
regarding naloxone and opioid overdose were among nurses, EMTs, other health
care providers, and physicians. In contrast, individuals who self-identified
as "naloxone-trained" had the highest optimism and the lowest amount of
burnout and stigma.CONCLUSIONS: Provider training and refinement of naloxone
administration procedures are needed to improve treatment outcomes and
reduce provider stigma. Social networking sites such as Twitter may have
potential for offering psychoeducation to health care providers.BACKGROUND:
As opioid overdose rates continue to pose a major public health crisis, the
need for naloxone treatment by emergency first responders is critical.
Little is known about the views of those who administer naloxone. The
current study examines attitudes of health professionals on the social media
platform Twitter to better understand their perceptions of opioid users, the
role of naloxone, and potential training needs.METHODS: Public comments on
Twitter regarding naloxone were collected for a period of 3 consecutive
months. The occupations of individuals who posted tweets were identified
through Twitter profiles or hashtags. Categories of emergency service first
responders and medical personnel were created. Qualitative analysis using a
grounded theory approach was used to produce thematic content. The
relationships between occupation and each theme were analyzed using Pearson
chi-square statistics and post hoc analyses.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health personnel attitude
psychology
social media
EMTREE MEDICAL INDEX TERMS
burnout
drug overdose (drug therapy)
evaluation study
human
opiate addiction (drug therapy)
rescue personnel
social stigma
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26860229 (http://www.ncbi.nlm.nih.gov/pubmed/26860229)
PUI
L616639959
DOI
10.1080/08897077.2015.1129390
FULL TEXT LINK
http://dx.doi.org/10.1080/08897077.2015.1129390
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 387
TITLE
Case review: 17-year-old-female with respiratory depression as a result of
opioid overdose
AUTHOR NAMES
Inkrott J.C.
AUTHOR ADDRESSES
(Inkrott J.C.) Orlando, United States.
CORRESPONDENCE ADDRESS
J.C. Inkrott, Orlando, United States.
SOURCE
Air Medical Journal (2016) 35:2 (52). Date of Publication: 2016
ISSN
1532-6497 (electronic)
1067-991X
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
respiration depression
EMTREE MEDICAL INDEX TERMS
adolescent
adult respiratory distress syndrome
case report
drug overdose
emergency health service
esophagus pressure
female
human
letter
positive end expiratory pressure
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160471089
MEDLINE PMID
27021664 (http://www.ncbi.nlm.nih.gov/pubmed/27021664)
PUI
L610934447
DOI
10.1016/j.amj.2015.12.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2015.12.009
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 388
TITLE
Patient controlled analgesia for adults with sickle cell disease awaiting
admission from the emergency department
AUTHOR NAMES
Santos J.
Jones S.
Wakefield D.
Grady J.
Andemariam B.
AUTHOR ADDRESSES
(Santos J.; Jones S.; Andemariam B., andemariam@uchc.edu) New England Sickle
Cell Institute, Division of Hematology-Oncology, University of Connecticut,
Health Center, 263 Farmington Avenue, Farmington, United States.
(Wakefield D.; Grady J.) Connecticut Institute for Clinical and
Translational Science, 263 Farmington Avenue, Farmington, United States.
(Grady J.) Department of Community Medicine and Health Care, University of
Connecticut, Health Center, 263 Farmington Avenue, Farmington, United
States.
CORRESPONDENCE ADDRESS
B. Andemariam, New England Sickle Cell Institute, Division of
Hematology-Oncology, University of Connecticut, Health Center, 263
Farmington Avenue, Farmington, United States. Email: andemariam@uchc.edu
SOURCE
Pain Research and Management (2016) 2016 Article Number: 3218186. Date of
Publication: 2016
ISSN
1203-6765
BOOK PUBLISHER
Pulsus Group Inc., 410 Park Avenue, 15th Floor, 287 pmb, New York, United
States.
ABSTRACT
Background: A treatment algorithm for sickle cell disease (SCD) pain in
adults presenting to a single emergency department (ED) was developed
prioritizing initiation of patient controlled analgesia (PCA) for patients
awaiting hospitalization. Objectives: Evaluate the proportion of ED visits
in which PCA was started in the ED. Methods: A two-year retrospective chart
review of consecutive SCD pain ED visits was undertaken. Data abstracted
included PCA initiation, low versus high utilizer status, pain scores, bolus
opioid number, treatment times, and length of hospitalization. Results: 258
visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of
which 157 (68%) were initiated in the ED. Time to PCA initiation was longer
when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5
hours, p < 0.001). ED PCA initiation was associated with fewer opioid
boluses following decision to admit and less time without analgesic
treatment (all p < 0.05). Mean pain intensity (MPI) reduction did not differ
between groups. Among visits where PCA was begun in the ED, low utilizers
demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, p =
0.04). Conclusions: ED PCA initiation for SCD-related pain is possible and
associated with more timely analgesic delivery.
EMTREE DRUG INDEX TERMS
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
patient controlled analgesia
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
article
clinical decision making
emergency ward
female
hospital admission
hospitalization
human
length of stay
major clinical study
male
pain intensity
phenotype
retrospective study
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Hematology (25)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160631845
PUI
L611853496
DOI
10.1155/2016/3218186
FULL TEXT LINK
http://dx.doi.org/10.1155/2016/3218186
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 389
TITLE
Addressing social determinants of health from the emergency department
through social emergency medicine
AUTHOR NAMES
Anderson E.S.
Lippert S.
Newberry J.
Bernstein E.
Alter H.J.
Wang N.E.
AUTHOR ADDRESSES
(Anderson E.S., esoremanderson@gmail.com; Lippert S.; Newberry J.; Alter
H.J.; Wang N.E.) Stanford University, Highland Hospital, Alameda Health
System, Department of Emergency Medicine, Oakland, Stanford Emergency
Department, 300 Pasteur Dr Alway Bldg M121 MC 5119, Stanford, United States.
(Bernstein E.) Boston University, Department of Emergency Medicine, Boston,
United States.
CORRESPONDENCE ADDRESS
E.S. Anderson, Stanford University, Highland Hospital, Alameda Health
System, Department of Emergency Medicine, Oakland, Stanford Emergency
Department, 300 Pasteur Dr Alway Bldg M121 MC 5119, Stanford, United States.
Email: esoremanderson@gmail.com
SOURCE
Western Journal of Emergency Medicine (2016) 17:4 (487-489). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
EMTREE DRUG INDEX TERMS
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
emergency ward
social determinants of health
social emergency medicine
EMTREE MEDICAL INDEX TERMS
asthma
cost control
crowding (area)
diabetes mellitus
emergency physician
health care access
health care policy
human
hyperglycemia
medical care
patient referral
preventive health service
resuscitation
review
social work
ST segment elevation myocardial infarction
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160523500
MEDLINE PMID
27429706 (http://www.ncbi.nlm.nih.gov/pubmed/27429706)
PUI
L611226483
DOI
10.5811/westjem.2016.5.30240
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.5.30240
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 390
TITLE
Intranasal drug delivery in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
Utilisation de la voie intranasale en médecine d'urgence
AUTHOR NAMES
Jacques J.-M.
AUTHOR ADDRESSES
(Jacques J.-M., jmjacques@skynet.be) Service des Urgences EpiCURA Sites
Hornu-Baudour, Avenue de la déportation 24, Ecaussinnes, Belgium.
CORRESPONDENCE ADDRESS
J.-M. Jacques, Service des Urgences EpiCURA Sites Hornu-Baudour, Avenue de
la déportation 24, Ecaussinnes, Belgium. Email: jmjacques@skynet.be
SOURCE
Louvain Medical (2016) 135:4 (223-230). Date of Publication: 2016
ISSN
0024-6956
BOOK PUBLISHER
Louvain Medical asbl, isabelle.istasse@uclouvain.be
ABSTRACT
Whereas intranasal (IN) drug delivery has been used for many years, this
administration route has not gained much interest in Belgium. IN drug
delivery is painless, easy, and quick, thus proving attractive in emergency
settings, especially in pediatric patients. While achieving an efficacy
comparable to that of intravenous administration, the IN route is an
interesting new alternative for emergency doctors, who can use it to induce
opioid analgesia, reach optimal procedural sedation with midazolam, stop
epileptic seizures with benzodiazepines, or antagonize morphine overdosage
with naloxone.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (drug therapy)
midazolam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug delivery system
emergency medicine
intranasal drug administration
EMTREE MEDICAL INDEX TERMS
analgesia
article
Belgium
drug efficacy
human
outcome assessment
seizure (drug therapy)
CAS REGISTRY NUMBERS
midazolam (59467-70-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20170286282
PUI
L615510326
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 391
TITLE
Prehospital Opioid Administration in the Emergency Care of Injured Children
AUTHOR NAMES
Browne L.R.
Studnek J.R.
Shah M.I.
Brousseau D.C.
Guse C.E.
Lerner E.B.
AUTHOR ADDRESSES
(Browne L.R.; Studnek J.R.; Shah M.I.; Brousseau D.C.; Guse C.E.; Lerner
E.B.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2016)
20:1 (59-65). Date of Publication: 2016
ISSN
1545-0066 (electronic)
ABSTRACT
OBJECTIVE: Prior studies have identified provider and system characteristics
that impede pain management in children, but no studies have investigated
the effect of changing these characteristics on prehospital opioid
analgesia. Our objectives were to determine: 1) the frequency of opioid
analgesia and pain score documentation among prehospital pediatric patients
after system wide changes to improve pain treatment, and 2) if older age,
longer transport times, the presence of vascular access and pain score
documentation were associated with increased prehospital administration of
opioid analgesia in children.METHODS: This was a retrospective
cross-sectional study of pediatric patients aged 3-18 years assessed by a
single EMS system between October 1, 2011 and September 30, 2013. Prior to
October 2011, the EMS system had implemented 3 changes to improve pain
treatment: (1) training on age appropriate pain scales, (2) protocol changes
to allow opioid analgesia without contacting medical control, and (3) the
introduction of intranasal fentanyl. All patients with working assessments
of blunt, penetrating, lacerating, and/or burn trauma were included. We used
descriptive statistics to determine the frequency of pain score
documentation and opioid analgesia administration and logistic regression to
determine the association of age, transport time, and the presence of
intravenous access with opioid analgesia administration.RESULTS: Of the
1,368 eligible children, 336 (25%) had a documented pain score. Eleven
percent (130/1204) of children without documented contraindications to
opioid administration received opioids. Of the children with no documented
pain score and no protocol exclusions, 9% (81/929) received opioid
analgesia, whereas 18% (49/275) with a documented pain score ≥4 and no
protocol exclusions received opioids. Multivariate analysis revealed that
vascular access (OR = 11.89; 95% CI: 7.33-19.29), longer patient transport
time (OR = 1.07; 95% CI: 1.04-1.11), age (OR 0.93; 95% CI: 0.88-0.98) and
pain score documentation (OR 2.23; 95% CI: 1.40-3.55) were associated with
opioid analgesia.CONCLUSIONS: Despite implementation of several best
practice recommendations to improve prehospital pain treatment, few children
have a documented pain score and even fewer receive opioid analgesia.
Children with longer transport times, successful IV placement, and/or
documentation of pain score(s) were more likely to receive prehospital
analgesia.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
EMTREE MEDICAL INDEX TERMS
adolescent
analgesia
child
cross-sectional study
documentation
emergency health service
female
human
injury (therapy)
male
pain measurement
preschool child
retrospective study
Wisconsin
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26727339 (http://www.ncbi.nlm.nih.gov/pubmed/26727339)
PUI
L616010690
DOI
10.3109/10903127.2015.1056897
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2015.1056897
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 392
TITLE
FASTER RESPONSE. Hospitals backing increased use of opioid antidote
AUTHOR NAMES
Asplund J.
AUTHOR ADDRESSES
(Asplund J.)
SOURCE
Hospitals & health networks / AHA (2016) 90:1 (20, 22, 2). Date of
Publication: 1 Jan 2016
ISSN
1068-8838
ABSTRACT
Hospitals are intensifying efforts to cut opioid abuse. One way is by
donating a lifesaving drug to police departments.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic agent (drug toxicity)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
human
Indiana
opiate addiction (drug therapy)
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26904909 (http://www.ncbi.nlm.nih.gov/pubmed/26904909)
PUI
L612408326
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 393
TITLE
Opioid dependent malingerer with self-induced sepsis
AUTHOR NAMES
Kesler K.A.
Langdorf M.I.
Burns M.J.
AUTHOR ADDRESSES
(Kesler K.A., kkesler@uci.edu; Langdorf M.I.; Burns M.J.) University of
California, Irvine, School of Medicine, Department of Emergency Medicine,
333 The City Boulevard West, Orange, United States.
CORRESPONDENCE ADDRESS
K.A. Kesler, University of California, Irvine, School of Medicine,
Department of Emergency Medicine, 333 The City Boulevard West, Orange,
United States. Email: kkesler@uci.edu
SOURCE
Western Journal of Emergency Medicine (2016) 17:6 (798-800). Date of
Publication: 2016
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
A 21-year-old woman was admitted to the emergency department (ED) with
severe sepsis. Both the mechanism of infection and organisms discovered were
unusual.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
aztreonam (intravenous drug administration)
ciprofloxacin (drug therapy)
daptomycin (intravenous drug administration)
fluconazole (oral drug administration)
levofloxacin (adverse drug reaction, oral drug administration)
micafungin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
sepsis
EMTREE MEDICAL INDEX TERMS
adult
ambulance
anaphylaxis (drug therapy, side effect)
antibiotic therapy
anxiety disorder
article
asthma
blood pressure
borderline state
case report
cellulitis
dyspnea
electrocardiogram
emergency ward
female
fever
hospital admission
human
lung alveolus proteinosis
lung infection
lung volume
medical history
medical record review
pneumonia
sinus tachycardia
vital sign
young adult
CAS REGISTRY NUMBERS
aztreonam (78110-38-0)
ciprofloxacin (85721-33-1)
daptomycin (103060-53-3)
fluconazole (86386-73-4)
levofloxacin (100986-85-4, 138199-71-0)
micafungin (208538-73-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160837328
MEDLINE PMID
27833691 (http://www.ncbi.nlm.nih.gov/pubmed/27833691)
PUI
L613257989
DOI
10.5811/westjem.2016.9.31515
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2016.9.31515
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 394
TITLE
Health care costs and utilization in patients receiving prescriptions for
long-acting opioids for acute postsurgical pain
AUTHOR NAMES
Gold L.S.
Strassels S.A.
Hansen R.N.
AUTHOR ADDRESSES
(Gold L.S., goldl@uw.edu) Departments of Radiology, Pharmaceutical Outcomes
Research and Policy Program, University of Washington, P.O. Box 359455,
Seattle, United States.
(Strassels S.A.) Pharmacy, Pharmaceutical Outcomes Research and Policy
Program, University of Washington, Seattle, United States.
(Gold L.S., goldl@uw.edu; Hansen R.N.) Health Economics and Outcomes
Research, Mallinckrodt Pharmaceuticals, Hazelwood, United States.
CORRESPONDENCE ADDRESS
L.S. Gold, Departments of Radiology, Pharmaceutical Outcomes Research and
Policy Program, University of Washington, P.O. Box 359455, Seattle, United
States. Email: goldl@uw.edu
SOURCE
Clinical Journal of Pain (2016) 32:9 (747-754). Date of Publication: 2016
ISSN
1536-5409 (electronic)
0749-8047
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Objectives: Severe pain after joint replacement surgeries is common and is
usually managed by opioid analgesics. We described joint replacement surgery
patients who received prescriptions for long-acting opioids (Laos) and
compared their health care utilization and costs with postsurgical patients
who did not receive Lao prescriptions. Materials and Methods: Patients
undergoing hip, knee, or shoulder replacement surgery between January 1,
2008 and December 31, 2011were included in the study and were classified by
their exposure to Laos. We estimated multivariate models to compare the
groups' health care utilization and costs in the first 7 days and in the 1,
3, 6, and 12 months after surgery. Results: Of 118,816 patients who met our
inclusion criteria, 15,094 (13%) received Lao prescriptions in 30 days
following surgery. Lao recipients were slightly younger and more likely than
nonrecipients to have taken antibiotics, antidepressants, benzodiazepines,
antihypertensives, sedatives, muscle relaxants, and short-acting opioids in
the 60 days before surgery. Lao recipients were more likely to have had a
hospitalization and an emergency department visit in the subsequent 1 week
and in the next 1, 3, 6, and 12 months. Patients receiving Lao prescriptions
incurred greater costs in the 1 week and in the 1, 3, 6, and 12 months
following their surgeries compared with patients who did not receive Lao
prescriptions. Discussion: We found associations between patients who
received prescriptions for Laos and increased costs and utilization. Future
studies should elucidate causal relationships between Laos and increased
resource use. Providers should consider alternative pain management
strategies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
long acting drug (drug therapy, pharmacoeconomics)
opiate (drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
antibiotic agent
antidepressant agent
antihypertensive agent
benzodiazepine derivative
fentanyl (drug therapy, pharmacoeconomics, transdermal drug administration)
hydromorphone (drug therapy, pharmacoeconomics)
methadone (drug therapy, pharmacoeconomics)
morphine (drug therapy, pharmacoeconomics)
muscle relaxant agent
oxycodone (drug therapy, pharmacoeconomics)
oxymorphone (drug therapy, pharmacoeconomics)
sedative agent
short acting drug
tapentadol (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health care utilization
postoperative pain (drug therapy, disease management, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
comparative study
emergency ward
female
groups by age
hip replacement
hospitalization
human
knee replacement
major clinical study
male
middle aged
priority journal
shoulder replacement
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151003606
MEDLINE PMID
26626298 (http://www.ncbi.nlm.nih.gov/pubmed/26626298)
PUI
L607151540
DOI
10.1097/AJP.0000000000000322
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0000000000000322
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 395
TITLE
Mortality in the Melbourne injecting drug user cohort study (MIX)
AUTHOR NAMES
Nambiar D.
Agius P.A.
Stoové M.
Hickman M.
Dietze P.
AUTHOR ADDRESSES
(Nambiar D., dhanya@burnet.edu.au; Agius P.A., pagius@burnet.edu.au; Stoové
M., stove@burnet.edu.au; Dietze P., pauld@burnet.edu.au) Centre for
Population Health, Burnet Institute, Melbourne, Australia.
(Nambiar D., dhanya@burnet.edu.au; Agius P.A., pagius@burnet.edu.au; Stoové
M., stove@burnet.edu.au; Dietze P., pauld@burnet.edu.au) Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne,
Australia.
(Hickman M., Matthew.Hickman@bristol.ac.uk) School of Social and Community
Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.
CORRESPONDENCE ADDRESS
D. Nambiar, Centre for Population Health, Burnet Institute, Melbourne,
Australia. Email: dhanya@burnet.edu.au
SOURCE
Harm Reduction Journal (2015) 12:1 Article Number: 55. Date of Publication:
9 Dec 2015
ISSN
1477-7517 (electronic)
BOOK PUBLISHER
BioMed Central Ltd., info@biomedcentral.com
ABSTRACT
Background: There are few studies of mortality amongst people who inject
drugs (PWID) in Australia. In this study, we estimate mortality in a cohort
of PWID in Melbourne and examine predictors of mortality including health
service use, demographic characteristics, drug use and personal wellbeing.
Findings: We linked identifiers from the Melbourne injecting drug use cohort
study (MIX; n = 655) to the National Death Index from 2008 to 2012 to
estimate standardised mortality ratios (SMRs). Cox regression was used to
examine the bivariate relationship between exposures determined at baseline
and subsequent mortality. There were 24 (3.6 %) deaths over the study
period. The mortality rate in the cohort was 1.0 per 100 PY (95 % CI
0.71-1.57), with an SMR of 17.3 (95 % CI 11.6-25.8). Baseline reports of
four or more lifetime incarcerations (HR 3.65, 95 % CI 1.16-11.52), past
month ambulance attendance (HR 4.43, 95 % CI 1.76-11.17), past month
emergency department presentation (HR 3.44, 95 % CI 1.47-8.03) and past
6-month self-reported heroin overdose (HR 3.14, 95 % CI 1.24-7.96) were
associated with increased mortality risk. Conclusions: Contact with
emergency services, particularly for drug overdose, remains a lost
opportunity to provide referrals for harm reduction and naloxone training
programmes to PWID at greater risk of mortality.
EMTREE DRUG INDEX TERMS
alcohol
antidepressant agent
benzodiazepine derivative
diamorphine (drug toxicity)
methadone
neuroleptic agent
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intravenous drug abuse
mortality
EMTREE MEDICAL INDEX TERMS
adult
ambulance
article
assault
Australia
clinical article
cohort analysis
controlled study
drug overdose
emergency ward
female
health care utilization
human
male
prediction
prison
standardized mortality ratio
suicide
wellbeing
CAS REGISTRY NUMBERS
alcohol (64-17-5)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151014901
MEDLINE PMID
26654430 (http://www.ncbi.nlm.nih.gov/pubmed/26654430)
PUI
L607201347
DOI
10.1186/s12954-015-0089-3
FULL TEXT LINK
http://dx.doi.org/10.1186/s12954-015-0089-3
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 396
TITLE
Development of an opioid reduction protocol in an emergency department
AUTHOR NAMES
Cohen V.
Motov S.
Rockoff B.
Smith A.
Fromm C.
Bosoy D.
Hossain R.
Likourezos A.
Jellinek-Cohen S.P.
Marshall J.
AUTHOR ADDRESSES
(Cohen V., vcohen@maimonidesmed.org) Health and Hospital Corporation of New
York City, New York, United States.
(Cohen V., vcohen@maimonidesmed.org; Smith A.) Long Island University (LIU),
Arnold and Marie Schwartz College of Pharmacy and Health Sciences,
Department of Pharmacy, Maimonides Medical Center, Brooklyn, United States.
(Motov S.; Rockoff B.; Fromm C.; Bosoy D.; Hossain R.; Likourezos A.;
Marshall J.) Department of Emergency Medicine, Maimonides Medical Center,
United States.
(Jellinek-Cohen S.P.) Department of Clinical Health Professions, St. John's
University College of Pharmacy and Health Sciences, Mount Sinai Beth Israel,
New York, United States.
CORRESPONDENCE ADDRESS
V. Cohen, Health and Hospital Corporation of New York City, New York, United
States. Email: vcohen@maimonidesmed.org
SOURCE
American Journal of Health-System Pharmacy (2015) 72:23 (2080-2086). Date of
Publication: 1 Dec 2015
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
ABSTRACT
Purpose: Results of a study of an opioidsparing protocol for acute pain
management in the emergency department (ED) are reported. Methods: The ED of
a large hospital conducted a project, the "Opioid-Free Shift," to test a
multimodal pharmacologic approach to analgesic therapy as an alternative to
routine use of opioids. During a specified eight-hour period, all adults
arriving at the ED with a complaint of pain were treated according to an
opioid-sparing protocol based on principles of channel enzyme
receptor-targeted analgesia (CERTA). Pain severity was assessed at baseline
and at 30 and 60 minutes after analgesia administration using a validated
rating scale. Results: Seventeen patients were treated in the ED for acute
or chronic pain during the study period. The median pain score on the
11-point rating scale was 8 (range, 4-10) at baseline, declining to 6
(range, 0-10) at 30 minutes and to 5 (range, 1-10) at 60 minutes. At 30
minutes, 7 patients (41%) had a pain score reduction of ≥30% and 3 (18%) had
a reduction of ≥50%. Six of the 15 patients (40%) reassessed at 60 minutes
had a pain score reduction of ≥30%; 4 patients (27%) had a reduction of
≥50%. More than 80% of patients were satisfied with the pain relief provided
through the CERTA-based protocol, and no adverse drug reactions were
reported. Conclusion: The 17 patients treated for acute or chronic pain
during the opioidfree shift were managed mainly with i.v. ketorolac and oral
ibuprofen, with only 1 patient requiring rescue opioid therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent
diazepam (oral drug administration)
ibuprofen (oral drug administration)
ketorolac (intravenous drug administration, regional perfusion)
lidocaine (intravenous drug administration)
methocarbamol (oral drug administration)
morphine
paracetamol (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
adult
analgesia
article
chronic pain (drug therapy)
clinical article
clinical pharmacy
emergency medicine
emergency ward
hospital
human
nephrolithiasis
pain severity
priority journal
rating scale
scoring system
CAS REGISTRY NUMBERS
diazepam (439-14-5)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketorolac (74103-06-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methocarbamol (532-03-6)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160296157
MEDLINE PMID
26581934 (http://www.ncbi.nlm.nih.gov/pubmed/26581934)
PUI
L609853138
DOI
10.2146/ajhp140903
FULL TEXT LINK
http://dx.doi.org/10.2146/ajhp140903
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 397
TITLE
Emergency visits for prescription opioid poisonings
AUTHOR NAMES
Tadros A.
Layman S.M.
Davis S.M.
Davidov D.M.
Cimino S.
AUTHOR ADDRESSES
(Tadros A.; Layman S.M.; Davis S.M.; Davidov D.M.; Cimino S.) Department of
Emergency Medicine, West Virginia University, 1 Medical Center Dr.,
Morgantown, United States.
CORRESPONDENCE ADDRESS
A. Tadros, Department of Emergency Medicine, West Virginia University, 1
Medical Center Dr., Morgantown, United States.
SOURCE
Journal of Emergency Medicine (2015) 49:6 (871-877). Date of Publication: 1
Dec 2015
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Prescription opioid abuse and overdose has steadily increased in
the United States (US) over the past two decades, and current research has
shown a dramatic increase in hospitalizations resulting from opioid
poisonings. Still, much is unknown about the clinical and demographic
features of patients presenting to emergency departments (EDs) for poisoning
from prescription drugs. Objective We sought to evaluate ED visits by adults
for prescription opioids. Methods This was a retrospective cohort study
utilizing 2006-2011 data from the Nationwide Emergency Department Sample.
Total number of admissions (weighted), disposition, gender, age, expected
payer, income, geographic region, charges, and procedures performed were
examined. Results From 2006 through 2010, there were 259,093 ED visits by
adults for poisoning by opioids, and 53.50% of these were unintentional. The
overall mean age of patients was 45.5 years, with more visits made by
females (52.37%). Patients who unintentionally overdosed were more likely to
have Medicare (36.54%), whereas those who intentionally overdosed had
private insurance (29.41%). The majority of patients resided in the South
(40.93%) and came from lower-income neighborhoods. Approximately 108,504
patients were discharged, and 140,395 were admitted. Conclusions There were
over 250,000 visits to US EDs from 2006 through 2011 with a primary
diagnosis of poisoning by a prescription opioid. Females made the majority
of visits, and over half were admitted to the hospital, resulting in over $4
billion in charges. Future studies should examine preventative measures,
optimal screening, and intervention programs for these patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
opioid poisoning
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
emergency ward
female
hospital admission
hospital discharge
human
intentional poisoning
lowest income group
major clinical study
male
medicare
priority journal
private health insurance
retrospective study
unintentional poisoning
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015480528
MEDLINE PMID
26409674 (http://www.ncbi.nlm.nih.gov/pubmed/26409674)
PUI
L606678600
DOI
10.1016/j.jemermed.2015.06.035
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.06.035
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 398
TITLE
Correlates of opioid use in adults with self-reported drug use recruited
from public safety-net primary care clinics
AUTHOR NAMES
Ries R.
Krupski A.
West I.I.
Maynard C.
Bumgardner K.
Donovan D.
Dunn C.
Roy-Byrne P.
AUTHOR ADDRESSES
(Ries R.; Krupski A., krupski@u.washington.edu; West I.I.; Bumgardner K.;
Donovan D.; Dunn C.; Roy-Byrne P.) Department of Psychiatry and Behavioral
Sciences, University of Washington, Harborview Medical Center, Seattle,
United States.
(Maynard C.) Department of Health Services, University of Washington, School
of Public Health, Seattle, United States.
(Donovan D.) Alcohol and Drug Abuse Institute, University of Washington,
Seattle, United States.
CORRESPONDENCE ADDRESS
A. Krupski, University of Washington, 325 Ninth Ave, Seattle, United States.
Email: krupski@u.washington.edu
SOURCE
Journal of Addiction Medicine (2015) 9:5 (417-426). Date of Publication: 1
Dec 2015
ISSN
1935-3227 (electronic)
1932-0620
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
ABSTRACT
Objectives: The purpose of this study was to compare demographic, clinical,
and survival characteristics of drug-using safety-net primary care patients
who used or did not use opioids, and to examine treatment implications of
our findings. Methods: The sample consisted of 868 adults who reported
illicit drug use in the 90 days before study enrollment, 396 (45.6%) of whom
were opioid users. Results: Multiple measures indicated that, as a group,
opioid users were less physically and psychiatrically healthy than drug
users who did not endorse using opioids, and were heavy users of medical
services (eg, emergency departments, inpatient hospitals, and outpatient
medical) at considerable public expense. After adjusting for age, they were
2.61 (confidence interval, 1.48-4.61) times more likely to die in the 1 to 5
years after study enrollment and more likely to die from accidental
poisoning than nonopioid users. Subgroup analyses suggested patients using
any nonprescribed opioids had more serious drug problems including more
intravenous drug use and greater HIV risk than patients using opioids only
as prescribed. Conclusions: Use of opioids adds a dimension of severity over
and above illicit drug use as it presents in the primary care setting.
Opioid users may benefit from psychiatric and addiction care integrated into
their primary care setting, naloxone overdose prevention kits, and
prevention efforts such as clean needle exchanges. Addiction or primary care
providers are in a key position to facilitate change among such patients,
especially the third or more opioid users having a goal of abstinence from
drugs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
alcohol
amphetamine derivative
benzodiazepine derivative
cannabis
cocaine
diamorphine
hypnotic sedative agent
methadone (drug therapy)
tranquilizer
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy, therapy)
primary medical care
public safety net primary care
EMTREE MEDICAL INDEX TERMS
adult
alcohol consumption
article
controlled study
death
drug intoxication
female
health care cost
health care utilization
health service
heroin dependence
human
Human immunodeficiency virus infection
infection risk
intravenous drug abuse
major clinical study
male
mental health care
opiate substitution treatment
patient care
prescription
priority journal
scoring system
self report
survival
urban area
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160107847
MEDLINE PMID
26428361 (http://www.ncbi.nlm.nih.gov/pubmed/26428361)
PUI
L608163809
DOI
10.1097/ADM.0000000000000151
FULL TEXT LINK
http://dx.doi.org/10.1097/ADM.0000000000000151
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 399
TITLE
Using Alternatives to Opioids In an Acute Care Setting
AUTHOR NAMES
Faley B.
AUTHOR ADDRESSES
(Faley B.)
SOURCE
Managed care (Langhorne, Pa.) (2015) 24:12 (52). Date of Publication: 1 Dec
2015
ISSN
1062-3388
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug substitution
emergency health service
EMTREE MEDICAL INDEX TERMS
adverse drug reaction (prevention)
human
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
26803896 (http://www.ncbi.nlm.nih.gov/pubmed/26803896)
PUI
L609219663
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 400
TITLE
Bilateral pallidal and medial temporal lobe ischaemic lesions after opioid
overdose
AUTHOR NAMES
Ramirez-Zamora A.
Ramani H.
Pastena G.
AUTHOR ADDRESSES
(Ramirez-Zamora A., Ramirea@mail.amc.edu; Ramani H.) MC-70 Department of
Neurology, Albany Medical Center, 47 New Scotland Ave, Albany, United
States.
(Pastena G.) MC-70 Department of Radiology, Albany Medical Center, Albany,
United States.
CORRESPONDENCE ADDRESS
A. Ramirez-Zamora, MC-70 Department of Neurology, Albany Medical Center, 47
New Scotland Ave, Albany, United States. Email: Ramirea@mail.amc.edu
SOURCE
Journal of Neurology, Neurosurgery and Psychiatry (2015) 86:12 (1383-1384).
Date of Publication: 1 Dec 2015
ISSN
1468-330X (electronic)
0022-3050
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
oxycodone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain ischemia
drug overdose
globus pallidus
medial temporal lobe
EMTREE MEDICAL INDEX TERMS
case report
confusion
disease control
emergency health service
hippocampus
hospital admission
human
low back pain (drug therapy)
medical history
note
nuclear magnetic resonance imaging
priority journal
sensory dysfunction
suicide attempt
CAS REGISTRY NUMBERS
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015100442
MEDLINE PMID
25240058 (http://www.ncbi.nlm.nih.gov/pubmed/25240058)
PUI
L604740778
DOI
10.1136/jnnp-2014-308730
FULL TEXT LINK
http://dx.doi.org/10.1136/jnnp-2014-308730
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 401
TITLE
Development and process evaluation of an educational intervention for
overdose prevention and naloxone distribution by general practice trainees
AUTHOR NAMES
Klimas J.
Egan M.
Tobin H.
Coleman N.
Bury G.
AUTHOR ADDRESSES
(Klimas J., jan.klimas@ucd.ie.British; Egan M., mairead.egan@ucd.ie; Tobin
H., helen.tobin@ucd.ie; Coleman N., neil.coleman@ucd.ie; Bury G.,
gerard.bury@ucd.ie) Centre for Emergency Medical Science, School of Medicine
and Medical Science, University College Dublin, Dublin, Ireland
(Klimas J., jan.klimas@ucd.ie.British) British Columbia Centre for
Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street,
Vancouver, British Columbia, V6Z 1Y6, Canada
(Klimas J., jan.klimas@ucd.ie.British) c/o Coombe Family Practice, Dolphins
barn, Dublin, Ireland
SOURCE
BMC medical education (2015) 15 (206). Date of Publication: 20 Nov 2015
ISSN
1472-6920 (electronic)
ABSTRACT
BACKGROUND: Overdose is the most common cause of fatalities among opioid
users. Naloxone is a life-saving medication for reversing opioid overdose.
In Ireland, it is currently available to ambulance and emergency care
services, but General Practitioners (GP) are in regular contact with opioid
users and their families. This positions them to provide naloxone themselves
or to instruct patients how to use it. The new Clinical Practice Guidelines
of the Pre-hospital Emergency Care Council of Ireland allows trained
bystanders to administer intranasal naloxone. We describe the development
and process evaluation of an educational intervention, designed to help GP
trainees identify and manage opioid overdose with intranasal
naloxone.METHODS: Participants (N = 23) from one postgraduate training
scheme in Ireland participated in a one-hour training session. The
repeated-measures design, using the validated Opioid Overdose Knowledge
(OOKS) and Attitudes (OOAS) Scales, examined changes immediately after
training. Acceptability and satisfaction with training were measured with a
self-administered questionnaire.RESULTS: Knowledge of the risks of overdose
and appropriate actions to be taken increased significantly post-training
[OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes
improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most
and least useful delivery methods were simulation and video,
respectively.CONCLUSION: Appropriate training is a key requirement for the
distribution of naloxone through general practice. In future studies, the
knowledge from this pilot will be used to inform a train-the-trainer model,
whereby healthcare professionals and other front-line service providers will
be trained to instruct opioid users and their families in overdose
prevention and naloxone use.
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug therapy)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
attitude to health
education
EMTREE MEDICAL INDEX TERMS
adult
caregiver
drug overdose (diagnosis, drug therapy, prevention)
family
feasibility study
female
friend
general practice
health education
human
intranasal drug administration
Ireland
male
medical education
opiate addiction (diagnosis, drug therapy)
pilot study
procedures
program evaluation
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26590066 (http://www.ncbi.nlm.nih.gov/pubmed/26590066)
PUI
L615943905
DOI
10.1186/s12909-015-0487-y
FULL TEXT LINK
http://dx.doi.org/10.1186/s12909-015-0487-y
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 402
TITLE
Ketamine for prehospital trauma analgesia in a low-resource rural trauma
system: a retrospective comparative study of ketamine and opioid analgesia
in a ten-year cohort in Iraq
AUTHOR NAMES
Losvik O.K.
Murad M.K.
Skjerve E.
Husum H.
AUTHOR ADDRESSES
(Losvik O.K., losvik@gmail.com.Tromso) Department of Clinical Medicine,
Faculty of Health Sciences, University of Tromso, PO Box 6050 Langnes,
Tromso, 9037, Norway
(Losvik O.K., losvik@gmail.com.Tromso; Husum H., husumhans@gmail.com) Tromso
Mine Victim Resource Centre, University Hospital of North Norway, PO Box 80,
Tromso, 9038, Norway
(Murad M.K.) Trauma Care Foundation Iraq, Sulaymaniyah, Iraq.
tcfiraq@yahoo.com
(Skjerve E., eystein.skjerve@nmbu.no) Norwegian University of Life Sciences,
Ås, Norway
SOURCE
Scandinavian journal of trauma, resuscitation and emergency medicine (2015)
23 (94). Date of Publication: 9 Nov 2015
ISSN
1757-7241 (electronic)
ABSTRACT
BACKGROUND: Opioid analgesics are used in most trauma systems, and only a
few studies report on the use of ketamine for prehospital analgesia. In a
low-cost rural trauma system in Iraq paramedics have been using prehospital
ketamine analgesia for ten years. This study aims to evaluate the effects of
prehospital analgesia on physiologic trauma severity indicators and compare
the effect of ketamine and pentazocine on those indicators.METHODS: The
investigation was conducted as a retrospective cohort study with parallel
group design. Three subsamples of trauma patients were compared: no
analgesia (n = 275), pentazocine analgesia (n = 888), and ketamine analgesia
(n = 713). Physiologic severity scores were calculated based on rated values
for respiratory rate, blood pressure, and consciousness. The associations
between outcomes and explanatory variables were assessed using a generalized
linear model.RESULTS: Paramedic administration of analgesia was associated
with a better physiologic severity score (PSS) outcome (p = 0.01). In the
two subsamples receiving analgesia significantly better outcomes were
observed for respiration (p < 0.0001) and systolic blood pressure (p <
0.0001). In patients with Injury Severity Score >8 ketamine was associated
with a significantly better effect on the systolic blood pressure compared
to opioid analgesia (p = 0.03).CONCLUSION: Prehospital analgesia for trauma
victims improves physiologic severity indicators in a low-resource trauma
system. Compared to pentazocine, ketamine was associated with improved blood
pressure for patients with serious injuries. In a low-resource setting,
ketamine seems to be a good choice for prehospital analgesia in trauma
patients.
EMTREE DRUG INDEX TERMS
analgesic agent (drug administration)
ketamine (drug administration)
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS
adult
analgesia
cohort analysis
comparative study
emergency health service
female
follow up
human
injury (diagnosis, drug therapy)
injury scale
Iraq
male
mortality
pain measurement
patient safety
procedures
retrospective study
risk assessment
survival rate
time factor
treatment outcome
young adult
CAS REGISTRY NUMBERS
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26552691 (http://www.ncbi.nlm.nih.gov/pubmed/26552691)
PUI
L615901171
DOI
10.1186/s13049-015-0176-1
FULL TEXT LINK
http://dx.doi.org/10.1186/s13049-015-0176-1
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 403
TITLE
Prescription of opioid analgesics for nontraumatic dental conditions in
emergency departments
AUTHOR NAMES
Okunseri C.
Dionne R.A.
Gordon S.M.
Okunseri E.
Szabo A.
AUTHOR ADDRESSES
(Okunseri C., christopher.okunseri@marquette.edu; Okunseri E.) Department of
Clinical Services, School of Dentistry, Marquette University, P.O. Box 1881,
Milwaukee, United States.
(Dionne R.A.; Gordon S.M.) Department of Foundational Sciences, School of
Dental Medicine, East Carolina University, Greenville, United States.
(Dionne R.A.) Department of Pharmacology and Toxicology, Brody School of
Medicine, East Carolina University, Greenville, United States.
(Szabo A.) Division of Biostatistics, Institute of Health and Society,
Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, United
States.
CORRESPONDENCE ADDRESS
C. Okunseri, Department of Clinical Services, Marquette University School of
Dentistry, P.O. Box 1881, Milwaukee, United States. Email:
christopher.okunseri@marquette.edu
SOURCE
Drug and Alcohol Dependence (2015) 156 (261-266) Article Number: 5760. Date
of Publication: 1 Nov 2015
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background: Opioid analgesics prescribed for nontraumatic dental conditions
(NTDCs) by emergency physicians continue to receive attention because of the
associated potential for misuse, abuse and addiction. This study examined
rates of prescription of opioid analgesics and types of opioid analgesics
prescribed for NTDC visits in U.S. emergency departments. Methods: Data from
the National Hospital Ambulatory Medical Care Survey from 2007 to 2010 were
analyzed. Descriptive statistics and logistic regression analysis were
performed and adjusted for the survey design. Results: NTDCs made up 1.7% of
all ED visits from 2007 to 2010. The prescription of opioid analgesics was
50.3% for NTDC and 14.8% for non-NTDC visits. The overall rate of opioid
analgesics prescribed for NTDCs remained fairly stable from 2007 through
2010. Prescription of opioids was highest among patients aged 19-33 years
(56.8%), self-paying (57.1%), and non-Hispanic Whites (53.2%). The
probability of being prescribed hydrocodone was highest among uninsured
patients (68.7%) and for oxycodone, it was highest among private insurance
patients (33.6%). Compared to 34-52 year olds, children 0-4 years were
significantly more likely to be prescribed codeine and less likely to be
prescribed oxycodone. Compared to non-Hispanic Whites, non-Hispanic Blacks
had significantly higher odds of been prescribed codeine and somewhat lower
odds of been prescribed oxycodone, but it was not statistically significant.
Conclusions: There was no significant change in the rates of opioid
analgesics prescribed over time for NTDC visits to EDs. Age, payer type and
race/ethnicity were significant predictors for the prescription of different
opioid analgesics by emergency physicians for NTDC visits.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
hydrocodone (drug therapy)
oxycodone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
nontraumatic dental condition (drug therapy, drug therapy)
prescription
tooth disease (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age distribution
aged
article
Black person
Caucasian
child
controlled study
drug misuse
drug preference
ethnicity
female
high risk population
Hispanic
human
infant
major clinical study
male
medical expert
medical practice
newborn
priority journal
private health insurance
race difference
risk assessment
United States
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015499265
MEDLINE PMID
26471416 (http://www.ncbi.nlm.nih.gov/pubmed/26471416)
PUI
L606816238
DOI
10.1016/j.drugalcdep.2015.09.023
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2015.09.023
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 404
TITLE
Prescription monitoring programs and emergency department visits involving
opioids, 2004-2011
AUTHOR NAMES
Maughan B.C.
Bachhuber M.A.
Mitra N.
Starrels J.L.
AUTHOR ADDRESSES
(Maughan B.C., bmaughan@gmail.com; Bachhuber M.A.,
marcus.bachhuber@gmail.com) Center for Health Equity Research and Promotion,
Philadelphia Veterans Affairs Medical Center, Philadelphia, United States.
(Maughan B.C., bmaughan@gmail.com; Bachhuber M.A.,
marcus.bachhuber@gmail.com; Mitra N., nanditam@mail.med.upenn.edu) Leonard
Davis Institute of Health Economics, University of Pennsylvania,
Philadelphia, United States.
(Maughan B.C., bmaughan@gmail.com; Bachhuber M.A.,
marcus.bachhuber@gmail.com) Robert Wood Johnson Foundation Clinical Scholars
Program, University of Pennsylvania, Philadelphia, United States.
(Mitra N., nanditam@mail.med.upenn.edu) Department of Biostatistics and
Epidemiology, University of Pennsylvania Perelman School of Medicine,
Philadelphia, United States.
(Starrels J.L., jostarre@montefiore.org) Division of General Internal
Medicine, Montefiore Medical Center/Albert Einstein College of Medicine,
Bronx, United States.
(Maughan B.C., bmaughan@gmail.com) 2886 E. Oquirrh Drive, Salt Lake City,
United States.
CORRESPONDENCE ADDRESS
B.C. Maughan, University of Pennsylvania, 1303-A Blockley Hall, 423 Guardian
Drive, Philadelphia, United States. Email: bmaughan@gmail.com
SOURCE
Drug and Alcohol Dependence (2015) 156 (282-288) Article Number: 5753. Date
of Publication: 1 Nov 2015
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Objective: To determine the association between prescription drug monitoring
program (PDMP) implementation and emergency department (ED) visits involving
opioid analgesics. Methods: Rates of ED visits involving opioid analgesics
per 100,000 residents were estimated from the Drug Abuse Warning Network
dataset for 11 geographically diverse metropolitan areas in the United
States on a quarterly basis from 2004 to 2011. Generalized estimating
equations assessed whether implementation of a prescriber-accessible PDMP
was associated with a difference in ED visits involving opioid analgesics.
Models were adjusted for calendar quarter, metropolitan area, metropolitan
area-specific linear time trends, and unemployment rate. Results: Rates of
ED visits involving opioid analgesics increased in all metropolitan areas.
PDMP implementation was not associated with a difference in ED visits
involving opioid analgesics (mean difference of 0.8 visits [95% CI: -3.7 to
5.2] per 100,000 residents per quarter). Conclusions: During 2004-2011, PDMP
implementation was not associated with a change in opioid-related morbidity,
as measured by emergency department visits involving opioid analgesics.
Urgent investigation is needed to determine the optimal PDMP structure and
capabilities to improve opioid analgesic safety.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug surveillance program
emergency care
prescription drug monitoring program
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
drug safety
emergency ward
geographic distribution
health care access
health care quality
human
medical information system
morbidity
priority journal
retrospective study
United States
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015499267
MEDLINE PMID
26454836 (http://www.ncbi.nlm.nih.gov/pubmed/26454836)
PUI
L606816240
DOI
10.1016/j.drugalcdep.2015.09.024
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2015.09.024
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 405
TITLE
A Rare but Lethal Cause of Chest Pain
AUTHOR NAMES
Anderson R.E.
Wilcox S.
Miller E.S.
AUTHOR ADDRESSES
(Anderson R.E.) Department of Emergency Medicine, Massachusetts General
Hospital, Brigham and Women's Hospital, Boston, United States.
(Anderson R.E.; Wilcox S.; Miller E.S.) Department of Emergency Medicine,
Harvard Medical School, Boston, United States.
(Wilcox S.; Miller E.S.) Department of Emergency Medicine, Massachusetts
General Hospital, Zero Emerson Place, Boston, United States.
CORRESPONDENCE ADDRESS
E.S. Miller, Department of Emergency Medicine, Massachusetts General
Hospital, Zero Emerson Place, Boston, United States.
SOURCE
Journal of Emergency Medicine (2015) 49:5 (698-702). Date of Publication: 1
Nov 2015
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
amlodipine (drug therapy)
atorvastatin
contrast medium (intravenous drug administration, oral drug administration)
fluconazole (intravenous drug administration)
hydrochlorothiazide (drug therapy)
hydromorphone (drug therapy, intravenous drug administration)
infusion fluid
ketamine (drug therapy)
lactic acid (endogenous compound)
naloxone (drug therapy, intravenous drug administration)
noradrenalin
pantoprazole
phosphate (endogenous compound)
piperacillin plus tazobactam (intravenous drug administration)
pseudoephedrine (adverse drug reaction)
suxamethonium (drug therapy)
valsartan (drug therapy)
vancomycin (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Boerhaave syndrome (diagnosis, therapy)
esophagus rupture (diagnosis)
thorax pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abnormal respiratory sound
acidemia
acute cholecystitis (diagnosis)
acute coronary syndrome (diagnosis)
acute disease (diagnosis)
acute valvular disease (diagnosis)
adult
agitation
alcohol consumption
analgesia
antihypertensive therapy
antimicrobial therapy
aortic dissection (diagnosis)
artery catheter
backache (drug therapy)
bougie
carbon dioxide tension
cardiogenic shock (diagnosis)
case report
central venous catheter
chest tube
computer assisted tomography
congestive heart failure (diagnosis)
contrast enhancement
differential diagnosis
drug hypersensitivity (side effect)
early diagnosis
emergency ward
endotracheal tube
esophagram
esophagus examination
esophagus pressure
esophagus ulcer (diagnosis)
fever
gastroesophageal reflux
hiatus hernia
human
hydrothorax
hypertension (drug therapy)
hypotension (drug therapy)
intubation
lactate blood level
laryngoscopy
lung embolism (diagnosis)
male
medical history
mental health
mesenteric ischemia (diagnosis)
middle aged
nasal cannula
neurologic examination
non rebreathing valve
note
oxygen consumption
oxygen desaturation
oxygen saturation
pancreatitis (diagnosis)
paralysis (drug therapy)
parenteral nutrition
pericardial effusion (diagnosis)
phosphate blood level
physical examination
pleura effusion (diagnosis)
pneumomediastinum
pneumonia (diagnosis)
priority journal
respiratory distress
retching
sepsis
sinus rhythm
sinus tachycardia
somnolence
stomach ulcer (diagnosis)
tachycardia
tachypnea
thorax radiography
thorax surgery
valvular heart disease (diagnosis)
venous blood
videolaryngoscope
videorecording
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
amlodipine (88150-42-9, 103129-82-4, 736178-83-9)
atorvastatin (134523-00-5, 134523-03-8)
fluconazole (86386-73-4)
hydrochlorothiazide (58-93-5)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lactic acid (113-21-3, 50-21-5)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
pantoprazole (102625-70-7)
phosphate (14066-19-4, 14265-44-2)
pseudoephedrine (345-78-8, 7460-12-0, 90-82-4)
suxamethonium (306-40-1, 71-27-2)
valsartan (137862-53-4)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Radiology (14)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015300067
MEDLINE PMID
26281817 (http://www.ncbi.nlm.nih.gov/pubmed/26281817)
PUI
L605637162
DOI
10.1016/j.jemermed.2015.06.066
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.06.066
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 406
TITLE
Emergency department utilization and subsequent prescription drug overdose
death
AUTHOR NAMES
Ruan X.
Kaye A.D.
AUTHOR ADDRESSES
(Ruan X.; Kaye A.D.) Department of Anesthesiology, Louisiana State
University Health Science Center, New Orleans, United States.
SOURCE
Annals of Epidemiology (2015) 25:11 (879-880). Date of Publication: 1 Nov
2015
ISSN
1873-2585 (electronic)
1047-2797
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prescription drug (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine
naloxone (drug therapy)
opiate (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
death
drug overdose (drug therapy, drug therapy, prevention)
emergency ward
EMTREE MEDICAL INDEX TERMS
addiction
analgesia
chronic pain (drug therapy)
drug abuse
drug misuse (drug therapy)
high risk patient
human
letter
mental disease
pain (drug therapy)
prescription
prevalence
priority journal
reimbursement
resident
substance abuse
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015352648
MEDLINE PMID
26344326 (http://www.ncbi.nlm.nih.gov/pubmed/26344326)
PUI
L605901119
DOI
10.1016/j.annepidem.2015.07.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annepidem.2015.07.013
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 407
TITLE
Opioid use among same-day surgery patients: Prevalence, management and
outcomes
AUTHOR NAMES
Wilson J.L.C.
Poulin P.A.
Sikorski R.
Nathan H.J.
Taljaard M.
Smyth C.
AUTHOR ADDRESSES
(Wilson J.L.C.; Poulin P.A.; Nathan H.J.; Smyth C., csmyth@toh.on.ca)
Department of Anesthesiology, University of Ottawa, 501 Smyth Road, Ottawa,
Canada.
(Poulin P.A.) Department of Psychology, Ottawa Hospital, Canada.
(Poulin P.A.; Nathan H.J.) Ottawa Hospital Research Institute, Canada.
(Poulin P.A.) School of Psychology, University of Ottawa, Ottawa, Canada.
(Sikorski R.) Department of Anesthesiology, Thunder Bay Regional Health
Sciences Centre, Thunder Bay, Canada.
(Taljaard M.) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Canada.
(Sikorski R.) Department of Epidemiology and Community Medicine, University
of Ottawa, Ottawa, Canada.
CORRESPONDENCE ADDRESS
C. Smyth, Department of Anesthesiology, University of Ottawa, 501 Smyth
Road, Ottawa, Canada. Email: csmyth@toh.on.ca
SOURCE
Pain Research and Management (2015) 20:6 (300-304). Date of Publication: 1
Nov 2015
ISSN
1203-6765
BOOK PUBLISHER
Pulsus Group Inc., 410 Park Avenue, 15th Floor, 287 pmb, New York, United
States.
ABSTRACT
Objectives: To determine whether the prevalence of opioid use among patients
requiring elective same-day admission (SDA) surgery is greater than the 2.5%
prevalence found in the general population. Secondary objectives were to
assess compliance with expert recommendations on acute pain management in
opioid-tolerant patients and to examine clinical outcomes. Methods: A
retrospective review of 812 systematically sampled adult SDA surgical cases
between April 1, 2008 and March 31, 2009 was conducted. Results : Among 798
eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed
opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use
of opioids was most prevalent among orthopedic and neurosurgery patients.
Among the 35 patients on long-acting opioids who had a high likelihood of
being tolerant, anesthesiologists correctly identified 33, but only 13 (37%)
took their usual opioid preoperatively while 22 (63%) had opioids continued
postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and
pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%)
cases, respectively, while ketamine was used in 15 (43%) patients
intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and
pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%)
of the cases, respectively. No differences in length of stay, readmissions
and emergency room visits were found between opioid-tolerant and opioidnaïve
patients. Conclusion: Opioid use is more common in SDA surgical patients
than in the general population and is most prevalent within orthopedic and
neurosurgery patients. Uptake of expert opinion on the management of acute
pain in the opioid tolerant patient population is lacking.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy, transdermal drug administration)
hydromorphone (drug therapy)
ketamine (intravenous drug administration)
lidocaine
morphine (drug therapy)
nonsteroid antiinflammatory agent
oxycodone (drug therapy)
paracetamol
pregabalin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory surgery
drug use
neurosurgery
orthopedic surgery
pain (drug therapy, drug therapy)
patient controlled analgesia
EMTREE MEDICAL INDEX TERMS
adult
anesthesist
article
atrial fibrillation (complication)
chest infection (complication)
controlled study
emergency ward
female
hospital readmission
human
length of stay
major clinical study
male
middle aged
outcome assessment
postoperative period
preoperative evaluation
prevalence
regional anesthesia
retrospective study
surgical infection (complication)
surgical patient
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pregabalin (148553-50-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20160158042
MEDLINE PMID
26357683 (http://www.ncbi.nlm.nih.gov/pubmed/26357683)
PUI
L608571525
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 408
TITLE
Longitudinal Analysis of Opioid Analgesic Dose and Diabetes Quality of Care
Measures
AUTHOR NAMES
Gautam S.
Franzini L.
Mikhail O.I.
Chan W.
Turner B.J.
AUTHOR ADDRESSES
(Gautam S.; Franzini L.; Mikhail O.I.; Chan W.) School of Public Health,
University of Texas Health Science Center at Houston, Houston, United
States.
(Turner B.J., turner@uthscsa.edu) University of Texas Health Science Center
at San Antonio (UTHSCSA), San Antonio, United States.
CORRESPONDENCE ADDRESS
B.J. Turner, 7411 John Smith Rd. Suite 1050, San Antonio, United States.
Email: turner@uthscsa.edu
SOURCE
Pain Medicine (United States) (2015) 16:11 (2134-2141). Date of Publication:
1 Nov 2015
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., jnl.info@oup.co.uk
ABSTRACT
Objective: To examine associations of opioid analgesic dose with quality of
care for diabetes mellitus. Design: Longitudinal statewide cohort. Subjects:
Subjects with diabetes filled one or more prescriptions for Schedule II/III
opioids for noncancer pain in Blue Cross Blue Shield of Texas from 2008
through 2012. Methods: Opioid dose and outcomes were assessed in 6-month
intervals after first filled prescription. Two morphine equivalent dose
measures were daily dose and quartiles of total dose from all filled
prescriptions. In fixed effects models adjusted for clinical and treatment
variables, associations of opioid measures were examined for five outcomes:
hemoglobin A1c (HbA1c) test, low density lipoprotein cholesterol (LDL) test,
any hospitalization, any diabetes-related preventable hospitalization, and
any emergency department (ED) visit. Results: All daily and total opioid
doses were associated (P<0.05) with poorer outcomes for all five measures.
For HbA1c testing, adjusted odds ratios (AORs) were reduced by 19% for high
daily dose (≥100 mg) and highest quartile total dose (>900 mg),
respectively, vs no opioids but >900 mg total dose had the lowest AOR for
LDL testing (0.74 [CI 0.68, 0.80]). The AORs of any hospitalization or
diabetes-related hospitalization were, respectively, 8.19 (CI 7.21, 9.30)
and 2.76 (CI 2.19, 3.48) for >900 mg total dose but only 6.22 (CI 4.94,
7.83) and 2.16 (CI 1.34, 3.48) for >100 mg daily dose. Both opioid measures
had nonmonotonic associations with ED use. Conclusions: Daily opioid dose
but especially total dose of opioids was strongly associated with poorer
diabetes quality of care in a statewide cohort.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug dose)
EMTREE DRUG INDEX TERMS
hemoglobin A1c (endogenous compound)
low density lipoprotein (endogenous compound)
morphine (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diabetes mellitus
drug dose regimen
health care quality
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
emergency treatment
female
hospitalization
human
laboratory test
longitudinal study
major clinical study
male
outcome assessment
pain
prescription
retrospective study
United States
CAS REGISTRY NUMBERS
hemoglobin A1c (62572-11-6)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Endocrinology (3)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160064698
MEDLINE PMID
26179032 (http://www.ncbi.nlm.nih.gov/pubmed/26179032)
PUI
L607888947
DOI
10.1111/pme.12835
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12835
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 409
TITLE
Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid
overdose--an important opportunity for saving lives
AUTHOR NAMES
Dailey M.
AUTHOR ADDRESSES
(Dailey M.) Division of Prehospital and Operational Medicine, Albany Medical
College-Emergency Medicine, Albany, NY, USA
SOURCE
Addiction (Abingdon, England) (2015) 110:11 (1775-1776). Date of
Publication: 1 Nov 2015
ISSN
1360-0443 (electronic)
ABSTRACT
Overdose reversal must be seen as an opportunity for intervention because of
the elevated risk of death following the event. While emergency medical
cardiac arrest care is a poor parallel for opioid overdose, the need for
rigorous review and fiscally prudent solutions is similar. Efforts must be
made to look for solutions to prevent and treat future overdose specifically
in the population that has had an overdose event.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug overdose (epidemiology)
emergency health service
human
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26471158 (http://www.ncbi.nlm.nih.gov/pubmed/26471158)
PUI
L611791854
DOI
10.1111/add.13093
FULL TEXT LINK
http://dx.doi.org/10.1111/add.13093
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 410
TITLE
The influence of propoxyphene withdrawal on opioid use in veterans
AUTHOR NAMES
Hayes C.J.
Hudson T.J.
Phillips M.M.
Bursac Z.
Williams J.S.
Austin M.A.
Edlund M.J.
Martin B.C.
AUTHOR ADDRESSES
(Hayes C.J.) Department of Pharmacy, Baptist Health Medical Center -Little
Rock, United States.
(Hayes C.J.; Martin B.C., BMartin@uams.edu) Division of Pharmaceutical
Evaluation and Policy, University of Arkansas for Medical Sciences, Little
Rock, United States.
(Hudson T.J.) Department of Psychiatry, University of Arkansas for Medical
Sciences, Little Rock, United States.
(Hudson T.J.; Williams J.S.; Austin M.A.; Martin B.C., BMartin@uams.edu)
Center for Mental Healthcare and Outcomes Research, Central Arkansas
Veterans Healthcare System, Little Rock, United States.
(Phillips M.M.) College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, United States.
(Bursac Z.) Division of Biostatistics and Center for Population Sciences,
Department of Preventive Medicine, College of Medicine, University of
Tennessee Health Science Center, Memphis, United States.
(Edlund M.J.) Behavioral Health Epidemiology Program, RTI International,
United States.
(Edlund M.J.) Behavioral Health Services, St. Luke's Health System, Twin
Falls, United States.
CORRESPONDENCE ADDRESS
B.C. Martin, Division of Pharmaceutical Evaluation and Policy, University of
Arkansas for Medical Sciences College of Pharmacy, 4301W. Markham, Slot 522,
Little Rock, United States. Email: BMartin@uams.edu
SOURCE
Pharmacoepidemiology and Drug Safety (2015) 24:11 (1180-1188). Date of
Publication: 1 Nov 2015
ISSN
1099-1557 (electronic)
1053-8569
BOOK PUBLISHER
John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United
Kingdom.
ABSTRACT
Purpose: Our aim is to determine if propoxyphene withdrawal from the US
market was associated with opioid continuation, continued chronic opioid
use, and secondary propoxyphene-related adverse events (emergency department
visits, opioid-related events, and acetaminophen toxicity). Methods: Medical
service use and pharmacy data from 19/11/08 to 19/11/11 were collected from
the national Veterans Healthcare Administration healthcare databases. A
quasi-experimental pre-post retrospective cohort design utilizing a
historical comparison group provided the study framework. Logistic
regression controlling for baseline covariates was used to estimate the
effect of propoxyphene withdrawal. Results: There were 24328 subjects
(policy affected n=10747; comparison n=13581) meeting inclusion criteria. In
the policy-affected cohort, 10.6% of users ceased using opioids, and 26.6%
stopped chronic opioid use compared with 3.8% and 13.5% in the historical
comparison cohort, respectively. Those in the policy-affected cohort were
2.7 (95%CI: 2.5-2.8) and 3.2 (95%CI: 2.9-3.6) times more likely than those
in the historical comparison cohort to discontinue chronic opioid and any
opioid use, respectively. Changes in adverse events and Emergency Department
(ED) visits were not different between policy-affected and historical
comparison cohorts (p>0.05). Conclusions: The withdrawal of
propoxyphene-containing products resulted in rapid and virtually complete
elimination in propoxyphene prescribing in the veterans population; however,
nearly 90% of regular users of propoxyphene switched to an alternate opioid,
and three quarters continued to use opioids chronically.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dextropropoxyphene (adverse drug reaction, drug combination, drug therapy)
opiate (adverse drug reaction, drug combination, drug therapy)
EMTREE DRUG INDEX TERMS
dextropropoxyphene plus paracetamol (adverse drug reaction, drug therapy)
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
treatment withdrawal
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
arthritis (drug therapy)
article
backache (drug therapy)
chronotherapy
cohort analysis
controlled study
drug megadose
drug safety
drug withdrawal
emergency ward
female
food and drug administration
fracture (drug therapy)
genital pain (drug therapy)
headache (drug therapy)
health care policy
human
injury (drug therapy)
major clinical study
male
musculoskeletal pain (drug therapy)
neuropathy (drug therapy)
pain (drug therapy)
prescription
pretest posttest control group design
priority journal
quasi experimental study
retrospective study
secondary analysis
treatment duration
United States
unspecified side effect (side effect)
veteran
visceral pain (drug therapy)
wound (drug therapy)
DRUG TRADE NAMES
darvon
CAS REGISTRY NUMBERS
dextropropoxyphene (1639-60-7, 469-62-5)
dextropropoxyphene plus paracetamol (39400-85-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015256178
MEDLINE PMID
26248742 (http://www.ncbi.nlm.nih.gov/pubmed/26248742)
PUI
L605541107
DOI
10.1002/pds.3851
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.3851
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 411
TITLE
The Fentanyl Patch Boil-Up - A Novel Method of Opioid Abuse
AUTHOR NAMES
Schauer C.K.M.W.
Shand J.A.D.
Reynolds T.M.
AUTHOR ADDRESSES
(Schauer C.K.M.W., cameron.schauer@gmail.com; Shand J.A.D.) Department of
General Medicine, Whangarei Hospital, Whangarei, New Zealand.
(Reynolds T.M.) Emergency Medicine Department, Whangarei Hospital,
Whangarei, New Zealand.
CORRESPONDENCE ADDRESS
C.K.M.W. Schauer, Department of General Medicine, Whangarei Hospital,
Private Bag 9742, Whangarei, New Zealand. Email: cameron.schauer@gmail.com
SOURCE
Basic and Clinical Pharmacology and Toxicology (2015) 117:5 (358-359). Date
of Publication: 1 Nov 2015
ISSN
1742-7843 (electronic)
1742-7835
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Fentanyl is a potent opioid analgesic used in the treatment of pain.
Transdermal fentanyl patches are now widely utilized as an acceptable and
efficacious method of medication delivery. Unfortunately, the potential for
their abuse is well recognized. Previous case reports have documented deaths
after intravenous (IV) misuse of fentanyl which had been extracted from
Duragesic (liquid reservoir type) patches. We present a case of IV fentanyl
abuse after the extraction from a Mylan (matrix type) patch. This method of
abuse has not previously been described in the literature.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
EMTREE DRUG INDEX TERMS
glucose (endogenous compound)
methadone (drug therapy)
tap water
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
transdermal patch
EMTREE MEDICAL INDEX TERMS
adult
article
blood pressure
breathing
case report
drowsiness
drug abuse
drug dependence (drug therapy)
drug substitution
drug withdrawal
emergency ward
falling
female
glucose blood level
human
intravenous drug abuse
methadone treatment
oxygen saturation
physical examination
priority journal
pulse rate
puncture
QT prolongation
respiration depression
unconsciousness
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
glucose (50-99-7, 84778-64-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015057338
MEDLINE PMID
25892448 (http://www.ncbi.nlm.nih.gov/pubmed/25892448)
PUI
L604461685
DOI
10.1111/bcpt.12412
FULL TEXT LINK
http://dx.doi.org/10.1111/bcpt.12412
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 412
TITLE
New Drugs of Abuse and Withdrawal Syndromes
AUTHOR NAMES
Andrabi S.
Greene S.
Moukkadam N.
Li B.
AUTHOR ADDRESSES
(Andrabi S., andrabi.sara@gmail.com; Greene S.) Section of Emergency
Medicine, Emergency Center, Baylor College of Medicine, 1504 Taub Loop,
Houston, United States.
(Moukkadam N.) Stabilization, Treatment and Rehabilitation (STAR) Program
for Psychosis, Menninger Department of Psychiatry, Baylor College of
Medicine, 1504 Taub Loop, Houston, United States.
(Li B.) Menninger Department of Psychiatry, Harris Health System, Baylor
College of Medicine, 1504 Taub Loop, Houston, United States.
CORRESPONDENCE ADDRESS
S. Andrabi, Section of Emergency Medicine, Emergency Center, Baylor College
of Medicine, 1504 Taub Loop, Houston, United States.
SOURCE
Emergency Medicine Clinics of North America (2015) 33:4 (779-795). Date of
Publication: 1 Nov 2015
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS
25I NBOMe (drug analysis, drug toxicity)
2C I (drug analysis, drug toxicity)
3 (1 naphthoyl) 1 pentylindole (drug analysis, drug toxicity)
ab fubinaca (drug analysis, drug toxicity)
adb pinaca (drug analysis, drug toxicity)
akb 48 (drug analysis, drug toxicity)
calcium channel blocking agent (drug therapy)
cannabinoid (drug analysis, drug toxicity)
central stimulant agent (drug toxicity)
creatinine (endogenous compound)
dexanabinol (drug analysis, drug toxicity)
diphenhydramine (drug combination, drug therapy)
flumazenil (drug therapy)
haloperidol (drug combination, drug therapy)
hypertensive factor (drug therapy)
jwh 122 (drug analysis, drug toxicity)
lorazepam (drug combination, drug therapy)
midazolam
naloxone (drug therapy)
neuroleptic agent (drug therapy)
phenethylamine derivative (drug analysis, drug toxicity)
unclassified drug
vasodilator agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
artificial ventilation
benzodiazepine dependence (drug therapy)
blood cell count
central nervous system disease (drug therapy)
cognitive therapy
computer assisted tomography
creatinine blood level
drug identification
drug intoxication
drug structure
electrocardiography
emergency care
emergency ward
fluid resuscitation
high risk population
human
hypertension (drug therapy)
hypotension (drug therapy)
laboratory test
law enforcement
liquid chromatography
liver function test
mass fragmentography
metabolic acidosis (therapy)
motivational interviewing
outpatient care
patient assessment
patient care
patient counseling
priority journal
psychosis (drug therapy)
public health
respiration depression (drug therapy)
restlessness (drug therapy)
review
risk assessment
substance abuse
thorax radiography
urinalysis
DRUG TRADE NAMES
akb 48
hu 210
jwh 018
jwh 122
CAS REGISTRY NUMBERS
3 (1 naphthoyl) 1 pentylindole (209414-07-3)
creatinine (19230-81-0, 60-27-5)
dexanabinol (112924-45-5)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
haloperidol (52-86-8, 1511-16-6)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015477499
MEDLINE PMID
26493523 (http://www.ncbi.nlm.nih.gov/pubmed/26493523)
PUI
L606647332
DOI
10.1016/j.emc.2015.07.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2015.07.006
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 413
TITLE
Acute recreational drug and new psychoactive substance toxicity in Europe:
12 months data collection from the European Drug Emergencies Network
(Euro-DEN)
AUTHOR NAMES
Dines A.M.
Wood D.M.
Yates C.
Heyerdahl F.
Hovda K.E.
Giraudon I.
Sedefov R.
Dargan P.I.
AUTHOR ADDRESSES
(Dines A.M., alison.dines@gstt.nhs.uk; Wood D.M.; Dargan P.I.) Clinical
Toxicology, Guy's and St Thomas NHS Foundation Trust and King's Health
Partners, Westminster Bridge Road, London, United Kingdom.
(Wood D.M.; Dargan P.I.) Faculty of Life Sciences and Medicine, King's
College London, London, United Kingdom.
(Yates C.) Emergency Department and Clinical Toxicology Unit, Hospital
Universitari Son Espases, Mallorca, Spain.
(Heyerdahl F.; Hovda K.E.) National CBRNe Centre of Medicine, Department of
Acute Medicine, Medical Division, Oslo University Hospital, Norway.
(Giraudon I.; Sedefov R.) European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA), Lisbon, Portugal.
CORRESPONDENCE ADDRESS
A.M. Dines, Clinical Toxicology, Guy's and St Thomas NHS Foundation Trust
and King's Health Partners, Westminster Bridge Road, London, United Kingdom.
SOURCE
Clinical Toxicology (2015) 53:9 (893-900). Date of Publication: 21 Oct 2015
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Context. Despite the potential for recreational drugs and new psychoactive
substances (NPSs) to cause significant morbidity and mortality, there is
limited collection of systematic data on acute drug/NPS toxicity in Europe.
Objective. To report data on acute drug/NPS toxicity collected by a network
of sentinel centres across Europe with a specialist clinical and research
interest in the acute toxicity of recreational drugs and NPS to address this
knowledge gap. Methods. Sixteen sentinel centres in 10 European countries
(Denmark, Estonia, France, Germany, Ireland, Norway, Poland, Spain,
Switzerland and the UK) collected data on all acute drug toxicity
presentations to their Emergency Rooms (ERs) for 12 months (October
2013-September 2014); information on the drug(s) involved in the
presentations was on the basis of patient self-reporting. Results. Data were
collected on a total of 5529 presentations involving 8709 drugs (median
(interquartile range [IQR]): 1 (1-2) drugs per presentation), a median of
0.3% of all ER attendances. Classical recreational drugs were most common
(64.6%) followed by prescription drugs (26.5%) and NPS (5.6%). The top five
drugs recorded were heroin (1345 reports), cocaine (957), cannabis (904),
GHB/GBL (711) and amphetamine (593). 69.5% of individuals went to hospital
by ambulance (peak time between 19:00 and 02:00 at weekends); the median
(IQR) age was 31 (24-39) years and 75.4% were male. Although serious
clinical features were not seen in most presentations and 56.9% were
medically discharged from the ER (median length of stay: 4.6 hours), a
significant number (26.5%) was agitated, in 10.5% the GCS was 8 or less and
35 presented in cardiac arrest. There were 27 fatalities with opioids
implicated in 13. Conclusion. The Euro-DEN dataset provides a unique insight
into the drugs involved in and clinical pattern of toxicity/outcome of acute
recreational drug toxicity presentations to hospitals around Europe. This is
complimentary to other indicators of drug-related harm and helps to build a
fuller picture of the public health implications of drug use in Europe.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
psychotropic agent (drug toxicity)
recreational drug (drug toxicity)
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
4' methylmethcathinone (drug toxicity)
amphetamine (drug toxicity)
benzodiazepine derivative (drug toxicity)
buprenorphine (drug toxicity)
butane (drug toxicity)
caffeine (drug toxicity)
cannabis (drug toxicity)
cathinone (drug toxicity)
clonazepam (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
diazepam (drug toxicity)
gamma butyrolactone (drug toxicity)
hydroxyzine (drug toxicity)
methadone (drug toxicity)
methedrone (drug toxicity)
midomafetamine (drug toxicity)
naloxone (drug toxicity)
prescription drug (drug toxicity)
propofol (drug toxicity)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute toxicity
EMTREE MEDICAL INDEX TERMS
adult
aged
article
child
clinical feature
controlled study
Europe
fatality
female
heart arrest
human
information processing
length of stay
major clinical study
male
prescription
very elderly
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 hydroxybutyric acid (591-81-1)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
buprenorphine (52485-79-7, 53152-21-9)
butane (106-97-8)
caffeine (58-08-2)
cannabis (8001-45-4, 8063-14-7)
cathinone (5265-18-9, 71031-15-7, 77271-59-1)
clonazepam (1622-61-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
gamma butyrolactone (96-48-0)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015485785
MEDLINE PMID
26503789 (http://www.ncbi.nlm.nih.gov/pubmed/26503789)
PUI
L606700142
DOI
10.3109/15563650.2015.1088157
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2015.1088157
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 414
TITLE
Part 3: Adult basic life support and automated external defibrillation: 2015
international consensus on cardiopulmonary resuscitation and emergency
cardiovascular care science with treatment recommendations
AUTHOR NAMES
Travers A.H.
Perkins G.D.
Berg R.A.
Castren M.
Considine J.
Escalante R.
Gazmuri R.J.
Koster R.W.
Lim S.H.
Nation K.J.
Olasveengen T.M.
Sakamoto T.
Sayre M.R.
Sierra A.
Smyth M.A.
Stanton D.
Vaillancourt C.
Bierens J.J.L.M.
Bourdon E.
Brugger H.
Buick J.E.
Charette M.L.
Chung S.P.
Couper K.
Daya M.R.
Drennan I.R.
Gräsner J.-T.
Idris A.H.
Lerner E.B.
Lockhat H.
Løfgren B.
McQueen C.
Monsieurs K.G.
Mpotos N.
Orkin A.M.
Quan L.
Raffay V.
Reynolds J.C.
Ristagno G.
Scapigliati A.
Vadeboncoeur T.F.
Wenzel V.
Yeung J.
AUTHOR ADDRESSES
(Travers A.H.; Perkins G.D.; Berg R.A.; Castren M.; Considine J.; Escalante
R.; Gazmuri R.J.; Koster R.W.; Lim S.H.; Nation K.J.; Olasveengen T.M.;
Sakamoto T.; Sayre M.R.; Sierra A.; Smyth M.A.; Stanton D.; Vaillancourt C.;
Bierens J.J.L.M.; Bourdon E.; Brugger H.; Buick J.E.; Charette M.L.; Chung
S.P.; Couper K.; Daya M.R.; Drennan I.R.; Gräsner J.-T.; Idris A.H.; Lerner
E.B.; Lockhat H.; Løfgren B.; McQueen C.; Monsieurs K.G.; Mpotos N.; Orkin
A.M.; Quan L.; Raffay V.; Reynolds J.C.; Ristagno G.; Scapigliati A.;
Vadeboncoeur T.F.; Wenzel V.; Yeung J.)
SOURCE
Circulation (2015) 132 Supplement1 (S51-S83). Date of Publication: 20 Oct
2015
ISSN
1524-4539 (electronic)
0009-7322
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
This review comprises the most extensive literature search and evidence
evaluation to date on the most important international BLS interventions,
diagnostics, and prognostic factors for cardiac arrest victims. It
reemphasizes that the critical lifesaving steps of BLS are (1) prevention,
(2) immediate recognition and activation of the emergency response system,
(3) early high-quality CPR, and (4) rapid defibrillation for shockable
rhythms. Highlights in prevention indicate the rational and judicious
deployment of search-and-rescue operations in drowning victims and the
importance of education on opioid-associated emergencies. Other 2015
highlights in recognition and activation include the critical role of
dispatcher recognition and dispatch-assisted chest compressions, which has
been demonstrated in multiple international jurisdictions with consistent
improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS
treatment recommendations, the importance of high quality was reemphasized
across all measures of CPR quality: rate, depth, recoil, and minimal chest
compression pauses, with a universal understanding that we all should be
providing chest compressions to all victims of cardiac arrest. This review
continued to focus on the interface of BLS sequencing and ensuring
high-quality CPR with other important BLS interventions, such as ventilation
and defibrillation. In addition, this consensus statement highlights the
importance of EMS systems, which employ bundles of care focusing on
providing high-quality chest compressions while extricating the patient from
the scene to the next level of care. Highlights in defibrillation indicate
the global importance of increasing the number of sites with public-access
defibrillation programs. Whereas the 2010 ILCOR Consensus on Science
provided important direction for the "what" in resuscitation (ie, what to
do), the 2015 consensus has begun with the GRADE methodology to provide
direction for the quality of resuscitation. We hope that resuscitation
councils and other stakeholders will be able to translate this body of
knowledge of international consensus statements to build their own effective
resuscitation guidelines.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
opiate (adverse drug reaction, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
resuscitation
EMTREE MEDICAL INDEX TERMS
article
cardiac resuscitator
drowning
drug overdose
emergency health service
hand
heart arrest (drug therapy, prevention, side effect, therapy)
heart rhythm
hospital admission
hospital discharge
human
knowledge
out of hospital cardiac arrest
priority journal
respiratory arrest (drug therapy, side effect)
return of spontaneous circulation
survival
water temperature
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015476375
MEDLINE PMID
26472859 (http://www.ncbi.nlm.nih.gov/pubmed/26472859)
PUI
L606641400
DOI
10.1161/CIR.0000000000000272
FULL TEXT LINK
http://dx.doi.org/10.1161/CIR.0000000000000272
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 415
TITLE
Citalopram Overdose: a Fatal Case
AUTHOR NAMES
Kraai E.P.
Seifert S.A.
AUTHOR ADDRESSES
(Kraai E.P.; Seifert S.A., sseifert@salud.unm.edu) University of New Mexico
Health Sciences Center, MSC09 5080, 1 University of New Mexico, Albuquerque,
United States.
(Seifert S.A., sseifert@salud.unm.edu) New Mexico Poison Center, MSC09 5080,
1 University of New Mexico, Albuquerque, United States.
CORRESPONDENCE ADDRESS
S.A. Seifert, University of New Mexico Health Sciences Center, MSC09 5080, 1
University of New Mexico, Albuquerque, United States.
SOURCE
Journal of Medical Toxicology (2015) 11:2 (232-236). Date of Publication: 18
Oct 2015
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, journals@springer-sbm.com
ABSTRACT
Background: Citalopram is a selective serotonin reuptake inhibitor (SSRI)
with cardiac and neurologic toxicities as well as the potential for
serotonin syndrome. In most instances, patients recover fully from toxic
ingestions of SSRIs. We describe a fatal case of a citalopram overdose. Case
Report: A 35-year-old woman presented to the emergency department after
having witnessed seizures at home. An empty citalopram prescription bottle
was located, and an intentional overdose was suspected. At the scene, she
was found to be in cardiac arrest with pulseless electrical activity and
underwent cardiopulmonary resuscitation, including intravenous epinephrine
and bicarbonate. In the emergency department, her physical exam was notable
for cough and gag reflexes and movement in all extremities with increased
muscle tone and tachycardia. Her initial postresuscitation ECG showed sinus
rhythm with QRS 92 ms and QTc 502 ms. Her temperature was initially normal,
but she rapidly became febrile to 41.8 °C shortly after admission. She was
treated symptomatically and with cyproheptadine for suspected serotonin
syndrome (SS) but became increasingly hemodynamically unstable over the next
6 h and then developed torsades des pointes (TdP) progressing to pulseless,
wide complex tachycardia. She underwent cardiopulmonary resuscitation (CPR)
for approximately 50 min but ultimately expired. Postmortem serum analysis
revealed a citalopram concentration of 7300 ng/mL (therapeutic range
9–200 ng/mL) and THC, but no other non-resuscitation drugs or substances.
Case Discussion: Citalopram overdoses often have only mild to moderate
symptoms, particularly with ingestions under 600 mg in adults. However, with
higher doses, severe manifestations have been described, including QTc
prolongation, TdP, and seizures. Serotonin syndrome has also been described
in SSRI overdose, and our patient exhibited signs consistent with SS,
including increased muscle tone and autonomic dysregulation. Our patient’s
serum concentration suggests a massive overdose, with major clinical
effects, possible SS, and death. Conclusions: Although most patients recover
from citalopram overdose, high-dose ingestions can produce severe effects
and fatalities may occur. In this case, it is likely that the patient’s
delayed presentation also contributed significantly to her death. The
clinician must be aware of the potential for large ingestions of citalopram
to produce life-threatening effects and monitor closely for the neurologic,
cardiovascular, and other manifestations that, in rare cases, can be fatal.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
citalopram (drug toxicity)
EMTREE DRUG INDEX TERMS
alanine aminotransferase (endogenous compound)
aspartate aminotransferase (endogenous compound)
bicarbonate (intravenous drug administration)
cyproheptadine
epinephrine (intravenous drug administration)
magnesium (intravenous drug administration)
midazolam (intravenous drug administration)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
autopsy
blood analysis
capnometry
cardiovascular reflex
case report
death
drug overdose
electric activity
electrocardiography
fatality
female
heart arrest
heart muscle tension
heart rate
human
QTc interval
resuscitation
seizure
serotonin syndrome
sinus rhythm
tachycardia
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alanine aminotransferase (9000-86-6, 9014-30-6)
aspartate aminotransferase (9000-97-9)
bicarbonate (144-55-8, 71-52-3)
citalopram (59729-33-8)
cyproheptadine (129-03-3, 969-33-5)
magnesium (7439-95-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014861406
PUI
L600297803
DOI
10.1007/s13181-014-0441-0
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-014-0441-0
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 416
TITLE
Naloxone--does over-antagonism matter? Evidence of iatrogenic harm after
emergency treatment of heroin/opioid overdose
AUTHOR NAMES
Neale J.
Strang J.
AUTHOR ADDRESSES
(Neale J.) Reader in Qualitative and Mixed Methods Research, National
Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience,
King's College London, London, UK
(Strang J.) Professor of the Addictions, National Addiction Centre,
Institute of Psychiatry, Psychology and Neuroscience, King's College London,
London, UK
SOURCE
Addiction (Abingdon, England) (2015) 110:10 (1644-1652). Date of
Publication: 1 Oct 2015
ISSN
1360-0443 (electronic)
ABSTRACT
AIM: To analyse drug users' views and experiences of naloxone during
emergency resuscitation after illicit opiate overdose to identify (i) any
evidence of harm caused by excessive naloxone dosing ('over-antagonism');
and (ii) implications for the medical administration of naloxone within
contemporary emergency settings.DESIGN: Re-analysis of a large qualitative
data set comprising 70 face-to-face interviews conducted within a few hours
of heroin/opioid overdose occurring, observations from hospital settings and
a further 130 interviews with illicit opiate users. Data were generated
between 1997 and 1999.SETTING: Emergency departments, drug services and
pharmacies in two Scottish cities.PARTICIPANTS: Two hundred illicit opiate
users: 131 males and 69 females.FINDINGS: Participants had limited knowledge
of naloxone and its pharmacology, yet described it routinely in negative
terms and were critical of its medical administration. In particular, they
complained that naloxone induced acute withdrawal symptoms, causing patients
to refuse treatment, become aggressive, discharge themselves from hospital
and take additional street drugs to counter the naloxone effects.
Participants believed that hospital staff should administer naloxone
selectively and cautiously, and prescribe counter-naloxone medication if
dosing precipitated withdrawals. In contrast, observational data indicated
that participants did not always know that they had received naloxone and
hospital doctors did not necessarily administer it incautiously.CONCLUSIONS:
Opiate users in urban Scotland repeatedly report harm caused by naloxone
over-antagonism, although this is not evident in observational data. The
concept of contemporary legend (a form of folklore that can be based on fact
and provides a means of communicating and negotiating anxiety) helps to
explain why naloxone has such a feared reputation among opiate users.
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
naloxone (adverse drug reaction)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
drug overdose (drug therapy, etiology)
emergency treatment
female
hospital emergency service
human
iatrogenic disease
male
middle aged
patient satisfaction
qualitative research
Scotland
treatment refusal
withdrawal syndrome (etiology)
young adult
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26119038 (http://www.ncbi.nlm.nih.gov/pubmed/26119038)
PUI
L615130636
DOI
10.1111/add.13027
FULL TEXT LINK
http://dx.doi.org/10.1111/add.13027
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 417
TITLE
Variation between Physicians and Mid-level Providers in Opioid Treatment for
Musculoskeletal Pain in the Emergency Department
AUTHOR NAMES
Thomas S.H.
Mumma S.
Satterwhite A.
Haas T.
Arthur A.O.
Todd K.H.
Mace S.
Diercks D.B.
Pollack C.V.
AUTHOR ADDRESSES
(Thomas S.H.; Mumma S.; Satterwhite A.; Haas T.; Arthur A.O.) Department of
Emergency Medicine, University of Oklahoma, College of Medicine, Tulsa,
United States.
(Todd K.H.) Department of Emergency Medicine, University of Texas, MD
Anderson Cancer Center, Houston, United States.
(Mace S.) Department of Emergency Medicine, Cleveland Clinic Foundation,
Cleveland, United States.
(Diercks D.B.) Department of Emergency Medicine, University of California
Davis Medical Center, Sacramento, United States.
(Pollack C.V.) Department of Emergency Medicine, Pennsylvania Hospital,
University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
S.H. Thomas, Department of Emergency Medicine, University of Oklahoma,
College of Medicine, Tulsa, United States.
SOURCE
Journal of Emergency Medicine (2015) 49:4 (415-423). Date of Publication: 1
Oct 2015
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Background Effective, appropriate, and safe opioid analgesia administration
in the Emergency Department (ED) is a complex issue, with risks of both
over- and underutilization of medications. Objective To assess for possible
association between practitioner status (physician [MD] vs. mid-level
provider [MLP]) and use of opioids for in-ED treatment of musculoskeletal
pain (MSP). Methods This was a secondary, hypothesis-generating analysis of
a subset of subjects who had ED analgesia noted as part of entry into a
prospective registry trial of outpatient analgesia. The study was conducted
at 12 U.S. academic EDs, 10 of which utilized MLPs. Patients were enrolled
as a convenience sample from September 2012 through February 2014. Study
patients were adults (>17 years of age) with acute MSP and eligibility for
both nonsteroidal antiinflammatory drugs and opioids at ED discharge. The
intervention of interest was whether patients received opioid therapy in the
ED prior to discharge. Results MDs were significantly more likely to order
opioids than MLPs for ED patients with MSP. The association between MD/MLP
status and likelihood of treatment with opioids was similar in both
classical logistic regression (odds ratio [OR] 2.3, 95% confidence interval
[CI] 1.1-4.5, p = 0.019) and in propensity-adjusted modeling (OR 2.1, 95% CI
1.0-4.5, p = 0.049). Conclusions In preliminary analysis, MD/MLP status was
significantly associated with likelihood of provider treatment of MSP with
opioids. A follow-up study is warranted to confirm the results of this
hypothesis-testing analysis and to inform efforts toward consistency in
opioid therapy in the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
nonsteroid antiinflammatory agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care personnel
musculoskeletal pain
physician
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
emergency ward
female
hospital discharge
human
logistic regression analysis
major clinical study
male
musculoskeletal disease (drug therapy)
pain (drug therapy)
priority journal
propensity score
statistics
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015237221
MEDLINE PMID
26238183 (http://www.ncbi.nlm.nih.gov/pubmed/26238183)
PUI
L605423295
DOI
10.1016/j.jemermed.2015.05.036
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.05.036
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 418
TITLE
Opiate refractory pain from an intestinal obstruction responsive to an
intravenous lidocaine infusion
AUTHOR NAMES
Bafuma P.J.
Nandi A.
Weisberg M.
AUTHOR ADDRESSES
(Bafuma P.J., pbafuma@gmail.com; Nandi A., nandia@ema.net; Weisberg M.,
weisbergm@ema.net) Emergency Medicine, Columbia Memorial Hospital, 71
Prospect Avenue, Hudson, United States.
CORRESPONDENCE ADDRESS
P.J. Bafuma, Emergency Medicine, Columbia Memorial Hospital, 71 Prospect
Avenue, Hudson, United States.
SOURCE
American Journal of Emergency Medicine (2015) 33:10 (1544.e3-1544.e4). Date
of Publication: 1 Oct 2015
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
lidocaine (intravenous drug administration)
EMTREE DRUG INDEX TERMS
contrast medium (intravenous drug administration, oral drug administration)
hydromorphone (drug therapy, intravenous drug administration)
metoclopramide (drug therapy, intravenous drug administration)
ondansetron (drug therapy, intravenous drug administration)
oxycodone (drug combination, drug therapy)
paracetamol (drug combination, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (drug therapy, drug resistance, drug therapy)
intestine obstruction (complication)
EMTREE MEDICAL INDEX TERMS
abdominal tenderness
adult
analgesia
article
breakthrough pain
case report
colostomy
colostomy bag
computer assisted tomography
dietary intake
emergency ward
feces analysis
female
hospital discharge
human
inflammation
patient history of surgery
postoperative complication (complication)
priority journal
reoperation
tertiary care center
vomiting
young adult
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015317314
MEDLINE PMID
26306434 (http://www.ncbi.nlm.nih.gov/pubmed/26306434)
PUI
L605719019
DOI
10.1016/j.ajem.2015.07.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2015.07.027
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 419
TITLE
Sustained release oral morphine as an alternative to methadone for the
treatment of opioid-use disorder post Torsades de Pointes cardiac arrest
AUTHOR NAMES
Walton G.
Nolan S.
Sutherland C.
Ahamad K.
AUTHOR ADDRESSES
(Walton G.) Department of Medicine, University of British Columbia,
Vancouver, Canada.
(Nolan S.; Ahamad K., keithahamad@gmail.com) Urban Health Research
Initiative, BC Centre for Excellence in HIV/AIDS, University of British
Columbia, Vancouver, Canada.
(Sutherland C.) Department of Family Medicine, University of British
Columbia, Vancouver, Canada.
CORRESPONDENCE ADDRESS
K. Ahamad, Urban Health Research Initiative, BC Centre for Excellence in
HIV/AIDS, University of British Columbia, Vancouver, Canada. Email:
keithahamad@gmail.com
SOURCE
BMJ Case Reports (2015) 2015 Article Number: 210239. Date of Publication: 21
Sep 2015
ISSN
1757-790X (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
In most settings, approved medications for the treatment of opioid-use
disorder include methadone and buprenorphine/naloxone, and in some settings,
naltrexone. We present a case in which methadone administration was
associated with an in-hospital episode of Torsades de Pointes in a patient
who was subsequently maintained on sustained release oral morphine (SROM)
for treatment of his opioid-use disorder. This transition was made in the
context of long-term compliance to methadone maintenance, and with a
previous adverse reaction to buprenorphine/ naloxone precluding its use. The
change to SROM, supported by emerging evidence, resulted in a reduction in
the patient's measured QTc interval, prevention of further arrhythmias and
continued abstinence from illicit opioid-use. In this context, we believe
careful consideration should be given to the use of SROM.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (adverse drug reaction, drug therapy)
morphine (drug therapy, oral drug administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
bisoprolol (drug therapy)
buprenorphine (drug therapy)
calcium ion (endogenous compound)
esmolol (drug therapy)
haloperidol (drug therapy, intravenous drug administration)
magnesium (endogenous compound)
magnesium sulfate (drug therapy, intravenous drug administration)
morphine sulfate (drug therapy)
naloxone (drug therapy)
phosphorus (endogenous compound)
potassium ion (endogenous compound)
quetiapine (drug therapy)
rabeprazole
ramiprilat (drug therapy)
simvastatin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest (therapy)
opiate addiction (drug therapy, drug therapy)
sustained drug release
torsade des pointes (drug therapy, side effect, drug therapy, side effect,
therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
benzodiazepine dependence
case report
cocaine dependence
computed tomographic angiography
coronary artery disease (diagnosis, drug therapy, therapy)
defibrillation
drug dependence treatment
drug dose increase
drug safety
drug substitution
drug withdrawal
echocardiography
electrocardiogram
electrolyte blood level
emergency ward
extubation
follow up
heart infarction (diagnosis, drug therapy, therapy)
heart left ventricle ejection fraction
heart left ventricle hypertrophy (diagnosis)
heart rate
heart ventricle fibrillation (diagnosis, therapy)
hospital admission
hospital discharge
human
implantable cardioverter defibrillator
independent living
intensive care unit
intubation
left ventricular systolic dysfunction (diagnosis)
long QT syndrome (diagnosis, drug therapy, side effect)
long term care
male
medical history
middle aged
morning dosage
nuclear magnetic resonance imaging
patient compliance
patient counseling
patient education
patient transport
priority journal
QTc interval
restlessness (drug therapy)
resuscitation
sedation
self report
sinus bradycardia (diagnosis)
sleep disorder (drug therapy)
withdrawal syndrome (drug therapy, prevention)
DRUG TRADE NAMES
m eslon
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
bisoprolol (66722-44-9)
buprenorphine (52485-79-7, 53152-21-9)
calcium ion (14127-61-8)
esmolol (81147-92-4, 81161-17-3)
haloperidol (52-86-8, 1511-16-6)
magnesium (7439-95-4)
magnesium sulfate (7487-88-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
phosphorus (7723-14-0)
potassium ion (24203-36-9)
quetiapine (111974-72-2)
rabeprazole (117976-89-3, 117976-90-6)
ramiprilat (87269-97-4)
simvastatin (79902-63-9)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015446283
MEDLINE PMID
26392442 (http://www.ncbi.nlm.nih.gov/pubmed/26392442)
PUI
L606395921
DOI
10.1136/bcr-2015-210239
FULL TEXT LINK
http://dx.doi.org/10.1136/bcr-2015-210239
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 420
TITLE
Safety and efficacy of intranasally administered medications in the
emergency department and prehospital settings
AUTHOR NAMES
Corrigan M.
Wilson S.S.
Hampton J.
AUTHOR ADDRESSES
(Corrigan M.) Department of Pharmacy, Advocate Illinois Masonic Medical
Center, Chicago, United States.
(Wilson S.S.) Department of Pharmacy Services, Detroit Receiving Hospital,
Detroit, United States.
(Hampton J., hamptonjp@umkc.edu) Truman Medical Center, Kansas City, United
States.
(Hampton J., hamptonjp@umkc.edu) School of Pharmacy, University of
Missouri-Kansas City, Kansas City, United States.
CORRESPONDENCE ADDRESS
J. Hampton, Truman Medical Center, Kansas City, United States. Email:
hamptonjp@umkc.edu
SOURCE
American Journal of Health-System Pharmacy (2015) 72:18 (1544-1554). Date of
Publication: 15 Sep 2015
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
ABSTRACT
Purpose. The safety and efficacy of medications that may be administered via
the intranasal route in adult patients in the prehospital and emergency
department (ED) settings are reviewed. Summary. When medications of
appropriate molecular character and concentration are delivered
intranasally, they are quickly transported across this capillary network and
delivered to the systemic circulation, thereby avoiding the
absorption-limiting effects of first-pass metabolism. Therapeutic drug
concentrations are rapidly attained in the cerebrospinal fluid, making
intranasal administration a very effective mode of delivery. To optimize the
bioavailability of intranasally administered drugs, providers must minimize
the barriers to absorption, minimize the volume by maximizing the
concentration, maximize the absorptive surface of the nasal mucosa, and use
a delivery system that maximizes drug dispersion and minimizes drug runoff.
Medications can be instilled into the nasal cavity with syringes or droppers
by applying a few drops at a time or via atomization. The intranasal route
of administration may be advantageous for patients who require analgesia,
sedation, anxiolysis, termination of seizures, hypoglycemia management,
narcotic reversal, and benzodiazepine reversal in the ED or prehospital
settings. Medications that have been studied in the adult population include
fentanyl, sufentanil, hydromorphone, ketamine, midazolam, haloperidol,
naloxone, flumazenil, and glucagon. The available data do indicate, however,
that intranasal administration may be a safe, effective, and well tolerated
route of administration. Conclusion. Based on the published literature,
intranasal administration of fentanyl, sufentanil, ketamine, hydromorphone,
midazolam, haloperidol, naloxone, glucagon, and, in limited cases,
flumazenil may be a safe, effective, and well-tolerated alternative to
intramuscular or intravenous administration in the prehospital and ED
settings.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
agents used in emergency medicine (intranasal drug administration,
pharmaceutics, pharmacokinetics)
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
flumazenil (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
glucagon (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
haloperidol (intranasal drug administration, pharmaceutics,
pharmacokinetics)
hydromorphone (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
ketamine (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
midazolam (drug therapy, intranasal drug administration, pharmaceutics,
pharmacokinetics)
naloxone (drug therapy, intranasal drug administration, pharmaceutics,
pharmacokinetics)
nose drops
sufentanil (adverse drug reaction, drug therapy, intranasal drug
administration, pharmaceutics, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug efficacy
drug safety
emergency care
nasal drug delivery system
EMTREE MEDICAL INDEX TERMS
analgesia
anticonvulsant therapy
apnea (side effect)
ataxia (side effect)
bitter taste
cerebrospinal fluid
dizziness (side effect)
drug absorption
drug bioavailability
dysarthria (side effect)
dysphasia (side effect)
dysphoria (side effect)
emergency ward
epileptic state (side effect)
first pass effect
human
hypoglycemia (drug therapy)
hypoxia (side effect)
migraine (side effect)
nausea (side effect)
nebulization
nose cavity
nose mucosa
pain (drug therapy)
paresthesia (side effect)
priority journal
pruritus (side effect)
respiration depression (drug therapy, side effect)
review
sedation
seizure (drug therapy, side effect)
systemic circulation
tranquilizing activity
visual disorder (side effect)
vomiting (side effect)
weakness (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
haloperidol (52-86-8, 1511-16-6)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160423711
MEDLINE PMID
26346210 (http://www.ncbi.nlm.nih.gov/pubmed/26346210)
PUI
L610638225
DOI
10.2146/ajhp140630
FULL TEXT LINK
http://dx.doi.org/10.2146/ajhp140630
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 421
TITLE
Constipation Prophylaxis Is Rare for Adults Prescribed Outpatient Opioid
Therapy from U.S. Emergency Departments
AUTHOR NAMES
Hunold K.M.
Smith S.A.
Platts-Mills T.F.
AUTHOR ADDRESSES
(Hunold K.M., kmh5ee@virginia.edu) University of Virginia School of
Medicine, Charlottesville, United States.
(Smith S.A.; Platts-Mills T.F.) Department of Emergency Medicine, University
of North Carolina, Chapel Hill, United States.
(Platts-Mills T.F.) Department of Anesthesiology, University of North
Carolina, Chapel Hill, United States.
CORRESPONDENCE ADDRESS
K.M. Hunold, University of Virginia School of Medicine, Charlottesville,
United States. Email: kmh5ee@virginia.edu
SOURCE
Academic Emergency Medicine (2015) 22:9 (1118-1121). Date of Publication: 1
Sep 2015
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives Constipation is a common and potentially serious side effect of
oral opioids. Accordingly, most clinical guidelines suggest routine use of
laxatives to prevent opioid-induced constipation. The objective was to
characterize emergency provider prescribing of laxatives to prevent
constipation among adults initiating outpatient opioid treatment. Methods
National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2010
were analyzed. Among visits by individuals aged 18 years and older
discharged from the emergency department (ED) with opioid prescriptions, the
authors estimated the survey-weighted proportion of visits in which
laxatives were also prescribed. A subgroup analysis was conducted for
individuals aged 65 years and older, as the potential risks associated with
opioid-induced constipation are greater among older individuals. To examine
a group expected to be prescribed laxative medication and confirm that
NHAMCS captures prescriptions for these medications, the authors estimated
the proportion of visits by individuals discharged with prescriptions for
laxatives among those who presented with constipation. Results Among visits
in 2010 by adults aged 18 years and older discharged from the ED with opioid
prescriptions, 0.9% (95% confidence interval [CI] = 0.7% to 1.3%, estimated
total n = 191,203 out of 21,075,050) received prescriptions for laxatives.
Among the subset of visits by adults aged 65 years and older, 1.0% (95% CI =
0.5% to 2.0%, estimated total n = 18,681 out of 1,904,411) received
prescriptions for laxatives. In comparison, among visits by individuals aged
18 years and older with constipation as a reason for visit, 42% received
prescriptions for laxatives. Conclusions In this nationally representative
sample, laxatives were not routinely prescribed to adults discharged from
the ED with prescriptions for opioid pain medications. Routine prescribing
of laxatives for ED visits may improve the safety and effectiveness of
outpatient opioid pain management.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
laxative (drug therapy)
opiate
EMTREE DRUG INDEX TERMS
bisacodyl (drug therapy)
docusate sodium (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation (drug therapy, drug therapy, prevention)
prophylaxis
EMTREE MEDICAL INDEX TERMS
adult
aged
article
emergency ward
hospital discharge
human
major clinical study
outpatient care
prescription
priority journal
CAS REGISTRY NUMBERS
bisacodyl (603-50-9)
docusate sodium (577-11-7)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015329380
MEDLINE PMID
26291177 (http://www.ncbi.nlm.nih.gov/pubmed/26291177)
PUI
L605787382
DOI
10.1111/acem.12745
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12745
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 422
TITLE
Chronic Pain Patients' Impressions of an Emergency Department Opioid
Prescribing Guideline Poster
AUTHOR NAMES
Weiner S.G.
Yannopoulos P.F.
Lu C.
AUTHOR ADDRESSES
(Weiner S.G., sgweiner@partners.org) Division of Health Policy Translation,
Department of Emergency Medicine, Brigham and Women's Hospital, Boston,
United States.
(Yannopoulos P.F.) Tufts University School of Medicine, Boston, United
States.
(Lu C.) Craniofacial Pain Center, Tufts University School of Dental
Medicine, Boston, United States.
CORRESPONDENCE ADDRESS
S.G. Weiner, Division of Health Policy Translation, Department of Emergency
Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House,
Boston, United States. Email: sgweiner@partners.org
SOURCE
Pain Medicine (United States) (2015) 16:9 (1759-1763). Date of Publication:
1 Sep 2015
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., jnl.info@oup.co.uk
ABSTRACT
Objective: To determine if an opioid prescribing guideline poster, meant to
be posted in an emergency department (ED) triage area, would deter patients
with chronic pain from seeking care. Methods: We prospectively enrolled
patients presenting to a chronic craniofacial pain clinic affiliated with an
urban academic Level I trauma center. Patients were surveyed with a
close-ended, structured questionnaire. Included patients were aged 18 and
older with pain lasting 12 weeks or longer. Patients were shown a sample
pain poster. The primary outcome was determination if such a poster would
prevent the patient from staying to receive care in the ED. Results: One
hundred patients were surveyed. Most patients (77%) reported having been a
patient in the ED in the past, and of these, 23% reported visiting the ED
for worsening of chronic pain. After being shown the poster, 97% believed
the recommendations in the poster were reasonable and 97% thought that the
poster should be displayed in the ED. Seven patients (7%) reported that
seeing the poster in the ED waiting room or triage area would intimidate
them, and two patients within this group (2% of total sample) reported that
it would prevent them from staying to get care. Conclusions: The vast
majority of patients with chronic pain in this cohort believes that a pain
guideline poster is reasonable and should be posted in the ED. However, a
small percentage of patients reported that they would feel intimidated by
such a poster and that it would prevent them from staying to get care, a
result meant to inform hospitals and policy-makers deciding if such posters
should be displayed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain
emergency ward
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
female
help seeking behavior
human
major clinical study
male
prospective study
structured questionnaire
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015000507
MEDLINE PMID
25929837 (http://www.ncbi.nlm.nih.gov/pubmed/25929837)
PUI
L604178457
DOI
10.1111/pme.12776
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12776
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 423
TITLE
Patient Perspectives of Acute Pain Management in the Era of the Opioid
Epidemic
AUTHOR NAMES
Smith R.J.
Rhodes K.
Paciotti B.
Kelly S.
Perrone J.
Meisel Z.F.
AUTHOR ADDRESSES
(Smith R.J.; Rhodes K.; Paciotti B.; Kelly S.; Perrone J.; Meisel Z.F.,
zfm@upenn.edu) Center for Emergency Care Policy and Research, Department of
Emergency Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States.
(Perrone J.) Division of Medical Toxicology, Department of Emergency
Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States.
(Rhodes K.; Meisel Z.F., zfm@upenn.edu) Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
Z.F. Meisel, Center for Emergency Care Policy and Research, Department of
Emergency Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States. Email: zfm@upenn.edu
SOURCE
Annals of Emergency Medicine (2015) 66:3 (246-252). Date of Publication: 1
Sep 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective To inform the development of interventions that could
improve patient engagement around the risks and benefits of alternative
approaches to pain management in the emergency department (ED), we seek to
capture the perspectives and experiences of patients treated for pain in
this setting. Methods Three trained interviewers conducted semistructured
open-ended telephone interviews with patients discharged from a single urban
academic ED after presenting with acute pain related to fracture, renal
colic, or musculoskeletal back injury. We recruited subjects until achieving
thematic saturation according to periodic review of the interview
transcripts. Interviews were audio recorded, professionally transcribed, and
uploaded into QSR NVivo (version 10.0) for coding and analysis using
modified grounded theory. An interdisciplinary team double coded the data
and convened to review emerging themes, ensure interrater reliability, and
establish consensus on discrepancies. Results We had 23 completed subject
interviews, the majority of which were women. Interrater reliability for
coding exceeded 90%. The major themes elicited centered on domains of
patient awareness of the potential for opioid dependence and
patient-provider communication relating to pain management. From the patient
perspective, emergency physicians typically do not present alternative pain
management options or discuss the risks of opioid dependence. Patients with
negative experiences related to pain management describe deficiencies in
patient-provider communication leading to misunderstanding of clinical
diagnoses, fragmentation of care among their health care providers, and a
desire to be involved in the decisionmaking process around their pain
management. Patients with positive experiences commented on regular
communication with their care team, rapid pain management, and the
empathetic nature of their care providers. Patients communicate fears about
the risks of opioid addiction, beliefs that following a prescribed opioid
regimen is protective of developing opioid dependence, and an understanding
of the broader tensions that providers face relating to the prescription of
opioid therapy. Conclusion Patients identified a deficit of communication
around opioid risk and pain management options in the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
epidemic
pain
patient attitude
EMTREE MEDICAL INDEX TERMS
adult
article
coding
controlled study
emergency physician
female
human
interrater reliability
kidney colic (drug therapy)
limb fracture (drug therapy)
major clinical study
male
middle aged
musculoskeletal injury (drug therapy)
opiate addiction
priority journal
qualitative analysis
semi structured interview
telephone interview
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Orthopedic Surgery (33)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015900833
MEDLINE PMID
25865093 (http://www.ncbi.nlm.nih.gov/pubmed/25865093)
PUI
L603624025
DOI
10.1016/j.annemergmed.2015.03.025
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2015.03.025
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 424
TITLE
Prehospital Naloxone Administration as a Public Health Surveillance Tool: A
Retrospective Validation Study
AUTHOR NAMES
Lindstrom H.A.
Clemency B.M.
Snyder R.
Consiglio J.D.
May P.R.
Moscati R.M.
AUTHOR ADDRESSES
(Lindstrom H.A.) 1Department of Emergency Medicine,University at
Buffalo,Buffalo,New YorkUSA
(Clemency B.M.) 1Department of Emergency Medicine,University at
Buffalo,Buffalo,New YorkUSA
(Snyder R.) 1Department of Emergency Medicine,University at
Buffalo,Buffalo,New YorkUSA
(Consiglio J.D.) 2Department of Mathematics and Computer Science,John
Carroll University,Cleveland,OhioUSA
(May P.R.) 1Department of Emergency Medicine,University at
Buffalo,Buffalo,New YorkUSA
(Moscati R.M.) 1Department of Emergency Medicine,University at
Buffalo,Buffalo,New YorkUSA
SOURCE
Prehospital and disaster medicine (2015) 30:4 (385-389). Date of
Publication: 1 Aug 2015
ISSN
1049-023X
ABSTRACT
RESULTS: Naloxone was administered during 1,812 prehospital patient
encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The
distribution of patients in the prehospital and ED datasets did not differ
by gender, but it did differ by race and age. The frequency of naloxone
administration by prehospital providers varied directly with the frequency
of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for
opiate-related ODs was associated with an increase in one prehospital
naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021).
A monthly increase of 100 ED visits for heroin-related ODs was associated
with an increase in 94 prehospital naloxone administrations (CCF=0.46;
P=.0012).BACKGROUND: Abuse or unintended overdose (OD) of opiates and heroin
may result in prehospital and emergency department (ED) care. Prehospital
naloxone use has been suggested as a surrogate marker of community opiate
ODs. The study objective was to verify externally whether prehospital
naloxone use is a surrogate marker of community opiate ODs by comparing
Emergency Medical Services (EMS) naloxone administration records to an
independent database of ED visits for opiate and heroin ODs in the same
community.METHODS: A retrospective chart review of prehospital and ED data
from July 2009 through June 2013 was conducted. Prehospital naloxone
administration data obtained from the electronic medical records (EMRs) of a
large private EMS provider serving a metropolitan area were considered a
surrogate marker for suspected opiate OD. Comparison data were obtained from
the regional trauma/psychiatric ED that receives the majority of the OD
patients. The ED maintains a de-identified database of narcotic-related
visits for surveillance of narcotic use in the metropolitan area. The ED
database was queried for ODs associated with opiates or heroin.
Cross-correlation analysis was used to test if prehospital naloxone
administration was independent of ED visits for opiate/heroin
ODs.CONCLUSIONS: Frequency of naloxone administration by EMS providers in
the prehospital setting varied directly with frequency of opiate/heroin
OD-related ED visits. The data correlated both for short-term frequency and
longer term trends of use. However, there was a marked difference in
demographic data suggesting neither data source alone should be relied upon
to determine which populations are at risk within the community.
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug administration)
narcotic antagonist (drug administration, drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
procedures
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
child
drug overdose (therapy, therapy)
female
health survey
heroin dependence (therapy, therapy)
human
male
middle aged
opiate addiction (therapy, therapy)
preschool child
retrospective study
validation study
very elderly
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26061280 (http://www.ncbi.nlm.nih.gov/pubmed/26061280)
PUI
L607477039
DOI
10.1017/S1049023X15004793
FULL TEXT LINK
http://dx.doi.org/10.1017/S1049023X15004793
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 425
TITLE
Association between non-fatal opioid overdose and encounters with healthcare
and criminal justice systems: Identifying opportunities for intervention
AUTHOR NAMES
Wagner K.D.
Liu L.
Davidson P.J.
Cuevas-Mota J.
Armenta R.F.
Garfein R.S.
AUTHOR ADDRESSES
(Wagner K.D., karlawagner@unr.edu) School of Community Health Sciences,
University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, United
States.
(Liu L.) Division of Biostatistics and Bioinformatics, Department of Family
Medicine and Public Health, University of California School of Medicine,
9500 Gilman Drive MC 0717, La Jolla, United States.
(Davidson P.J.; Cuevas-Mota J.; Armenta R.F.; Garfein R.S.) Division of
Global Public Health, Department of Medicine, University of California San
Diego School of Medicine, 9500 Gilman Drive MC 0507, La Jolla, United
States.
CORRESPONDENCE ADDRESS
K.D. Wagner, School of Community Health Sciences, University of Nevada,
Reno, 1664 N. Virginia St. MC 0274, Reno, United States. Email:
karlawagner@unr.edu
SOURCE
Drug and Alcohol Dependence (2015) 153 (215-220). Date of Publication: 1 Aug
2015
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background: Accidental overdose, driven largely by opioids, is a leading
cause of death among people who inject drugs (PWIDs). We conducted secondary
analysis of data from a cohort of PWIDs to identify venues where high-risk
PWID could be targeted by overdose education/naloxone distribution (OEND)
programs. Methods: 573 PWIDs completed a quantitative survey between June,
2012 and January, 2014, which was analyzed using multivariable logistic
regression. The dependent variable was a dichotomous indicator of
experiencing a heroin/opioid-related overdose in the past six months.
Independent variables included: demographics, drug use behavior, and
encounters with two venues - the health care and criminal justice systems -
that could serve as potential venues for OEND programs. Results: Almost half
(41.5%) reported ever experiencing a heroin/opioid overdose, and 45 (7.9%)
reported experiencing at least one heroin/opioid overdose in the past six
months. In the final multivariable model, receiving care in a hospital in
the past six months (Adjusted Odds Ratio [AdjOR] 4.08, 95% Confidence
Interval [C.I.] 2.07, 8.04, p<. 0.001) and being arrested for drug
possession in the past six months (AdjOR 5.17, 95% C.I. 2.37, 11.24, p<.
0.001) were associated with experiencing an opioid overdose in the past six
months. Conclusions: Identifying venues outside of those that traditionally
target services to PWIDs (i.e., syringe exchange programs) will be critical
to implementing OEND interventions at a scale sufficient to address the
growing epidemic of heroin/opioid related deaths. Clinical settings, such as
hospitals, and drug-related encounters with law enforcement officers are
promising venues for the expansion of OEND programs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
buprenorphine plus naloxone (drug therapy)
diamorphine (drug toxicity)
methamphetamine (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
criminal justice
drug overdose (drug therapy, drug therapy)
health care system
health program
nonfatal opioid overdose (drug therapy, drug therapy)
overdose education naloxone distribution program
EMTREE MEDICAL INDEX TERMS
adult
age distribution
alcohol consumption
article
behavior
cohort analysis
comparative study
controlled study
demography
drug use
drug use behavior
emergency ward
female
health care access
health care delivery
health care planning
high risk population
homelessness
human
law enforcement
major clinical study
male
medical history
outpatient department
patient identification
people who inject drug
priority journal
DRUG TRADE NAMES
suboxone
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015125665
MEDLINE PMID
26091751 (http://www.ncbi.nlm.nih.gov/pubmed/26091751)
PUI
L604849040
DOI
10.1016/j.drugalcdep.2015.05.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2015.05.026
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 426
TITLE
Engaging Law Enforcement in Overdose Reversal Initiatives: Authorization and
Liability for Naloxone Administration
AUTHOR NAMES
Davis C.S.
Carr D.
Southwell J.K.
Beletsky L.
AUTHOR ADDRESSES
(Davis C.S.) Derek Carr and Corey S. Davis are with the Network for Public
Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with
the North Carolina Institute for Public Health, Gillings School of Global
Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is
with the Northeastern University School of Law and Bouvé College of Health
Sciences, Boston, MA
(Carr D.) Derek Carr and Corey S. Davis are with the Network for Public
Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with
the North Carolina Institute for Public Health, Gillings School of Global
Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is
with the Northeastern University School of Law and Bouvé College of Health
Sciences, Boston, MA
(Southwell J.K.) Derek Carr and Corey S. Davis are with the Network for
Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is
with the North Carolina Institute for Public Health, Gillings School of
Global Public Health, University of North Carolina at Chapel Hill. Leo
Beletsky is with the Northeastern University School of Law and Bouvé College
of Health Sciences, Boston, MA
(Beletsky L.) Derek Carr and Corey S. Davis are with the Network for Public
Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with
the North Carolina Institute for Public Health, Gillings School of Global
Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is
with the Northeastern University School of Law and Bouvé College of Health
Sciences, Boston, MA
SOURCE
American journal of public health (2015) 105:8 (1530-1537). Date of
Publication: 1 Aug 2015
ISSN
1541-0048 (electronic)
ABSTRACT
Opioid overdose is reversible through the timely administration of naloxone,
which has been used by emergency medical services for decades. Law
enforcement officers (LEOs) are often the first emergency responders to
arrive at an overdose, but they are not typically equipped with naloxone.
This is rapidly changing; more than 220 law enforcement agencies in 24
states now carry naloxone. However, rollout in some departments has been
hampered by concerns regarding officer and agency liability. We
systematically examined the legal risk associated with LEO naloxone
administration. LEOs can be authorized to administer naloxone through a
variety of mechanisms, and liability risks related to naloxone
administration are similar to or lower than those of other activities in
which LEOs commonly engage.
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug therapy)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
police
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
human
legal liability
legislation and jurisprudence
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26066921 (http://www.ncbi.nlm.nih.gov/pubmed/26066921)
PUI
L611779597
DOI
10.2105/AJPH.2015.302638
FULL TEXT LINK
http://dx.doi.org/10.2105/AJPH.2015.302638
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 427
TITLE
Disparity in naloxone administration by emergency medical service providers
and the burden of drug overdose in US rural communities
AUTHOR NAMES
Faul M.
Dailey M.W.
Sugerman D.E.
Sasser S.M.
Levy B.
Paulozzi L.J.
AUTHOR ADDRESSES
(Faul M.; Dailey M.W.; Sugerman D.E.; Sasser S.M.; Levy B.; Paulozzi L.J.)
Mark Faul, David E. Sugerman, Benjamin Levy, and Len J. Paulozzi are with
the Centers for Disease Control and Prevention, Atlanta, GA. Michael W.
Dailey is with the Department of Emergency Medicine, Albany Medical Center,
NY. Scott M. Sasser is with the Department of Emergency Medicine, Greenville
Health System, SC
SOURCE
American journal of public health (2015) 105 Supplement 3 (e26-e32). Date of
Publication: 1 Jul 2015
ISSN
1541-0048 (electronic)
ABSTRACT
OBJECTIVES: We determined the factors that affect naloxone (Narcan)
administration in drug overdoses, including the certification level of
emergency medical technicians (EMTs).METHODS: In 2012, 42 states contributed
all or a portion of their ambulatory data to the National Emergency Medical
Services Information System. We used a logistic regression model to measure
the association between naloxone administration and emergency medical
services certification level, age, gender, geographic location, and patient
primary symptom.RESULTS: The odds of naloxone administration were much
higher among EMT-intermediates than among EMT-basics (adjusted odds ratio
[AOR] = 5.4; 95% confidence interval [CI] = 4.5, 6.5). Naloxone use was
higher in suburban areas than in urban areas (AOR = 1.41; 95% CI = 1.3,
1.5), followed by rural areas (AOR = 1.23; 95% CI = 1.1, 1.3). Although the
odds of naloxone administration were 23% higher in rural areas than in urban
areas, the opioid drug overdose rate is 45% higher in rural
communities.CONCLUSIONS: Naloxone is less often administered by EMT-basics,
who are more common in rural areas. In most states, the scope-of-practice
model prohibits naloxone administration by basic EMTs. Reducing this barrier
could help prevent drug overdose death.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
drug overdose (drug therapy, epidemiology)
female
human
male
middle aged
risk factor
rural health care
rural population
United States
very elderly
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25905856 (http://www.ncbi.nlm.nih.gov/pubmed/25905856)
PUI
L609384012
DOI
10.2105/AJPH.2014.302520
FULL TEXT LINK
http://dx.doi.org/10.2105/AJPH.2014.302520
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 428
TITLE
What can the medical record reveal about problem opioid use?
AUTHOR NAMES
Ballantyne J.C.
AUTHOR ADDRESSES
(Ballantyne J.C.) Department of Anesthesiology and Pain Medicine, University
of Washington School of Medicine, Seattle, United States.
CORRESPONDENCE ADDRESS
J.C. Ballantyne, Department of Anesthesiology and Pain Medicine, University
of Washington School of Medicine, Seattle, United States.
SOURCE
Pain (2015) 156:7 (1182-1183). Date of Publication: 1 Jul 2015
ISSN
1872-6623 (electronic)
0304-3959
BOOK PUBLISHER
Lippincott Williams and Wilkins, agents@lww.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
alcohol
cannabis
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medical record
opiate addiction
EMTREE MEDICAL INDEX TERMS
adaptation
alcohol abuse
chronic pain
drug abuse
drug safety
DSM-5
DSM-IV
electronic medical record
emergency ward
human
ICD-9
medical documentation
natural language processing
note
prescription
priority journal
telephone interview
tobacco use
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015474653
MEDLINE PMID
25806606 (http://www.ncbi.nlm.nih.gov/pubmed/25806606)
PUI
L606629293
DOI
10.1097/j.pain.0000000000000165
FULL TEXT LINK
http://dx.doi.org/10.1097/j.pain.0000000000000165
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 429
TITLE
Impact of constipation on opioid therapy management among long-term opioid
users, based on a patient survey
AUTHOR NAMES
Gupta S.
Patel H.
Scopel J.
Mody R.R.
AUTHOR ADDRESSES
(Gupta S.) Health Outcomes Practice, Kantar Health, Princeton, United
States.
(Patel H.) Immensity Consulting, Inc., Chicago, United States.
(Scopel J.) US Medical Affairs, Takeda Pharmaceuticals International, Inc.,
Deerfield, United States.
(Mody R.R.) Global Outcomes Research Department, Takeda Pharmaceuticals
International, Inc., Deerfield, United States.
SOURCE
Journal of Opioid Management (2015) 11:4 (325-338). Date of Publication: 1
Jul 2015
ISSN
2375-0146 (electronic)
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Objective: The authors sought to characterize health-related quality of life
(HRQoL), medication adherence, productivity losses, and treatment
satisfaction associated with modifications to opioid therapy due to
opioid-induced constipation (OIC). Design: A cross-sectional,
between-subjects design was used to examine health outcomes among US
noncancer participants currently taking opioids. Patients, participants:
Participants were adults in the 2012 US National Health and Wellness Survey,
who reported currently using opioids (>30 days) and experiencing
constipation. Respondents were categorized as making modifications to opioid
therapy due to OIC (modifiers, n = 244) or making no modifications
(nonmodifiers, n = 247). Main outcome measures: Patient Assessment of
Constipation Quality of Life (PAC-QoL) and Symptoms (PAC-Sym), Morisky
Medication Adherence Scale (MMAS-4), Work Productivity and Activity
Impairment, and the Treatment Satisfaction Questionnaire for Medication
(TSQM II) for OIC treatment were administered. Generalized linear models
were adjusted to control for baseline characteristics (age, gender,
comorbidities, opioid strength, etc). Results: Modifiers reported poorer
HRQoL (PAC-QoL total: 1.74 vs 1.44, p < 0.001), worse constipation (PAC-Sym
total: 1.56 vs 1.35, p = 0.003), more pain-related resource use (surgery:
odds ratio (OR) = 3.72, p = 0.002; emergency room visits: OR = 1.88, p =
0.049; hospitalizations: OR = 2.47, p = 0.033), and lower adherence (MMAS-4
pain: OR = 0.12, p < 0.001; MMAS-4 OIC: OR = 0.39, p < 0.001) than
nonmodifiers. Modifiers reported greater presenteeism (49.75 percent vs
38.28 percent, p = 0.038), but no significant differences were found for
activity impairment or OIC treatment satisfaction. Conclusions: Treating OIC
effectively may help prevent inadequate pain management secondary to opioid
therapy modification, help increase HRQoL, lessen OIC symptoms, decrease
productivity loss, and improve adherence to opioid and OIC treatments.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
cocodamol (adverse drug reaction, pharmacoeconomics)
fentanyl (adverse drug reaction, pharmacoeconomics)
hydrocodone bitartrate plus paracetamol (adverse drug reaction,
pharmacoeconomics)
laxative (drug therapy, pharmacoeconomics)
morphine (adverse drug reaction, pharmacoeconomics)
non prescription drug (drug therapy, pharmacoeconomics)
oxycodone (adverse drug reaction, pharmacoeconomics)
tramadol (adverse drug reaction, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation (drug therapy, side effect, disease management, drug therapy,
side effect)
EMTREE MEDICAL INDEX TERMS
abdominal discomfort (side effect)
abdominal pain (side effect)
adult
anxiety disorder (side effect)
article
bloating (side effect)
cross-sectional study
dizziness (side effect)
female
health care cost
health care utilization
health survey
human
long term care
major clinical study
male
medication compliance
middle aged
mood disorder (side effect)
pain assessment
patient satisfaction
productivity
quality of life
questionnaire
restlessness (side effect)
somnolence (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160832916
MEDLINE PMID
26312960 (http://www.ncbi.nlm.nih.gov/pubmed/26312960)
PUI
L613241877
DOI
10.5055/jom.2015.0282
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2015.0282
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 430
TITLE
Cocaine-induced acute fatal basilar artery thrombosis: Report of a case and
review of the literature
AUTHOR NAMES
Alqahtani S.A.
Burger K.
Potolicchio S.
AUTHOR ADDRESSES
(Alqahtani S.A., sqanea@gwu.edu; Burger K.; Potolicchio S.) Department of
Neurology, The School of Medicine and Health Sciences, The George Washington
University, Washington, United States.
CORRESPONDENCE ADDRESS
S.A. Alqahtani, Department of Neurology, The School of Medicine and Health
Sciences, The George Washington University, Washington, United States.
Email: sqanea@gwu.edu
SOURCE
American Journal of Case Reports (2015) 16 (393-397) Article Number: A087.
Date of Publication: 25 Jun 2015
ISSN
1941-5923 (electronic)
BOOK PUBLISHER
Medical Science International, office@isl-science.com
ABSTRACT
Objective: Rare disease Background: Cocaine use is a well-known contributing
factor for both ischemic and hemorrhagic stroke; however, basilar artery
thrombosis due to cocaine use is a rare entity with few cases reported in
the literature. Case Report: A 75-year-old African-American man with history
of hypertension and cocaine use presented to the emergency room with coma.
Neurological examination revealed asymmetrical dilated pupils and preserved
oculocephalic and gag reflexes. The patient was noted to have semi-rhythmic
jerking movement of the right arm and extensor posturing in response to
noxious stimuli. Non-contrast computed tomography (CT) of the brain showed
hyperdense basilar sign consistent with acute thrombosis. On brain magnetic
resonance imaging (MRI), he was found to have bilateral pons acute ischemic
stroke with early petechial hemorrhagic conversion. His laboratory work-up
was unremarkable except for positive cocaine in the urine toxicology screen
test. Conclusions: Cocaine is a common global illicit drug that may trigger
acute basilar artery thrombosis leading to a catastrophic neurological
outcome.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
EMTREE DRUG INDEX TERMS
glucose (intravenous drug administration)
heparin
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute fatal basilar artery thrombosis (diagnosis, prevention)
artery thrombosis (diagnosis, prevention)
locked in syndrome (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
acute kidney failure (diagnosis)
African American
aged
article
brain ischemia (diagnosis)
brain magnetic resonance
case report
cocaine dependence
coma (diagnosis)
computer assisted tomography
creatinine blood level
electrocardiography
emergency care
enteric feeding
extensor reflex
fulminant pneumonia
gag reflex
human
hypertension
jerking movement
male
medical history
mydriasis
neurologic examination
nuclear magnetic resonance imaging
oculocephalic reflex
petechia (diagnosis)
pneumonia
rare disease
reflex
seizure (diagnosis)
sinus tachycardia (diagnosis)
somatosensory evoked potential
thrombosis
tracheostomy
urinalysis
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
glucose (50-99-7, 84778-64-3)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015191254
MEDLINE PMID
26109011 (http://www.ncbi.nlm.nih.gov/pubmed/26109011)
PUI
L605131172
DOI
10.12659/AJCR.894565
FULL TEXT LINK
http://dx.doi.org/10.12659/AJCR.894565
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 431
TITLE
Severe opioid withdrawal syndrome after a single dose of nalmefene
AUTHOR NAMES
Donnerstag N.
Schneider T.
Lüthi A.
Taegtmeyer A.
Raetz Bravo A.
Mehlig A.
AUTHOR ADDRESSES
(Donnerstag N.; Schneider T.; Lüthi A.) Department of Anaesthesiology,
Kantonsspital Baselland, Liestal, Switzerland.
(Taegtmeyer A.; Raetz Bravo A.) Department of Clinical Pharmacology and
Toxicology, University Hospital and Regional Pharmacovigilance Centre,
Basel, Switzerland.
(Mehlig A., annekathrin.mehlig@ksbl.ch) University Clinic of Internal
Medicine, Kantonsspital Baselland, University of Basel, Rheinstrasse 26,
Liestal, Switzerland.
CORRESPONDENCE ADDRESS
A. Mehlig, University Clinic of Internal Medicine, Kantonsspital Baselland,
University of Basel, Rheinstrasse 26, Liestal, Switzerland.
SOURCE
European Journal of Clinical Pharmacology (2015) 71:8 (1025-1026). Date of
Publication: 7 Jun 2015
ISSN
1432-1041 (electronic)
0031-6970
BOOK PUBLISHER
Springer Verlag, service@springer.de
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
alcohol
clonidine (intravenous drug administration)
codeine
midazolam (intravenous drug administration)
morphine (intravenous drug administration)
propofol (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
withdrawal syndrome (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
adult
agitation
alcohol consumption
alcoholism (drug therapy)
case report
continuous infusion
depression
disease severity
drug megadose
emergency ward
human
intensive care unit
letter
male
methadone treatment
middle aged
paranoid schizophrenia
priority journal
single drug dose
DRUG TRADE NAMES
selincro , SwitzerlandLundbeck
DRUG MANUFACTURERS
(Switzerland)Lundbeck
CAS REGISTRY NUMBERS
alcohol (64-17-5)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
codeine (76-57-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalmefene (55096-26-9)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015107383
MEDLINE PMID
26050241 (http://www.ncbi.nlm.nih.gov/pubmed/26050241)
PUI
L604771485
DOI
10.1007/s00228-015-1884-1
FULL TEXT LINK
http://dx.doi.org/10.1007/s00228-015-1884-1
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 432
TITLE
Replacement of Promethazine With Ondansetron for Treatment of Opioid- and
Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care
AUTHOR NAMES
Onifer D.J.
Butler F.K.
Gross K.R.
Otten E.J.
Patton R.
Russell R.J.
Stockinger Z.
Burrell E.
AUTHOR ADDRESSES
(Onifer D.J.; Butler F.K.; Gross K.R.; Otten E.J.; Patton R.; Russell R.J.;
Stockinger Z.; Burrell E.)
SOURCE
Journal of special operations medicine : a peer reviewed journal for SOF
medical professionals (2015) 15:2 (17-24). Date of Publication: 1 Jun 2015
ISSN
1553-9768
ABSTRACT
The current Tactical Combat Casualty Care (TCCC) Guidelines recommend
parenteral promethazine as the single agent for the treatment of
opioid-induced nausea and/or vomiting and give a secondary indication of
"synergistic analgesic effect." Promethazine, however, has a well-documented
history of undesired side effects relating to impairment and dysregulation
of the central and autonomic nervous systems, such as sedation,
extrapyramidal symptoms, dystonia, impairment of psychomotor function,
neuroleptic malignant syndrome, and hypotension. These may be particularly
worrisome in the combat casualty. Additionally, since 16 September 2009,
there has been a US Food and Drug Administration (FDA) black box warning for
the injectable form of promethazine, due to "the risk of serious tissue
injury when this drug is administered incorrectly." Conversely, ondansetron,
which is now available in generic form, has a well-established favorable
safety profile and demonstrated efficacy in undifferentiated nausea and
vomiting in the emergency department and prehospital settings. It has none
of the central and autonomic nervous system side effects noted with
promethazine and carries no FDA black box warning. Ondansetron is available
in parenteral form and an orally disintegrating tablet, providing multiple
safe and effective routes of administration. Despite the fact that it is an
off-label use, ondansetron is being increasingly given for acute,
undifferentiated nausea and vomiting and is presently being used in the
field on combat casualties by some US and Allied Forces. Considering the
risks involved with promethazine use, and the efficacy and safety of
ondansetron and ondansetron?s availability in a generic form, we recommend
removing promethazine from the TCCC Guidelines and replacing it with
ondansetron.
EMTREE DRUG INDEX TERMS
antiemetic agent (adverse drug reaction, drug therapy)
narcotic analgesic agent (adverse drug reaction)
ondansetron (drug therapy)
promethazine (adverse drug reaction, drug therapy)
tablet
EMTREE MEDICAL INDEX TERMS
complication
emergency health service
human
injury
military medicine
nausea (drug therapy)
off label drug use
retrospective study
tablet
vomiting (drug therapy)
warfare
CAS REGISTRY NUMBERS
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
promethazine (58-33-3, 60-87-7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26125161 (http://www.ncbi.nlm.nih.gov/pubmed/26125161)
PUI
L611135771
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 433
TITLE
Opioid abuse in the United States and department of health and human
services actions to address opioid-drug-related overdoses and deaths
AUTHOR ADDRESSES
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2015) 29:2 (133-139).
Date of Publication: 1 Jun 2015
ISSN
1536-0539 (electronic)
1536-0288
BOOK PUBLISHER
Informa Healthcare, healthcare.enquiries@informa.com
ABSTRACT
On March 26, 2015, the Office of the Assistant Secretary for Planning and
Evaluation of the U.S. Department of Health and Human Services (HSS)
published an online Issue Brief that addresses opioid abuse in the United
States and (HHS) actions to address opioid-drug-related overdoses and
deaths. This report, which contains the full content of the Issue Brief, is
adapted from that document.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
benzodiazepine
buprenorphine (drug therapy)
controlled substance
diamorphine
methadone (drug therapy)
naloxone (drug therapy)
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug fatality (epidemiology)
drug overdose (drug therapy, drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
age
Alaska Native
American Indian
analgesia
article
Caucasian
clinical decision making
decision support system
drug dependence treatment
drug misuse
drug surveillance program
electronic medical record
emergency health service
European American
high risk patient
high risk population
human
medical informatics
practice guideline
prescription
rural area
sex difference
United States
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015152043
MEDLINE PMID
26095483 (http://www.ncbi.nlm.nih.gov/pubmed/26095483)
PUI
L604969126
DOI
10.3109/15360288.2015.1037530
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2015.1037530
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 434
TITLE
Intoxications by the dissociative new psychoactive substances diphenidine
and methoxphenidine
AUTHOR NAMES
Helander A.
Beck O.
Bäckberg M.
AUTHOR ADDRESSES
(Helander A., anders.helander@ki.se; Beck O.) Department of Laboratory
Medicine, Karolinska Institutet, Stockholm, Sweden.
(Helander A., anders.helander@ki.se; Beck O.) Department of Clinical
Pharmacology, Karolinska University Laboratory, Stockholm, Sweden.
(Bäckberg M.) Swedish Poisons Information Centre, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A. Helander, Clinical Chemistry, Karolinska University Laboratory Huddinge,
C1:74, Stockholm, Sweden.
SOURCE
Clinical Toxicology (2015) 53:5 (446-453). Date of Publication: 1 Jun 2015
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Informa Healthcare, healthcare.enquiries@informa.com
ABSTRACT
Background. Diphenidine (1-(1,2-diphenylethyl)piperidine) and its
2-methoxylated derivative methoxphenidine (MXP, 2-MeO-diphenidine) are
substances with dissociative effects that were recently introduced for
"recreational" purpose through the online-based sale of new psychoactive
substances (NPS). A number of analytically confirmed non-fatal intoxications
associated with diphenidine or MXP have occurred in Sweden and were included
in the STRIDA project. Study design. Observational case series of
consecutive patients with admitted or suspected intake of NPS and requiring
intensive treatment in an emergency room and hospitalization in Sweden.
Patients and methods. Blood and urine samples were collected from
intoxicated patients presenting at emergency departments all over the
country. NPS analysis was performed by multi-component liquid
chromatography-mass spectrometry methods. Data on clinical features were
collected during telephone consultations with the Poisons Information Centre
and retrieved from medical records. Information was also obtained from
online drug discussion forums. Case series. Over a 12-month period from
January to December 2014, 750 cases of suspected NPS intoxication
originating from emergency departments were enrolled in the STRIDA project
of which 14 (1.9%) tested positive for diphenidine and 3 (0.4%) tested
positive for MXP. Co-exposure to several other NPS (e.g.,
5-/6-(2-aminopropyl)benzofuran, 2-4-bromomethcathinone, butylone,
3,4-dichloromethylphenidate, 5-methoxy-N-isopropyltryptamine,
methiopropamine, and α-pyrrolidinopentiothiophenone), also including other
dissociative substances (3-/4-methoxyphencyclidine), and classical drugs of
abuse (e.g., cannabis and ethanol) was documented in 87% of these cases. The
17 patients were aged 20-48 (median: 32) years, and 13 (76%) were men. They
commonly presented with hypertension (76%), tachycardia (47%), anxiety
(65%), and altered mental status (65%) including confusion, disorientation,
dissociation, and/or hallucinations. Eight patients (47%) displayed severe
intoxication (Poisoning Severity Score 3). The diphenidine- or MXP-positive
patients required hospitalization for 1-3 (median: 2) days. In addition to
standard supportive therapy, half of the cases were treated with
benzodiazepines and/or propofol. Conclusion. The adverse effects noted in
analytically confirmed cases of NPS intoxication involving diphenidine or
MXP were similar to those reported for other dissociative substances such as
ketamine and methoxetamine. However, the high proportion of polysubstance
use might have played a role in the intoxication and clinical features in
some cases.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diphenidine (drug toxicity)
methoxphenidine (drug toxicity)
psychotropic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
2 4 bromomethcathinone
3 methoxyphencyclidine
3,4 dichloromethylphenidate
4 methoxyphencyclidine
5 (2 aminopropyl)benzofuran
5 methoxy n isopropyltryptamine
6 (2 aminopropyl)benzofuran
alcohol
alpha pyrrolidinopentiothiophenone
anesthetic agent
benzodiazepine derivative (drug therapy)
butylone
cannabis
dexmedetomidine (drug therapy)
diazepam (drug therapy)
flumazenil (drug therapy)
haloperidol (drug therapy)
ketamine
methiopropamine
methoxetamine
midazolam (drug therapy)
naloxone (drug therapy)
propofol (drug therapy)
remifentanil (drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diphenidine intoxication (drug therapy, drug therapy, therapy)
intoxication (drug therapy, drug therapy, therapy)
methoxphenidine intoxication (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
alcohol abuse
anxiety
article
blood sampling
cannabis addiction
case study
clinical article
clinical feature
confusion
disorientation
drug abuse
emergency ward
female
hallucination
health care facility
hospital admission
hospitalization
human
hypertension
intensive care
length of stay
liquid chromatography
male
mass spectrometry
medical record review
mental disease
mental dissociation
nystagmus
observational study
oxygen therapy
patient care
poisoning severity score 3
scoring system
Sweden
tachycardia
teleconsultation
urinalysis
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
dexmedetomidine (113775-47-6)
diazepam (439-14-5)
flumazenil (78755-81-4)
haloperidol (52-86-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
remifentanil (132539-07-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015033112
MEDLINE PMID
25881797 (http://www.ncbi.nlm.nih.gov/pubmed/25881797)
PUI
L604287215
DOI
10.3109/15563650.2015.1033630
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2015.1033630
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 435
TITLE
Racial differences in opiate administration for pain relief at an academic
emergency department
AUTHOR NAMES
Myles Dickason R.
Chauhan V.
Mor A.
Ibler E.
Kuehnle S.
Mahoney D.
Armbrecht E.
Dalawari P.
AUTHOR ADDRESSES
(Myles Dickason R.) New York Hospital Queens, Department of Emergency
Medicine, Flushing, United States.
(Chauhan V.; Mor A.; Dalawari P., pdalawar@slu.edu) Saint Louis University
School of Medicine, Division of Emergency Medicine, St. Louis, United
States.
(Ibler E.) St. Luke's Roosevelt Hospital Center, Department of Surgery, New
York, United States.
(Kuehnle S.) Maricopa Medical Center, Department of Emergency Medicine,
Phoenix, United States.
(Mahoney D.) University of Nevada, School of Medicine, Department of
Emergency Medicine, Las Vegas, United States.
(Armbrecht E.) Saint Louis University Center for Outcomes Research, St.
Louis, United States.
CORRESPONDENCE ADDRESS
P. Dalawari, Division of Emergency Medicine, First Floor Desloge Towers,
3635 Vista at Grand Ave., St. Louis, United States. Email: pdalawar@slu.edu
SOURCE
Western Journal of Emergency Medicine (2015) 16:3 (372-380). Date of
Publication: 1 May 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: The decision to treat pain in the emergency department (ED) is
a complex, idiosyncratic process. Prior studies have shown that EDs
undertreat pain. Several studies demonstrate an association between
analgesia administration and race. This is the first Midwest single
institution study to address the question of race and analgesia, in addition
to examining the effects of both patient and physician characteristics on
race-based disparities in analgesia administration. Methods: This was a
retrospective chart review of patients presenting to an urban academic ED
with an isolated diagnosis of back pain, migraine, or long bone fracture
(LBF) from January 1, 2007 to December 31, 2011. Demographic and medication
administration information was collected from patient charts by trained data
collectors blinded to the hypothesis of the study. The primary outcome was
the proportion of African-Americans who received analgesia and opiates, as
compared to Caucasians, using Pearson's chi-squared test. We developed a
multiple logistic regression model to identify which physician and patient
characteristics correlated with increased opiate administration. Results: Of
the 2,461 patients meeting inclusion criteria, 57% were African-American and
30% Caucasian (n=2136). There was no statistically significant racial
difference in the administration of any analgesia (back pain: 86% vs. 86%,
p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17), or in
opiate administration for migraine or LBF. African-Americans who presented
with back pain were less likely to receive an opiate than Caucasians (50%
vs. 72%, p<0.001). Secondary outcomes showed that higher acuity, older age,
physician training in emergency medicine, and male physicians were
positively associated with opiate administration. Neither race nor gender
patientphysician congruency correlated with opiate administration.
Conclusion: No race-based disparity in overall analgesia administration was
noted for all three conditions: LBF, migraine, and back pain at this
institution. A race-based disparity in the likelihood of receiving opiate
analgesia for back pain was observed in this ED. The etiology of this is
likely multifactorial, but understanding physician and patient
characteristics of institutions may help to decrease the disparity by
raising awareness of practice patterns and can provide the basis for quality
improvement projects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency health service
health care disparity
race difference
EMTREE MEDICAL INDEX TERMS
adult
African American
article
backache (disease management, drug therapy)
Caucasian
emergency medicine
emergency ward
female
fracture (disease management, drug therapy)
human
major clinical study
male
migraine (disease management, drug therapy)
outcome assessment
retrospective study
university hospital
urban area
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015033298
MEDLINE PMID
25987909 (http://www.ncbi.nlm.nih.gov/pubmed/25987909)
PUI
L604331769
DOI
10.5811/westjem.2015.3.23893
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.3.23893
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 436
TITLE
Opioid education and nasal naloxone rescue kits in the emergency department
AUTHOR NAMES
Dwyer K.
Walley A.Y.
Langlois B.K.
Mitchell P.M.
Nelson K.P.
Cromwell J.
Bernstein E.
AUTHOR ADDRESSES
(Dwyer K.; Langlois B.K.; Mitchell P.M.; Cromwell J.; Bernstein E.) Boston
University School of Medicine, Boston Medical Center, Department of
Emergency Medicine, Boston, United States.
(Walley A.Y., awalley@bu.edu) Boston University School of Medicine, Boston
Medical Center, Department of Medicine, 801 Massachusetts Ave., Boston,
United States.
(Nelson K.P.) Boston University School of Public Health, Department of
Biostatistics, Boston, United States.
(Bernstein E.) Boston University School of Public Health, Department of
Community Health Sciences, Boston, United States.
CORRESPONDENCE ADDRESS
A.Y. Walley, Boston University School of Medicine, Boston Medical Center,
Department of Medicine, 801 Massachusetts Ave., Boston, United States.
Email: awalley@bu.edu
SOURCE
Western Journal of Emergency Medicine (2015) 16:3 (381-384). Date of
Publication: 1 May 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Emergency departments (EDs) may be high-yield venues to
address opioid deaths with education on both overdose prevention and
appropriate actions in a witnessed overdose. In addition, the ED has the
potential to equip patients with nasal naloxone kits as part of this effort.
We evaluated the feasibility of an ED-based overdose prevention program and
described the overdose risk knowledge, opioid use, overdoses, and overdose
responses among participants who received overdose education and naloxone
rescue kits (OEN) and participants who received overdose education only
(OE). Methods: Program participants were surveyed by telephone after their
ED visit about their substance use, overdose risk knowledge, history of
witnessed and personal overdoses, and actions in a witnessed overdose
including use of naloxone. Results: A total of 415 ED patients received OE
or OEN between January 1, 2011 and February 28, 2012. Among those, 51 (12%)
completed the survey; 37 (73%) of those received a naloxone kit, and 14
(27%) received OE only. Past 30-day opioid use was reported by 35% OEN and
36% OE, and an overdose was reported by 19% OEN and 29% OE. Among 53%
(27/51) of participants who witnessed another individual experiencing an
overdose, 95% OEN and 88% OE stayed with victim, 74% OEN and 38% OE called
911, 26% OEN and 25% OE performed rescue breathing, and 32% OEN (n=6) used a
naloxone kit to reverse the overdose. We did not detect statistically
significant differences between OEN and OE-only groups in opioid use,
overdose or response to a witnessed overdose. Conclusion: This is the first
study to demonstrate the feasibility of ED-based opioid overdose prevention
education and naloxone distribution to trained laypersons, patients and
their social network. The program reached a high-risk population that
commonly witnessed overdoses and that called for help and used naloxone,
when available, to rescue people. While the study was retrospective with a
low response rate, it provides preliminary data for larger, prospective
studies of ED-based overdose prevention programs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug toxicity)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
emergency ward
patient education
EMTREE MEDICAL INDEX TERMS
adult
female
human
knowledge
major clinical study
male
resuscitation
review
risk
substance use
telephone interview
victim
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015033299
MEDLINE PMID
25987910 (http://www.ncbi.nlm.nih.gov/pubmed/25987910)
PUI
L604331770
DOI
10.5811/westjem.2015.2.24909
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.2.24909
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 437
TITLE
Safety of an ED High-Dose Opioid Protocol for Sickle Cell Disease Pain
AUTHOR NAMES
Tanabe P.
Martinovich Z.
Buckley B.
Schmelzer A.
Paice J.A.
AUTHOR ADDRESSES
(Tanabe P., paula.tanabe@duke.edu; Martinovich Z.; Buckley B.; Schmelzer A.;
Paice J.A.) Durham, NC; Chicago, IL
SOURCE
Journal of emergency nursing: JEN : official publication of the Emergency
Department Nurses Association (2015) 41:3 (227-235). Date of Publication: 1
May 2015
ISSN
1527-2966 (electronic)
ABSTRACT
INTRODUCTION: A nurse-initiated high dose, opioid protocol for
vaso-occlusive crisis (VOC) was implemented. Total intravenous morphine
sulfate equivalents (IVMSE) in mgs] and safety was evaluated.METHODS: A
medical record review was conducted for all ED visits in adult patients with
VOC post protocol implementation. Opioids doses and routes administered
during the ED stay, and six hours into the hospital admission were
abstracted and total IVMSE administered calculated. Oxygen saturation
(SPO2), respiratory rate (RR), administration of naloxone or vasoactive
medications, evidence of respiratory arrest, or any other types of
resuscitation effort were abstracted. A RR of <10 or SPO2 <92% were coded as
abnormal. Descriptive statistics report the total dose. Logistic regression
was used to predict abnormal events. Predictors were age, gender, ED dose
(10 mg increments) administered, and time from 1st dose to discharge from
ED.RESULTS: 72 patients, 603 visits, 276 admitted. The total (ED & hospital
dose) mean (95% CI) mg IVMSE administered for all visits was 93 mg (CI 86,
100), ED visit 63 mg (CI 59, 67) and hospital 66 mg (CI 59, 72). The mean
(SD) time from administration of 1st analgesic dose to discharge from the ED
was 203 (143) minutes, (range = 30-1396 minutes). During two visits,
patients experienced a RR <10; while 61 visits were associated with a SPO2
<92%. No medications were administered, or resuscitative measures required.
Controlling for demographics and evaluated at the average total ED dose, the
longer patients were in the ED, patients were 1.359 times more likely to
experience an abnormal vital sign. Controlling for demographics and
evaluated at the average total time in the ED, for every 10 mg increase in
IVMSE, patients were 1.057 times more likely to experience an abnormal vital
sign. The effect of ED dose on the odds of experiencing an abnormal vital
sign decreased by a multiplicative factor of 0.0970 for every 1 hour
increase in time until discharge. The larger the dose administered in less
time, the more likely patients experienced an abnormal vital
sign.DISCUSSION: High opioid doses were safely administered to patients with
sickle cell disease.
EMTREE DRUG INDEX TERMS
morphine (drug administration, drug therapy)
narcotic analgesic agent (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital emergency service
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
complication
emergency nursing
female
human
intravenous drug administration
male
middle aged
pain (drug therapy, etiology)
retrospective study
sickle cell anemia
young adult
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25241635 (http://www.ncbi.nlm.nih.gov/pubmed/25241635)
PUI
L615105442
DOI
10.1016/j.jen.2014.07.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2014.07.014
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 438
TITLE
Accidental methadone intoxication masquerading as asthma exacerbation with
respiratory arrest in a six-year-old boy
AUTHOR NAMES
Swenson O.
AUTHOR ADDRESSES
(Swenson O.)
SOURCE
Delaware medical journal (2015) 87:5 (147-149). Date of Publication: 1 May
2015
ISSN
0011-7781
ABSTRACT
A 6-year-old boy is brought to the emergency department of a level 1 trauma
center by emergency medical services (EMS) for presumed asthma exacerbation
with subsequent unresponsiveness and transient bradycardia. The initial
physician exam was remarkable for an unresponsive child, with diffusely
diminished breath sounds bilaterally, accompanied by diffuse wheezing, as
well as pinpoint pupils. This last observation led to the recommendation to
attempt a dose of naloxone for a possible overdose prior to proceeding with
intubation for the altered mental status. The child had a brisk response to
the naloxone, was subsequently placed on a naloxone drip, and admitted to
the hospital. Initial provider thoughts were that the naloxone had worked on
an accidental overdose of over-the-counter dextromethorphan containing
medication. These suspicions were later proven incorrect after mass
spectrometry yielded a positive methadone presence in the urine. The child
was ultimately discharged home with ongoing input from child protective
services, without further medical complications. The increased utilization
of methadone for the treatment of both opioid withdrawal, as well as for
chronic pain management demands, heightened awareness of the clinicians, as
cases such as this will continue to appear.
EMTREE DRUG INDEX TERMS
methadone (drug toxicity)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
asthma (diagnosis)
bradycardia
chemically induced
child
differential diagnosis
drug overdose (diagnosis, drug therapy)
human
male
respiratory failure
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26058121 (http://www.ncbi.nlm.nih.gov/pubmed/26058121)
PUI
L605157814
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 439
TITLE
Life-threatening opioid toxicity from a fentanyl patch applied to eczematous
skin
AUTHOR NAMES
Doris M.K.
Sandilands E.A.
AUTHOR ADDRESSES
(Doris M.K.) NHS Lothian, Edinburgh, United Kingdom.
(Sandilands E.A., euan.sandilands@nhslothian.scot.nhs.uk) National Poisons
Information Service Edinburgh, NHS Lothian, Edinburgh, United Kingdom.
CORRESPONDENCE ADDRESS
E.A. Sandilands, National Poisons Information Service Edinburgh, NHS
Lothian, Edinburgh, United Kingdom.
SOURCE
BMJ Case Reports (2015) 2015 Article Number: 208945. Date of Publication: 29
Apr 2015
ISSN
1757-790X (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
A 19-year-old man with a history of eczema was admitted to the emergency
department following collapsing at home. The paramedics found him
unresponsive with poor respiratory effort and a widespread erythematous
rash. Anaphylaxis, thought to be secondary to flucloxacillin he had recently
been prescribed, was diagnosed. Epinephrine, steroids and antihistamines
were administered without clinical improvement. On arrival to hospital,
constricted pupils were noted prompting the emergency physicians to consider
opiate toxicity. Intravenous naloxone brought about an immediate recovery.
His father subsequently disclosed that he had given his son one of his own
fentanyl patches to alleviate the distressing symptoms of eczema. Although
the patient had removed the patch prior to collapsing, he had suffered
life-threatening opioid toxicity likely due to enhanced opiate absorption
through eczematous skin. This case highlights the risks associated with
fentanyl patches in patients with chronic skin conditions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug therapy, drug toxicity, pharmacokinetics, transdermal drug
administration)
opiate (drug toxicity, pharmacokinetics, transdermal drug administration)
EMTREE DRUG INDEX TERMS
antihistaminic agent (drug therapy)
epinephrine (drug therapy)
flucloxacillin (drug therapy, oral drug administration)
naloxone (drug therapy, intravenous drug administration)
steroid (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
eczema (drug therapy, drug therapy)
opioid toxicity (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
anaphylaxis
article
case report
drug absorption
emergency ward
erythema
Glasgow coma scale
human
male
pain
priority journal
pruritus
pupil
rash (drug therapy)
treatment failure
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
fentanyl (437-38-7)
flucloxacillin (1847-24-1, 5250-39-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015131905
MEDLINE PMID
25926584 (http://www.ncbi.nlm.nih.gov/pubmed/25926584)
PUI
L604425747
DOI
10.1136/bcr-2014-208945
FULL TEXT LINK
http://dx.doi.org/10.1136/bcr-2014-208945
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 440
TITLE
Nitroglycerin administration during cardiac arrest caused by coronary
vasospasm secondary to misoprostol
AUTHOR NAMES
Owusu K.A.
Brennan J.J.
Perelman A.
Meoli E.
Altshuler J.
AUTHOR ADDRESSES
(Owusu K.A., kao0006@gmail.com; Altshuler J.) Department of Pharmacy,
Yale-New Haven Hospital, New-Haven, United States.
(Brennan J.J.) Cardiac Intensive Care Unit, Yale-New Haven Hospital,
New-Haven, United States.
(Brennan J.J.; Perelman A.; Meoli E.) Department of Internal Medicine, Yale
School of Medicine, New-Haven, United States.
(Altshuler J.) Department of Pharmacy, Mount Sinai Beth Israel, New York,
United States.
CORRESPONDENCE ADDRESS
K.A. Owusu, Yale-New Haven Hospital, 20 York Street, New Haven, United
States.
SOURCE
Journal of Cardiology Cases (2015) 12:5 (166-168). Date of Publication: 21
Apr 2015
ISSN
1878-5409 (electronic)
1878-5409
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
There have been no reports of successful resuscitation using nitroglycerin
(NTG) for cardiac arrest due to definitive coronary vasospasm. A 42-year-old
female was brought to the Emergency Department in ventricular fibrillation
after being found collapsed with the consumption of misoprostol. NTG, a
potent coronary arterial dilator, not typically used in the management of
cardiac arrest, was administered after 27. min of resuscitation efforts
following advanced cardiac life support. NTG aided in the return of
spontaneous circulation during a ventricular fibrillation cardiac arrest in
the setting of prostaglandin use.<. Learning objective: Nitroglycerin is not
typically employed in the management of cardiac arrest. We report successful
cardiac resuscitation after administration of intravenous nitroglycerin
during a prolonged cardiac arrest event secondary to coronary artery
vasospasm in the setting of recent misoprostol ingestion. Nitroglycerin may
have a role in cardiac arrest in the setting of coronary vasospasm.>.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
glyceryl trinitrate (drug therapy, intravenous drug administration)
misoprostol (adverse drug reaction, sublingual drug administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
amiodarone (intravenous drug administration)
amlodipine
atorvastatin (drug therapy)
bicarbonate
epinephrine
lisinopril (drug therapy)
metoprolol (drug therapy)
naloxone
nicardipine (intravenous drug administration)
nifedipine (oral drug administration)
noradrenalin (drug therapy, intravenous drug administration)
norethisterone
vasopressin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coronary artery spasm (drug therapy, side effect, drug therapy, side effect)
heart arrest (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
angiocardiography
article
cardiomyopathy (drug therapy)
cardiovascular magnetic resonance
case report
collapse
coronary artery disease (drug therapy)
coronary artery occlusion
electrocardiogram
emergency ward
female
heart catheterization
heart ejection fraction
heart tamponade
heart ventricle arrhythmia
heart ventricle fibrillation
heart ventricle tachycardia
human
hypertension
hypokinesia
implantable cardioverter defibrillator
induced hypothermia
intensive care unit
left coronary artery
mean arterial pressure
mental health
priority journal
resuscitation
return of spontaneous circulation
ST segment elevation
transthoracic echocardiography
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amlodipine (88150-42-9, 103129-82-4, 736178-83-9)
atorvastatin (134523-00-5, 134523-03-8)
bicarbonate (144-55-8, 71-52-3)
glyceryl trinitrate (55-63-0, 80738-44-9)
lisinopril (76547-98-3, 83915-83-7)
metoprolol (37350-58-6)
misoprostol (59122-46-2, 59122-48-4)
naloxone (357-08-4, 465-65-6)
nicardipine (54527-84-3, 55985-32-5)
nifedipine (21829-25-4)
noradrenalin (1407-84-7, 51-41-2)
norethisterone (68-22-4)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015285268
PUI
L605554093
DOI
10.1016/j.jccase.2015.07.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jccase.2015.07.003
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 441
TITLE
A retrospective, matched cohort study of potential drug-drug interaction
prevalence and opioid utilization in a diabetic peripheral neuropathy
population initiated on pregabalin or duloxetine
AUTHOR NAMES
Ellis J.J.
Sadosky A.B.
Ten Eyck L.L.
Mudumby P.
Cappelleri J.C.
Ndehi L.
Suehs B.T.
Parsons B.
AUTHOR ADDRESSES
(Ellis J.J., jellis21@humana.com; Mudumby P., pmudumby@humana.com; Suehs
B.T., bsuehs6@humana.com) Comprehensive Health Insights Inc., 325 West Main
Street WFP6W, Louisville, KY, 40202, USA
(Sadosky A.B., Alesia.Sadosky@pfizer.com; Cappelleri J.C.,
joseph.c.cappelleri@pfizer.com; Parsons B., Bruce.Parsons@pfizer.com) Pfizer
Inc., 235 East 42nd Street, NewYork, NY, 10017, USA
(Ten Eyck L.L.) Formerly of Comprehensive Health Insights Inc., 325 West
Main Street WFP6W, Louisville, KY, 40202, USA. lten_eyck@humana.com
(Ndehi L., lndehi@humana.com) Humana Inc., 323 West Main Street WFP-05C,
Louisville, KY, 40202, USA
SOURCE
BMC health services research (2015) 15 (159). Date of Publication: 15 Apr
2015
ISSN
1472-6963 (electronic)
ABSTRACT
BACKGROUND: Anticipating and controlling drug-drug interactions (DDIs) in
older patients with painful diabetic peripheral neuropaty (pDPN) presents a
significant challenge to providers. The purpose of this study was to examine
the impact of newly initiated pregabalin or duloxetine treatment on Medicare
Advantage Prescription Drug (MAPD) plan pDPN patients' encounters with
potential drug-drug interactions, the healthcare cost and utilization
consequences of those interactions, and opioid utilization.METHODS: Study
subjects required a pregabalin or duloxetine pharmacy claim between
07/01/2008-06/30/2012 (index event), ≥1 inpatient or ≥2 outpatient medical
claims with pDPN diagnosis between 01/01/2008-12/31/2012, and ≥12 months
pre- and ≥6 post-index enrollment. Propensity score matching was used to
balance the pregabalin and duloxetine cohorts on pre-index demographics and
comorbidities. Potential DDIs were defined by Micromedex 2.0 and identified
by prescription claims. Six-month post-index healthcare utilization (HCU)
and costs were calculated using pharmacy and medical claims.RESULTS: No
significant differences in pre-index demographics or comorbidities were
found between pregabalin subjects (n = 446) and duloxetine subjects (n =
446). Potential DDI prevalence was significantly greater (p < 0.0001) among
duoxetine subjects (56.7%) than among pregabalin subjects (2.9%). There were
no significant differences in HCU or costs between pregablin subjects with
and without a potential DDI. By contrast, duloxetine subjects with a
potential DDI had higher mean all-cause costs ($13,908 vs. $9,830; p =
0.001), more subjects with ≥1 inpatient visits (35.6% vs 25.4%; p = 0.02),
and more subjects with ≥1 emergency room visits (32.8% vs. 20.7%; p = 0.005)
in comparison to duloxetine subjects without a potential DDI. There was a
trend toward a difference between pregabalin and duloxetine subjects in
their respective pre-versus-post differences in milligrams (mg) of morphine
equivalents/30 days used (60.2 mg and 176.9 mg, respectively; p =
0.058).CONCLUSION: The significantly higher prevalence of potential DDIs and
potential cost impact found in pDPN duloxetine users, relative to pregabalin
users, underscore the importance of considering DDIs when selecting a
treatment.
EMTREE DRUG INDEX TERMS
duloxetine (drug therapy)
narcotic analgesic agent (drug therapy)
pregabalin (drug therapy)
prescription drug (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug interaction
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
cohort analysis
diabetic neuropathy (drug therapy)
economics
female
human
male
medicare
middle aged
pain (drug therapy)
prevalence
retrospective study
United States
very elderly
young adult
CAS REGISTRY NUMBERS
duloxetine (116539-59-4, 136434-34-9)
pregabalin (148553-50-8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25889173 (http://www.ncbi.nlm.nih.gov/pubmed/25889173)
PUI
L615658320
DOI
10.1186/s12913-015-0829-9
FULL TEXT LINK
http://dx.doi.org/10.1186/s12913-015-0829-9
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 442
TITLE
Overdose of etizolam: The abuse and rise of a benzodiazepine analog
AUTHOR NAMES
O'Connell C.W.
Sadler C.A.
Tolia V.M.
Ly B.T.
Saitman A.M.
Fitzgerald R.L.
AUTHOR ADDRESSES
(O'Connell C.W.; Sadler C.A.; Tolia V.M.; Ly B.T.) Department of Emergency
Medicine, University of California-San Diego, San Diego, United States.
(O'Connell C.W.; Sadler C.A.; Tolia V.M.; Ly B.T.) Veterans Association San
Diego Health Center, San Diego, United States.
(Saitman A.M.; Fitzgerald R.L.) Department of Pathology, University of
California-San Diego, San Diego, United States.
SOURCE
Annals of Emergency Medicine (2015) 65:4 (465-466). Date of Publication: 1
Apr 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
etizolam (drug toxicity)
EMTREE DRUG INDEX TERMS
creatinine (endogenous compound)
diamorphine
flumazenil (drug therapy, intravenous drug administration)
glucose (endogenous compound)
naloxone (drug therapy, intranasal drug administration, intravenous drug
administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alertness
bradypnea
case report
creatinine blood level
drug urine level
emergency ward
glucose blood level
hospital discharge
human
intubation
letter
leukocyte count
male
medical society
priority journal
sedation
sinus tachycardia
standard
CAS REGISTRY NUMBERS
creatinine (19230-81-0, 60-27-5)
diamorphine (1502-95-0, 561-27-3)
etizolam (40054-69-1)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015095205
MEDLINE PMID
25805032 (http://www.ncbi.nlm.nih.gov/pubmed/25805032)
PUI
L604714518
DOI
10.1016/j.annemergmed.2014.12.019
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.12.019
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 443
TITLE
Rising fentanyl-related overdose deaths in British Columbia
AUTHOR NAMES
Jafari S.
Buxton J.A.
Joe R.
AUTHOR ADDRESSES
(Jafari S., siavash.jafari@Alumni.ubc.ca; Buxton J.A.) School of Population
and Public Health, University of British Columbia, Canada.
(Buxton J.A.) BC Center for Disease Control, Vancouver, Canada.
(Joe R., ronald.joe@vch.ca) Addiction Medicine Program, Vancouver Coastal
Health Authority, Vancouver, Canada.
CORRESPONDENCE ADDRESS
S. Jafari, School of Population and Public Health, The University of British
Columbia, 2206 East Mall, Vancouver, Canada. Email:
siavash.jafari@Alumni.ubc.ca
SOURCE
Canadian Journal of Addiction (2015) 6:1 (4-6). Date of Publication: 1 Apr
2015
ISSN
2368-4720
BOOK PUBLISHER
Canadian Society of Addiction Medicine, admin@csam.org
ABSTRACT
There has been a surge in the number of fentanyl-detected overdoses in 2014
among people who use drugs in British Columbia. Provisional data indicates a
constant increase in the number of fentanyl-detected overdoses over the past
3 years. A green pill, 'fake oxy' tablets, which resemble Oxycontin 80mg
(oxycodone) have been found to contain variable amounts of fentanyl and not
oxycodone. The physiological effects, symptoms and signs of fentanyl
overdose are largely indistinguishable from that of heroin. This can
complicate the management of overdoses in emergency settings. Emergency room
physicians may find that the standard protocol dose of 0.4 - 0.8 mg of
naloxone for heroin overdoses insufficient to reverse fentanyl overdoses. In
such cases, in addition to investigations to rule out other potential use of
other substances, larger doses of naloxone are often necessary to reverse
the overdose. Take home naloxone programs are one harm reduction approach
which is available in many jurisdictions in US1 and was initiated in British
Columbia in 2012 and it is currently available at 62 sites throughout the
province of British Columbia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl
EMTREE DRUG INDEX TERMS
diamorphine
naloxone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug fatality (etiology)
EMTREE MEDICAL INDEX TERMS
article
British Columbia
clinical feature
drug effect
drug overdose
emergency
harm reduction
human
symptom
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
20170703596
PUI
L618652720
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 444
TITLE
Do serotonin reuptake inhibitors worsen outcome of patients referred to the
emergency department for deliberate multi-drug exposure?
AUTHOR NAMES
Beaune S.
Curis E.
Casalino E.
Juvin P.
Mégarbane B.
AUTHOR ADDRESSES
(Beaune S.; Curis E.; Mégarbane B., bruno-megarbane@wanadoo.fr) Inserm,
U1144, Paris, France.
(Beaune S.; Curis E.; Mégarbane B., bruno-megarbane@wanadoo.fr)
Paris-Descartes University, UMR-S 1144, Paris, France.
(Beaune S.; Curis E.; Mégarbane B., bruno-megarbane@wanadoo.fr)
Paris-Diderot University, UMR-S 1144, Paris, France.
(Beaune S.) Emergency Department, Ambroise Pare University Hospital,
Boulogne, France.
(Beaune S.) Emergency Department, Beaujon University Hospital, Clichy,
France.
(Casalino E.) Emergency Department, Bichat University Hospital, Paris,
France.
(Juvin P.) Emergency Department, Georges Pompidou University Hospital,
Paris, France.
(Mégarbane B., bruno-megarbane@wanadoo.fr) Department of Medical and
Toxicological Critical Care, Lariboisiere University Hospital, Paris,
France.
CORRESPONDENCE ADDRESS
B. Mégarbane, Lariboisiere University Hospital, Deaprtment of Medical and
Toxicological Critical Care, 2 Rue Ambroise Paré, Paris, France.
SOURCE
Basic and Clinical Pharmacology and Toxicology (2015) 116:4 (372-377). Date
of Publication: 1 Apr 2015
ISSN
1742-7843 (electronic)
1742-7835
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Incidence of poisonings with serotonin reuptake inhibitors (SRIs) is
growing. SRI toxicity is considered low, but its actual impact in multi-drug
poisonings remains unclear. Our objective was to evaluate the consequences
of SRI exposure in patients referred to the emergency department (ED) for
deliberate multi-drug exposure. Patients admitted for multi-drug exposure
involving at least one SRI were matched with patients who did not ingest any
SRI, according to age, gender, type of drug and ingested doses. Features of
serotonin syndrome according to Sternbach's criteria and Hunter's serotonin
toxicity criteria were evaluated from records. In 4 years, 148 SRI-exposed
patients were included and compared to 296 matched controls. The SRIs mainly
involved were escitalopram (22%), venlafaxine (20%), fluoxetine (19%),
citalopram (15%) and paroxetine (11%). Serotonin syndrome was diagnosed in
one patient, but actually occurred in five SRI-exposed patients based on the
retrospective evaluation of records. Twenty patients (14%) exhibited one or
more serotonin syndrome criteria. At least two of 11 of Sternbach's criteria
and two of nine of Hunter's serotonin toxicity criteria were missing in each
chart. Using a conditional logistic regression analysis, seizures (p = 0.04)
and serotonin syndrome (p = 0.01 based on Sternbach's criteria and p = 0.004
based on Hunter's serotonin toxicity criteria) more frequently occurred in
SRI-exposed patients. Requirement for mechanical ventilation was
significantly increased (p = 0.03), although admission to the intensive care
unit was not. In multi-drug-poisoned patients admitted to the ED, exposure
to SRIs significantly increases the risk of seizures and requirement for
mechanically ventilation. Diagnosis of serotonin syndrome remains
insufficient justifying improved training.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
serotonin uptake inhibitor (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
antidote (drug therapy)
charcoal (drug therapy)
citalopram (drug toxicity)
duloxetine (drug toxicity)
escitalopram (drug toxicity)
flumazenil (drug therapy)
fluoxetine (drug toxicity)
fluvoxamine (drug toxicity)
hypertensive factor (drug therapy)
milnacipran (drug toxicity)
naloxone (drug therapy)
paroxetine (drug toxicity)
venlafaxine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
emergency ward
multi drug poisoning (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
agitation
article
artificial ventilation
clonus
controlled study
coordination disorder
diaphoresis
diarrhea
disease assessment
ECG abnormality
female
fever
human
Hunter serotonin toxicity
hyperreflexia
major clinical study
male
myoclonus
observational study
outcome assessment
priority journal
QT prolongation
retrospective study
self poisoning
serotonin syndrome
shivering
stomach lavage
tremor
vital sign
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
charcoal (16291-96-6)
citalopram (59729-33-8)
duloxetine (116539-59-4, 136434-34-9)
escitalopram (128196-01-0, 219861-08-2)
flumazenil (78755-81-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
fluvoxamine (54739-18-3)
milnacipran (101152-94-7, 86181-08-0, 92623-85-3, 96847-55-1, 175131-60-9)
naloxone (357-08-4, 465-65-6)
paroxetine (61869-08-7)
venlafaxine (93413-69-5, 99300-78-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014912683
MEDLINE PMID
25154631 (http://www.ncbi.nlm.nih.gov/pubmed/25154631)
PUI
L600501948
DOI
10.1111/bcpt.12311
FULL TEXT LINK
http://dx.doi.org/10.1111/bcpt.12311
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 445
TITLE
Availability of antidotes, antivenoms, and antitoxins in New Zealand
hospital pharmacies
AUTHOR NAMES
Fountain J.S.
Sly B.
Holt A.
MacDonell S.
AUTHOR ADDRESSES
(Fountain J.S., john.fountain@otago.ac.nz) Medical Toxicologist, Preventive
and Social Medicine, University of Otago, Dunedin, New Zealand.
(Sly B.; Holt A.; MacDonell S.) Information Science, University of Otago,
Dunedin, New Zealand.
CORRESPONDENCE ADDRESS
J.S. Fountain, National Poisons Centre, Preventive and Social Medicine,
University of Otago, PO Box 913, Dunedin, New Zealand. Email:
john.fountain@otago.ac.nz
SOURCE
New Zealand Medical Journal (2015) 128:1411 (23-33). Date of Publication: 27
Mar 2015
ISSN
1175-8716 (electronic)
0028-8446
BOOK PUBLISHER
New Zealand Medical Association, 26 The Terrace, P.O. Box 156, Wellington,
New Zealand.
ABSTRACT
Aim To assess the adequacy of the types and quantities of antidotes,
antivenoms and antitoxins held by New Zealand hospital pharmacies. Methods A
list of 61 antidotes, antivenoms, antitoxins and their various forms was
developed following literature review and consideration of national
pharmaceutical listings. An Internet-accessible survey was then developed,
validated and, during the period 28 February to 7 April 2014, sent to 24
hospital pharmacies nationally for completion. Results were assessed and
compared with published guidelines for adequate stocking of antidotes in
hospitals that provide emergency care. Results The response rate for the
survey was 100%. Wide variation in stock levels were reported with only
Nacetylcysteine and octreotide held in adequate quantities by all hospitals
to manage a single patient for 24 hours. While archaic compounds were still
stocked, newer and more effective pharmaceuticals were not. The national
replacement cost for expiring drugs was estimated at $171,024, with smaller,
more isolated facilities facing the greatest expense and difficulty in
achieving timely resupply. Conclusion Shortcomings in the types and
quantities of antidotes, antivenoms and antitoxins held by New Zealand
hospital pharmacies were recognised. This situation may be improved through
national rationalisation of pharmaceutical storage and supply, and
implementation of a national antidote database.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
antiserum
antitoxin
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
botulinum antiserum
calcium chloride
diphtheria antibody
flumazenil
glucagon
gluconate calcium
naloxone
octreotide
penicillamine
potassium iodide
pralidoxime
pyridoxine
snake venom antiserum
succimer
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care availability
hospital pharmacy
EMTREE MEDICAL INDEX TERMS
article
cost benefit analysis
drug storage
emergency care
emergency ward
follow up
health care survey
hospital purchasing
human
New Zealand
questionnaire
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
calcium chloride (10043-52-4)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9, 1607842-55-6)
penicillamine (2219-30-9, 52-67-5)
potassium iodide (7681-11-0)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
EMBASE CLASSIFICATIONS
Immunology, Serology and Transplantation (26)
Health Policy, Economics and Management (36)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160159513
MEDLINE PMID
25820500 (http://www.ncbi.nlm.nih.gov/pubmed/25820500)
PUI
L608494671
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 446
TITLE
Prescription Opioid Use and Misuse Among Older Adult Rhode Island Hospital
Emergency Department Patients
AUTHOR NAMES
Henderson A.W.
Babu K.M.
Merchant R.C.
Beaudoin F.L.
AUTHOR ADDRESSES
(Henderson A.W.) Medical Student, The Department of Emergency Medicine,
Alpert Medical School of Brown University, Providence, RI
(Babu K.M.) Assistant Professor of Emergency Medicine, The Department of
Emergency Medicine, Alpert Medical School of Brown University, Providence,
RI. Current affiliation: The Department of Emergency Medicine, University of
Massachusetts Medical School, Worcester, MA
(Merchant R.C.) Associate Professor of Emergency Medicine, The Department of
Emergency Medicine, Alpert Medical School of Brown University, Providence,
RI
(Beaudoin F.L.) Assistant Professor of Emergency Medicine, The Department of
Emergency Medicine, Alpert Medical School of Brown University, Providence,
RI
SOURCE
Rhode Island medical journal (2013) (2015) 98:3 (28-31). Date of
Publication: 3 Mar 2015
ISSN
2327-2228 (electronic)
ABSTRACT
Because of the multitude of financial, health, and social problems
associated with prescription opioid misuse, effective methods of identifying
older adults who are misusing these medications are needed. We conducted a
pilot investigation to determine the prevalence of previous and current
prescription opioid use among older adults visiting the Rhode Island
Hospital Emergency Department and their need for opioid misuse
interventions. Among 88 randomly selected older adults (≥ 65 years of age)
presenting to the ED with sub-critical illness or injury, 19% (95% CI:
11-27%) were current opioid users and 6% (95% CI: 4-8%) would require an
intervention for prescription opioid misuse. We identified problems of
improper acquisition, diversion, provider refusal to prescribe opioids,
hoarding, and inappropriate use of opioids among this population. Emergency
medicine clinicians should query their older adult patients about
prescription opioid misuse and associated problematic behaviors.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
aged
drug misuse
female
hospital emergency service
human
male
opiate addiction (diagnosis, epidemiology)
pilot study
questionnaire
Rhode Island
very elderly
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26056833 (http://www.ncbi.nlm.nih.gov/pubmed/26056833)
PUI
L615682027
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 447
TITLE
Treatment patterns, healthcare utilization, and costs of chronic opioid
treatment for non-cancer pain in the United States
AUTHOR NAMES
Kern D.M.
Zhou S.
Chavoshi S.
Tunceli O.
Sostek M.
Singer J.
LoCasale R.J.
AUTHOR ADDRESSES
(Kern D.M.; Zhou S.; Chavoshi S.; Tunceli O.; Sostek M.; Singer J.; LoCasale
R.J.)
SOURCE
The American journal of managed care (2015) 21:3 (e222-e234). Date of
Publication: 1 Mar 2015
ISSN
1936-2692 (electronic)
ABSTRACT
OBJECTIVES: To evaluate treatment patterns, healthcare resource utilization,
and costs among patients within a large managed care population chronically
using opioids for non-cancer pain.STUDY DESIGN: Retrospective cohort
study.METHODS: Patients aged ≥18 years with ≥1 prescription initiating
opioids between January 1, 2007, and December 31, 2011, who also had 12
months of continuous pre-index health plan enrollment, were identified.
Patients with pre-index opioid use or cancer diagnosis were excluded. Opioid
exposure was stratified by treatment duration-short-term (30-182 days)
versus chronic (≥183 days)-and by index opioid type (weak vs
strong).RESULTS: A total of 2.9 million patients initiating opioids were
identified, of which 257,602 had at least 30 days of continuous use and were
included in the study. The mean age was 51 years and 52% were female.
Overall, 239,998 (93%) patients had short-term opioid use, and 17,604 (7%)
had chronic use; 215,424 (84%) initiated treatment with a weak opioid, and
44,712 (17%) with a strong opioid. The specialty most associated with the
use of less potent opioids was general/family practice (28%), and for more
potent opioids it was surgery (22%). Large increases in health-care
utilization were reported between the pre-index and first 6-month post
initiation periods for chronic users. Utilization rates decreased after the
first 6 months but never reverted to baseline levels. Costs mirrored
utilization trends, more than doubling between baseline and the first 6
months of treatment for pharmacy ($2029 vs $4331) and all-cause medical
($11,430 vs $27,365). Costs declined after the first 6 months of opioid use
but remained above pre-index levels.CONCLUSIONS: These results demonstrated
that healthcare resource utilization and costs increased during the first 6
months following clinical scenarios that necessitated opioid initiation and
subsequently declined, suggesting the need to monitor patients beyond the
acute care period.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
utilization
EMTREE MEDICAL INDEX TERMS
ambulatory care
cohort analysis
female
follow up
hospital emergency service
human
male
middle aged
pain (drug therapy)
retrospective study
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
26014310 (http://www.ncbi.nlm.nih.gov/pubmed/26014310)
PUI
L615130846
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 448
TITLE
Lessons learned from the expansion of naloxone access in Massachusetts and
North Carolina
AUTHOR NAMES
Davis C.S.
Walley A.Y.
Bridger C.M.
AUTHOR ADDRESSES
(Davis C.S.) Deputy Director of the Southeastern Region of the Network for
Public Health Law and a Staff Attorney for the National Health Law Program
(Walley A.Y.; Bridger C.M.)
SOURCE
The Journal of law, medicine & ethics : a journal of the American Society of
Law, Medicine & Ethics (2015) 43 Supplement 1 (19-22). Date of Publication:
1 Mar 2015
ISSN
1748-720X (electronic)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug overdose (prevention)
emergency health service
health care delivery
health care policy
human
legislation and jurisprudence
Massachusetts
North Carolina
opiate addiction (drug therapy)
prescription
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
25846157 (http://www.ncbi.nlm.nih.gov/pubmed/25846157)
PUI
L615134392
DOI
10.1111/jlme.12208
FULL TEXT LINK
http://dx.doi.org/10.1111/jlme.12208
COPYRIGHT
Copyright 2017 Medline is the source for the citation and abstract of this
record.
RECORD 449
TITLE
The benefits and potential drawbacks in the approval of EVZIO for lay
reversal of opioid overdose
AUTHOR NAMES
Beletsky L.
AUTHOR ADDRESSES
(Beletsky L., l.beletsky@neu.edu) Northeastern University, School of Law and
Bouve, College of Health Sciences, 400Huntington Avenue, Boston, United
States.
(Beletsky L., l.beletsky@neu.edu) Division of Global Public Health,
University of California, San Diego, United States.
CORRESPONDENCE ADDRESS
L. Beletsky, Northeastern University, School of Law and Bouve, College of
Health Sciences, 400Huntington Avenue, Boston, United States.
SOURCE
American Journal of Preventive Medicine (2015) 48:3 (357-359). Date of
Publication: 1 Mar 2015
ISSN
1873-2607 (electronic)
0749-3797
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, pharmacoeconomics)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
epinephrine
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, disease management, drug therapy)
opioid overdose (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
algorithm
article
drug approval
drug cost
drug marketing
drug monitoring
drug overdose
emergency health service
evidence based practice
food and drug administration
health care access
high risk population
patent
prescription
risk assessment
support group
DRUG TRADE NAMES
epipen
evzio
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014627164
MEDLINE PMID
25547930 (http://www.ncbi.nlm.nih.gov/pubmed/25547930)
PUI
L601052437
DOI
10.1016/j.amepre.2014.09.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amepre.2014.09.011
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 450
TITLE
Economic impact of a novel naloxone autoinjector on third-party payers
AUTHOR NAMES
Weiss R.C.
Bazalo G.R.
Thomson H.
Edwards E.
AUTHOR ADDRESSES
(Weiss R.C.; Bazalo G.R.; Thomson H.; Edwards E.)
SOURCE
Managed care (Langhorne, Pa.) (2015) 24:2 (41-48). Date of Publication: 1
Feb 2015
ISSN
1062-3388
ABSTRACT
RESULTS: NAI prescriptions increased from 218 in Year 1 to 2,527 in Year 3.
In Year 3, 86 NAI patients (and their matched controls) experienced opioid
overdose events. For this period, fatal overdoses in the NAI cohort totaled
11.1 vs. 14.7 for the control group. In Year 3, 2.5 deaths (10.1-7.6) were
avoided. NAI acquisition costs rose from $125,000 in Year 1 (PMPM = $0.01)
to nearly $1.5 million in Year 3 (PMPM = $0.12).This cost was offset by
medical resource savings of approximately $84,000 in Year 1, increasing to
$975,000 in Year 3. The total net cost (NAI less offsets) in Year 3, when
NAI uptake was assumed to plateau, was $481,000 (PMPM = $0.04).CONCLUSION: A
deterministic model demonstrated that NAI acquisition costs can be offset
through medical cost reductions with improved timely access to
naloxone.BACKGROUND: Patient overdoses on prescription opioid analgesics in
the United States continue to rise, resulting in increased emergency
department and hospitalization costs. Opioid overdose is readily reversible
with naloxone, a fast-acting opioid antagonist. A new naloxone autoinjector
(NAI), Evzio, which does not require medical training to use, was approved
by the FDA in April 2014. Payers must decide on reimbursement policies for
this product.PURPOSE: To demonstrate to payer decision makers the costs and
potential medical resource cost offsets associated with the utilization of a
new NAI.DESIGN: A deterministic model using matched controls.METHODOLOGY: An
Excel-based cost model was developed for a hypothetical health plan with 1
million adult members. Costs of prescription opioid overdose events for
patients appropriately dispensed NAI were compared with matched controls.
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
devices
reimbursement
EMTREE MEDICAL INDEX TERMS
comparative study
drug self administration
economics
human
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25951656 (http://www.ncbi.nlm.nih.gov/pubmed/25951656)
PUI
L605249222
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 451
TITLE
Emergency department-initiated buprenorphine/naloxone treatment for opioid
dependence: A randomized clinical trial
AUTHOR NAMES
D'Onofrio G.
O'Connor P.G.
Pantalon M.V.
Chawarski M.C.
Busch S.H.
Owens P.H.
Bernstein S.L.
Fiellin D.A.
AUTHOR ADDRESSES
(D'Onofrio G., gail.donofrio@yale.edu; Pantalon M.V.; Owens P.H.; Bernstein
S.L.) Department of Emergency Medicine, Yale School of Medicine, 464
Congress Ave, Ste 260, New Haven, United States.
(O'Connor P.G.; Fiellin D.A.) Department of Internal Medicine, Yale School
of Medicine, New Haven, United States.
(Chawarski M.C.) Department of Psychiatry, Yale School of Medicine, New
Haven, United States.
(Busch S.H.; Fiellin D.A.) Yale School of Public Health, New Haven, United
States.
CORRESPONDENCE ADDRESS
G. D'Onofrio, Department of Emergency Medicine, Yale School of Medicine, 464
Congress Ave, Ste 260, New Haven, United States.
SOURCE
JAMA - Journal of the American Medical Association (2015) 313:16
(1636-1644). Date of Publication: 28 Apr 2015
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
ABSTRACT
IMPORTANCE: Opioid-dependent patients often use the emergency department
(ED) for medical care. OBJECTIVE: To test the efficacy of 3 interventions
for opioid dependence: (1) screening and referral to treatment (referral);
(2) screening, brief intervention, and facilitated referral to
community-based treatment services (brief intervention); and (3) screening,
brief intervention, ED-initiated treatment with buprenorphine/naloxone, and
referral to primary care for 10-week follow-up (buprenorphine). DESIGN,
SETTING, AND PARTICIPANTS: A randomized clinical trial involving 329
opioid-dependent patients who were treated at an urban teaching hospital ED
from April 7, 2009, through June 25, 2013. INTERVENTIONS: After screening,
104 patients were randomized to the referral group, 111 to the brief
intervention group, and 114 to the buprenorphine treatment group. MAIN
OUTCOMES AND MEASURES: Enrollment in and receiving addiction treatment 30
days after randomization was the primary outcome. Self-reported days of
illicit opioid use, urine testing for illicit opioids, human
immunodeficiency virus (HIV) risk, and use of addiction treatment services
were the secondary outcomes. RESULTS: Seventy-eight percent of patients in
the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral
group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group
(50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the
30th day after randomization (P < .001). The buprenorphine group
reduced the number of days of illicit opioid use perweek from 5.4 days (95%
CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95%
CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from
5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief
intervention group (P < .001 for both time and intervention effects; P = .02
for the interaction effect). The rates of urine samples that tested negative
for opioids did not differ statistically across groups, with 53.8% (95% CI,
42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief
intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group
(P = .17). There were no statistically significant differences in HIV risk
across groups (P = .66). Eleven percent of patients in the buprenorphine
group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas
37% in the referral group (95% CI, 27%-48%) and 35% in the brief
intervention group (95% CI, 25%-37%) used inpatient addiction treatment
services (P < .001). CONCLUSIONS AND RELEVANCE: Among opioid-dependent
patients, ED-initiated buprenorphine treatment vs brief intervention and
referral significantly increased engagement in addiction treatment, reduced
self-reported illicit opioid use, and decreased use of inpatient addiction
treatment services but did not significantly decrease the rates of urine
samples that tested positive for opioids or of HIV risk. These findings
require replication in other centers before widespread adoption. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT00913770.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (clinical trial, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
brief intervention
controlled study
drug efficacy
female
follow up
hospital service
human
Human immunodeficiency virus infection
infection risk
major clinical study
male
outcome assessment
patient referral
primary medical care
priority journal
randomized controlled trial
screening
self report
social welfare
teaching hospital
therapy
urinalysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT00913770)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015003107
MEDLINE PMID
25919527 (http://www.ncbi.nlm.nih.gov/pubmed/25919527)
PUI
L604201956
DOI
10.1001/jama.2015.3474
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2015.3474
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 452
TITLE
Opioid Prescribing in a Cross Section of US Emergency Departments
AUTHOR NAMES
Hoppe J.A.
Nelson L.S.
Perrone J.
Weiner S.G.
Rathlev N.K.
Sanchez L.D.
Babineau M.
Griggs C.A.
Mitchell P.M.
Ma J.
Hoch W.B.
Totten V.
Salzman M.S.
Karmakar R.
Iwanicki J.L.
Morgan B.W.
Pomerleau A.C.
Delgado J.
Medoro A.
Whiteley P.
Offerman S.
Hemmert K.
Lank P.M.
Thundiyil J.G.
Thomas A.
Chagani S.
Beaudoin F.L.
Friedman F.D.
Cleveland N.
Jayathilaka K.
D'Onofrio G.
Naftilan M.
Koploy A.
AUTHOR ADDRESSES
(Hoppe J.A.) Department of Emergency Medicine, University of Colorado,
Aurora, United States.
(Hoppe J.A.) Rocky Mountain Poison and Drug Center, Denver, United States.
(Nelson L.S.) Department of Emergency Medicine, New York University School
of Medicine, New York, United States.
(Perrone J.) Department of Emergency Medicine, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States.
(Weiner S.G., sgweiner@partners.org) Department of Emergency Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
(Rathlev N.K.; Sanchez L.D.; Babineau M.; Griggs C.A.; Mitchell P.M.; Ma J.;
Hoch W.B.; Totten V.; Salzman M.S.; Karmakar R.; Iwanicki J.L.; Morgan B.W.;
Pomerleau A.C.; Delgado J.; Medoro A.; Whiteley P.; Offerman S.; Hemmert K.;
Lank P.M.; Thundiyil J.G.; Thomas A.; Chagani S.; Beaudoin F.L.; Friedman
F.D.; Cleveland N.; Jayathilaka K.; D'Onofrio G.; Naftilan M.; Koploy A.)
CORRESPONDENCE ADDRESS
S.G. Weiner, Department of Emergency Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, United States.
SOURCE
Annals of Emergency Medicine (2015) 66:3 (253-259.E1). Date of Publication:
1 Sep 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective Opioid pain reliever prescribing at emergency department
(ED) discharge has increased in the past decade but specific prescription
details are lacking. Previous ED opioid pain reliever prescribing estimates
relied on national survey extrapolation or prescription databases. The main
goal of this study is to use a research consortium to analyze the
characteristics of patients and opioid prescriptions, using a national
sample of ED patients. We also aim to examine the indications for opioid
pain reliever prescribing, characteristics of opioids prescribed both in the
ED and at discharge, and characteristics of patients who received opioid
pain relievers compared with those who did not. Methods This observational,
multicenter, retrospective, cohort study assessed opioid pain reliever
prescribing to consecutive patients presenting to the consortium EDs during
1 week in October 2012. The consortium study sites consisted of 19 EDs
representing 1.4 million annual visits, varied geographically, and were
predominantly academic centers. Medical records of all patients aged 18 to
90 years and discharged with an opioid pain reliever (excluding tramadol)
were individually abstracted by standardized chart review by investigators
for detailed analysis. Descriptive statistics were generated. Results During
the study week, 27,516 patient visits were evaluated in the consortium EDs;
19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and
17.0% of discharged patients) received an opioid pain reliever prescription.
For patients prescribed an opioid pain reliever, mean age was 41 years (SD
14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD
2.4). The most common diagnoses associated with opioid pain reliever
prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity
fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers
prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%).
Greater than 99% of pain relievers were immediate release and 90.0% were
combination preparations, and the mean and median number of pills was 16.6
(SD 7.6) and 15 (interquartile range 12 to 20), respectively. Conclusion In
a study of ED patients treated during a single week across the country, 17%
of discharged patients were prescribed opioid pain relievers. The majority
of the prescriptions had small pill counts and almost exclusively
immediate-release formulations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
hydrocodone (drug therapy)
hydromorphone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
aged
article
backache
cohort analysis
emergency ward
female
flank pain
headache
hospital discharge
human
limb fracture
major clinical study
male
medical record
medical record review
multicenter study
observational study
pain assessment
pill
priority journal
retrospective study
sprain
thorax pain
very elderly
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015004014
MEDLINE PMID
25952503 (http://www.ncbi.nlm.nih.gov/pubmed/25952503)
PUI
L604202881
DOI
10.1016/j.annemergmed.2015.03.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2015.03.026
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 453
TITLE
Impact of age, sex and route of administration on adverse events after
opioid treatment in the emergency department: A retrospective study
AUTHOR NAMES
Daoust R.
Paquet J.
Lavigne G.
Piette É.
Chauny J.-M.
AUTHOR ADDRESSES
(Daoust R., raoul.daoust@videotron.ca; Paquet J.; Piette É.; Chauny J.-M.)
Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de
Montréal, 5400 boul. Gouin Ouest, Montréal, Canada.
(Daoust R., raoul.daoust@videotron.ca; Piette É.; Chauny J.-M.) Faculty of
Medicine, Université de Montréal, Montréal, Canada.
(Paquet J.; Lavigne G.) Centre for Advanced Research in Sleep Medicine,
Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
(Lavigne G.) Faculties of Dental Medicine and Medicine, Université de
Montréal, Montréal, Canada.
CORRESPONDENCE ADDRESS
R. Daoust, Department of Emergency Medicine, Research Centre, Hôpital du
Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Canada. Email:
raoul.daoust@videotron.ca
SOURCE
Pain Research and Management (2015) 20:1 (23-28). Date of Publication: 1 Jan
2015
ISSN
1203-6765
BOOK PUBLISHER
Pulsus Group Inc., 410 Park Avenue, 15th Floor, 287 pmb, New York, United
States.
ABSTRACT
BACKGROUND: The efficacy of opioids for acute pain relief in the emergency
department (ED) is well recognized, but treatment with opioids is associated
with adverse events ranging from minor discomforts to life-threatening
events. OBJECTIVE: To assess the impact of age, sex and route of
administration on the incidence of adverse events due to opioid
administration in the ED. METHODS: Real-time archived data were analyzed
retrospectively in a tertiary care urban hospital. All consecutive patients
(≥16 years of age) who were assigned to an ED bed and received an opioid
between March 2008 and December 2012 were included. Adverse events were
defined as: nausea/vomiting (minor); systolic blood pressure (SBP) <90 mmHg,
oxygen saturation (Sat) <92% and respiration rate <10 breaths/min (major)
within 2 h of the first opioid doses. RESULTS: In the study period, 31,742
patients were treated with opioids. The mean (± SD) age was 55.8±20.5 years,
and 53% were female. The overall incidence of adverse events was 12.0% (95%
CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea/vomiting,
2.4% (95% CI 2.2% to 2.6%) SBP <90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that
dropped to <92% and 0.09% respiration rate <10 breaths/min. After
controlling for confounding factors, these adverse events were associated
with: female sex (more nausea/vomiting, more SBP <90 mmHg, less Sat <92%);
age ≥65 years (less nausea/vomiting, more SBP <90 mmHg, more Sat <92%); and
route of administration (intravenous > subcutaneous > oral). CONCLUSIONS:
The incidence of adverse events associated with opioid administration in the
ED is generally low and is associated with age, sex and route of
administration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug administration, drug therapy, intravenous drug
administration)
hydromorphone (drug administration, drug therapy, intravenous drug
administration, oral drug administration, subcutaneous drug administration)
morphine (adverse drug reaction, drug administration, drug therapy,
intravenous drug administration, oral drug administration, subcutaneous drug
administration)
oxycodone (drug administration, drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
age
analgesia
emergency ward
sex
EMTREE MEDICAL INDEX TERMS
aged
article
breathing rate
controlled study
drug efficacy
female
heart rate
hospital admission
human
incidence
length of stay
major clinical study
male
nausea and vomiting (side effect)
outcome assessment
oxygen saturation
pain (drug therapy)
retrospective study
systolic blood pressure
tachycardia (side effect)
vital sign
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2015715735
MEDLINE PMID
25664538 (http://www.ncbi.nlm.nih.gov/pubmed/25664538)
PUI
L602006862
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 454
TITLE
Feasibility of tablet computer screening for opioid abuse in the emergency
department
AUTHOR NAMES
Weiner S.G.
Horton L.C.
Green T.C.
Butler S.F.
AUTHOR ADDRESSES
(Weiner S.G., sgweiner@partners.org) Brigham and Women's Hospital,
Department of Emergency Medicine, 75 Francis Street, Neville House, Boston,
United States.
(Horton L.C.) Tufts University School of Medicine, Boston, United States.
(Green T.C.) Rhode Island Hospital, Department of Emergency Medicine,
Providence, United States.
(Green T.C.; Butler S.F.) Inflexxion, Inc., Newton, United States.
CORRESPONDENCE ADDRESS
S.G. Weiner, Brigham and Women's Hospital, Department of Emergency Medicine,
75 Francis Street, Neville House, Boston, United States. Email:
sgweiner@partners.org
SOURCE
Western Journal of Emergency Medicine (2015) 16:1 (18-23). Date of
Publication: 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Tablet computer-based screening may have the potential for
detecting patients at risk for opioid abuse in the emergency department
(ED). Study objectives were a) to determine if the revised Screener and
Opioid Assessment for Patients with Pain (SOAPP®-R), a 24-question
previously paper-based screening tool for opioid abuse potential, could be
administered on a tablet computer to an ED patient population; b) to
demonstrate that >90% of patients can complete the electronic screener
without assistance in <5 minutes and; c) to determine patient ease of use
with screening on a tablet computer. Methods: This was a cross-sectional
convenience sample study of patients seen in an urban academic ED. SOAPP®-R
was programmed on a tablet computer by study investigators. Inclusion
criteria were patients ages ≥18 years who were being considered for
discharge with a prescription for an opioid analgesic. Exclusion criteria
included inability to understand English or physical disability preventing
use of the tablet. Results: 93 patients were approached for inclusion and 82
(88%) provided consent. Fifty-two percent (n=43) of subjects were male; 46%
(n=38) of subjects were between 18-35 years, and 54% (n=44) were >35 years.
One hundred percent of subjects completed the screener. Median time to
completion was 148 (interquartile range 117.5-184.3) seconds, and 95% (n=78)
completed in <5 minutes. 93% (n=76) rated ease of completion as very easy.
Conclusions: It is feasible to administer a screening tool to a cohort of ED
patients on a tablet computer. The screener administration time is minimal
and patient ease of use with this modality is high.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
computer system
drug abuse
revised screener and opioid assessment for patients with pain
screening test
EMTREE MEDICAL INDEX TERMS
adult
article
emergency ward
female
high risk patient
human
major clinical study
male
middle aged
prescription
young adult
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015693996
MEDLINE PMID
25671003 (http://www.ncbi.nlm.nih.gov/pubmed/25671003)
PUI
L601732183
DOI
10.5811/westjem.2014.11.23316
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2014.11.23316
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 455
TITLE
The changing use of intravenous opioids in an emergency department
AUTHOR NAMES
Sutter M.E.
Wintemute G.J.
Clarke S.O.
Roche B.M.
Chenoweth J.A.
Gutierrez R.
Albertson T.E.
AUTHOR ADDRESSES
(Wintemute G.J.; Clarke S.O.) University of California, Davis, Department of
Emergency Medicine, Sacramento, United States.
(Sutter M.E., mesutter@ucdavis.edu; Roche B.M.; Chenoweth J.A.; Albertson
T.E.) University of California, Davis, Department of Emergency Medicine,
Division of Medical Toxicology, Sacramento, United States.
(Sutter M.E., mesutter@ucdavis.edu; Roche B.M.; Chenoweth J.A.; Albertson
T.E.) VA Northern California Health Care System, Mather, United States.
(Gutierrez R.) University of California, Davis, Department of Pharmacy,
United States.
(Albertson T.E.) University of California, Davis, Department of Internal
Medicine, Sacramento, United States.
CORRESPONDENCE ADDRESS
M.E. Sutter, UC Davis Medical Center, 2315 Stockton Blvd., Sacramento,
United States. Email: mesutter@ucdavis.edu
SOURCE
Western Journal of Emergency Medicine (2015) 16:7 (1079-1083). Date of
Publication: 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Government agencies are increasingly emphasizing opioid safety
in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) started a sentinel event program, the "Safe Use of
Opioids in Hospitals." We sought to determine if opioid use patterns in our
emergency department (ED) changed from 2011, before the program began, to
2013, after start of the program. Methods: This was a retrospective study of
all adult ED patients who received an intravenous opioid and had a serum
creatinine measured. We recorded opioids used, dose prescribed, and serum
creatinine. As an index of the safety of opioids, uses of naloxone after
administration of an opioid was recorded. Results: Morphine is still the
most commonly used opioid by doses given, but its percentage of opioids used
decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use
of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl
changed little (3.6% to 4.3%). Naloxone administration was rare after an
opioid had been given. Opioids were not dosed in an equipotent manner.
Conclusion: The use of hydromorphone in our ED increased by 56% (absolute
increase of 15.4%), while the use of morphine decreased by 30.5% (absolute
decrease 16.1%) of total opioid use from 2011 to 2013. The JCAHO program
likely was at least indirectly responsible for this change in relative
dosing of the opioids. Based on frequency of naloxone administered after
administration of an opioid, the use of opioids was safe.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, intravenous drug administration)
EMTREE DRUG INDEX TERMS
creatinine (endogenous compound)
fentanyl (drug dose)
hydromorphone (drug dose)
morphine (drug dose)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
EMTREE MEDICAL INDEX TERMS
adult
article
creatinine blood level
drug use
emergency medicine
female
human
major clinical study
male
CAS REGISTRY NUMBERS
creatinine (19230-81-0, 60-27-5)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160005169
MEDLINE PMID
26759658 (http://www.ncbi.nlm.nih.gov/pubmed/26759658)
PUI
L607454526
DOI
10.5811/westjem.2015.10.28454
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.10.28454
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 456
TITLE
Descriptive study of prescriptions for opioids from a Suburban Academic
Emergency Department before New York's I-STOP act
AUTHOR NAMES
Ung L.
Dvorkin R.
Sattler S.
Yens D.
AUTHOR ADDRESSES
(Ung L., lyncean.ung@gmail.com; Sattler S.) Good Samaritan Hospital Medical
Center, Department of Emergency Medicine, 1000 Montauk Hwy, West Islip,
United States.
(Dvorkin R.) Premier Care Physicians, Department of Emergency Medicine,
Bellmore, United States.
(Yens D.) New York Colleges of Osteopathic Medicine Educational Consortium,
New York, United States.
(Yens D.) Touro College of Osteopathic Medicine, Middletown, United States.
CORRESPONDENCE ADDRESS
L. Ung, Good Samaritan Hospital Medical Center, Department of Emergency
Medicine, 1000 Montauk Hwy, West Islip, United States. Email:
lyncean.ung@gmail.com
SOURCE
Western Journal of Emergency Medicine (2015) 16:1 (62-66). Date of
Publication: 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
Introduction: Controlled prescription opioid use is perceived as a national
problem attributed to all specialties. Our objective was to provide a
descriptive analysis of prescriptions written for controlled opioids from a
database of emergency department (ED) visits prior to the enactment of the
I-STOP law, which requires New York prescribers to consult the Prescription
Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV
controlled substances for prescriptions of greater than five days duration.
Methods: We conducted a retrospective medical record review of patients 21
years of age and older, who presented to the ED between July 1, 2011 - June
30, 2012 and were given a prescription for a controlled opioid. Our primary
purpose was to characterize each prescription as to the type of controlled
substance, the quantity dispensed, and the duration of the prescription. We
also looked at outliers, those patients who received prescriptions for
longer than five days. Results: A total of 9,502 prescriptions were written
for opioids out of a total 63,143 prescriptions for 69,500 adult patients.
Twenty-six (0.27%) of the prescriptions for controlled opioids were written
for greater than five days. Most prescriptions were for five days or less
(99.7%, 95% CI [99.6 to 99.8%]). Conclusion: The vast majority of opioid
prescriptions in our ED prior to the I-STOP legislature were limited to a
five-day or less supply. These new regulations were meant to reduce the ED's
contribution to the rise of opioid related morbidity. This study suggests
that the emergency physicians' usual prescribing practices were negligibly
limited by the new restrictive regulations. The ED may not be primarily
contributing to the increase in opioid-related overdoses and death. The
effect of the I-STOP regulation on future prescribing patterns in the ED
remains to be determined.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
controlled substance
opiate
EMTREE DRUG INDEX TERMS
fentanyl
hydrocodone
hydromorphone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
emergency ward
female
human
law
major clinical study
male
medical record review
United States
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015694003
MEDLINE PMID
25671010 (http://www.ncbi.nlm.nih.gov/pubmed/25671010)
PUI
L601732325
DOI
10.5811/westjem.2014.12.22669
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2014.12.22669
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 457
TITLE
Association of Emergency Department Opioid Initiation with Recurrent Opioid
Use
AUTHOR NAMES
Hoppe J.A.
Kim H.
Heard K.
AUTHOR ADDRESSES
(Hoppe J.A., jason.hoppe@ucdenver.edu; Kim H.; Heard K.) Department of
Emergency Medicine, University of Colorado, Denver School of Medicine,
Aurora, United States.
(Kim H.) Denver Health Residency in Emergency Medicine, Denver, United
States.
(Hoppe J.A., jason.hoppe@ucdenver.edu; Heard K.) Rocky Mountain Poison and
Drug Center, Denver, United States.
CORRESPONDENCE ADDRESS
J.A. Hoppe, Department of Emergency Medicine, University of Colorado, Denver
School of Medicine, Aurora, United States.
SOURCE
Annals of Emergency Medicine (2015) 65:5 (493-499). Date of Publication: 1
May 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective: Acute pain complaints are commonly treated in the emergency
department (ED). Short courses of opioids are presumed to be safe for acute
pain; however, the risk of recurrent opioid use after receipt of an ED
opioid prescription is unknown. We describe the risk of recurrent opioid use
in patients receiving an opioid prescription from the ED for an acute
painful condition. Methods: This is a retrospective cohort study of all
patients discharged from an urban academic ED with an acute painful
condition during a 5-month period. Clinical information was linked to data
from Colorado's prescription drug monitoring program. We compared
opioid-naive patients (no opioid prescription during the year before the
visit) who filled an opioid prescription or received a prescription but did
not fill it to those who did not receive a prescription. The primary outcome
was the rate of recurrent opioid use, defined as filling an opioid
prescription within 60 days before or after the first anniversary of the ED
visit. Results: Four thousand eight hundred one patients were treated for an
acute painful condition; of these, 52% were opioid naive and 48% received an
opioid prescription. Among all opioid-naive patients, 775 (31%) received and
filled an opioid prescription, and 299 (12%) went on to recurrent use. For
opioid-naive patients who filled a prescription compared with those who did
not receive a prescription, the adjusted odds ratio for recurrent use was
1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who
received a prescription but did not fill it compared with those who did not
receive a prescription, the adjusted odds ratio for recurrent use was 0.8
(95% confidence interval 0.5 to 1.3). Conclusion: Opioid-naive ED patients
prescribed opioids for acute pain are at increased risk for additional
opioid use at 1 year.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
controlled study
drug monitoring
female
hospital discharge
human
major clinical study
male
outcome assessment
pain (drug therapy)
prescription
priority journal
retrospective study
risk
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014618283
MEDLINE PMID
25534654 (http://www.ncbi.nlm.nih.gov/pubmed/25534654)
PUI
L601009361
DOI
10.1016/j.annemergmed.2014.11.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.11.015
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 458
TITLE
Legal changes to increase access to naloxone for opioid overdose reversal in
the United States
AUTHOR NAMES
Davis C.S.
Carr D.
AUTHOR ADDRESSES
(Davis C.S., cdavis@networkforphl.org) Network for Public Health Law, 3701
Wilshire Blvd. #750, Los Angeles, United States.
(Carr D., carr@healthlaw.org) Network for Public Health Law, 101 E. Weaver
St. #G-07, Carrboro, United States.
CORRESPONDENCE ADDRESS
C.S. Davis, Network for Public Health Law, 3701 Wilshire Blvd. #750, Los
Angeles, United States. Email: cdavis@networkforphl.org
SOURCE
Drug and Alcohol Dependence (2015) 157 (112-120). Date of Publication: 2015
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background: Opioid overdose, which has reached epidemic levels in the United
States, is reversible by administration of the medication naloxone. Naloxone
requires a prescription but is not a controlled substance and has no abuse
potential. In the last half-decade, the majority of states have modified
their laws to increase layperson access to the medication. Methods: We
utilized a structured legal research protocol to systematically identify and
review all statutes and regulations related to layperson naloxone access in
the United States that had been adopted as of September, 2015. Each law
discovered via this process was reviewed and coded by two trained legal
researchers. Results: As of September, 2015, 43 states and the District of
Columbia have passed laws intended to increase layperson naloxone access. We
categorized these laws into three domains: (1) laws intended to increase
naloxone prescribing and distribution, (2) laws intended to increase
pharmacy naloxone access, and (3) laws intended to encourage overdose
witnesses to summon emergency responders. These laws vary greatly across
states in such characteristics as the types of individuals who can receive a
prescription for naloxone, whether laypeople can dispense the medication,
and immunity provided to those who prescribe, dispense and administer
naloxone or report an overdose emergency. Conclusions: Most states have now
passed laws intended to increase layperson access to naloxone. While these
laws will likely reduce overdose morbidity and mortality, the cost of
naloxone and its prescription status remain barriers to more widespread
access.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
drug legislation
health care access
EMTREE MEDICAL INDEX TERMS
article
drug overdose
embryo
emergency care
emergency health service
government regulation
health care policy
human
law enforcement
medical practice
medical research
medical society
patient safety
political participation
prescription
priority journal
rescue personnel
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160242554
MEDLINE PMID
26507172 (http://www.ncbi.nlm.nih.gov/pubmed/26507172)
PUI
L609209992
DOI
10.1016/j.drugalcdep.2015.10.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2015.10.013
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 459
TITLE
Cocaine-induced agitated delirium: A case report and review
AUTHOR NAMES
Plush T.
Shakespeare W.
Jacobs D.
Ladi L.
Sethi S.
Gasperino J.
AUTHOR ADDRESSES
(Plush T.; Shakespeare W.; Jacobs D.; Ladi L.; Sethi S.; Gasperino J.,
james.gasperino@drexelmed.edu) Department of Medicine, Drexel University,
College of Medicine, 245 N. 15th Street, Philadelphia, United States.
CORRESPONDENCE ADDRESS
J. Gasperino, Department of Medicine, Drexel University, College of
Medicine, 245 N. 15th Street, Philadelphia, United States.
SOURCE
Journal of Intensive Care Medicine (2015) 30:1 (49-57). Date of Publication:
16 Jan 2015
ISSN
1525-1489 (electronic)
0885-0666
BOOK PUBLISHER
SAGE Publications Inc., claims@sagepub.com
ABSTRACT
Cocaine use continues to be a major public health problem in the United
States. Although many of the initial signs and symptoms of cocaine
intoxication result from increased stimulation of the sympathetic nervous
system, this condition can present as a spectrum of acuity from hypertension
and tachycardia to multiorgan system failure. Classic features of acute
intoxication include tachycardia, arterial vasoconstriction, enhanced
thrombus formation, mydriasis, psychomotor agitation, and altered level of
consciousness. At the extreme end of this toxidrome is a rare condition
known as cocaine-induced agitated delirium. This syndrome is characterized
by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic
changes frequently leading to death. We report a case of cocaine-induced
agitated delirium in a man who presented to our institution in a paradoxical
form of circulatory shock. Rapid evaluation, recognition, and proper
management enabled our patient not only to survive but also to leave the
hospital without neurologic sequelae.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
EMTREE DRUG INDEX TERMS
acetylcysteine (intravenous drug administration)
alcohol
benzodiazepine derivative
bilirubin (endogenous compound)
cannabinoid
creatine kinase (endogenous compound)
creatinine (endogenous compound)
dopamine
epinephrine
etomidate
fentanyl
heparin (intravenous drug administration)
levamisole
midazolam
naloxone
noradrenalin (intravenous drug administration)
paracetamol (rectal drug administration)
salicylic acid
sodium chloride
suxamethonium
troponin I (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitated delirium
cocaine dependence
delirium
restlessness
EMTREE MEDICAL INDEX TERMS
adult
African American
article
bradycardia
case report
computer assisted tomography
consciousness level
echocardiography
emergency health service
emergency ward
environmental temperature
Glasgow coma scale
hospital admission
human
hypotension
intensive care unit
male
mean arterial pressure
middle aged
multiple organ failure
nuclear magnetic resonance imaging
oliguria
recognition
renal replacement therapy
respiratory distress
rhabdomyolysis
shock
sinus tachycardia
tachypnea
thorax radiography
urine volume
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
bilirubin (18422-02-1, 635-65-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
creatine kinase (9001-15-4)
creatinine (19230-81-0, 60-27-5)
dopamine (51-61-6, 62-31-7)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
levamisole (14769-73-4, 16595-80-5)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
sodium chloride (7647-14-5)
suxamethonium (306-40-1, 71-27-2)
troponin I (77108-40-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014969756
MEDLINE PMID
24212597 (http://www.ncbi.nlm.nih.gov/pubmed/24212597)
PUI
L600771664
DOI
10.1177/0885066613507420
FULL TEXT LINK
http://dx.doi.org/10.1177/0885066613507420
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 460
TITLE
Drugs for the doctor's bag: 1-adults
AUTHOR ADDRESSES
SOURCE
Drug and Therapeutics Bulletin (2015) 53:5 (56-60). Date of Publication:
2015
ISSN
1755-5248 (electronic)
0012-6543
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
In the past, GPs carried a range of medicines for acute or emergency visits,
which is now less necessary where paramedics are trained and equipped, and
where emergency transfers to hospital are rapid. Indeed, acute services and
ambulance trusts in some areas may discourage GPs from attending emergencies
as it could delay patient transfers. However, there is still a need for some
GPs to carry a range of medicines for use in acute situations when on home
visits. What to include in the GP's bag is determined by the medical
conditions likely to be met; medicines the GP is confident and competent to
use; storage requirements and shelf-lives of drugs; ambulance paramedic
cover and the proximity of the nearest hospital. Here we suggest medicines
suitable for GPs for emergency or acute treatment of adult patients,
updating our previous advice and including the underlying guideline
recommendations for their use. A later article will cover treatment for
children. The intention is not to imply that every doctor should carry every
drug mentioned. Instead, we aim to highlight some of the key treatments and
suggest choices in some of the more common clinical scenarios that GPs may
have to deal with in everyday practice, which may be prior to referral to
secondary care. Each section ends with a list of drug recommendations for
the doctor's bag; drugs may be referred to in several sections but are only
listed in one section to avoid repetition. The article does not provide
recommendations for drugs to be stocked for use in routine clinical practice
in the surgery (e.g. for minor surgery) or for drugs to be held by
out-of-hours primary care services. Separate guidance and advice is
available on drugs suitable for use by those providing out-of-hours primary
care services. For example, in England a national out-of-hours core
formulary contains the minimum list of drugs that patients should be able to
access.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prescription drug
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
cefotaxime (drug therapy)
chlorpheniramine (drug therapy)
codeine (drug therapy)
cyclizine (drug therapy)
dexamethasone
diamorphine (drug therapy)
diazepam (drug therapy)
diclofenac (drug therapy)
epinephrine (drug therapy)
furosemide (drug therapy)
glucagon (drug therapy)
glucose (drug therapy)
glyceryl trinitrate (drug therapy)
hydrocortisone sodium phosphate (drug therapy)
hydrocortisone sodium succinate (drug therapy)
ibuprofen (drug therapy)
ketorolac
levomepromazine
metoclopramide (drug therapy)
midazolam (drug therapy)
naloxone (drug therapy)
paracetamol (drug therapy)
penicillin G (drug therapy)
prednisolone (drug therapy)
prochlorperazine (drug therapy)
salbutamol (drug therapy)
scopolamine butyl bromide
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
general practitioner
practice guideline
EMTREE MEDICAL INDEX TERMS
acute heart infarction (drug therapy)
adrenal insufficiency (drug therapy)
ampoule
analgesia
anaphylaxis (drug therapy)
angina pectoris (drug therapy)
antibiotic therapy
anticonvulsant therapy
article
asthma (drug therapy)
bacterial meningitis (drug therapy)
drug intoxication (drug therapy)
heart left ventricle failure (drug therapy)
human
hypoglycemia (drug therapy)
meningococcemia (drug therapy)
nausea and vomiting (drug therapy)
pain (drug therapy)
palliative therapy
patient information
seizure (drug therapy)
suppository
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
cefotaxime (63527-52-6, 64485-93-4)
chlorpheniramine (132-22-9)
codeine (76-57-3)
cyclizine (303-25-3, 5897-18-7, 82-92-8)
dexamethasone (50-02-2)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0, 80738-44-9)
hydrocortisone sodium phosphate (315-33-3, 3863-59-0, 6000-74-4)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketorolac (74103-06-3)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
penicillin G (1406-05-9, 61-33-6)
prednisolone (50-24-8)
prochlorperazine (58-38-8)
salbutamol (18559-94-9, 35763-26-9)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015055890
MEDLINE PMID
25977403 (http://www.ncbi.nlm.nih.gov/pubmed/25977403)
PUI
L604440816
DOI
10.1136/dtb.2015.5.0328
FULL TEXT LINK
http://dx.doi.org/10.1136/dtb.2015.5.0328
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 461
TITLE
A case of overdose via tattoo
AUTHOR NAMES
Borg R.
Ashton A.
AUTHOR ADDRESSES
(Borg R.; Ashton A., antony.ashton@hhft.nhs.uk) Hampshire Hospitals NHS
Foundation Trust, Basingstoke, United Kingdom.
CORRESPONDENCE ADDRESS
A. Ashton, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road,
Basingstoke, United Kingdom.
SOURCE
Journal of the Intensive Care Society (2015) 16:3 (253-256). Date of
Publication: 1 Aug 2015
ISSN
1751-1437
BOOK PUBLISHER
SAGE Publications Inc., claims@sagepub.com
ABSTRACT
Transdermal fentanyl patches are used frequently for the management of both
acute and chronic pain. Adverse events with their use, in particular
overdose, are not uncommon. We describe a case of fentanyl overdose from
transdermal patch placed over a five-day old tattoo. The report will review
the pharmacology of transdermal fentanyl and the physiology of tattooing, as
well as the potential link between the two, which may have lead to the
overdose.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
aciclovir
atorvastatin
ceftriaxone
citalopram (drug therapy)
fentanyl
lorazepam (drug combination, drug therapy)
naloxone (drug therapy)
naproxen (drug therapy)
phenytoin (drug combination, drug therapy)
tramadol (drug therapy)
valproic acid (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
tattoo
EMTREE MEDICAL INDEX TERMS
article
bipolar disorder (drug therapy)
case report
drug overdose
emergency ward
encephalitis
erythema (therapy)
human
hypertension
hypoventilation
low back pain (drug therapy)
male
non insulin dependent diabetes mellitus
oropharynx airway
respiratory acidosis
sedation
tattooing
transdermal patch
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
aciclovir (59277-89-3)
atorvastatin (134523-00-5, 134523-03-8)
ceftriaxone (73384-59-5, 74578-69-1)
citalopram (59729-33-8)
fentanyl (437-38-7)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
phenytoin (57-41-0, 630-93-3)
tramadol (27203-92-5, 36282-47-0)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015454400
PUI
L606496171
DOI
10.1177/1751143715574509
FULL TEXT LINK
http://dx.doi.org/10.1177/1751143715574509
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 462
TITLE
National Institutes of Health Pathways to Prevention Workshop: The role of
opioids in the treatment of chronic pain
AUTHOR NAMES
Reuben D.B.
Alvanzo A.A.H.
Ashikaga T.
Bogat G.A.
Callahan C.M.
Ruffing V.
Steffens D.C.
AUTHOR ADDRESSES
(Reuben D.B.) Division of Geriatrics, David Geffen School of Medicine,
University of California, Los Angeles, 10945 Le Conte Avenue, Los Angeles,
United States.
(Alvanzo A.A.H.) Johns Hopkins University School of Medicine, 1830 East
Monument Street, Baltimore, United States.
(Ashikaga T.) University of Vermont, Medical Biostatistics, 27 Hills
Building, 105 Carrigan Drive, Burlington, United States.
(Bogat G.A.) Department of Psychology, Michigan State University, 107E
Psychology Building, East Lansing, United States.
(Callahan C.M.) Indiana University Center for Aging Research, Regenstrief
Institute, Building HS2000, 410 West 10th Street, Indianapolis, United
States.
(Ruffing V.) Johns Hopkins University, 5501 Hopkins Bayview Circle, JHAAC
1B1, Baltimore, United States.
(Steffens D.C.) University of Connecticut Health Center, 263 Farmington
Avenue, Farmington, United States.
CORRESPONDENCE ADDRESS
D.B. Reuben, Division of Geriatrics, David Geffen School of Medicine,
University of California, Los Angeles, 10945 Le Conte Avenue, Los Angeles,
United States.
SOURCE
Annals of Internal Medicine (2015) 162:4 (295-300). Date of Publication: 17
Feb 2015
ISSN
1539-3704 (electronic)
0003-4819
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
ABSTRACT
This National Institutes of Health (NIH) Pathways to Prevention Workshop was
cosponsored by the NIH Office of Disease Prevention (ODP), the NIH Pain
Consortium, the National Institute on Drug Abuse, and the National Institute
of Neurological Disorders and Stroke. A multidisciplinary working group
developed the workshop agenda, and an evidence-based practice center
prepared an evidence report through a contract with the Agency for
Healthcare Research and Quality to facilitate the workshop discussion.
During the 1.5-day workshop, invited experts discussed the body of evidence,
and attendees had opportunities to provide comments during open discussion
periods. After weighing evidence from the evidence report, expert
presentations, and public comments, an unbiased, independent panel prepared
a draft report that identified research gaps and future research priorities.
The report was posted on the ODP Web site for 2 weeks for public comment.
This article is an abridged version of the panel's full report, which is
available at
https://prevention.nih.gov/programs-events/pathways-to-
prevention/workshops/opioids-chronic-pain/workshop-resources#finalreport.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, disease management, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
alternative medicine
analgesia
article
behavior therapy
emergency health service
evidence based practice center
falling
fracture (side effect)
health care system
heart infarction (side effect)
human
hypogonadism (side effect)
long term care
longitudinal study
methodology
national health organization
outcome assessment
patient assessment
physiotherapy
priority journal
quality of life
sensitivity and specificity
sexual dysfunction (side effect)
side effect (side effect)
workshop
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015773138
MEDLINE PMID
25581341 (http://www.ncbi.nlm.nih.gov/pubmed/25581341)
PUI
L602492476
DOI
10.7326/M14-2775
FULL TEXT LINK
http://dx.doi.org/10.7326/M14-2775
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 463
TITLE
Characteristics of high-cost patients diagnosed with opioid abuse
AUTHOR NAMES
Shei A.
Rice J.B.
Kirson N.Y.
Bodnar K.
Enloe C.J.
Birnbaum H.G.
Holly P.
Ben-Joseph R.
AUTHOR ADDRESSES
(Shei A., ashei@analysisgroup.com; Rice J.B.; Kirson N.Y.; Enloe C.J.;
Birnbaum H.G.) Analysis Group, Boston, United States.
(Bodnar K.) Clinton Health Access Initiative, Lusaka, Zambia.
(Holly P.; Ben-Joseph R.) Health Outcomes and Pharmacoeconomics, Purdue
Pharma, Stamford, United States.
CORRESPONDENCE ADDRESS
A. Shei, United States.
SOURCE
Journal of Managed Care and Specialty Pharmacy (2015) 21:10 (902-912). Date
of Publication: 2015
ISSN
2376-1032 (electronic)
2376-0540
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
BACKGROUND: Prescription opioid abuse is associated with substantial
economic burden, with estimates of incremental annual per-patient health
care costs of diagnosed opioid abuse exceeding $10,000 in prior literature.
A subset of patients diagnosed with opioid abuse has disproportionately high
health care costs, but little is known about the characteristics of these
patients. OBJECTIVE: To describe the characteristics of a subset of patients
diagnosed with opioid abuse with disproportionately high health care costs
to assist physicians and managed care organizations in targeting
interventions at the costliest patients. METHODS: This retrospective claims
data analysis identified patients aged 12 to 64 years diagnosed with opioid
abuse/dependence in the OptumHealth Reporting and Insights medical and
pharmacy claims database, Quarter 1 (Q1) 1999-Q1 2012. Inclusion criteria
required that patients had a diagnosis of opioid abuse during or after Q1
2006, no prior diagnoses of opioid abuse, and continuous non-HMO coverage
over an 18-month study period. The study period comprised a 12-month
observation period centered on the date of the first opioid abuse diagnosis
(index date) and a 6-month baseline period immediately preceding the
observation period. Patients in the top 20[%] of total health care costs in
the observation period were classified as "high-cost patients,"
and the remaining patients were classified as "lower-cost
patients." Patient characteristics, comorbidities, health care resource
use, and health care costs were compared between high-cost patients and
lower-cost patients using chi-square tests for dichotomous variables and
Wilcoxon rank-sum tests for continuous variables. In addition, multivariate
regression was used to assess the relationship between patient
characteristics in the baseline period and total health care costs in the
observation period among all patients diagnosed with opioid abuse. RESULTS:
9,291 patients diagnosed with opioid abuse met the inclusion criteria. The
20[%] of patients classified as high-cost patients accounted for
approximately two thirds of the total health care costs of patients
diagnosed with opioid abuse. Compared with lower-cost patients, high-cost
patients were older (42.5 vs. 36.1; P < 0.001) and more likely to be
female (55.9[%] vs. 42.9[%]; P < 0.001). They had a higher comorbidity
burden at baseline, as reflected in the Charlson Comorbidity Index (0.8 vs.
0.2; P < 0.001), and rates of conditions such as chronic pulmonary
disease (12.9[%] vs. 5.6[%]; P < 0.001) and mild/moderate diabetes
(8.4[%] vs. 3.4[%]; P < 0.001). High-cost patients also had higher rates
of nonopioid substance abuse diagnoses (12.4[%] vs. 8.9[%]; P < 0.001)
and psychotic disorders (26.5[%] vs. 13.6[%]; P < 0.001). In the
observation period, high-cost patients continued to have higher rates of
nonopioid substance abuse diagnoses (53.0[%] vs. 47.2[%]; P < 0.001) and
psychotic disorders (67.1[%] vs. 47.5[%]; P < 0.001). In addition, they
had greater medical resource use across all places of service (i.e.,
inpatient, emergency department, outpatient, drug/alcohol rehabilitation
facility, and other) compared with lower-cost patients. The mean observation
period health care costs of high-cost patients was $89,177 compared with
$11,653 for lower-cost patients (P < 0.001). Highcost patients had higher
medical costs linked to claims with an opioid abuse diagnosis in absolute
terms, but the share of total medical costs attributed to such claims was
lower among high-cost patients than among lower-cost patients. While many
baseline characteristics were found to have a statistically significant (P
< 0.05) association with observation period health care costs, only
27.3[%] of the variation in observation period health care costs was
explained by patient characteristics in the baseline period. CONCLUSIONS:
This study found that the costliest patients diagnosed with opioid abuse had
high rates of preexisting and concurrent chronic comorbidities and mental
health conditions, suggesting potential indicators for targeted intervention
and a need for greater awareness and screening of comorbid conditions.
Opioid abuse may exacerbate existing conditions and make it difficult for
patients to adhere to treatment plans for those underlying conditions.
Baseline patient characteristics explained only a small share of the
variation in observation period health care costs, however. Future research
should explore the degree to which other factors not captured in
administrative claims data (e.g., severity of abuse) can explain the wide
variation in health care costs among opioid abusers.
EMTREE DRUG INDEX TERMS
alcohol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
opiate addiction
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
Charlson Comorbidity Index
child
chronic lung disease
comorbidity
data base
diabetes mellitus
emergency ward
female
health care
hospital patient
human
major clinical study
male
managed care organization
pharmacy
physician
psychosis
retrospective study
substance abuse
CAS REGISTRY NUMBERS
alcohol (64-17-5)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160210274
MEDLINE PMID
26402390 (http://www.ncbi.nlm.nih.gov/pubmed/26402390)
PUI
L608970001
DOI
10.18553/jmcp.2015.21.10.902
FULL TEXT LINK
http://dx.doi.org/10.18553/jmcp.2015.21.10.902
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 464
TITLE
Opioid medication practices observed in chronic pain patients presenting for
all-causes to emergency departments: Prevalence and impact on health care
outcomes
AUTHOR NAMES
Ernst F.R.
Mills J.R.
Berner T.
House J.
Herndon C.
AUTHOR ADDRESSES
(Ernst F.R., fernst@indegenettm.com) Health Economics and Outcomes Research,
Indegene TTM, Kennesaw, United States.
(Mills J.R.) Research and Hospital Engagement, Charlotte, United States.
(House J.) Premier Research Services, Premier, Charlotte, United States.
(Berner T.) Baxalta, Bannockburn, United States.
(Herndon C.) Southern Illinois University, Edwardsville, United States.
CORRESPONDENCE ADDRESS
F.R. Ernst, Indegene TTM, United States.
SOURCE
Journal of Managed Care and Specialty Pharmacy (2015) 21:10 (925-936). Date
of Publication: 2015
ISSN
2376-1032 (electronic)
2376-0540
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
BACKGROUND: Chronic pain is a significant health problem that affects an
estimated 100 million American adults (aged = 18 years). Chronic pain
affects more individuals than heart disease, stroke, diabetes, and cancer
combined. Chronic pain sufferers cost up to $635 billion annually in medical
treatment and lost productivity. Opioids are commonly used to treat chronic
pain, but their metabolic interactions with concurrently prescribed
medications for concomitant disease burdens can affect potency and efficacy
of pain therapy. Additionally, misuse of short-acting opioids (SAOs) for
chronic pain versus breakthrough pain can create gaps in pain relief. These
potentially suboptimal prescribing practices may contribute to the high
economic impact associated with chronic pain. OBJECTIVE: To examine the
prevalence of suboptimal opioid therapy and the associated health care costs
resulting from these prescribing practices in real-world patients presenting
for all-causes to the emergency department (ED). METHODS: This retrospective
observational database cohort analysis used the linked Premier-Optum
database and included patients with ED visits from 2006 to 2010 having = 60
days supply of opioids in the 75 days prior to the visit. Suboptimal
prescribing practices were identified as patients with (a) drug-drug
exposures (DDEs), defined as cytochrome P-450 (CYP-450)-metabolized opioids
prescribed concurrently with CYP-450 inhibitors or inducers and/or (b)
monotherapy with SAOs. Comorbid conditions and principal diagnoses were
documented. Readmission rates to the ED and hospital within 72 hours as well
as = 30, = 45, = 60, and = 90 days were computed. Total costs for health
care were calculated, and reimbursement rates were normalized using 2011
Medicare severity diagnosis-related group (MS-DRG) and CPT-4 information.
Nonparametric bootstrapping to adjust for patient comorbidities was applied
to cost data. RESULTS: Of the 9,214 patients identified with chronic pain,
potentially suboptimal medication practices prior to the index ED visit were
found for 8,539 (92.6[%]) patients. These appeared to be corrected in 345
(4.0[%]) patients before leaving the ED. Of 675 (7.3[%]) patients without
prior DDE or exclusive use of SAOs, 345 (51.1[%]) patients were discharged
with one of these. Of the 8,352 patients who left the ED with DDE or
exclusive use of SAOs, 1,525 (18.3[%]) left with a DDE without exclusive SAO
use; 4,812 (57.6[%]) left with both DDE and exclusive SAO use; and 2,015
(24.1[%]) left with only exclusive SAO use. Only 862 (9.3[%]) patients from
the entire cohort left the ED without DDE or exclusive SAO use. Patients
identified with suboptimal opioid use were aged 50 ± 13.5 years and
were predominantly female (64.0[%]). Hypertension (44.0[%]), fluid and
electrolyte disorders (32.7[%]), chronic pulmonary disease (22.8[%]),
depression (19.6[%]), diabetes without chronic complications (16.2[%]), and
drug abuse (15.6[%]) were the most prevalent comorbid conditions identified.
The most prevalent principal diagnoses involved symptoms and signs of
ill-defined conditions (36.5[%]), injury and poisoning (18.2[%]), and
diseases of the musculoskeletal system (13.2[%]). The majority of revisits
to the ED and hospital admissions occurred within 72 hours (73.6[%]) of the
index visit and within 30 days (70[%]), respectively. When adjusted total
costs were compared for all patients whose opioid use included DDE versus
those without, a significantly greater cost (P < 0.05) was observed at
every time period except = 72 hours. Respective mean increases in costs were
$581, $689, $773, and $1,275 at 30, 45, 60, and 90 days. Exclusive SAO use
with or without DDE resulted in a significant increase (P < 0.05) in mean
costs at all times: $214 at 72 hours; $836 at 30 days; $1,023 at 45 days;
$1,022 at 60 days; and $1,536 at 90 days. CONCLUSIONS: This study identified
potentially suboptimal opioid prescribing practices in a real-world
population presenting for all-causes to the ED. The observed rate of ED
revisits and inpatient admissions in these patients was associated with
increased health care costs. These findings suggest that the ED has the
future potential to serve as an ideal setting to identify and correct such
practices, thereby improving patient care and reducing resource use and
beneficiary costs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug combination, drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
cytochrome P450 inducer (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
clinical practice
emergency ward
health care
health care cost
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
bootstrapping
chronic lung disease
cohort analysis
comorbidity
data base
depression
disease severity
drug abuse
drug cost
drug exposure
drug safety
electrolyte disturbance
female
hospital admission
hospital discharge
hospital readmission
human
hypertension
injury
major clinical study
male
medicare
medication therapy management
middle aged
monotherapy
musculoskeletal system
patient care
prevalence
reimbursement
resource allocation
retrospective study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160210275
MEDLINE PMID
26402391 (http://www.ncbi.nlm.nih.gov/pubmed/26402391)
PUI
L608970002
DOI
10.18553/jmcp.2015.21.10.925
FULL TEXT LINK
http://dx.doi.org/10.18553/jmcp.2015.21.10.925
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 465
TITLE
Rhabdomyolysis associated with opiate abuse: A case report
AUTHOR NAMES
Gülpembe M.
Acar D.
Akilli N.B.
Çalik S.G.
Günaydin Y.K.
Köylü R.
Cander B.
AUTHOR ADDRESSES
(Gülpembe M.; Acar D., dr_demetacar@hotmail.com; Akilli N.B.; Çalik S.G.;
Günaydin Y.K.; Köylü R.) Department of Emergency Medicine, Konya Training
and Research Hospital, Konya, Turkey.
(Cander B.) Department of Emergency Medicine, Necmettin Erbakan University
Faculty of Medicine, Konya, Turkey.
CORRESPONDENCE ADDRESS
D. Acar, Department of Emergency Medicine, Konya Training and Research
Hospital, Konya, Turkey.
SOURCE
Akademik Acil Tip Olgu Sunumlari Dergisi (2015) 6:1 (13-15). Date of
Publication: 2015
ISSN
2146-2925 (electronic)
1309-534X
BOOK PUBLISHER
AVES Ibrahim Kara, 105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul, Turkey.
info@avesyayincilik.com
ABSTRACT
Introduction: There are several complications associated with opiate abuse,
including respiratory suppression, disturbance of consciousness, aspiration
pneumonia, pulmonary edema, myocarditis, rhabdomyolysis, and compartment
syndrome. Some of these complications may be life-threatening. Case Report:
Herein, we present a case of rhabdomyolysis due to opiate abuse in a young
man. Rhabdomyolysis is a known but rare complication of intravenous opiate
abuse. Conclusion: Because rhabdomyolysis may be life-threatening, and
prompt diagnosis and treatment are essential, physicians should be aware of
this complication among opioid addicts.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
carvedilol (drug therapy, oral drug administration)
ceftriaxone (intravenous drug administration)
clopidogrel (drug therapy)
creatine kinase MB (endogenous compound)
enoxaparin (drug therapy, subcutaneous drug administration)
hemoglobin (endogenous compound)
troponin I (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
rhabdomyolysis (complication, diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
acute coronary syndrome (drug therapy)
adult
antibiotic prophylaxis
arterial gas
article
blood pressure
body temperature
case report
clinical examination
computer assisted tomography
echography
emergency ward
fever
fluid resuscitation
focal glomerulosclerosis (diagnosis)
heart rate
hematoma
hematuria
hemoglobin blood level
hospital admission
hospital discharge
human
intensive care unit
kidney function
leukocyte count
male
metabolic acidosis
muscle weakness
neuroimaging
neurologic examination
nuclear magnetic resonance imaging
patient transport
protein blood level
respiratory acidosis
tachycardia
toxicology
treatment outcome
unconsciousness
urinalysis
urine volume
young adult
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
carvedilol (72956-09-3)
ceftriaxone (73384-59-5, 74578-69-1)
clopidogrel (113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8)
enoxaparin (679809-58-6)
hemoglobin (9008-02-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
troponin I (77108-40-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Turkish
EMBASE ACCESSION NUMBER
2015229079
PUI
L605380096
DOI
10.5152/jaemcr.2015.746
FULL TEXT LINK
http://dx.doi.org/10.5152/jaemcr.2015.746
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 466
TITLE
Case series of heroin-induced non-cardiac pulmonary oedema
AUTHOR NAMES
Arslan E.D.
Büyükcam F.
Avcı S.
Genç S.
Demir Ö.F.
Usul E.
Birgi E.
Aydın M.
Özkan S.
AUTHOR ADDRESSES
(Arslan E.D.; Büyükcam F., fatihbuyukcam@gmail.com; Avcı S.; Genç S.; Demir
Ö.F.; Usul E.; Aydın M.; Özkan S.) Department of Emergency Medicine, Diskapi
Yildirim Beyazit Education and Research Hospital, Altindag, Turkey.
(Birgi E.) Department of Radiology, Diskapi Yildirim Beyazit Education and
Research Hospital, Altindag, Turkey.
CORRESPONDENCE ADDRESS
F. Büyükcam, Department of Emergency Medicine, Dıskapı Education and
Research Hospital, İrfan Bastug Street, Altindag, Turkey. Email:
fatihbuyukcam@gmail.com
SOURCE
Heroin Addiction and Related Clinical Problems (2015) 17:6 (17-22). Date of
Publication: 1 Dec 2015
ISSN
1592-1638
BOOK PUBLISHER
Pacini Editore S.p.A., Via A. Gherardesca 1, Ospedaletto (Pisa), Italy.
ABSTRACT
Background. Heroin usage is a significant health care problem in many
countries. It can cause altered mental status, and even induce respiratory
depression. Respiratory manifestations are generally caused by exacerbation,
pulmonary oedema and respiratory distress. In this study we report eleven
cases of patients that were admitted to an emergency department with
dyspnoea in a ten-month period. Methods. The age, gender, past medical
history, laboratory results and radiological images were collected
retrospectively. Results. The median age of the patients was 27 (range:
21-70). Naloxone was administered to three of the patients because of
respiratory depression. Mean WBC count was 20136±8773. 10 out of 11 patients
had abnormal chest x-ray findings: 8 of them had peribronchial thickening, 6
had consolidation. Chest computed tomography (CT) was obtained from 10 of
the patients; in 7 of them peribronchial thickening and ground glass
densities were detected. None of the patients were intubated. All of the
patients but one left the emergency department in the first 24 hours. One of
the patients was hospitalized; in the first 48 hours significant improvement
was seen and on the 7th day after admission his chest CT was completely
normal. Conclusions. Heroin addiction not only causes respiratory depression
but also marked pulmonary oedema at an early phase. Patients with pulmonary
oedema due to heroin use may respond well to supportive therapy, including
oxygenation via a face mask or mechanical ventilation; in heroin users it
should, however, be considered as an alarming predictor of upcoming
fatalities.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heroin dependence
lung edema (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
auditory system parameters
clinical article
computer assisted tomography
consciousness disorder
controlled study
dyspnea
emergency ward
female
gorung glass density
ground glass density
hospital patient
human
male
middle aged
neutrophil count
peribronchial thickening
priority journal
respiration depression (drug therapy)
retrospective study
thorax radiography
young adult
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015530345
PUI
L607009178
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 467
TITLE
Timing of opioid administration as a quality indicator for pain crises in
sickle cell disease
AUTHOR NAMES
Mathias M.D.
McCavit T.L.
AUTHOR ADDRESSES
(Mathias M.D.) Department of Pediatrics, Memorial Sloan-Kettering Cancer
Center, New York, United States.
(McCavit T.L., tim.mccavit@childrens.com) Division of Hematology-Oncology,
Department of Pediatrics, University of Texas Southwestern Medical Center at
Dallas, 5323 Harry Hines Blvd, Dallas, United States.
(McCavit T.L., tim.mccavit@childrens.com) Center for Cancer and Blood
Disorders, Children's Medical Center Dallas, Dallas, United States.
CORRESPONDENCE ADDRESS
T.L. McCavit, Division of Hematology-Oncology, Department of Pediatrics,
University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, United States.
SOURCE
Pediatrics (2015) 135:3 (475-482). Date of Publication: 1 Mar 2015
ISSN
1098-4275 (electronic)
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
BACKGROUND AND OBJECTIVE: Time to opioid administration (TTO) has been
suggested as a quality of care measure for sickle cell disease patients with
vaso-occlusive crisis (VOC). We sought to determine whether TTO was
associated with outcomes of emergency department (ED) visits for VOC.
METHODS: We conducted a single-center retrospective cohort study of ED
visits for VOC. The primary outcome was hospital admission, with secondary
outcomes of change between the first 2 pain scores, area under the curve
(AUC) for pain scores at 4 hours (pain score AUC), total ED length of stay,
and total intravenous opioids. In both univariate and multivariate analyses,
mixed regression (logistic for admission, linear for secondary outcome
variables) was used to evaluate association of TTO with outcome. RESULTS: In
177 subjects, 414 ED visits for VOC were identified. Inpatient admission
occurred in 53% of visits. The median TTO for admitted patients was 86
minutes vs 87 minutes for those not admitted. TTO was not associated with
inpatient admission in either univariate or multivariate analyses. In
multivariate analyses with secondary outcomes, decreased TTO was associated
with greater improvement between the first 2 pain scores, decreased pain
score AUC, decreased total ED length of stay, and increased total opioids.
CONCLUSIONS: Although TTO was not associated with admission, it was
independently associated with 4 important secondary outcomes: change in
initial pain scores, pain score AUC, total ED length of stay, and total
intravenous opioids. The association of a process measure, TTO, with these
outcomes encourages the institution of TTO reduction efforts in the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, intravenous drug administration, parenteral drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care quality
sickle cell anemia (drug therapy, drug therapy)
time to treatment
EMTREE MEDICAL INDEX TERMS
adolescent
article
child
cohort analysis
emergency care
female
hospital admission
human
length of stay
major clinical study
male
outcome assessment
pain assessment
priority journal
retrospective study
treatment response
vaso occlusive crisis
vaso occlusive crisis (drug therapy)
vein occlusion (drug therapy)
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Hematology (25)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015812427
MEDLINE PMID
25667245 (http://www.ncbi.nlm.nih.gov/pubmed/25667245)
PUI
L602859475
DOI
10.1542/peds.2014-2874
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2014-2874
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 468
TITLE
Extracorporeal membrane oxygenation rewarming in the ED: An opportunity for
success
AUTHOR NAMES
Ginty C.
Srivastava A.
Rosenbloom M.
Fowler S.
Filippone L.
AUTHOR ADDRESSES
(Ginty C., kateginty@gmail.com; Filippone L.,
filippone-lisa@cooperhealth.edu) Department of Emergency Medicine, Cooper
Medical School of Rowan University, Cooper University Hospital, One Cooper
Plaza, Camden, United States.
(Srivastava A., draksmd@outlook.com) Department of Emergency Medicine,
University of Cincinnati, College of Medicine, 231 Albert Sabin Way,
Cincinnati, United States.
(Rosenbloom M., rosenbloom-michael@cooperhealth.edu) Department of Surgery,
Cooper Medical School of Rowan University, Cooper University Hospital, One
Cooper Plaza, Camden, United States.
(Fowler S., salfowler@hotmail.com) Cooper University Hospital, Heart
Institute, Cardiovascular Perfusion, United States.
CORRESPONDENCE ADDRESS
C. Ginty, Cooper University Hospital, Department of Emergency Medicine, One
Cooper Plaza Kelemen 152, Camden, United States.
SOURCE
American Journal of Emergency Medicine (2015) 33:6 (857.e1-e857.e2). Date of
Publication: 1 Jun 2015
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
On average, approximately 1300 Americans die of hypothermia each year [1].
Although accidental hypothermia is commonly associatedwith severely cold
regions or mountain accident victims, hypothermia also commonly occurs in
urban centers. Contributing factors often include homelessness, mental
illness, and substance abuse [2]. Hypothermia can profoundly affect the
cardiovascular system. As the myocardium cools, the conduction systemslows
down,which results in prolongation of the QT interval as well as propensity
for arrhythmias. Eventually, bradycardia, atrial fibrillation, and
ventricular fibrillation (VF) can develop [3]. The risk of cardiac arrest
increases as the core temperature drops below 32°C and increases
substantially when less than 28°C [2].
EMTREE DRUG INDEX TERMS
bicarbonate (endogenous compound)
epinephrine
hot water
lactic acid (endogenous compound)
naloxone
potassium (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
extracorporeal oxygenation
heart arrest (therapy)
hypothermia (therapy)
hypothermic cardiac arrest (therapy)
intensive care
EMTREE MEDICAL INDEX TERMS
apnea
arterial gas
article
cardiopulmonary bypass
case report
chest tube
cold
core temperature
defibrillation
emergency health service
emergency ward
endotracheal tube
Foley balloon catheter
human
lactate blood level
lavage
male
medical procedures
peritoneal catheter
potassium blood level
priority journal
resuscitation
sinus rhythm
thoracotomy
thorax surgery
winter
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
lactic acid (113-21-3, 50-21-5)
naloxone (357-08-4, 465-65-6)
potassium (7440-09-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014618354
MEDLINE PMID
25534814 (http://www.ncbi.nlm.nih.gov/pubmed/25534814)
PUI
L601009548
DOI
10.1016/j.ajem.2014.11.045
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2014.11.045
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 469
TITLE
Penetrating aortic injury due to a projectile from a lawn mower
AUTHOR NAMES
Gaillard J.
Joines J.B.
Coker A.C.
AUTHOR ADDRESSES
(Gaillard J.; Joines J.B.; Coker A.C.) Department of Emergency Medicine,
Wake Forest Baptist Health, 300 Medical Center Boulevard, Winston Salem,
United States.
CORRESPONDENCE ADDRESS
J. Gaillard, Department of Emergency Medicine, Wake Forest Baptist Health,
300 Medical Center Boulevard, Winston Salem, United States.
SOURCE
Journal of Emergency Medicine (2015) 49:2 (188-191). Date of Publication: 1
Aug 2015
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aortic trauma (etiology)
thorax penetrating trauma (etiology)
EMTREE MEDICAL INDEX TERMS
adult
aortic dissection
article
case report
computed tomographic angiography
computer assisted tomography
descending aorta
diaphoresis
differential diagnosis
emergency physician
emergency ward
extracorporeal circulation
faintness
foreign body
heart tamponade
hematoma
hematothorax
human
male
mediastinum disease
neurologic disease
priority journal
somnolence
ST segment elevation
ST segment elevation myocardial infarction
thorax radiography
thorax surgery
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
General Pathology and Pathological Anatomy (5)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015054127
PUI
L604434270
DOI
10.1016/j.jemermed.2015.02.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2015.02.015
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 470
TITLE
Impact of armed conflicts and warfare on opioid substitution treatment in
Ukraine: Responding to emergency needs
AUTHOR NAMES
Filippovych S.
AUTHOR ADDRESSES
(Filippovych S., Fil2006@bigmir.net) International HIV/AIDS Alliance,
Ukraine.
CORRESPONDENCE ADDRESS
S. Filippovych, International HIV/AIDS Alliance, Ukraine.
SOURCE
International Journal of Drug Policy (2015) 26:1 (3-5). Date of Publication:
1 Jan 2015
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
methadone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
conflict
emergency care
health care need
opiate substitution treatment
war
EMTREE MEDICAL INDEX TERMS
case manager
editorial
government
health program
health service
high risk population
human
Human immunodeficiency virus infection
intravenous drug abuse
mental health
migration
opiate addiction (drug therapy)
politics
Ukraine
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014624909
MEDLINE PMID
25483411 (http://www.ncbi.nlm.nih.gov/pubmed/25483411)
PUI
L601042157
DOI
10.1016/j.drugpo.2014.11.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2014.11.005
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 471
TITLE
Overdose risk perceptions and experience of overdose among heroin users in
Cork, Ireland. Preliminary results from a pilot overdose prevention study
AUTHOR NAMES
Horan J.A.
Deasy C.
Henry K.
O’Brien D.
Van Hout M.C.
AUTHOR ADDRESSES
(Horan J.A.; O’Brien D.) Arbour House, HSE Addiction Services, Cork,
Ireland.
(Deasy C.) Emergency Medicine, Cork University Hospital, Ireland.
(Deasy C.) National Ambulance Service, Ireland.
(Henry K.) HSE Ambulance Service, Cork, Ireland.
(Van Hout M.C., mcvanhout@wit.ie) School of Health Sciences, Waterford
Institute of Technology, Waterford, Ireland.
CORRESPONDENCE ADDRESS
M.C. Van Hout, School of Health Sciences, Waterford Institute of Technology,
Waterford, Ireland.
SOURCE
Heroin Addiction and Related Clinical Problems (2015) 17:5 (19-26). Date of
Publication: 2015
ISSN
1592-1638
BOOK PUBLISHER
Pacini Editore S.p.A., Via A. Gherardesca 1, Ospedaletto (Pisa), Italy.
ABSTRACT
Background. Opioid overdose is the primary cause of death among injecting
drug users (IDU). Overdose is generally not sudden, occurs over one to three
hours, and often in the presence of bystanders. This presents a unique
window of opportunity to intervene. Aim. Successful overdose prevention
training includes appropriate clinical and non-clinical responses. The study
aimed to investigate Irish IDU experience of overdose, and need for
education and resuscitation skills programming. We report on pilot findings.
Methods. Phase One assessed service user experience of overdose, substances
used, setting for overdose, and awareness of appropriate non-clinical
responses (n=52). Phase two implemented an educational intervention at two
Cork addiction service sites. This involved assessing service user awareness
of appropriate non-clinical methods to manage overdose and their interest in
receiving resuscitation training (n=26). Phase three piloted a resuscitation
skills training intervention for staff, family and IDU consisting of
instruction on how to recognise and prevent overdose, appropriate response
techniques; rescue breathing, and calling emergency services (n=26).
Results. The findings illustrated the majority had experienced overdose,
described the main substances involved, the settings, the responses
employed, and the perceptions of risk. The need for education equipping IDU
with overdose prevention and management skills was identified. Awareness of
appropriate responses (correct emergency numbers, recovery and resuscitation
skills) improved following the educational and skills training
interventions. Conclusions. Continued efforts in Ireland to integrate
culturally specific overdose prevention into agonist opioid treatment
services, prison discharge, homeless primary health and needle and syringe
exchange are warranted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
amphetamine (drug toxicity)
benzodiazepine derivative (drug toxicity)
cannabis (drug toxicity)
cocaine (drug toxicity)
codeine (drug toxicity)
dextropropoxyphene plus paracetamol (drug toxicity)
illicit drug (drug toxicity)
methadone (drug therapy, drug toxicity)
midomafetamine (drug toxicity)
naloxone (drug therapy)
paracetamol (drug toxicity)
psychotropic agent (drug toxicity)
tramadol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy, prevention)
education program
health care need
health education
heroin dependence
resuscitation
skill
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
awareness
competence
drug dependence (drug therapy)
emergency health service
family attitude
fatality
female
human
injecting drug user
Ireland
major clinical study
male
named groups of persons
patient assessment
personal experience
pilot study
preventive health service
priority journal
public health service
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
dextropropoxyphene plus paracetamol (39400-85-6)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015477988
PUI
L606659718
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 472
TITLE
Focused use of drug screening in overdose patients increases impact on
management
AUTHOR NAMES
Erdmann A.
Werner D.
Hugli O.
Yersin B.
AUTHOR ADDRESSES
(Erdmann A., andreas.erdmann@chuv.ch; Hugli O.; Yersin B.) Emergency
Department, University Hospital (CHUV), Lausanne, Switzerland.
(Werner D.) Laboratory of Clinical Chemistry, University Hospital (CHUV),
Lausanne, Switzerland.
(Erdmann A., andreas.erdmann@chuv.ch) Angiology Department, University
Hospital (CHUV), Lausanne, Switzerland.
CORRESPONDENCE ADDRESS
A. Erdmann, Service d'Angiologie, University Hospital (CHUV), Lausanne,
Switzerland. Email: andreas.erdmann@chuv.ch
SOURCE
Swiss Medical Weekly (2015) 145 Article Number: w14242. Date of Publication:
2015
ISSN
1424-3997 (electronic)
1424-7860
BOOK PUBLISHER
EMH Swiss Medical Publishers Ltd., verlag@emh.ch
ABSTRACT
Drug poisoning is a common cause for attendance in the emergency department.
Several toxicology centres suggest performing urinary drug screens, even
though they rarely influence patient management. STUDY OBJECTIVES: Measuring
the impact on patient management, in a University Emergency Department with
approximately 40 000 admissions annually, of a rapid urinary drug screening
test using specifically focused indications. Drug screening was restricted
to patients having a first psychotic episode or cases demonstrating
respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe
opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia,
acquired long QT or QRS >100 ms, and high-degree heart block. METHODS:
Retrospective analysis of Triage® TOX drug screen tests performed between
September 2009 and November 2011, and between January 2013 and March 2014.
RESULTS: A total of 262 patients were included, mean age 35 ± 14.6 (standard
deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths.
Indications for testing were as follows: 34% were first psychotic episodes;
20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic
toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular
arrhythmias or acquired long QT intervals on electrocardiogram. A total of
78% of the tests were positive (median two substances, maximum five). The
test resulted in drug-specific therapy in 6.1%, drug specific diagnostic
tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests,
and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient
management. CONCLUSIONS: In contrast to previous studies showing modest
effects of toxicological testing, restricted use of rapid urinary drug
testing increases the impact on management of suspected overdose patients in
the ED.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
benzodiazepine derivative (drug toxicity)
cannabinoid
cocaine (drug toxicity)
diphenhydramine
flumazenil (drug therapy)
methadone (drug toxicity)
methamphetamine (drug toxicity)
naloxone (drug therapy)
opiate (drug toxicity)
paracetamol (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis)
drug screening
patient care
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
biochemical equipment
coma
diagnostic test
drug intoxication (drug therapy, etiology)
emergency ward
female
heart block
heart ventricle arrhythmia
hospital admission
human
hypotension
long QT syndrome
major clinical study
male
psychosis
QRS interval
respiratory failure
retrospective study
screening test
seizure
toxicity testing
university hospital
urinalysis
DEVICE TRADE NAMES
Triage TOX drug screen , United StatesBiosite
DEVICE MANUFACTURERS
(United States)Biosite
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160588684
MEDLINE PMID
26709671 (http://www.ncbi.nlm.nih.gov/pubmed/26709671)
PUI
L611554116
DOI
10.4414/smw.2015.14242
FULL TEXT LINK
http://dx.doi.org/10.4414/smw.2015.14242
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 473
TITLE
Part 10: Special circumstances of resuscitation: 2015 American Heart
Association guidelines update for cardiopulmonary resuscitation and
emergency cardiovascular care
AUTHOR NAMES
Lavonas E.J.
Drennan I.R.
Gabrielli A.
Heffner A.C.
Hoyte C.O.
Orkin A.M.
Sawyer K.N.
Donnino M.W.
AUTHOR ADDRESSES
(Lavonas E.J.; Drennan I.R.; Gabrielli A.; Heffner A.C.; Hoyte C.O.; Orkin
A.M.; Sawyer K.N.; Donnino M.W.)
SOURCE
Circulation (2015) 132:18 Supplement12 (S501-S518). Date of Publication: 20
Oct 2015
ISSN
1524-4539 (electronic)
0009-7322
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
EMTREE DRUG INDEX TERMS
lipid emulsion
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
article
cesarean section
disease association
drug intoxication
drug overdose
first aid
heart arrest
human
lung embolism
medical society
patient education
patient positioning
percutaneous coronary intervention
pregnancy
priority journal
respiratory arrest
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015474188
MEDLINE PMID
26472998 (http://www.ncbi.nlm.nih.gov/pubmed/26472998)
PUI
L606628157
DOI
10.1161/CIR.0000000000000264
FULL TEXT LINK
http://dx.doi.org/10.1161/CIR.0000000000000264
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 474
TITLE
Hemiplegia and Headache: a Review of Hemiplegia in Headache Disorders
AUTHOR NAMES
Lopez J.I.
Holdridge A.
Rothrock J.F.
AUTHOR ADDRESSES
(Lopez J.I., jlopez@renown.org; Rothrock J.F., jrothrock@renown.org)
Department of Neurology, University of Nevada, 75 Pringle Way, Suite 401,
Reno, United States.
(Holdridge A., ashley.holdridge@lumc.edu) Loyola University Health Systems,
2160 S. First Avenue, Maywood, United States.
CORRESPONDENCE ADDRESS
J.I. Lopez, Department of Neurology, University of Nevada, 75 Pringle Way,
Suite 401, Reno, United States.
SOURCE
Current Pain and Headache Reports (2015) 19:2. Date of Publication: 2015
ISSN
1534-3081 (electronic)
1531-3433
BOOK PUBLISHER
Current Medicine Group LLC 1, info@phl.cursci.com
ABSTRACT
The most common scenario wherein the practicing neurologist is likely to
encounter a patient with headache and hemiplegia will vary depending on
his/her specific type of practice. A neurologist providing consultative
service to an emergency department is far more likely to see patients with
“secondary” headache and hemiplegia in the setting of either ischemic or
hemorrhagic stroke than hemiplegia as a transient feature of a primary
headache disorder. Neurologists subspecializing in headache medicine who
practice in a tertiary referral headache clinic are more likely to encounter
hemiplegic migraine, but even in that clinical setting hemiplegic migraine
is by no means a frequent diagnosis. The acute onset of hemiplegia can be
very frightening not only to the patient but also to the medical personnel.
Given the abundance of mimicry, practitioners must judiciously ascertain the
correct diagnosis as treatment may greatly vary depending on the cause of
both headache and hemiplegia. In this review, we will address the most
common causes of hemiplegia associated with headache.
EMTREE DRUG INDEX TERMS
acetazolamide (drug therapy)
candesartan (drug therapy)
flunarizine (drug therapy)
lamotrigine (drug therapy)
naloxone (drug therapy)
propranolol (drug therapy)
topiramate (drug therapy)
triptan derivative (drug therapy)
valproic acid (drug therapy)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
headache
hemiplegia
EMTREE MEDICAL INDEX TERMS
acquired immune deficiency syndrome
artery dissection
brain abscess
brain artery aneurysm
brain hemorrhage
brain ischemia
brain metastasis
brain tumor
brain vasospasm
CADASIL
carotid artery injury
cerebral sinus thrombosis
clinical feature
disease association
disease classification
drug contraindication
drug safety
epidural hematoma
familial hemiplegic migraine (drug therapy)
head injury
human
MELAS syndrome
migraine with aura
migrainous infarction
neuroimaging
nuclear magnetic resonance imaging
posttraumatic headache
primary headache
primary tumor
prophylaxis
reversible cerebral vasoconstriction syndrome
review
secondary headache
sporadic hemiplegic migraine (drug therapy)
spreading cortical depression
subarachnoid hemorrhage
subdural hematoma
toxoplasmosis
transient ischemic attack
CAS REGISTRY NUMBERS
acetazolamide (1424-27-7, 59-66-5)
candesartan (139481-59-7)
flunarizine (30484-77-6, 52468-60-7)
lamotrigine (84057-84-1)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
topiramate (97240-79-4)
valproic acid (1069-66-5, 99-66-1)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014983127
PUI
L600793270
DOI
10.1007/s11916-014-0471-y
FULL TEXT LINK
http://dx.doi.org/10.1007/s11916-014-0471-y
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 475
TITLE
Serotonin syndrome and opioids - What's the deal?
AUTHOR NAMES
Jhun P.
Bright A.
Herbert M.
AUTHOR ADDRESSES
(Jhun P., paul.jhun@ucsf.edu) Department of Emergency Medicine, University
of California San Francisco, San Francisco, United States.
(Bright A.; Herbert M.) Department of Emergency Medicine, University of
Southern California, Los Angeles, United States.
CORRESPONDENCE ADDRESS
P. Jhun, Department of Emergency Medicine, University of California San
Francisco, San Francisco, United States.
SOURCE
Annals of Emergency Medicine (2015) 65:4 (434-435). Date of Publication: 1
Apr 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
pethidine
phenanthrene
serotonin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
serotonin syndrome (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
emergency medicine
emergency ward
human
mass medium
medical literature
note
priority journal
publication
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenanthrene (85-01-8)
serotonin (50-67-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015095220
MEDLINE PMID
25805026 (http://www.ncbi.nlm.nih.gov/pubmed/25805026)
PUI
L604714568
DOI
10.1016/j.annemergmed.2014.12.021
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.12.021
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 476
TITLE
Investigation and treatment of acute pain in the urgent care to focus of
opioid use and patients with chronic pain
ORIGINAL (NON-ENGLISH) TITLE
Diagnostika a léčba akutní bolesti v urgentní péči se zaměřením na použití
opioidu a nemocné s chronickou bolesti
AUTHOR NAMES
Vrba I.
AUTHOR ADDRESSES
(Vrba I., ivan.vrba@homolka.cz) Anesteziologické a resuscitační oddcleni,
Nemocnice Na Homolce, Roentgenova 2, Praha 5, Czech Republic.
CORRESPONDENCE ADDRESS
I. Vrba, Anesteziologické a resuscitační oddcleni, Nemocnice Na Homolce,
Roentgenova 2, Praha 5, Czech Republic.
SOURCE
Bolest (2015) 18:1 (21-28). Date of Publication: 2015
ISSN
1212-0634
BOOK PUBLISHER
TIGIS Spol. s.r.o., Trebohosticka 564/9, Praha 10, Czech Republic.
info@tigis.cz
ABSTRACT
Emergency medicine is a medical discipline of resuscitation where major
focus in teaching and practice is to rapidly diagnose, stabilize, and
initiate curative therapy. Treatment of pain is an important part of acute
injured patient care. It is necessary to well recognized and evaluated pain
which it often is not simple in the acute state. Use of opioids is very
important in the treatment of many types of painful acute and chronic
conditions. It is therefore imperative that surgeons in a prehospital care
and in an emergency department (ED) become familiar with currently-
Available special opioid formulations and opioid delivery systems (e.g. fast
used fentanyl. transdermally aplicated opioid plasters, neuromodulation
systems). As a prescribing of opioids for chronic painful conditions has
grown, many more opioid-tolerant patients are presenting for treatment of
their acute or recurrent pain in prehospital care or in EDs. Exacerbation of
chronic pain can lead to multiple visits in EDs that cause many- problems
(especially distress and dissatisfaction) for both the patients and the
medical and nursing staff. It is evident that the ED is not the ideal
setting for managing of patients with chronic pain and opioid treatment. It
shows that opioid tolerant patients should have specific appproach to
treatment of pain. Improving patient outcomes by identifying opioid-tolerant
patients with chronic pain and providing them with adequate (eg. effective
and safe) pain relief are primary and very important goals. There is also
necessary a specific and responsible approach to patients with acute pain at
prehospital and urgent care, who have used special analgesic (opoid) forms
or systems and to patients in palliative care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
chronic pain (drug therapy, drug therapy)
drug use
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
chronic patient
emergency care
emergency medicine
emergency ward
human
outcome assessment
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
Slovenian
LANGUAGE OF SUMMARY
English, Slovenian
EMBASE ACCESSION NUMBER
2015868332
PUI
L603448135
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 477
TITLE
Time to opioid administration after implementation of an intranasal fentanyl
protocol
AUTHOR NAMES
Schaefer J.A.
Mlekoday T.J.
AUTHOR ADDRESSES
(Schaefer J.A., jared.a.schaefer@gmail.com; Mlekoday T.J.,
tamara.mlekoday@integrisok.com) INTEGRIS Baptist Medical Center, Oklahoma
City, United States.
CORRESPONDENCE ADDRESS
J.A. Schaefer, INTEGRIS Baptist Medical Center, Oklahoma City, United
States. Email: jared.a.schaefer@gmail.com
SOURCE
American Journal of Emergency Medicine (2015) 33:12 (1805-1807). Date of
Publication: 2015
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Background Prompt and effective analgesia is a mainstay of emergency
department (ED) medicine; however, it is often delayed in times of
overcrowding and by the need to establish intravenous (IV) access. Thus,
noninvasive analgesic administration by means of the intranasal route could
potentially reduce time to analgesic administration by eliminating IV line
insertion. Methods This retrospective study evaluated time from physician
entry into patient's room to opioid administration after implementation of
an intranasal fentanyl protocol. Data were collected on pediatric patients
who received intranasal fentanyl in the ED 225 days after protocol
implementation. Time to opioid administration was then evaluated against
historical controls given IV opioids in the same ED 90 days before protocol
implementation. Results Seven patients were included in the intranasal
fentanyl group and were evaluated against 47 patients given IV opioids. Time
from physician entry into patient's room to opioid administration was
significantly reduced for intranasal fentanyl (20.43 ± 11.54 minutes) vs IV
opioids (42.04 ± 31.55 minutes; P =.002), and IV line insertion was avoided
in all 7 intranasal fentanyl patients. No significant differences in adverse
events were noted. Conclusion This study provides evidence that
administration of fentanyl via the intranasal route in the ED decreases time
to administration of opioids in pediatric patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug comparison, drug therapy, intranasal drug administration)
hydromorphone (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration)
morphine (adverse drug reaction, drug comparison, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
promethazine (drug therapy, topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical protocol
health care planning
time to treatment
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
achilles apophysitis (drug therapy)
achilles apophysitis (drug therapy)
adolescent
age
article
burn (drug therapy)
child
clinical evaluation
comparative effectiveness
controlled study
dizziness (drug therapy, side effect)
drug efficacy
drug indication
drug safety
emergency care
female
fracture (drug therapy)
headache (drug therapy)
human
infection (drug therapy)
laceration (drug therapy)
length of stay
major clinical study
male
pain assessment
priority journal
retrospective study
school child
tendinitis (drug therapy)
treatment duration
treatment outcome
treatment response
varicocele (drug therapy)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20151055284
MEDLINE PMID
26452510 (http://www.ncbi.nlm.nih.gov/pubmed/26452510)
PUI
L607376778
DOI
10.1016/j.ajem.2015.08.050
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2015.08.050
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 478
TITLE
Opioid Prescribing Laws and Emergency Department Guidelines for Chronic
Non-Cancer Pain in Washington State
AUTHOR NAMES
Skaer T.L.
Nwude A.C.
AUTHOR ADDRESSES
(Skaer T.L., tskaer@wsu.edu; Nwude A.C.) Department of Pharmacotherapy
College of Pharmacy Washington State University Spokane, Washington U.S.A
CORRESPONDENCE ADDRESS
T.L. Skaer, College of Pharmacy,Washington State University - Riverpoint
Campus, PO Box 1495, Spokane, WA 99210-1495, USA
SOURCE
Pain Practice (2015). Date of Publication: 2015
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Rising mortality rates, increased opioid prescription abuse, and a perceived
need to provide practitioners with structured guidance in opioid prescribing
have prompted the Washington State Legislature to establish new legal
standards of practice regarding chronic non-cancer pain management.
Clinicians are required to conduct a detailed physical examination and
health history prior to treatment. Risk assessments for abuse and detailed
periodic reviews of treatment are required at least every 6 months. Those
considered "high risk" or who have significant psychiatric comorbidities
will be required to sign and follow a written agreement or pain contract,
obtain their pain prescriptions from a single provider, and submit to
biological drug screening. Unless an exemption exists, patients prescribed >
120 mg of morphine-equivalents daily, considered severe pain nonresponders,
necessitating dosage escalation, diagnosed with multifaceted mental
health-related comorbidities, demonstrating diagnostic ambiguity, and/or
requiring significant treatment individualization are referred to a pain
specialist. Episodic care settings should refrain from supplying opioids to
chronic pain patients whenever possible. The ER is for Emergencies coalition
instituted the Seven Best Practices program throughout the state to reduce
unnecessary visits, coordinate prescribing practice, reduce Medicaid
expenditures, and improve overall patient care. The state reported
approximately $33.65 million in savings in 2013 through the use of these
practices and converting Medicaid participants from fee-for-service to
managed care plans. Similar legislation to complement clinical practice
guidelines is expected to be enacted in other states. It is vital that
practitioners comprehend the new guidelines and make appropriate adjustments
in their opioid prescribing habits.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
opiate
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain
chronic pain
emergency ward
human
management
medical specialist
pain
United States
EMTREE MEDICAL INDEX TERMS
abuse
ambiguity
analgesia
diagnosis
drug dose escalation
drug screening
emergency
habit
health
individualization
law
managed care
medicaid
mental health
mortality
patient
patient care
physical examination
physician
practice guideline
prescription
risk
risk assessment
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015380248
PUI
L606031198
DOI
10.1111/papr.12359
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12359
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 479
TITLE
Polysubstance abuse: Alcohol, opioids and benzodiazepines require
coordinated engagement by society, patients, and physicians
AUTHOR NAMES
Ogbu U.C.
Lotfipour S.
Chakravarthy B.
AUTHOR ADDRESSES
(Ogbu U.C.; Lotfipour S.; Chakravarthy B., bchakrav@uci.edu) Department of
Emergency Medicine, University of California, Irvine, 101 The City Drive
South, Orange, United States.
CORRESPONDENCE ADDRESS
B. Chakravarthy, Department of Emergency Medicine, University of California,
Irvine, 101 The City Drive South, Orange, United States. Email:
bchakrav@uci.edu
SOURCE
Western Journal of Emergency Medicine (2015) 16:1 (76-79). Date of
Publication: 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
ABSTRACT
The Centers for Disease Control and Prevention (CDC) has published
significant data trends related to substance abuse involving opioid pain
relievers (OPR), benzodiazepines and alcohol in the United States. The CDC
describes opioid misuse and abuse as an epidemic, with the use of OPR
surpassing that of illicit drugs. Alcohol has also been a persistent problem
and is associated with a number of emergency department visits and deaths
independent of other substances. The use of these drugs in combination
creates an additive effect with increased central nervous system suppression
and a heightened risk of an overdose. We present a summary of the findings
from the Morbidity and Mortality Weekly Report (MMWR) with commentary on
strategies to combat prescription drug and alcohol abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
benzodiazepine derivative
opiate derivative
EMTREE DRUG INDEX TERMS
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
physician
polysubstance abuse
society
substance abuse
EMTREE MEDICAL INDEX TERMS
alcohol abuse
article
central nervous system
drug use
emergency ward
human
morbidity
mortality
CAS REGISTRY NUMBERS
alcohol (64-17-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160603916
MEDLINE PMID
25671013 (http://www.ncbi.nlm.nih.gov/pubmed/25671013)
PUI
L611652284
DOI
10.5811/westjem.2014.11.24720
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2014.11.24720
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 480
TITLE
Outcome following physician supervised prehospital resuscitation: A
retrospective study e006167
AUTHOR NAMES
Mikkelsen S.
Krüger A.J.
Zwisler S.T.
Brøchner A.C.
AUTHOR ADDRESSES
(Mikkelsen S., mikkelsen@rsyd.dk) Mobile Emergency Care Unit, Department of
Anaesthesiology and Intensive Care Medicine, Odense University Hospital,
Odense, Denmark.
(Mikkelsen S., mikkelsen@rsyd.dk; Brøchner A.C.) Faculty of Medical
Sciences, Institute of Clinical Research, University of Southern Denmark,
Odense, Denmark.
(Krüger A.J.) Department of Anaesthesia and Emergency Medicine, St. Olavs
Hospital, Trondheim, Norway.
(Zwisler S.T.; Brøchner A.C.) Department of Anaesthesiology and Intensive
Care Medicine, Odense University Hospital, Odense, Denmark.
CORRESPONDENCE ADDRESS
S. Mikkelsen, Mobile Emergency Care Unit, Department of Anaesthesiology and
Intensive Care Medicine, Odense University Hospital, Odense, Denmark.
SOURCE
BMJ Open (2015) 5:1 Article Number: e006167. Date of Publication: 1 Jan 2015
ISSN
2044-6055 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Background: Prehospital care provided by specially trained, physician-based
emergency services (P-EMS) is an integrated part of the emergency medical
systems in many developed countries. To what extent P-EMS increases survival
and favourable outcomes is still unclear. The aim of the study was thus to
investigate ambulance runs initially assigned 'life-saving missions' with
emphasis on long-term outcome in patients treated by the Mobile Emergency
Care Unit (MECU) in Odense, Denmark Methods: All MECU runs are registered in
a database by the attending physician, stating, among other parameters, the
treatment given, outcome of the treatment and the patient's diagnosis. Over
a period of 80 months from May 1 2006 to December 31 2012, all missions in
which the outcome of the treatment was registered as 'life saving' were
scrutinised. Initial outcome, level of competence of the caretaker and
diagnosis of each patient were manually established in each case in a
combined audit of the prehospital database, the discharge summary of the
MECU and the medical records from the hospital. Outcome parameters were
final outcome, the aetiology of the life-threatening condition and the level
of competences necessary to treat the patient. Results: Of 25 647 patients
treated by the MECU, 701 (2.7%) received prehospital 'life saving
treatment'. In 596 (2.3%) patients this treatment exceeded the competences
of the attending emergency medical technician or paramedic. Of these
patients, 225 (0.9%) were ultimately discharged to their own home.
Conclusions: The present study demonstrates that anaesthesiologist
administrated prehospital therapy increases the level of treatment
modalities leading to an increased survival in relation to a prehospital
system consisting of emergency medical technicians and paramedics alone and
thus supports the concept of applying specialists in anaesthesiology in the
prehospital setting especially when treating patients with cardiac arrest,
patients in need of respiratory support and trauma patients.
EMTREE DRUG INDEX TERMS
glucagon
glucose
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical supervision
emergency care
resuscitation
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
ambulance
article
child
clinical competence
controlled study
descriptive research
female
follow up
human
major clinical study
medical record
outcome assessment
retrospective study
return of spontaneous circulation
survival
CAS REGISTRY NUMBERS
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015661411
MEDLINE PMID
25567065 (http://www.ncbi.nlm.nih.gov/pubmed/25567065)
PUI
L601163384
DOI
10.1136/bmjopen-2014-006167
FULL TEXT LINK
http://dx.doi.org/10.1136/bmjopen-2014-006167
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 481
TITLE
Immediate therapy of intoxications
ORIGINAL (NON-ENGLISH) TITLE
Akuttherapie von intoxikationen
AUTHOR NAMES
Schaper A.
Adams H.A.
AUTHOR ADDRESSES
(Schaper A., aschaper@giz-nord.de; Adams H.A.)
CORRESPONDENCE ADDRESS
A. Schaper, Klinischer Toxikologe Stv. Leiter Giftinformationszentrum
(GIZ)-Nord der Länder Bremen, Hamburg, Niedersachsen und Schleswig-Holstein
Zentrum Pharmakol. und Toxikol. Universitatsmedizin Gottingen Georg August
Univ., Robert-Koch-Straße 40, Göttingen, Germany.
SOURCE
Anasthesiologie und Intensivmedizin (2015) 56:4 (164-172). Date of
Publication: 1 Apr 2015
ISSN
1439-0256 (electronic)
0170-5334
BOOK PUBLISHER
DIOmed Verlags GmbH, info@diomed.de
ABSTRACT
Basic principles of clinical toxicology are primary poison elimination
(gastric lavage and application of activated charcoal), secondary poison
elimination (haemodialysis, haemoperfusion, multi-dose activated charcoal,
etc.) and the application of antidotes or antivenoms. Gastric lavage is
indicated within one hour after ingestion of a life-threatening dose of a
poison. In intoxications with CNS-penetrating substances and risk of
aspiration, gastric lavage should be performed after endotracheal
intubation. The "Bremen List" is a compilation of five antidotes (atropine,
4-DMAP, tolonium chloride, naloxone, activated charcoal) for the out of
hospital treatment by emergency doctors.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
intoxication (therapy)
EMTREE MEDICAL INDEX TERMS
human
review
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2015016920
PUI
L604269754
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 482
TITLE
VA patients with high numbers of opioid prescriptions: A national study of
sociodemographic and diagnostic characteristics, health service, and
psychotropic medication use
AUTHOR NAMES
Petrakis I.L.
Sofuoglu M.
Rosenheck R.
AUTHOR ADDRESSES
(Petrakis I.L., ismene.petrakis@yale.edu; Sofuoglu M.; Rosenheck R.)
Department of Psychiatry, Yale University School of Medicine, 950 Campbell
Avenue, West Haven, United States.
CORRESPONDENCE ADDRESS
I.L. Petrakis, Department of Psychiatry, Yale University School of Medicine,
950 Campbell Avenue, West Haven, United States. Email:
ismene.petrakis@yale.edu
SOURCE
Addictive Disorders and their Treatment (2015) 14:4 (167-175). Date of
Publication: 2015
ISSN
1531-5754
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
Background and Objectives: Prescription opioid use is a major public health
concern, particularly among military personnel and veterans. This study used
administrative data on Veterans Health Administration users to identify
characteristics associated with high numbers of opioid prescriptions.
Methods: Veterans Health Administration patients (n= 5,300,000) who attended
Z1 outpatient visit during fiscal year 2010 were classified into 5 groups:
no opioid prescriptions, 1 to 2, 3 to 10, 10 to 19, and >20 opioid
prescriptions filled during the year. Bivariate comparisons and logistic
regression were used to identify sociodemographic, diagnostic
characteristics, health service, and psychotropic medication usage that
differentiated the high opioid group (>20) from those who used none.
Results: On bivariate analysis, the patients in the high opioid group (1% of
sample) were more likely to be diagnosed with metastatic cancer, other
medical illnesses, and various forms of pain, drug abuse, alcohol abuse,
mood disorders, and anxiety. Psychotropic prescriptions were also associated
with high opioid use. Logistic regression showed that drug abuse, depressive
disorders, and dual diagnosis were independently associated with high
prescription opioid use. Medical outpatient visits but not mental health or
emergency room visits, and antidepressant prescriptions but not other
psychotropics, were more independently associated with high opioid use.
Service during the recent Middle East conflicts was associated with lower
risk of high opioid use. Discussion and Conclusions: Drug use disorders,
depression, and antidepressant medication prescriptions were independently
associated with extensive opioid use. Providers should be attuned to high
rates of comorbid drug use and depression and concomitant antidepressants
among patients with high opioid prescription use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
psychotropic agent
EMTREE DRUG INDEX TERMS
antidepressant agent
anxiolytic agent
hypnotic agent
mood stabilizer
neuroleptic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health service
prescription
EMTREE MEDICAL INDEX TERMS
adult
alcohol abuse
anxiety
article
comorbidity
controlled study
depression
drug abuse
female
human
major clinical study
male
metastasis
mood disorder
priority journal
veterans health
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014788780
PUI
L53266127
DOI
10.1097/ADT.0000000000000058
FULL TEXT LINK
http://dx.doi.org/10.1097/ADT.0000000000000058
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 483
TITLE
The pharmacist's role in advancing opioid safety: Preventing and treating
opioid overdose
AUTHOR NAMES
Cimino N.M.
McPherson M.L.
AUTHOR ADDRESSES
(Cimino N.M.; McPherson M.L.) Department of Pharmacy Practice and Science,
University of Maryland School of Pharmacy, Baltimore, United States.
CORRESPONDENCE ADDRESS
N.M. Cimino, Department of Pharmacy Practice and Science, University of
Maryland School of Pharmacy, Baltimore, United States.
SOURCE
Pharmacy Times (2015) 81:1. Date of Publication: 14 Jan 2015
ISSN
0003-0627
BOOK PUBLISHER
Intellisphere LLC, jburke@mdng.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (prevention)
drug safety
pharmacist attitude
EMTREE MEDICAL INDEX TERMS
article
caregiver
doctor patient relation
emergency treatment
health care personnel
health care planning
human
prevalence
risk factor
self injection
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015117175
PUI
L604805825
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 484
TITLE
Budgetary impact of the utilization of buprenorphine/naloxone sublingual
film and tablet for Medicaid in the United States
AUTHOR NAMES
Asche C.V.
Clay E.
Kharitonova E.
Zah V.
Ruby J.
Aballéa S.
AUTHOR ADDRESSES
(Asche C.V., cva@uic.edu) University of Illinois, College of Medicine at
Peoria, One Illini Drive, Peoria, United States.
(Asche C.V., cva@uic.edu) University of Illinois at Chicago, College of
Pharmacy, Peoria, United States.
(Clay E.; Aballéa S.) Creativ-Ceutical, Paris, France.
(Kharitonova E.) Creativ-Ceutical, Chicago, United States.
(Zah V.) ZRx Outcomes Research Inc., Mississauga, Canada.
(Ruby J.) Reckitt Benckiser Pharmaceuticals Inc., Richmond, United States.
CORRESPONDENCE ADDRESS
C.V. Asche, University of Illinois, College of Medicine at Peoria, One
Illini Drive, Peoria, United States. Email: cva@uic.edu
SOURCE
Journal of Medical Economics (2015) 18:8 (600-611). Date of Publication: 1
Jan 2015
ISSN
1941-837X (electronic)
1369-6998
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Objectives: The buprenorphine/naloxone combination for the treatment of
opioid dependence is available in a film or tablet formulation. Recent
retrospective studies demonstrated that treatment with the sublingual film
formulation is associated with improved treatment retention and lower
healthcare costs. In March 2013, generic buprenorphine/naloxone tablets were
approved in the US. A budget impact model was built to compare healthcare
expenditures for different market shares of sublingual film and tablet.
Methods: A Markov model was developed to track a cohort of opioid dependent
patients treated with sublingual film or tablet through the following
treatment phases: initiation, maintenance, discontinuation, off-treatment
and reinitiation. Transition probabilities and costs for each phase were
estimated from the MarketScan Medicaid database for the period between 1
March 2010 and 30 June 2012. The total expenditure for the plan and
expenditure per plan member per month were predicted over 5 years. Two
market share scenarios were considered: 1) sublingual film is progressively
replaced by generic tablet (current situation) and 2) the sublingual film
holds a market share of 100%. Results: Predicted total costs over 5 years
were $6400 million when the sublingual film holds a market share of 100% (as
per Scenario 2) which is lower than when sublingual film is progressively
replaced by generic tablet (current situation as per Scenario 1) by $64
million. These savings were mostly driven by inpatient care ($56 million
saved over 5 years), followed by emergency room care ($27 million) and
pharmaceutical costs ($24 million). Costs of outpatient care attenuated the
difference as they were predicted to be higher by $44 million in Scenario 2.
The reduction in total cost per member per month reached $0.027 in the fifth
year. Results were most sensitive to price rebates and to the probability of
non-psychiatric hospitalization. Conclusions: While using the sublingual
film formulation for more patients treated with buprenorphine/naloxone is
predicted to increase outpatient care costs, it would generate savings in
emergency care and hospitalizations. In the treatment of opioid dependence,
total direct medical costs for Medicaid would be lower for sublingual film
treated patients, at current drug prices.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug therapy, pharmacoeconomics, sublingual
drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
budget
drug formulation
drug utilization
medicaid
opiate addiction (drug therapy, disease management, drug therapy)
sublingual film formulation
tablet formulation
EMTREE MEDICAL INDEX TERMS
adult
article
capitation fee
cohort analysis
comparative study
controlled study
cost control
drug cost
drug withdrawal
emergency care
female
health care cost
hospital patient
human
incidence
maintenance therapy
major clinical study
male
mental disease
outpatient care
patient monitoring
prescription
tablet
treatment outcome
treatment response
United States
DRUG TRADE NAMES
suboxone Actavis
suboxone Amneal
suboxone Mallinckrodt
DRUG MANUFACTURERS
Actavis
Amneal
Mallinckrodt
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160323731
MEDLINE PMID
25851505 (http://www.ncbi.nlm.nih.gov/pubmed/25851505)
PUI
L610071391
DOI
10.3111/13696998.2015.1036760
FULL TEXT LINK
http://dx.doi.org/10.3111/13696998.2015.1036760
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 485
TITLE
A 17-Year-Old Female with Respiratory Depression as a Result of Opioid
Overdose
AUTHOR NAMES
McLean M.M.
Adibi S.
Ahmed A.
Lathrop C.
Kaster M.
Tilney P.V.R.
AUTHOR ADDRESSES
(McLean M.M.) Central Michigan University, College of Medicine Education
Partners, United States.
(Adibi S.) Central Michigan University in Saginaw, United States.
(Ahmed A.) Department of Emergency Medicine, Central Michigan University,
Mt. Pleasant, United States.
(Lathrop C.) Covenant Healthcare in Saginaw, United States.
(Kaster M.) Ross University in Dominica, West Indies, United States.
(Tilney P.V.R., tilneype@cmhc.org) Central Maine Medical Center in Lewiston,
United States.
SOURCE
Air Medical Journal (2015) 34:6 (302-305). Date of Publication: 1 Nov 2015
ISSN
1532-6497 (electronic)
1067-991X
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug toxicity)
EMTREE DRUG INDEX TERMS
bicarbonate (drug therapy)
calcium chloride (drug therapy)
hydrocodone bitartrate plus paracetamol (drug therapy)
hypertensive factor (drug therapy)
lorazepam (drug therapy)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
respiration depression (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
abnormal respiratory sound
acidosis (drug therapy)
adolescent
airplane crew
alcohol abuse
atrial fibrillation
blood gas
breathing
case report
computer assisted tomography
crackle
electrocardiogram
emergency ward
endotracheal intubation
female
hemodynamic monitoring
human
hypocalcemia (drug therapy)
hypotension (drug therapy)
intensive care unit
medical history
oxygen saturation
periorbital edema
physical examination
positive end expiratory pressure
priority journal
review
systolic blood pressure
DRUG TRADE NAMES
ativan , United StatesWest Ward
narcan , United StatesAmphastar
vicodin , United StatesAbbott
DRUG MANUFACTURERS
(United States)Abbott
(United States)Amphastar
(United States)West Ward
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Radiology (14)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015540399
MEDLINE PMID
26611212 (http://www.ncbi.nlm.nih.gov/pubmed/26611212)
PUI
L607055138
DOI
10.1016/j.amj.2015.08.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2015.08.003
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 486
TITLE
Wasted, overdosed, or beyond saving - To act or not to act? Heroin users'
views, assessments, and responses to witnessed overdoses in Malmö, Sweden
AUTHOR NAMES
Richert T.
AUTHOR ADDRESSES
(Richert T., torkel.richert@mah.se) Malmö University, Malmö, Sweden.
CORRESPONDENCE ADDRESS
T. Richert, Malmö University, Malmö, Sweden.
SOURCE
International Journal of Drug Policy (2015) 26:1 (92-99). Date of
Publication: 1 Jan 2015
ISSN
1873-4758 (electronic)
0955-3959
BOOK PUBLISHER
Elsevier
ABSTRACT
Background: Overdose is a significant cause of death among heroin users.
Frequently, other heroin users are present when an overdose occurs, which
means the victim's life could be saved. There is a lack of studies that,
based on heroin users own stories, examine their views, assessments, and
responses to witnessed overdoses. Methods: The study is based on qualitative
interviews with thirty-five heroin users who witnessed someone else's
overdose. Results: The heroin users generally had a positive attitude
towards assisting peers who had overdosed. A number of factors and
circumstances, however, contribute to witnesses often experiencing
resistance to or ambivalence about responding. The witness's own high, the
difficulty in assessing the seriousness of the situation, an unwillingness
to disturb someone else's high, uncertainty about the motive behind the
overdose and whether the victim does or does not want assistance as well as
fear of police involvement, were common factors that acted as barriers to
adequate responses in overdose situations. Conclusion: The fact that being
high makes it difficult to respond to overdoses, using traditional methods,
argues for simpler and more effective response techniques. This can include
intranasal naloxone programs for heroin users. The findings regarding the
uncertainty about the intention of the overdose victim and the sensitivity
to the experience of a good high argue for more up-front communication and
discussion amongst using peers so that they can make their intentions clear
to each other. Issues like this can be addressed in overdose education
interventions. Overdose prevention measures also need to address the fact
that fear of the police acts as a barrier to call emergency services.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
heroin dependence
EMTREE MEDICAL INDEX TERMS
adult
ambivalence
article
attitude
clinical article
fear
female
human
interview
male
motivation
peer group
police
qualitative analysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014708052
PUI
L53289756
DOI
10.1016/j.drugpo.2014.07.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2014.07.006
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 487
TITLE
Engaging patients around the risks of opioid misuse in the emergency
department
AUTHOR NAMES
Meisel Z.F.
Smith R.J.
AUTHOR ADDRESSES
(Meisel Z.F., zfm@wharton.upenn.edu; Smith R.J.) Center for Emergency Care
Policy and Research, Perelman School of Medicine, University of
Pennsylvania, 3400 Spruce St, Philadelphia, United States.
(Meisel Z.F., zfm@wharton.upenn.edu) Leonard Davis Institute of Health
Economics, Penn Medicine Center for Health Care Innovation, University of
Pennsylvania, , United States.
CORRESPONDENCE ADDRESS
Z.F. Meisel, Center for Emergency Care Policy and Research, Perelman School
of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia,
United States.
SOURCE
Pain Management (2015) 5:5 (323-326). Date of Publication: 1 Sep 2015
ISSN
1758-1877 (electronic)
1758-1869
BOOK PUBLISHER
Future Medicine Ltd., info@futuremedicine.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
emergency care
opiate addiction
EMTREE MEDICAL INDEX TERMS
analgesia
community care
drug surveillance program
emergency ward
epidemic
health literacy
hospitalization
human
interpersonal communication
medical decision making
narrative
patient education
priority journal
review
risk assessment
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015349393
MEDLINE PMID
26246148 (http://www.ncbi.nlm.nih.gov/pubmed/26246148)
PUI
L605887233
DOI
10.2217/pmt.15.31
FULL TEXT LINK
http://dx.doi.org/10.2217/pmt.15.31
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 488
TITLE
National institutes of health study shows benefit of emergency department
use of buprenorphine in opiate withdrawal
AUTHOR NAMES
Berger E.
AUTHOR ADDRESSES
(Berger E.)
CORRESPONDENCE ADDRESS
E. Berger,
SOURCE
Annals of Emergency Medicine (2015) 66:6 (20A-22A). Date of Publication: 1
Dec 2015
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
opiate
EMTREE DRUG INDEX TERMS
hydrocodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
withdrawal syndrome (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
anxiety
emergency physician
human
hypertension
myalgia
priority journal
review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015531533
PUI
L607013462
DOI
10.1016/j.annemergmed.2015.08.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2015.08.010
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 489
TITLE
μ-Opioid Receptor Gene A118 G Variants and Persistent Pain Symptoms Among
Men and Women Experiencing Motor Vehicle Collision
AUTHOR NAMES
Linnstaedt S.D.
Hu J.
Bortsov A.V.
Soward A.C.
Swor R.
Jones J.
Lee D.
Peak D.
Domeier R.
Rathlev N.
Hendry P.
McLean S.A.
AUTHOR ADDRESSES
(Linnstaedt S.D.; Hu J.; Bortsov A.V.; Soward A.C.; McLean S.A.,
smclean@aims.unc.edu) TRYUMPH Research Program, Anesthesiology Department,
University of North Carolina, Chapel Hill, United States.
(Linnstaedt S.D.; Hu J.; Bortsov A.V.; Soward A.C.; McLean S.A.,
smclean@aims.unc.edu) Department of Anesthesiology, University of North
Carolina, Chapel Hill, United States.
(Swor R.) Department of Emergency Medicine, University of North Carolina,
Chapel Hill, United States.
(Jones J.) Department of Emergency Medicine, William Beaumont Hospital,
Royal Oak, United States.
(Lee D.) Department of Emergency Medicine, Spectrum Health Butterworth
Campus, Grand Rapids, United States.
(Peak D.) Department of Emergency Medicine, North Shore University Hospital,
Manhasset, United States.
(Domeier R.) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, United States.
(Rathlev N.) Department of Emergency Medicine, St Joseph Mercy Hospital, Ann
Arbor, United States.
(Hendry P.) Department of Emergency Medicine, Baystate Medical Center,
Springfield, United States.
(McLean S.A., smclean@aims.unc.edu) Department of Emergency Medicine,
University of Florida, College of Medicine/Jacksonville, Jacksonville,
United States.
CORRESPONDENCE ADDRESS
S.A. McLean, University of North Carolina, Medical School Wing C, Chapel
Hill, United States.
SOURCE
Journal of Pain (2015) 16:7 (637-644) Article Number: 3070. Date of
Publication: 1 Jul 2015
ISSN
1528-8447 (electronic)
1526-5900
BOOK PUBLISHER
Churchill Livingstone Inc.
ABSTRACT
Abstract The μ-opioid receptor 1 (OPRM1) binds endogenous opioids.
Increasing evidence suggests that endogenous OPRM1 agonists released at the
time of trauma may contribute to the development of posttraumatic
musculoskeletal pain (MSP). In this prospective observational study, we
evaluated the hypothesis that individuals with an AG or GG genotype at the
OPRM1 A118 G allele, which results in a reduced response to opioids, would
have less severe MSP 6 weeks after motor vehicle collision (MVC). Based on
previous evidence, we hypothesized that this effect would be sex-dependent
and most pronounced among women with substantial peritraumatic distress.
European American men and women ≥18 years of age presenting to the emergency
department after MVC and discharged to home after evaluation (N = 948) were
enrolled. Assessments included genotyping and 6-week evaluation of overall
MSP severity (0-10 numeric rating scale). In linear regression modeling, a
significant A118 G Allele × Sex interaction was observed: an AG/GG genotype
predicted reduced MSP severity among women with substantial peritraumatic
distress (β = -.925, P = .014) but not among all women. In contrast, men
with an AG/GG genotype experienced increased MSP severity at 6 weeks (β =
.827, P = .019). Further studies are needed to understand the biologic
mechanisms mediating observed sex differences in A118 G effects. Perspective
These results suggest a sex-dependent mechanism by which an emotional
response to trauma (distress) contributes to a biologic mechanism
(endogenous opioid release) that increases MSP in the weeks after stress
exposure. These results also support the hypothesis that endogenous opioids
influence pain outcomes differently in men and women.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
mu opiate receptor (endogenous compound)
mu opiate receptor 1 (endogenous compound)
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
musculoskeletal pain
posttraumatic pain
single nucleotide polymorphism
traffic accident
EMTREE MEDICAL INDEX TERMS
adult
allele
article
disease severity
distress syndrome
education
emergency ward
emotion
European American
female
finger fracture
genotype
human
hyperalgesia
income
laceration
major clinical study
male
pain severity
peritraumatic distress
sex difference
EMBASE CLASSIFICATIONS
Human Genetics (22)
Clinical and Experimental Biochemistry (29)
General Pathology and Pathological Anatomy (5)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015066674
MEDLINE PMID
25842347 (http://www.ncbi.nlm.nih.gov/pubmed/25842347)
PUI
L604495888
DOI
10.1016/j.jpain.2015.03.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2015.03.011
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 490
TITLE
Pharmacoepidemiology of chronic noncancer pain patients requiring chronic
opioid therapy: A nationwide population-based study
AUTHOR NAMES
Chang S.-C.
Ma C.-C.
Lee C.-T.
Hsieh S.-W.
AUTHOR ADDRESSES
(Chang S.-C.; Hsieh S.-W., felidhsieh@gmail.com) Division of Anesthesiology,
E-DA Hospital, Kaohsiung, Taiwan.
(Ma C.-C.) Department of Healthcare Administration, I-Shou University,
Kaohsiung, Taiwan.
(Lee C.-T.) Department of Leisure and Sports Management, Cheng-Shiu
University, Kaohsiung, Taiwan.
CORRESPONDENCE ADDRESS
S.-W. Hsieh, Division of Anesthesiology, E-DA Hospital, Kaohsiung, Taiwan.
SOURCE
Acta Anaesthesiologica Taiwanica (2015) 53:3 (89-94) Article Number: 212.
Date of Publication: 1 Sep 2015
ISSN
1875-452X (electronic)
1875-4597
BOOK PUBLISHER
Elsevier Taiwan LLC, 96 Chung Shan North Road, Section 2, Taipei, Taiwan.
ABSTRACT
Objective This study was aimed to explore the pharmacoepidemiology of
chronic noncancer pain (CNCP) patients who required chronic opioid therapy
(COT) in the Taiwanese population. Methods Using the Taiwan National Health
Insurance Research Database during 2008-2009, COT-requiring CNCP patients
were identified by the inclusion criteria of both chronic analgesic
requirement for > 3 months per year and long-term use of controlled opioids
for > 28 therapeutic days during any 3-month period in ambulatory visits
with malignancy-related pain excluded. Their demographic data and
pharmacoepidemiological characteristics of opioid consumption and opioid
prescriptions issued in ambulatory visits were analyzed. Results In total,
159 patients were enrolled as COT-requiring CNCP patients, and the
prevalence was calculated at 0.016% in a 2-year period. Females were
outnumbered by males (45.3% vs. 54.7%). Almost 60% of them were of working
age and 93.7% belonged to low-income households, as in the health insurance
claims, probably implying socioeconomic disadvantages associated with CNCP.
The leading three diagnoses were unspecified myalgia and myositis, lumbago,
and abdominal pain of unspecified site. The most common department from
where these 159 CNCP patients obtained their opioid prescriptions was the
emergency department (27.6%), ensued by a pain clinic (25.3%), but they
could acquire only a few opioid therapeutic days through emergency
department visits. Moreover, pain clinic satisfied the majority of opioid
therapeutic days. Among all opioids, morphine was the most frequently
prescribed in opioid-obtaining ambulatory visits, accounting for most of the
opioid therapeutic days as well as opioid consumption. Conclusion
COT-requiring CNCP patients were easily associated with adverse
socioeconomic liabilities and often visited emergency department as well as
pain clinics. Morphine was the main opioid used for their chronic pain.
Transfer of COT-requiring CNCP patients to appropriate departments is
strongly recommended for efficient long-term pharmacotherapy for their
chronic pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
fentanyl (drug therapy)
morphine (drug therapy)
pethidine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic noncancer pain (drug therapy, drug therapy)
chronic pain (drug therapy, drug therapy)
pharmacoepidemiology
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adult
aged
article
drug use
emergency ward
female
headache (drug therapy)
health insurance
human
long term care
low back pain (drug therapy)
lowest income group
major clinical study
male
myalgia (drug therapy)
myositis (drug therapy)
neuralgia (drug therapy)
neuritis (drug therapy)
neuropathic pain (drug therapy)
pain clinic
prescription
prevalence
radiculitis (drug therapy)
socioeconomics
Taiwanese
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015073326
PUI
L604532704
DOI
10.1016/j.aat.2015.04.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.aat.2015.04.002
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 491
TITLE
Opioid considerations for emergency practice
AUTHOR NAMES
Terndrup T.
AUTHOR ADDRESSES
(Terndrup T., thomas.terndrup@osumc.edu) Ohio State University College of
Medicine, Department of Emergency Medicine, 760 Prior Hall, 376 W. 10th
Avenue, Columbus, United States.
CORRESPONDENCE ADDRESS
T. Terndrup, Ohio State University College of Medicine, Department of
Emergency Medicine, 760 Prior Hall, 376 W. 10th Avenue, Columbus, United
States. Email: thomas.terndrup@osumc.edu
SOURCE
Western Journal of Emergency Medicine (2015) 16:7 (1084-1085). Date of
Publication: 2015
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
emergency treatment
EMTREE MEDICAL INDEX TERMS
backache
breathing rate
headache
human
note
patient monitoring
patient safety
prescription
substance abuse
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160005170
MEDLINE PMID
26759659 (http://www.ncbi.nlm.nih.gov/pubmed/26759659)
PUI
L607454538
DOI
10.5811/westjem.2015.12.29447
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2015.12.29447
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 492
TITLE
"Hard" and "soft" patient cues that influence ED prescribing for potential
opioid misusers
AUTHOR NAMES
Mannina L.
Varney S.M.
Bebarta V.S.
Ganem V.J.
Carey K.R.
Ramos R.G.
AUTHOR ADDRESSES
(Mannina L., mannina.1@gmail.com) SAUSHEC Emergency Medicine PGYII, San
Antonio Military Medical Center, San Antonio, United States.
(Varney S.M., smvarney@gmail.com; Ramos R.G., rosemarieramos@hotmail.com)
Department of Emergency Medicine, San Antonio Military Medical Center, San
Antonio, United States.
(Bebarta V.S., vikbebarta@yahoo.com; Ganem V.J.,
victoria.j.ganem.vol@mail.mil) Department of Emergency Medicine, San Antonio
Military Medical Center, Air Force Enroute Care Research Center, San
Antonio, United States.
(Carey K.R., KCarey@genevausa.org) Geneva Foundation, San Antonio, United
States.
SOURCE
American Journal of Emergency Medicine (2015) 33:1 (109-111). Date of
Publication: 1 Jan 2015
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
prescription
EMTREE MEDICAL INDEX TERMS
abdominal pain
analgesia
association
drug seeking behavior
emergency health service
emergency medicine
emergency physician
emergency ward
ethnicity
headache
high risk behavior
human
letter
limb pain
medical history
medical record review
military dependent
nurse practitioner
pain
physician assistant
practice guideline
resident
sex
tertiary care center
tooth pain
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014976509
MEDLINE PMID
25445857 (http://www.ncbi.nlm.nih.gov/pubmed/25445857)
PUI
L600797444
DOI
10.1016/j.ajem.2014.09.034
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2014.09.034
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 493
TITLE
Opioid intoxications involving butyrfentanyl, 4-fluorobutyrfentanyl, and
fentanyl from the Swedish STRIDA project
AUTHOR NAMES
Bäckberg M.
Beck O.
Jönsson K.-H.
Helander A.
AUTHOR ADDRESSES
(Bäckberg M.) Swedish Poisons Information Centre, Stockholm, Sweden.
(Beck O.; Helander A., anders.helander@ki.se) Department of Laboratory
Medicine, Karolinska Institutet, Stockholm, Sweden.
(Beck O.; Helander A., anders.helander@ki.se) Department of Clinical
Pharmacology, Karolinska University Laboratory, Stockholm, Sweden.
(Jönsson K.-H.) Medical Products Agency, Uppsala, Sweden.
(Helander A., anders.helander@ki.se) Department of Laboratory Medicine,
Karolinska University Laboratory Huddinge, C1:74, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A. Helander, Department of Laboratory Medicine, Karolinska University
Laboratory Huddinge, C1:74, Stockholm, Sweden.
SOURCE
Clinical Toxicology (2015) 53:7 (609-617). Date of Publication: 9 Aug 2015
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Taylor and Francis Ltd, healthcare.enquiries@informa.com
ABSTRACT
Background. The supply of unregulated "new psychoactive substances" (NPS)
has shown a steady increase over the past six years. This report from the
Swedish STRIDA project describes analytically confirmed non-fatal
intoxications involving butyrfentanyl (butyrylfentanyl) or
4-fluorobutyrfentanyl (para-fluorobutyrfentanyl), two fentanyl analogues
recently introduced as NPS opioids. Study design. Observational case series
of consecutive patients with suspected acute NPS exposure and requiring
hospital care from all over Sweden. Patients and methods. From May 2014 to
January 2015, blood and urine samples were obtained from four intoxication
cases involving butyrfentanyl and one case involving 4-fluorobutyrfentanyl
(men, 19-30 years) presenting in emergency departments (ED) or intensive
care units (ICU). Laboratory analysis of serum and/or urine samples was
performed by multi-component liquid chromatography-mass spectrometry
methods. Data on clinical features were collected during consultations with
the Poisons Information Centre and retrieved from medical records. Case
details. Of the five patients, two were discharged home from the ED and
three were admitted to the ICU, of whom two required intubation and
mechanical ventilation. Clinical features included typical opioid symptoms
such as unconsciousness, respiratory depression, and apnea. In one case,
naloxone successfully countered the effects. All patients were discharged
the same or the following day. Butyrfentanyl was detected in two serum (0.6
and 0.9 ng/mL) and three urine (2.0-65.6 ng/mL) samples from three of four
cases; three cases also contained fentanyl. In the 4-fluorobutyrfentanyl
case, the substance was detected in serum (∼15 ng/mL) and urine (∼10 ng/mL).
In four cases, other NPS and/or classical drugs were also detected. Analysis
of two "butyrfentanyl" NPS products (nasal spray and powder) brought to
hospital by patients showed that the 10-fold more potent fentanyl was the
main active ingredient (∼7.5-10-fold higher amount) in both. Conclusion.
Typical and potentially life-threatening opioid toxicity was seen in acute
intoxications involving butyrfentanyl, 4F-butyrfentanyl, and fentanyl. The
incorrect labelling of butyrfentanyl NPS products which instead mainly
contained fentanyl is alarming, given the narrow range between a safe and a
lethal dose for opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 fluorobutyrfentanyl (drug toxicity)
butyrfentanyl (drug toxicity)
fentanyl derivative (drug toxicity)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alkalosis
apnea
article
artificial ventilation
case report
controlled study
human
insomnia
intubation
liquid chromatography
male
mass spectrometry
metabolic acidosis
observational study
respiration depression
respiratory arrest
resuscitation
tachycardia
unconsciousness
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015253155
MEDLINE PMID
26083809 (http://www.ncbi.nlm.nih.gov/pubmed/26083809)
PUI
L605517948
DOI
10.3109/15563650.2015.1054505
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2015.1054505
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 494
TITLE
Butyrfentanyl overdose resulting in diffuse alveolar hemorrhage
AUTHOR NAMES
Cole J.B.
Dunbar J.F.
McIntire S.A.
Regelmann W.E.
Slusher T.M.
AUTHOR ADDRESSES
(Cole J.B., jon.cole@hcmed.org) Department of Emergency Medicine, Hennepin
Regional Poison Center, 701 Park Ave, Minneapolis, United States.
(Dunbar J.F.) Transitional Residency, Hennepin County Medical Center,
Minneapolis, United States.
(McIntire S.A.) Departments of Pediatrics and Medicine, University of
Minnesota Medical School, Minneapolis, United States.
(Regelmann W.E.) Division of Pulmonary Medicine, Department of Pediatrics,
University of Minnesota Medical School, Minneapolis, United States.
(Slusher T.M.) Division of Critical Care Medicine, Department of Pediatrics,
Minneapolis, United States.
CORRESPONDENCE ADDRESS
J.B. Cole, Department of Emergency Medicine, Hennepin Regional Poison
Center, 701 Park Ave, Minneapolis, United States.
SOURCE
Pediatrics (2015) 135:3 (e740-e743). Date of Publication: 1 Mar 2015
ISSN
1098-4275 (electronic)
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
Butyrfentanyl is a potent short-acting opioid and a fentanyl analog with
uncertain clinical effects. A review of the literature reveals no human case
reports of butyrfentanyl overdose. As the use of analog and synthetic drugs
continues to increase, clinicians are often faced with tremendous
uncertainty when they encounter patients exposed to these synthetic drugs.
We describe, to our knowledge, the first case of a butyrfentanyl overdose
that resulted in clinically significant hemoptysis, acute lung injury,
hypoxic respiratory failure, and diffuse alveolar hemorrhage. Complicating
this case was a false-positive urine drug screen for fentanyl. Clinicians
who encounter fentanyl exposures should be aware they may in fact be dealing
with butyrfentanyl. As little is known of butyrfentanyl and our patient
suffered a significant pulmonary hemorrhage, those who encounter
butyrfentanyl exposures should monitor for hemorrhagic complications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
butyrfentanyl (drug dose, drug toxicity)
fentanyl derivative (drug dose, drug toxicity)
opiate derivative (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (intravenous drug administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
lung hemorrhage (diagnosis)
EMTREE MEDICAL INDEX TERMS
acute lung injury
adult
article
breathing disorder
bronchoscopy
case report
drug overdose
dyspnea (therapy)
echocardiography
emergency ward
false positive result
gas chromatography
heart ejection fraction
hemoptysis
heroin dependence
human
immunoassay
intravenous drug abuse
intubation
laboratory test
length of stay
lung lavage
male
mass spectrometry
physical examination
positive end expiratory pressure
priority journal
respiratory failure
thorax radiography
unconsciousness
ventilator associated pneumonia (complication)
vital sign
young adult
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015812447
MEDLINE PMID
25713275 (http://www.ncbi.nlm.nih.gov/pubmed/25713275)
PUI
L602859542
DOI
10.1542/peds.2014-2878
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2014-2878
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 495
TITLE
Codeine: An under-recognized and easily treated cause of acute abdominal
pain
AUTHOR NAMES
Tabner A.
Johnson G.
AUTHOR ADDRESSES
(Tabner A., andrew.tabner@nhs.net; Johnson G.) Emergency Department, Royal
Derby Hospital, Uttoxeter Road, Derby, United Kingdom.
CORRESPONDENCE ADDRESS
A. Tabner, Emergency Department, Royal Derby Hospital, Uttoxeter Road,
Derby, United Kingdom. Email: andrew.tabner@nhs.net
SOURCE
American Journal of Emergency Medicine (2015) 33:12 (1847.e1-1847.e2). Date
of Publication: 2015
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (adverse drug reaction, drug therapy, oral drug administration)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (drug therapy, side effect, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain
aged
article
case report
computer assisted tomography
digital rectal examination
disease association
electrocardiogram
emergency ward
epigastric pain
first lumbar vertebra
general practitioner
heart block (diagnosis)
human
liver function test
low back pain (drug therapy)
male
medical history
medical record
neurologic examination
patient referral
physical examination
priority journal
skeleton radiography
spine fracture
urinalysis
urine retention
very elderly
CAS REGISTRY NUMBERS
codeine (76-57-3)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Radiology (14)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015044272
MEDLINE PMID
25983269 (http://www.ncbi.nlm.nih.gov/pubmed/25983269)
PUI
L604393142
DOI
10.1016/j.ajem.2015.04.082
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2015.04.082
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 496
TITLE
Post-medication Hypotension after Administration of Sedatives and Opioids
during Critical Care Transport
AUTHOR NAMES
Singh J.M.
MacDonald R.D.
Ahghari M.
AUTHOR ADDRESSES
(Singh J.M.; MacDonald R.D.; Ahghari M.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2015)
19:4 (464-474). Date of Publication: 2015
ISSN
1545-0066 (electronic)
ABSTRACT
OBJECTIVE: Identification of modifiable risk factors for hypotension during
critical care transport is important to optimize patient preparation, crew
training, and patient safety. We set out to determine the incidence of
hemodynamic deterioration after administration of opioids or sedatives
during critical care transport, and identify patient- and transport-level
predictors.METHODS: We assembled a retrospective cohort of adults undergoing
urgent critical care transport between January 1, 2005, and December 31,
2010. The primary outcome was post-medication hypotension, defined by new
hypotension or new vasopressor within 10 minutes of medication
administration.RESULTS: Opioids or sedatives were administered 28,592 times
in 8,328 patient transports, with 159 episodes of post-medication
hypotension (0.6% of all medication administrations). Mechanical ventilation
(adjusted odds ratio [OR] 4.9; 95% confidence interval [95%CI] 2.7-8.9),
baseline vasopressor requirement (adjusted OR 2.1; 95%CI 1.3-3.4), transport
duration (adjusted OR 1.5; 95%CI 1.1-2.2) per log unit increment of
duration), surgical diagnosis (adjusted OR 4.1; 95%CI 1.6-10.7 compared to
trauma), and ACP crew level (adjusted OR 2.4 compared to baseline of CCP;
95%CI 1.5-3.8) were all associated with an increased odds of post-medication
hypotension. ACP crew level remained associated with increased
post-medication hypotension in a sensitivity analysis of 1,242
propensity-matched pairs (crude OR for ACP vs. CCP 3.0; 95%CI
1.4-6.5).CONCLUSIONS: Post-medication hypotension occurred once in every 160
drug administrations and was associated with mechanical ventilation,
baseline hemodynamic instability, transport duration, surgical diagnosis,
and ACP crew. These findings provide targets for improvements in patient
preparation, crew training, and clinical practices.
EMTREE DRUG INDEX TERMS
hypnotic sedative agent (drug administration, adverse drug reaction)
narcotic analgesic agent (drug administration, adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chemically induced
EMTREE MEDICAL INDEX TERMS
adult
aged
cohort analysis
combination drug therapy
comparative study
confidence interval
critical illness (therapy)
emergency health service
female
human
hypotension (epidemiology)
intensive care
male
middle aged
mortality
odds ratio
Ontario
pathophysiology
patient transport
procedures
propensity score
retrospective study
risk assessment
survival rate
treatment outcome
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25658022 (http://www.ncbi.nlm.nih.gov/pubmed/25658022)
PUI
L610882191
DOI
10.3109/10903127.2014.995848
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2014.995848
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 497
TITLE
Opioid-dependent patients in ED need more than a treatment referral
AUTHOR NAMES
Talsma J.
AUTHOR ADDRESSES
(Talsma J.)
SOURCE
Drug Topics (2015) 2015:JUNE. Date of Publication: 1 Jun 2015
ISSN
1937-8157 (electronic)
0012-6616
BOOK PUBLISHER
Advanstar Communications Inc., info@advanstar.com
EMTREE DRUG INDEX TERMS
buprenorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
patient referral
EMTREE MEDICAL INDEX TERMS
health insurance
high risk behavior
human
note
psychologic assessment
randomized controlled trial (topic)
reimbursement
sexual behavior
withdrawal syndrome
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015196966
PUI
L605197839
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 498
TITLE
Delayed emergence from general anesthesia in a dementia patient with Lewy
bodies
AUTHOR NAMES
Takebe S.
Inoue K.
Kawanishi H.
Nakamura H.
Ohnishi A.
Ohnishi J.
Yatsu Y.
Nagai A.
Matsuda R.
Hirasaki A.
AUTHOR ADDRESSES
(Takebe S.; Inoue K.; Kawanishi H.; Nakamura H.; Ohnishi A.; Ohnishi J.;
Yatsu Y.; Nagai A.; Matsuda R.; Hirasaki A.) Department of Anesthesiology,
Kagawa Prefectural Central Hospital, Takamatsu, Japan.
CORRESPONDENCE ADDRESS
S. Takebe, Department of Anesthesiology, Kagawa Prefectural Central
Hospital, Takamatsu, Japan.
SOURCE
Japanese Journal of Anesthesiology (2015) 64:1 (81-83). Date of Publication:
1 Jan 2015
ISSN
0021-4892
BOOK PUBLISHER
Kokuseido Publishing Co. Ltd, tkoike@jptco.co.jp
ABSTRACT
A 73-year-old man (164 cm height, 51kg body weight) with a history of
Parkinson's disease and dementia was scheduled for a cervical lymph node
biopsy under general anesthesia. We induced anesthesia with thiamylal and
fentanyl, and maintained with sevoflurane and remifentanil without any
incident The patient did not emerge from anesthesia after the surgery. He
developed coma and did not respond to painful stimuli. However, his
breathing was spontaneous with stable hemodynamics. Although naloxone was
given, he was still comatose. His clinical neurological findings showed no
organic abnormalities. Forty minutes after the surgery, he suddenly woke up
and followed instructions. We learned that previously he had been diagnosed
with dementia with Lewy bodies.
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction)
naloxone (adverse drug reaction)
remifentanil (adverse drug reaction)
sevoflurane (adverse drug reaction)
thiamylal (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
delayed emergence from anesthesia (side effect, side effect)
diffuse Lewy body disease
general anesthesia
EMTREE MEDICAL INDEX TERMS
aged
article
breathing
case report
cervical lymph node
coma (side effect)
hemodynamics
human
lymph node biopsy
male
Parkinson disease
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
remifentanil (132539-07-2)
sevoflurane (28523-86-6)
thiamylal (337-47-3, 77-27-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
Japanese
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015091691
MEDLINE PMID
25868207 (http://www.ncbi.nlm.nih.gov/pubmed/25868207)
PUI
L604702642
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 499
TITLE
Strong opioids for noncancer pain due to musculoskeletal diseases: Not more
effective than acetaminophen or NSAIDs
AUTHOR NAMES
Berthelot J.-M.
Darrieutort-Lafitte C.
Le Goff B.
Maugars Y.
AUTHOR ADDRESSES
(Berthelot J.-M., jeanmarie.berthelot@chu-nantes.fr; Darrieutort-Lafitte C.;
Le Goff B.; Maugars Y.) Service de rhumatologie, Hôtel-Dieu, CHU de Nantes,
place Alexis-Ricordeau, Nantes cedex 01, France.
CORRESPONDENCE ADDRESS
J.-M. Berthelot, Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, place
Alexis-Ricordeau, Nantes cedex 01, France. Email:
jeanmarie.berthelot@chu-nantes.fr
SOURCE
Joint Bone Spine (2015) 82:6 (397-401). Date of Publication: 2015
ISSN
1778-7254 (electronic)
1297-319X
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
The classification of morphine as a step III analgesic, based on
pharmacological data, creates a strong bias toward a belief in the efficacy
of this drug. However, double-blind emergency-room trials showed similar
levels of pain relief with intravenous acetaminophen as with intravenous
morphine in patients with renal colic, low back pain or acute limb pain. In
patients with chronic noncancer low back pain, morphine and other strong
opioids in dosages of up to 100 mg/day were only slightly more effective
than their placebos, no more effective than acetaminophen, and somewhat less
effective than nonsteroidal anti-inflammatory drugs (NSAIDs). In patients
with osteoarthritis, strong opioids were not more effective than NSAIDs and,
in some studies, than placebos. The only randomized controlled trial in
patients with sciatica found no difference with the placebo. Chronic use of
strong opioids can induce hyperalgesia in some patients. Hyperpathia with
increased sensitivity to cold leading the patient to request higher dosages
should suggest opioid-induced hyperalgesia. Pain specialists in the US have
issued a petition asking that strong opioids be used in dosages no higher
than 100 mg/day of morphine-equivalent, in an effort to decrease the high
rate of mortality due to the misuse and abuse of strong opioids (10,000
deaths/year in the US). Healthcare providers often overestimate the efficacy
of step III analgesics, despite pain score decreases of only 0.8 to 1.2
points.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (clinical trial, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
duloxetine (drug therapy)
hydromorphone (drug therapy)
morphine (drug comparison - placebo, drug dose, drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
oxycodone (drug therapy)
oxymorphone (drug therapy)
paracetamol (clinical trial, drug therapy)
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
musculoskeletal disease
pain (drug therapy, complication, drug therapy)
EMTREE MEDICAL INDEX TERMS
acute limb pain (drug therapy)
acute limb pain (drug therapy)
adverse drug reaction
chronic pain (drug therapy)
drug efficacy
human
hyperalgesia
kidney colic (drug therapy)
limb pain (drug therapy)
low back pain (drug therapy)
randomized controlled trial (topic)
sciatica
short survey
DRUG TRADE NAMES
cimbalta
oxycontin
oxynorm
sophidone
CAS REGISTRY NUMBERS
duloxetine (116539-59-4, 136434-34-9)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160262879
MEDLINE PMID
26453108 (http://www.ncbi.nlm.nih.gov/pubmed/26453108)
PUI
L609403397
DOI
10.1016/j.jbspin.2015.08.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jbspin.2015.08.003
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 500
TITLE
Characteristics of high-cost patients diagnosed with opioid abuse
AUTHOR NAMES
Shei A.
Rice J.B.
Kirson N.Y.
Bodnar K.
Enloe C.J.
Birnbaum H.G.
Holly P.
Ben-Joseph R.
AUTHOR ADDRESSES
(Shei A., ashei@analysisgroup.com; Rice J.B.; Kirson N.Y.; Enloe C.J.;
Birnbaum H.G.) Analysis Group, Boston, United States.
(Bodnar K.) Clinton Health Access Initiative, Lusaka, Zambia.
(Holly P.; Ben-Joseph R.) Health Outcomes and Pharmacoeconomics, Purdue
Pharma, Stamford, United States.
CORRESPONDENCE ADDRESS
A. Shei, 111 Huntington Ave., Tenth Fl., Boston, United States.
SOURCE
Journal of Managed Care Pharmacy (2015) 21:10 (902-912). Date of
Publication: 2015
ISSN
1083-4087
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
Background: Prescription opioid abuse is associated with substantial
economic burden, with estimates of incremental annual per-patient health
care costs of diagnosed opioid abuse exceeding $10,000 in prior literature.
A subset of patients diagnosed with opioid abuse has disproportionately high
health care costs, but little is known about the characteristics of these
patients. OBJECTIVE: To describe the characteristics of a subset of patients
diagnosed with opioid abuse with disproportionately high health care costs
to assist physicians and managed care organizations in targeting
interventions at the costliest patients. METHODS: This retrospective claims
data analysis identified patients aged 12 to 64 years diagnosed with opioid
abuse/dependence in the OptumHealth Reporting and Insights medical and
pharmacy claims database, Quarter 1 (Q1) 1999-Q1 2012. Inclusion criteria
required that patients had a diagnosis of opioid abuse during or after Q1
2006, no prior diagnoses of opioid abuse, and continuous non-HMO coverage
over an 18-month study period. The study period comprised a 12-month
observation period centered on the date of the first opioid abuse diagnosis
(index date) and a 6-month baseline period immediately preceding the
observation period. Patients in the top 20% of total health care costs in
the observation period were classified as "high-cost patients," and the
remaining patients were classified as "lower-cost patients." Patient
characteristics, comorbidities, health care resource use, and health care
costs were compared between high-cost patients and lower-cost patients using
chi-square tests for dichotomous variables and Wilcoxon rank-sum tests for
continuous variables. In addition, multivariate regression was used to
assess the relationship between patient characteristics in the baseline
period and total health care costs in the observation period among all
patients diagnosed with opioid abuse. RESULTS: 9,291 patients diagnosed with
opioid abuse met the inclusion criteria. The 20% of patients classified as
high-cost patients accounted for approximately two thirds of the total
health care costs of patients diagnosed with opioid abuse. Compared with
lower-cost patients, high-cost patients were older (42.5 vs. 36.1; P <
0.001) and more likely to be female (55.9% vs. 42.9%; P < 0.001). They had a
higher comorbidity burden at baseline, as reflected in the Charlson
Comorbidity Index (0.8 vs. 0.2; P < 0.001), and rates of conditions such as
chronic pulmonary disease (12.9% vs. 5.6%; P < 0.001) and mild/moderate
diabetes (8.4% vs. 3.4%; P < 0.001). High-cost patients also had higher
rates of nonopioid substance abuse diagnoses (12.4% vs. 8.9%; P < 0.001) and
psychotic disorders (26.5% vs. 13.6%; P < 0.001). In the observation period,
high-cost patients continued to have higher rates of nonopioid substance
abuse diagnoses (53.0% vs. 47.2%; P < 0.001) and psychotic disorders (67.1%
vs. 47.5%; P < 0.001). In addition, they had greater medical resource use
across all places of service (i.e., inpatient, emergency department,
outpatient, drug/alcohol rehabilitation facility, and other) compared with
lower-cost patients. The mean observation period health care costs of
high-cost patients was $89,177 compared with $11,653 for lower-cost patients
(P < 0.001). High-cost patients had higher medical costs linked to claims
with an opioid abuse diagnosis in absolute terms, but the share of total
medical costs attributed to such claims was lower among high-cost patients
than among lower-cost patients. While many baseline characteristics were
found to have a statistically significant (P < 0.05) association with
observation period health care costs, only 27.3% of the variation in
observation period health care costs was explained by patient
characteristics in the baseline period. CONCLUSIONS: This study found that
the costliest patients diagnosed with opioid abuse had high rates of
preexisting and concurrent chronic comorbidities and mental health
conditions, suggesting potential indicators for targeted intervention and a
need for greater awareness and screening of comorbid conditions. Opioid
abuse may exacerbate existing conditions and make it difficult for patients
to adhere to treatment plans for those underlying conditions. Baseline
patient characteristics explained only a small share of the variation in
observation period health care costs, however. Future research should
explore the degree to which other factors not captured in administrative
claims data (e.g., severity of abuse) can explain the wide variation in
health care costs among opioid abusers.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
opiate addiction (diagnosis)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
Charlson Comorbidity Index
child
chronic lung disease
comorbidity
controlled study
data analysis
diabetes mellitus
female
health care utilization
human
major clinical study
male
managed care organization
physician
psychosis
rank sum test
substance abuse
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015497680
PUI
L606799604
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 501
TITLE
Opioid medication practices observed in chronic pain patients presenting for
all-causes to emergency departments: Prevalence and impact on health care
outcomes
AUTHOR NAMES
Ernst F.R.
Mills J.R.
Berner T.
House J.
Herndon C.
AUTHOR ADDRESSES
(Ernst F.R., fernst@indegenettm.com) Health Economics and Outcomes Research,
Indegene TTM, Kennesaw, United States.
(Mills J.R.) Research and Hospital Engagement, Charlotte, United States.
(House J.) Premier Research Services, Premier, Charlotte, United States.
(Berner T.) Global Medical Affairs Strategy, Immunology, Baxalta,
Bannockburn, United States.
(Herndon C.) Southern Illinois University, Edwardsville, United States.
CORRESPONDENCE ADDRESS
F.R. Ernst, Indegene TTM, 222 Chastain Meadows Ct., Ste. 300, Kennesaw,
United States.
SOURCE
Journal of Managed Care Pharmacy (2015) 21:10 (925-936). Date of
Publication: 2015
ISSN
1083-4087
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
Background: Chronic pain is a significant health problem that affects an
estimated 100 million American adults (aged ≥ 18 years). Chronic pain
affects more individuals than heart disease, stroke, diabetes, and cancer
combined. Chronic pain sufferers cost up to $635 billion annually in medical
treatment and lost productivity. Opioids are commonly used to treat chronic
pain, but their metabolic interactions with concurrently prescribed
medications for concomitant disease burdens can affect potency and efficacy
of pain therapy. Additionally, misuse of short-acting opioids (SAOs) for
chronic pain versus breakthrough pain can create gaps in pain relief. These
potentially suboptimal prescribing practices may contribute to the high
economic impact associated with chronic pain. OBJECTIVE: To examine the
prevalence of suboptimal opioid therapy and the associated health care costs
resulting from these prescribing practices in real-world patients presenting
for all-causes to the emergency department (ED). METHODS: This retrospective
observational database cohort analysis used the linked Premier-Optum
database and included patients with ED visits from 2006 to 2010 having ≥ 60
days supply of opioids in the 75 days prior to the visit. Suboptimal
prescribing practices were identified as patients with (a) drug-drug
exposures (DDEs), defined as cytochrome P-450 (CYP-450)-metabolized opioids
prescribed concurrently with CYP-450 inhibitors or inducers and/or (b)
monotherapy with SAOs. Comorbid conditions and principal diagnoses were
documented. Readmission rates to the ED and hospital within 72 hours as well
as ≤ 30, ≤ 45, ≤ 60, and ≤ 90 days were computed. Total costs for health
care were calculated, and reimbursement rates were normalized using 2011
Medicare severity diagnosis-related group (MS-DRG) and CPT-4 information.
Nonparametric bootstrapping to adjust for patient comorbidities was applied
to cost data. RESULTS: Of the 9,214 patients identified with chronic pain,
potentially suboptimal medication practices prior to the index ED visit were
found for 8,539 (92.6%) patients. These appeared to be corrected in 345
(4.0%) patients before leaving the ED. Of 675 (7.3%) patients without prior
DDE or exclusive use of SAOs, 345 (51.1%) patients were discharged with one
of these. Of the 8,352 patients who left the ED with DDE or exclusive use of
SAOs, 1,525 (18.3%) left with a DDE without exclusive SAO use; 4,812 (57.6%)
left with both DDE and exclusive SAO use; and 2,015 (24.1%) left with only
exclusive SAO use. Only 862 (9.3%) patients from the entire cohort left the
ED without DDE or exclusive SAO use. Patients identified with suboptimal
opioid use were aged 50 ± 13.5 years and were predominantly female (64.0%).
Hypertension (44.0%), fluid and electrolyte disorders (32.7%), chronic
pulmonary disease (22.8%), depression (19.6%), diabetes without chronic
complications (16.2%), and drug abuse (15.6%) were the most prevalent
comorbid conditions identified. The most prevalent principal diagnoses
involved symptoms and signs of ill-defined conditions (36.5%), injury and
poisoning (18.2%), and diseases of the musculoskeletal system (13.2%). The
majority of revisits to the ED and hospital admissions occurred within 72
hours (73.6%) of the index visit and within 30 days (70%), respectively.
When adjusted total costs were compared for all patients whose opioid use
included DDE versus those without, a significantly greater cost (P < 0.05)
was observed at every time period except ≤ 72 hours. Respective mean
increases in costs were $581, $689, $773, and $1,275 at 30, 45, 60, and 90
days. Exclusive SAO use with or without DDE resulted in a significant
increase (P < 0.05) in mean costs at all times: $214 at 72 hours; $836 at 30
days; $1,023 at 45 days; $1,022 at 60 days; and $1,536 at 90 days.
CONCLUSIONS: This study identified potentially suboptimal opioid prescribing
practices in a real-world population presenting for all-causes to the ED.
The observed rate of ED revisits and inpatient admissions in these patients
was associated with increased health care costs. These findings suggest that
the ED has the future potential to serve as an ideal setting to identify and
correct such practices, thereby improving patient care and reducing resource
use and beneficiary costs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
cost of illness
diagnosis related group
emergency ward
female
health care cost
hospital readmission
human
male
medicare
outcome assessment
patient care
prescription
prevalence
reimbursement
retrospective study
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015497681
PUI
L606799606
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 502
TITLE
Swift recovery of severe acute hypoxemic respiratory failure under
non-invasive ventilation
AUTHOR NAMES
Pichot C.
Petitjeans F.
Ghignone M.
Quintin L.
AUTHOR ADDRESSES
(Pichot C.; Quintin L., quintin@univ-lyon1.fr) Department of Physiology (EA
4612), University of Lyon, Campus de la Doua 8 Rue R Dubois, Lyon,
Villeurbanne, France.
(Petitjeans F.) Department of Critical Care Medicine, Hopital Desgenettes,
Lyon, France.
(Ghignone M.) Department of Critical Care Medicine, Columbia Hospital, West
Palm Beach, United States.
CORRESPONDENCE ADDRESS
L. Quintin, Department of Physiology (EA 4612), University of Lyon, Campus
de la Doua 8 Rue R Dubois, Lyon, Villeurbanne, France.
SOURCE
Anaesthesiology Intensive Therapy (2015) 47:2 (138-139). Date of
Publication: 2015
ISSN
1731-2531 (electronic)
1642-5758
BOOK PUBLISHER
Via Medica, Ul. Swietokrzyska 73, Gdansk, Poland. viamedica@viamedica.com.pl
ABSTRACT
Background: In the setting of severe acute respiratory distress syndrome
(PaO2 to FiO2 ratio < 100), the cut-off point for
switching from non-invasive ventilation to tracheal intubation combined with
mechanical ventilation is poorly defined. Results: The swift resolution over
10 h of a severe acute hypoxemic respiratory failure
(PaO2/FiO2 = 57) caused by aspiration
following heroin overdose, using non-invasive ventilation with high positive
end expiratory pressure 15-20 cm H2O) along with low pressure
support (8 cm H2O) is reported. The success in treating
non-invasively severe hypoxia was presumably linked to a highly restricted
subset: healthy young patient, minimal alteration of consciousness,
non-combativeness, absence of severe metabolic acidosis, quick resolution of
supraventricular arrhythmia, one-to-one supervision by the intensivist in
the critical care unit. Conclusion: Given the complications associated with
tracheal intubation and mechanical ventilation on the one hand, and with
delayed intubation on the other hand, high PEEP-NIV may warrant study in a
restricted set of patients closely monitored in a critical care environment.
EMTREE DRUG INDEX TERMS
cocaine
diamorphine
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute respiratory failure (therapy)
convalescence
noninvasive ventilation
severe acute hypoxemic respiratory failure (therapy)
EMTREE MEDICAL INDEX TERMS
adult
arterial pressure
article
body temperature
case report
cyanosis
dyspnea
emergency ward
heart rate
heart supraventricular arrhythmia
human
intensive care unit
male
miosis
neurologic disease
positive end expiratory pressure
pulmonary aspiration
respiratory distress (therapy)
tachypnea
unconsciousness
vasoconstriction
vomiting
wheezing
young adult
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015004459
MEDLINE PMID
25338517 (http://www.ncbi.nlm.nih.gov/pubmed/25338517)
PUI
L604204388
DOI
10.5603/AIT.a2014.0053
FULL TEXT LINK
http://dx.doi.org/10.5603/AIT.a2014.0053
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 503
TITLE
Emergency department visits and overdose deaths from combined use of opioids
and benzodiazepines
AUTHOR NAMES
Jones C.M.
McAninch J.K.
AUTHOR ADDRESSES
(Jones C.M., christopher.m.jones@fda.hhs.gov) Office of the Commissioner,
U.S. Food and Drug Administration, Office of Public Health Strategy and
Analysis, 10903 New Hampshire Avenue, Silver Spring, United States.
(McAninch J.K.) Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Silver Spring, United States.
CORRESPONDENCE ADDRESS
C.M. Jones, Office of the Commissioner, U.S. Food and Drug Administration,
Office of Public Health Strategy and Analysis, 10903 New Hampshire Avenue,
Silver Spring, United States.
SOURCE
American Journal of Preventive Medicine (2015) 49:4 (493-501). Date of
Publication: 1 Oct 2015
ISSN
1873-2607 (electronic)
0749-3797
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Introduction Opioid analgesics and benzodiazepines are the prescription
drugs most commonly associated with drug overdose deaths. This study was
conducted to assess trends in nonmedical use-related emergency department
(ED) visits and drug overdose deaths that involved both opioid analgesics
and benzodiazepines in the U.S. from 2004 to 2011. Methods Opioid analgesic
and benzodiazepine nonmedical use-related ED visits from the Drug Abuse
Warning Network and drug overdose deaths from the National Vital Statistics
System were analyzed for 2004-2011 to determine trends and
demographic-specific rates. Data were analyzed from March 2014 to June 2014.
Results From 2004 to 2011, the rate of nonmedical use-related ED visits
involving both opioid analgesics and benzodiazepines increased from 11.0 to
34.2 per 100,000 population (p-trend<0.0001). During the same period, drug
overdose deaths involving both drugs increased from 0.6 to 1.7 per 100,000
(p-trend<0.0001). Statistically significant increases in ED visits occurred
among males and females, non-Hispanic whites, non-Hispanic blacks, and
Hispanics, and all age groups except 12- to 17-year-olds. For overdose
deaths, statistically significant increases were seen in males and females,
all three race/ethnicity groups, and all age groups except 12- to
17-year-olds. Benzodiazepine involvement in opioid analgesic overdose deaths
increased each year, increasing from 18% of opioid analgesic overdose deaths
in 2004 to 31% in 2011 (p-trend<0.0001). Conclusions ED visits and drug
overdose deaths involving both opioid analgesics and benzodiazepines
increased significantly between 2004 and 2011. Interventions to improve the
appropriate prescribing and use of these medications are needed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug toxicity)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
death
drug overdose
drug overdose death
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
Black person
Caucasian
drug use
ethnicity
female
gender
groups by age
Hispanic
human
major clinical study
male
race
trend study
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015193137
PUI
L605179458
DOI
10.1016/j.amepre.2015.03.040
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amepre.2015.03.040
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 504
TITLE
Benzodiazepine Use among Chronic Pain Patients Prescribed Opioids:
Associations with Pain, Physical and Mental Health, and Health Service
Utilization
AUTHOR NAMES
Nielsen S.
Lintzeris N.
Bruno R.
Campbell G.
Larance B.
Hall W.
Hoban B.
Cohen M.L.
Degenhardt L.
AUTHOR ADDRESSES
(Nielsen S., suzanne.nielsen@unsw.edu.au; Bruno R.; Campbell G.; Larance B.;
Hoban B.; Degenhardt L.) National Drug and Alcohol Research Centre,
University of New South Wales, Sydney, Australia.
(Cohen M.L.) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia.
(Nielsen S., suzanne.nielsen@unsw.edu.au; Lintzeris N.) The Langton Centre,
South East Sydney Local Health District (SESLHD) Drug and Alcohol Services,
Sydney, Australia.
(Lintzeris N.) Discipline of Addiction Medicine, University of Sydney,
Sydney, Australia.
(Bruno R.) School of Medicine, University of Tasmania, Hobart, Australia.
(Hall W.) Centre for Youth Substance Abuse Research, Royal Brisbane and
Women's Hospital, University of Queensland, Herston, Australia.
(Degenhardt L.) School of Population and Global Health, The University of
Melbourne, Melbourne, Australia.
(Degenhardt L.) Murdoch Children's Research Institute, The Royal Children's
Hospital, Melbourne, Australia.
(Degenhardt L.) Department of Global Health, School of Public Health,
University of Washington, Seattle, United States.
CORRESPONDENCE ADDRESS
S. Nielsen, National Drug and Alcohol Research Centre, University of New
South Wales, 22-32 King Street, Randwick, Australia.
SOURCE
Pain Medicine (United States) (2015) 16:2 (356-366). Date of Publication: 1
Feb 2015
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Benzodiazepines (BZDs) are commonly used by chronic pain
patients, despite limited evidence of any long-term benefits and concerns
regarding adverse events and drug interactions, particularly in older
patients. This article aims to: describe patterns of BZDs use; the
demographic, physical, and mental health correlates of BZD use; and examine
if negative health outcomes are associated with BZD use after controlling
for confounders. Subjects: A national sample of 1,220 chronic noncancer pain
(CNCP) patients prescribed long-term opioids. Methods: We report on baseline
data from a prospective cohort study comparing four groups based on their
current BZD use patterns. General demographics, pain, mental and physical
comorbidity, and health service utilization were examined. Results:
One-third (N=398, 33%) of participants reported BZD use in the past month,
and 17% (N=212) reported daily BZD use. BZD use was associated with: 1)
greater pain severity, pain interference with life, and lower feelings of
self-efficacy with respect to their pain; 2) being prescribed "higher-risk"
(>200mg oral morphine equivalent) doses of opioids; 3) using antidepressant
and/or antipsychotic medications; 4) substance use (including more illicit
and injection drug use, alcohol use disorder, and daily nicotine use); and
5) greater mental health comorbidity. After controlling for differences in
demographic characteristics, physical and mental health, substance use, and
opioid dose, BZD use was independently associated with greater past-month
use of emergency health care such as ambulance or accident and emergency
services. Conclusions: CNCP patients using BZDs daily represent a high-risk
group with multiple comorbid mental health conditions and higher rates of
emergency health care use. The high prevalence of BZD use is inconsistent
with guidelines for the management of CNCP or chronic mental health
conditions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
antidepressant agent
buprenorphine (drug therapy)
clonazepam (drug therapy)
codeine phosphate (drug therapy)
diazepam (drug therapy)
fentanyl (drug therapy)
hydromorphone (drug therapy)
methadone (drug therapy)
morphine (drug therapy, oral drug administration)
neuroleptic agent
nicotine
nitrazepam (drug therapy)
oxazepam (drug therapy)
oxycodone (drug therapy)
temazepam (drug therapy)
zolpidem (drug therapy)
zopiclone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic noncancer pain (drug therapy, drug therapy)
chronic pain (drug therapy, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
adult
alcoholism
analgesia
article
cohort analysis
comorbidity
demography
emergency health service
health care utilization
human
long term care
major clinical study
mental health
outcome assessment
pain severity
prospective study
substance use
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
clonazepam (1622-61-3)
codeine phosphate (52-28-8)
diazepam (439-14-5)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nicotine (54-11-5)
nitrazepam (146-22-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
oxycodone (124-90-3, 76-42-6)
temazepam (846-50-4)
zolpidem (82626-48-0)
zopiclone (43200-80-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015741928
MEDLINE PMID
25279706 (http://www.ncbi.nlm.nih.gov/pubmed/25279706)
PUI
L602221017
DOI
10.1111/pme.12594
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12594
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 505
TITLE
Opioid dependence treatment in the emergency department
AUTHOR NAMES
Swartz A.W.
AUTHOR ADDRESSES
(Swartz A.W., awswartz@acsalaska.net) Yukon Kuskokwim Health Corp, 6306 Tay
Cir, Anchorage, United States.
CORRESPONDENCE ADDRESS
A.W. Swartz, Yukon Kuskokwim Health Corp, 6306 Tay Cir, Anchorage, United
States.
SOURCE
JAMA - Journal of the American Medical Association (2015) 314:8 (834-835).
Date of Publication: 25 Aug 2015
ISSN
1538-3598 (electronic)
0098-7484
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
drug efficacy
drug monitoring
drug response
drug screening
drug use
high risk behavior
human
Human immunodeficiency virus
letter
priority journal
self report
treatment duration
treatment outcome
urinalysis
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015340078
MEDLINE PMID
26305656 (http://www.ncbi.nlm.nih.gov/pubmed/26305656)
PUI
L605839104
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 506
TITLE
Opioid Poisonings in Washington State Medicaid: Trends, Dosing, and
Guidelines
AUTHOR NAMES
Fulton-Kehoe D.
Sullivan M.D.
Turner J.A.
Garg R.K.
Bauer A.M.
Wickizer T.M.
Franklin G.M.
AUTHOR ADDRESSES
(Fulton-Kehoe D., debfk@u.washington.edu; Franklin G.M.) Department of
Environmental and Occupational Health Sciences, University of Washington
School of Public Health, 130 Nickerson St, Seattle, United States.
(Sullivan M.D.; Turner J.A.; Bauer A.M.) Department of Psychiatry and
Behavioral Sciences, University of Washington School of Medicine, United
States.
(Garg R.K.) Department of Epidemiology, University of Washington School of
Public Health, Seattle, United States.
(Wickizer T.M.) Division of Health Services Management and Policy, College
of Public Health, Ohio State University, Columbus, United States.
(Franklin G.M.) Department of Health Services, University of Washington
School of Public Health and Community Medicine, United States.
(Franklin G.M.) Washington State Department of Labor and Industries, United
States.
(Franklin G.M.) Department of Neurology, University of Washington School of
Medicine, Seattle, United States.
CORRESPONDENCE ADDRESS
D. Fulton-Kehoe, Department of Environmental and Occupational Health
Sciences, University of Washington School of Public Health, 130 Nickerson
St, Seattle, United States.
SOURCE
Medical Care (2015) 53:8 (679-685). Date of Publication: 25 Jul 2015
ISSN
1537-1948 (electronic)
0025-7079
BOOK PUBLISHER
Lippincott Williams and Wilkins, LRorders@phl.lrpub.com
ABSTRACT
Background: Opioid poisonings have increased as use of prescription opioid
medications have increased. To reduce these poisonings, guidelines for
chronic opioid use have been implemented. However, if opioid poisonings
occur in individuals who do not have high prescribed doses and who are not
chronic opioid users, the current guidelines may need revision. Objectives:
To examine changes in rates of methadone and other opioid poisonings after
implementation of the WA State Opioid Guideline in 2007 and to examine the
prescription history before poisonings. Methods: The study sample consisted
of individuals who had at least 1 paid claim for an opioid prescription in
the Medicaid fee-for-service system between April 2006 and December 2010 and
had an emergency department or inpatient hospital claim for an opioid
poisoning. Results: Methadone poisonings occurred at 10 times the rate of
other prescription opioid poisonings and increased between 2006 and 2010.
Rates of other prescription opioid poisonings appeared to level off after
implementation of the WA opioid guideline in 2007. Among individuals with
nonmethadone opioid poisonings, only 44% had chronic opioid use, 17% had
prescribed doses in the week before the poisoning >120 mg/d
morphine-equivalent dose (MED), 28% had doses <50 mg/d MED, and 48% had
concurrent sedative prescriptions. Conclusions: It may be prudent to revise
guidelines to address opioid poisonings occurring at relatively low
prescribed doses and with acute and intermittent opioid use. Research is
needed to establish the best strategies to prevent opioid poisonings. ©
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
morphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis)
practice guideline
EMTREE MEDICAL INDEX TERMS
adult
alcoholism (diagnosis)
article
cohort analysis
emergency ward
female
human
ICD-9-CM
major clinical study
male
medicaid
methadone treatment
morbidity
priority journal
retrospective study
United States
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015227738
MEDLINE PMID
26172937 (http://www.ncbi.nlm.nih.gov/pubmed/26172937)
PUI
L605372879
DOI
10.1097/MLR.0000000000000384
FULL TEXT LINK
http://dx.doi.org/10.1097/MLR.0000000000000384
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 507
TITLE
Part 3: Adult basic life support and automated external defibrillation. 2015
International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations
AUTHOR NAMES
Perkins G.D.
Travers A.H.
Berg R.A.
Castren M.
Considine J.
Escalante R.
Gazmuri R.J.
Koster R.W.
Lim S.H.
Nation K.J.
Olasveengen T.M.
Sakamoto T.
Sayre M.R.
Sierra A.
Smyth M.A.
Stanton D.
Vaillancourt C.
Bierens J.J.L.M.
Bour-don E.
Brugger H.
Buick J.E.
Charette M.L.
Chung S.P.
Couper K.
Daya M.R.
Drennan I.R.
Jan-Thorsten Gräsner
Idris A.H.
Lerner E.B.
Lockhat H.
Løfgren B.
McQueen C.
Monsieurs K.G.
Mpotos N.
Orkin A.M.
Quan L.
Raffay V.
Reynolds J.C.
Ristagno G.
Scapigliati A.
Vadebon-coeur T.F.
Wenzel V.
Yeung J.
AUTHOR ADDRESSES
(Perkins G.D., G.D.Perkins@warwick.ac.uk; Travers A.H.; Berg R.A.; Castren
M.; Considine J.; Escalante R.; Gazmuri R.J.; Koster R.W.; Lim S.H.; Nation
K.J.; Olasveengen T.M.; Sakamoto T.; Sayre M.R.; Sierra A.; Smyth M.A.;
Stanton D.; Vaillancourt C.; Bierens J.J.L.M.; Bour-don E.; Brugger H.;
Buick J.E.; Charette M.L.; Chung S.P.; Couper K.; Daya M.R.; Drennan I.R.;
Jan-Thorsten Gräsner; Idris A.H.; Lerner E.B.; Lockhat H.; Løfgren B.;
McQueen C.; Monsieurs K.G.; Mpotos N.; Orkin A.M.; Quan L.; Raffay V.;
Reynolds J.C.; Ristagno G.; Scapigliati A.; Vadebon-coeur T.F.; Wenzel V.;
Yeung J.)
CORRESPONDENCE ADDRESS
G.D. Perkins,
SOURCE
Resuscitation (2015) 95 (e43-e69). Date of Publication: 1 Oct 2015
ISSN
1873-1570 (electronic)
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intramuscular drug administration, intranasal drug
administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adult
consensus
defibrillation
emergency care
resuscitation
EMTREE MEDICAL INDEX TERMS
article
compression therapy
heart arrest (prevention, therapy)
hospital discharge
human
intoxication (drug therapy)
nonhuman
priority journal
respiratory arrest (therapy)
return of spontaneous circulation
survival
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015470537
MEDLINE PMID
26477428 (http://www.ncbi.nlm.nih.gov/pubmed/26477428)
PUI
L606594590
DOI
10.1016/j.resuscitation.2015.07.041
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2015.07.041
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 508
TITLE
Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year
Analysis
AUTHOR NAMES
Ganem V.J.
Mora A.G.
Varney S.M.
Bebarta V.S.
AUTHOR ADDRESSES
(Ganem V.J., ganemv@gmail.com; Mora A.G., alexgmora24@gmail.com) Air Force
En route Care Research Center, 59th Medical Wing Chief Scientist’s Office,
San Antonio Military Medical Center, San Antonio, United States.
(Varney S.M., smvarney@gmail.com) Department of Emergency Medicine,
University of Texas Health Sciences Center-San Antonio, San Antonio, United
States.
(Bebarta V.S., vikbebarta@yahoo.com) Air Force En route Care Research
Center, 59th Medical Wing Chief Scientist’s Office, Medical Toxicology,
Department of Emergency Medicine, San Antonio Military Medical Center, San
Antonio, United States.
CORRESPONDENCE ADDRESS
V.J. Ganem, Air Force En route Care Research Center, 59th Medical Wing Chief
Scientist’s Office, San Antonio Military Medical Center, San Antonio, United
States.
SOURCE
Journal of Medical Toxicology (2015) 11:3 (288-294). Date of Publication: 3
Dec 2014
ISSN
1937-6995 (electronic)
1556-9039
BOOK PUBLISHER
Springer New York LLC, journals@springer-sbm.com
ABSTRACT
Chronic pain is a common reason for emergency department (ED) visits. Our
objective was to describe opioid prescribing practices of ED providers when
treating patients with chronic pain. We retrospectively evaluated opioid
prescriptions from EDs at two tertiary care military hospitals. We queried
the outpatient record database to obtain a list of opioid medications
prescribed and ICD-9 codes associated with visits for chronic pain. We
collected provider type and gender, number of pills, opioid type, and
refills. We compared the incidence with chi-square or Fisher’s exact tests.
Wilcoxon test was used for non-parametric continuous variables. Over
3 years, 28,103 visits generated an opioid prescription. One thousand three
hundred twenty-two visits were associated with chronic pain, and 443 (33 %)
visits were associated with an opioid prescription. Providers were 79 %
physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty
military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol,
2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile
range (IQR) 15–30] (range 1–240), morphine equivalents (M.E.) per pill was
7.5 [7.5–7.5] (2.5–120) and total M.E. per prescription was 150 [112.5–270]
(15–6000). Physicians were more likely to prescribe a non-opioid than PAs
(77 vs 45 %, p < 0.0001). Civilian providers were more likely to prescribe
an opioid than active duty providers (58 vs 42 %, p < 0.0001). Providers
prescribed a median of 20 pills per prescription and most commonly
prescribed oxycodone. PAs were more likely to prescribe an opioid for
chronic pain than physicians. Civilian providers were more likely to
prescribe an opioid than active duty providers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
hydrocodone (drug therapy)
morphine (drug therapy)
oxycodone
paracetamol (drug therapy)
pethidine (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
article
female
human
job experience
male
military medicine
physician
physician assistant
retrospective study
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014948146
MEDLINE PMID
25468314 (http://www.ncbi.nlm.nih.gov/pubmed/25468314)
PUI
L600677954
DOI
10.1007/s13181-014-0449-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-014-0449-5
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 509
TITLE
Gender and prescription opioid misuse in the emergency department
AUTHOR NAMES
Choo E.K.
Douriez C.
Green T.
AUTHOR ADDRESSES
(Choo E.K., esther_choo@brown.edu; Green T.) Department of Emergency
Medicine, Warren Alpert Medical School, Providence, United States.
(Choo E.K., esther_choo@brown.edu; Green T.) School of Public Health, Brown
University, Providence, United States.
(Douriez C.) Department of Emergency Medicine, Boston University, Boston,
United States.
CORRESPONDENCE ADDRESS
E.K. Choo, Department of Emergency Medicine, Warren Alpert Medical School,
Providence, United States.
SOURCE
Academic Emergency Medicine (2014) 21:12 (1493-1498). Date of Publication: 1
Dec 2014
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives To the best of the authors' knowledge, gender differences in
nonmedical opioid presentations to the emergency department (ED) have not
been studied. The objective was to explore gender differences in ED visits
related to nonmedical prescription opioid use in a nationally representative
sample.Methods Data from the 2011 U.S. Department of Health and Human
Services Substance Abuse and Mental Health Services Administration's Drug
Abuse Warning Network (DAWN) were analyzed to compare visit characteristics
between women and men. Logistic regression models were developed to examine
the association between gender and specific drug presentations and clinical
outcomes.Results There were an estimated 426,010 DAWN-defined visits
involving prescription opioid use in 2011. The prevalence of drugs in
opioid-involved visits was similar between women and men. Ingestion of
another drug along with opioids was associated with increased odds of
hospital admission for both women and men, and types of opioids ingested
were similar between women and men. However, gender differences were noted
in clinical outcomes, depending on the specific drug combination.Conclusions
Gender differences exist in ED presentations related to prescription
opioids. Further research is needed to understand these differences and any
implications for gender-specific emergency care and brief interventions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug combination)
EMTREE DRUG INDEX TERMS
alcohol
antidepressant agent (drug combination)
anxiolytic agent (drug combination)
cocaine
diamorphine
hydrocodone bitartrate plus paracetamol
illicit drug
narcotic analgesic agent
oxycodone plus paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
emergency treatment
opiate addiction
sex difference
EMTREE MEDICAL INDEX TERMS
adult
aged
article
cohort analysis
drug fatality
female
hospital admission
human
major clinical study
male
mortality
outcome assessment
prescription
prevalence
retrospective study
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015634155
MEDLINE PMID
25491712 (http://www.ncbi.nlm.nih.gov/pubmed/25491712)
PUI
L601077698
DOI
10.1111/acem.12547
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12547
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 510
TITLE
Measures to quantify the abuse of prescription opioids: a review of data
sources and metrics
AUTHOR NAMES
Secora A.M.
Dormitzer C.M.
Staffa J.A.
Dal Pan G.J.
AUTHOR ADDRESSES
(Secora A.M.; Dormitzer C.M.; Staffa J.A.; Dal Pan G.J.) Office of
Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food
and Drug Administration, Silver Spring, MD, USA
SOURCE
Pharmacoepidemiology and drug safety (2014) 23:12 (1227-1237). Date of
Publication: 1 Dec 2014
ISSN
1099-1557 (electronic)
ABSTRACT
PURPOSE: The abuse and nonmedical use of prescription opioids and its
subsequent consequences are an important public health concern. This
phenomenon has paralleled the increase in the therapeutic use of opioids for
pain management. There is thus a need to measure prescription opioid abuse
to understand trends over time and to compare abuse of one product to
another. The purpose of this review is to provide an overview of the
strengths and weaknesses of frequently used numerators and denominators in
"abuse ratios" (ARs).METHODS: For this review, we critically evaluated the
various measures to quantify drug availability and the available data
sources to measure prescription opioid abuse.RESULTS: There are currently no
commonly adopted metrics for measuring either the prevalence of opioid
abuse, or abuse relative to drug availability. Because the settings,
manifestations, and severity of abuse can vary from one person to the next,
no one measure of abuse, abuse-related outcome, or drug exposure is ideal.
Each measure of abuse captures a specific facet of abuse, but not the whole
spectrum. Reliable estimation of population-adjusted or utilization-adjusted
rates of abuse can be accomplished with a prescription opioid AR. This
metric estimates the prevalence of abuse in a given population or abuse
relative to how much drug is available, and, in certain cases, can be used
to compare abuse among various opioid drugs. AR measurements in the
literature vary in the inclusion of specific measures of abuse and
availability, and there is little consensus in the field regarding which
measures allow for the most appropriate approximation of the extent of
abuse, and for comparisons among opioids. Crude numbers of outcomes related
to abuse (e.g., emergency department visits, treatment admissions, and
overdoses) cannot be properly understood without context as these may
overestimate or underestimate the true scope and severity of prescription
opioid abuse. They can, however, serve as numerators in properly constructed
ARs. The denominator of the AR provides the necessary context by accounting
for populations at risk or drug availability (e.g., prescriptions or tablets
dispensed, unique recipients of dispensed drug, total patient days of
therapy, or kilograms sold), and each comes with its own set of assumptions
to consider.CONCLUSIONS: Moving forward, it is important that there be a
common understanding in the scientific community regarding how to select
appropriate measures to serve as numerators and denominators in AR
calculations, and how to interpret the resultant findings. There is no
single best measure of abuse for use as a numerator in an AR, and each must
be chosen and interpreted in the context of what it measures. For public
health considerations, one must always look at both absolute numbers and
adjusted numbers. When conducting multiple analyses using different measures
of exposure as denominators, differences in ARs are not unexpected, but one
should explore why there are differences and assess the appropriateness of
each of the denominators. Copyright © 2014 John Wiley & Sons, Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction
standards
EMTREE MEDICAL INDEX TERMS
human
statistics
trends
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25257660 (http://www.ncbi.nlm.nih.gov/pubmed/25257660)
PUI
L605895891
DOI
10.1002/pds.3711
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.3711
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 511
TITLE
The ecology of prescription opioid abuse in the USA: geographic variation in
patients' use of multiple prescribers ("doctor shopping")
AUTHOR NAMES
McDonald D.C.
Carlson K.E.
AUTHOR ADDRESSES
(McDonald D.C.; Carlson K.E.) US Health Division, Abt Associates Inc.,
Cambridge, MA, USA
SOURCE
Pharmacoepidemiology and drug safety (2014) 23:12 (1258-1267). Date of
Publication: 1 Dec 2014
ISSN
1099-1557 (electronic)
ABSTRACT
PURPOSE: This study estimates the prevalence in US counties of opioid
patients who use large numbers of prescribers, the amounts of opioids they
obtain, and the extent to which their prevalence is predicted by ecological
attributes of counties, including general medical exposure to
opioids.METHODS: Finite mixture models were used to estimate the size of an
outlier subpopulation of patients with suspiciously large numbers of
prescribers (probable doctor shoppers), using a sample of 146 million opioid
prescriptions dispensed during 2008. Ordinary least squares regression
models of county-level shopper rates included independent variables
measuring ecological attributes of counties, including rates of patients
prescribed opioids, socioeconomic characteristics of the resident
population, supply of physicians, and measures of healthcare service
utilization.RESULTS: The prevalence of shoppers varied widely by county,
with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper
prevalence was strongly correlated with opioid prescribing for the general
population, accounting for 30% of observed county variation in shopper
prevalence, after adjusting for physician supply, emergency department
visits, in-patient hospital days, poverty rates, percent of county residents
living in urban areas, and racial/ethnic composition of resident
populations. Approximately 30% of shoppers obtained prescriptions in
multiple states.CONCLUSIONS: The correlation between prevalence of doctor
shoppers and opioid patients in a county could indicate either that easy
access to legitimate medical treatment raises the risk of abuse or that drug
abusers take advantage of greater opportunities in places where access is
easy. Approaches to preventing excessive use of different prescribers are
discussed.
EMTREE DRUG INDEX TERMS
prescription drug (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
age
clinical practice
cluster analysis
drug misuse
human
opiate addiction (epidemiology)
sex difference
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25111716 (http://www.ncbi.nlm.nih.gov/pubmed/25111716)
PUI
L605895797
DOI
10.1002/pds.3690
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.3690
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 512
TITLE
Prescription opioid abuse: A literature review of the clinical and economic
burden in the United States
AUTHOR NAMES
Meyer R.
Patel A.M.
Rattana S.K.
Quock T.P.
Mody S.H.
AUTHOR ADDRESSES
(Meyer R., rmeyer1@its.jnj.com; Patel A.M.; Mody S.H.) Health Economics and
Outcomes Research (HECOR), Translational Science, Janssen Scientific
Affairs, LLC, 29963 N. 122nd Drive, Peoria, United States.
(Rattana S.K.) InVentiv Health Clinical, Deerfield, United States.
(Quock T.P.) Covance Market Access Services Inc., San Diego, United States.
CORRESPONDENCE ADDRESS
R. Meyer, Health Economics and Outcomes Research (HECOR), Translational
Science, Janssen Scientific Affairs, LLC, 29963 N. 122nd Drive, Peoria,
United States.
SOURCE
Population Health Management (2014) 17:6 (372-387). Date of Publication: 1
Dec 2014
ISSN
1942-7905 (electronic)
1942-7891
BOOK PUBLISHER
Mary Ann Liebert Inc., info@liebertpub.com
ABSTRACT
Between 2002 and 2007, the nonmedical use of prescription pain relievers
grew from 11.0 million to 12.5 million people in the United States. Societal
costs attributable to prescription opioid abuse were estimated at $55.7
billion in 2007. The purpose of this study was to comprehensively review the
recent clinical and economic evaluations of prescription opioid abuse. A
comprehensive literature search was conducted for studies published from
2002 to 2012. Articles were included if they were original research studies
in English that reported the clinical and economic burden associated with
prescription opioid abuse. A total of 23 studies (183 unique citations
identified, 54 articles subjected to full text review) were included in this
review and analysis. Findings from the review demonstrated that rates of
opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in
2008. Furthermore, overdose reportedly results in 830,652 years of potential
life lost before age 65. Opioid abusers were generally more likely to
utilize medical services, such as emergency department, physician outpatient
visits, and inpatient hospital stays, relative to non-abusers. When compared
to a matched control group (non-abusers), mean annual excess health care
costs for opioid abusers with private insurance ranged from $14,054 to
$20,546. Similarly, the mean annual excess health care costs for opioid
abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid
abuse has significant clinical and economic consequences for patients,
health care providers, commercial and government payers, and society as a
whole.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
prescription
EMTREE MEDICAL INDEX TERMS
comorbidity
drug fatality
drug overdose
economic evaluation
emergency ward
health care cost
health care utilization
hospitalization
human
medicaid
Medline
outpatient
review
systematic review
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014977288
MEDLINE PMID
25075734 (http://www.ncbi.nlm.nih.gov/pubmed/25075734)
PUI
L600802588
DOI
10.1089/pop.2013.0098
FULL TEXT LINK
http://dx.doi.org/10.1089/pop.2013.0098
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 513
TITLE
Management of opioid painkiller dependence in primary care: Ongoing recovery
with buprenorphine/naloxone
AUTHOR NAMES
Hard B.
AUTHOR ADDRESSES
(Hard B., bhard@mac.com) Kaleidoscope, New-port, United Kingdom.
CORRESPONDENCE ADDRESS
B. Hard, Kaleidoscope, New-port, United Kingdom.
SOURCE
BMJ Case Reports (2014) 2014 Article Number: 207308. Date of Publication: 28
Nov 2014
ISSN
1757-790X (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Opioid painkiller dependence is a growing problem and best-practice
management is not well defined. We report a case of a young woman exhibiting
dependence on codeine, originally prescribed for myalgic encephalopathy,
after escalating use over a 10-year period. In 2012, a consultation with a
new general practitioner, who had extensive experience of patients with
substance abuse, revealed the underlying dependence. After building trust
for 6 months, she was able to admit to medication abuse, and was referred to
the community drug and alcohol team. On presentation to the team, the
patient had no pain issues and the dihydrocodeine use-600 tablets/week-
solely reflected her dependence. The patient successfully underwent rapid
induction with buprenorphine/naloxone as opioid substitution treatment over
2 days. She is currently stable, engaged with recovery support services and
psychosocial counselling, and has just returned to work. She is maintained
on a therapeutic dose of buprenorphine 10 mg/naloxone 2.5 mg.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
codeine
diazepam
dihydrocodeine
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy, rehabilitation, therapy)
primary medical care
EMTREE MEDICAL INDEX TERMS
accident
adult
article
brain disease
case report
drug abuse
drug dependence treatment
drug dose reduction
drug misuse
drug seeking behavior
emergency ward
female
general practitioner
human
opiate substitution treatment
prescription
treatment planning
urinalysis
young adult
CAS REGISTRY NUMBERS
codeine (76-57-3)
diazepam (439-14-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Rehabilitation and Physical Medicine (19)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014611092
MEDLINE PMID
25432908 (http://www.ncbi.nlm.nih.gov/pubmed/25432908)
PUI
L600803547
DOI
10.1136/bcr-2014-207308
FULL TEXT LINK
http://dx.doi.org/10.1136/bcr-2014-207308
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 514
TITLE
Take-home emergency naloxone to prevent deaths from heroin overdose: Time to
save lives
AUTHOR NAMES
Strang J.
Bird S.M.
Dietze P.
Gerra G.
McLellan A.T.
AUTHOR ADDRESSES
(Strang J., john.strang@kcl.ac.uk) National Addiction Centre (Institute of
Psychiatry and the Maudsley), King's College London, London, United Kingdom.
(Bird S.M.) MRC Biostatistics Unit, Cambridge, United Kingdom.
(Dietze P.) Burnet Institute, Melbourne, Australia.
(Gerra G.) Drug Prevention and Health Branch, United Nations Office on Drugs
and Crime, Vienna, Austria.
(McLellan A.T.) Treatment Research Institute, Philadelphia, United States.
CORRESPONDENCE ADDRESS
J. Strang, National Addiction Centre (Institute of Psychiatry and the
Maudsley), King's College London, London, United Kingdom.
SOURCE
BMJ (Online) (2014) 349 Article Number: g6580. Date of Publication: 4 Nov
2014
ISSN
1756-1833 (electronic)
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (clinical trial, drug therapy, intramuscular drug administration,
intranasal drug administration, intravenous drug administration,
subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
buprenorphine
methadone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy, prevention)
emergency treatment
EMTREE MEDICAL INDEX TERMS
death
editorial
heroin dependence
high risk population
human
opiate addiction
prisoner
resuscitation
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014891812
MEDLINE PMID
25378248 (http://www.ncbi.nlm.nih.gov/pubmed/25378248)
PUI
L600330322
DOI
10.1136/bmj.g6580
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.g6580
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 515
TITLE
How do physicians adopt and apply opioid prescription guidelines in the
emergency department? A qualitative study
AUTHOR NAMES
Kilaru A.S.
Gadsden S.M.
Perrone J.
Paciotti B.
Barg F.K.
Meisel Z.F.
AUTHOR ADDRESSES
(Kilaru A.S.; Perrone J.; Meisel Z.F., zfm@upenn.edu) Department of
Emergency Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States.
(Gadsden S.M.; Paciotti B.; Barg F.K.) Department of Family Medicine and
Community Health, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States.
(Meisel Z.F., zfm@upenn.edu) Leonard Davis Institute of Health Economics,
University of Pennsylvania, Philadelphia, United States.
CORRESPONDENCE ADDRESS
Z.F. Meisel, Department of Emergency Medicine, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States.
SOURCE
Annals of Emergency Medicine (2014) 64:5 (482-489). Date of Publication: 1
Nov 2014
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
Study objective An increase in prescriptions for opioid pain medications has
coincided with increasing opioid overdose deaths. Guidelines designed to
optimize opioid prescriptions written in the emergency department have been
implemented, with substantial controversy. Little is known about how
physicians perceive and apply these guidelines. We seek to identify key
themes about emergency physicians' definition, awareness, use, and opinions
of opioid-prescribing guidelines.Methods We conducted semistructured
qualitative interviews with a convenience sample of 61 emergency physicians
attending the American College of Emergency Physicians Scientific Assembly
(October 2012, Denver, CO). Participants varied with respect to age, sex,
geographic region, practice setting, and years of practice experience. We
analyzed the interview content with modified grounded theory, an iterative
coding process to identify patterns of responses and derive key themes. The
study team examined discrepancies in the coding process to ensure
reliability and establish consensus.Results When aware of opioid-prescribing
guidelines, emergency physicians often defined them as policies developed by
individual hospitals that sometimes reflected guidelines at the state or
national level. Guidelines were primarily used by physicians to communicate
decisions to limit prescriptions to patients on discharge rather than as
tools for decisionmaking. Attitudes toward guidelines varied with regard to
general attitudes toward opioid medications, as well as the perceived
effects of guidelines on physician autonomy, public health, liability, and
patient diversion.Conclusion These exploratory findings suggest that
hospital-based opioid guidelines complement and occasionally supersede state
and national guidelines and that emergency physicians apply guidelines
primarily as communication tools. The perspectives of providers should
inform future policy actions that seek to address the problem of opioid
abuse and overdose through practice guidelines.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
physician attitude
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
cause of death
consensus
doctor patient relation
drug overdose
drug program
emergency physician
emergency ward
female
hospital policy
human
male
normal human
patient safety
qualitative research
reliability
semi structured interview
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014785240
MEDLINE PMID
24743100 (http://www.ncbi.nlm.nih.gov/pubmed/24743100)
PUI
L53102027
DOI
10.1016/j.annemergmed.2014.03.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.03.015
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 516
TITLE
Alcohol involvement in opioid pain reliever and benzodiazepine drug
abuse-related emergency department visits and drug-related deaths - United
States, 2010
AUTHOR NAMES
Jones C.M.
Paulozzi L.J.
Mack K.A.
AUTHOR ADDRESSES
(Jones C.M.; Paulozzi L.J.; Mack K.A.)
()
SOURCE
MMWR. Morbidity and mortality weekly report (2014) 63:40 (881-885). Date of
Publication: 10 Oct 2014
ISSN
1545-861X (electronic)
ABSTRACT
The abuse of prescription drugs has led to a significant increase in
emergency department (ED) visits and drug-related deaths over the past
decade. Opioid pain relievers (OPRs) and benzodiazepines are the
prescription drugs most commonly involved in these events. Excessive alcohol
consumption also accounts for a significant health burden and is common
among groups that report high rates of prescription drug abuse. When taken
with OPRs or benzodiazepines, alcohol increases central nervous system
depression and the risk for overdose. Data describing alcohol involvement in
OPR or benzodiazepine abuse are limited. To quantify alcohol involvement in
OPR and benzodiazepine abuse and drug-related deaths and to inform
prevention efforts, the Food and Drug Administration (FDA) and CDC analyzed
2010 data for drug abuse-related ED visits in the United States and
drug-related deaths that involved OPRs and alcohol or benzodiazepines and
alcohol in 13 states. The analyses showed alcohol was involved in 18.5% of
OPR and 27.2% of benzodiazepine drug abuse-related ED visits and 22.1% of
OPR and 21.4% of benzodiazepine drug-related deaths. These findings indicate
that alcohol plays a significant role in OPR and benzodiazepine abuse.
Interventions to reduce the abuse of alcohol and these drugs alone and in
combination are needed.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (drug administration)
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
utilization
EMTREE MEDICAL INDEX TERMS
adolescent
adult
child
drinking behavior
drug dependence (epidemiology)
emergency health service
female
human
male
middle aged
mortality
United States
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25299603 (http://www.ncbi.nlm.nih.gov/pubmed/25299603)
PUI
L603314949
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 517
TITLE
Emergency department naloxone distribution: a Rhode Island department of
health, recovery community, and emergency department partnership to reduce
opioid overdose deaths
AUTHOR NAMES
Samuels E.
AUTHOR ADDRESSES
(Samuels E.) Resident in the Dept. of Emergency Medicine at the Rhode Island
Hospital and Alpert Medical School of Brown University
SOURCE
Rhode Island medical journal (2013) (2014) 97:10 (38-39). Date of
Publication: 1 Oct 2014
ISSN
2327-2228 (electronic)
ABSTRACT
In response to increasing rates of opioid overdose deaths in Rhode Island
(RI), the RI Department of Health, RI emergency physicians, and Anchor
Community Recovery Center designed an emergency department (ED) naloxone
distribution and peer-recovery coach program for people at risk of opioid
overdose. ED patients at risk for overdose are offered a take home naloxone
kit, patient education video, and, when available, an Anchor peer recovery
coach to provide recovery support and referral to treatment. In August 2014,
the program launched at Kent, Miriam, and Rhode Island Hospital Emergency
Departments.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
organization and management
EMTREE MEDICAL INDEX TERMS
community care
cooperation
directive counseling
drug overdose (epidemiology, prevention)
emergency health service
human
opiate addiction (epidemiology, prevention)
patient referral
practice guideline
prescription drug misuse (prevention)
program development
statistics and numerical data
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25271659 (http://www.ncbi.nlm.nih.gov/pubmed/25271659)
PUI
L606783395
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 518
TITLE
Resuscitation characteristics and outcomes in suspected drug
overdose-related out-of-hospital cardiac arrest
AUTHOR NAMES
Koller A.C.
Salcido D.D.
Callaway C.W.
Menegazzi J.J.
AUTHOR ADDRESSES
(Koller A.C., ack40@pitt.edu; Salcido D.D.; Callaway C.W.; Menegazzi J.J.)
Department of Emergency Medicine, University of Pittsburgh, School of
Medicine, United States.
CORRESPONDENCE ADDRESS
A.C. Koller, Suite 400A, 3600 Forbes Ave, Iroquois Building, Pittsburgh,
United States.
SOURCE
Resuscitation (2014) 85:10 (1375-1379). Date of Publication: 1 Oct 2014
ISSN
1873-1570 (electronic)
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Introduction: We sought to compare characteristics of emergency medical
services-treated out-of-hospital cardiac arrests resulting from suspected
drug overdose with non-overdose cases and test the relationship between
suspected overdose and survival to hospital discharge. Methods: Data from
emergency medical services-treated, non-traumatic out-of-hospital cardiac
arrests from 2006 to 2008 and late 2009 to 2011 were obtained from four EMS
agencies in the Pittsburgh, Pennsylvania metropolitan area. Case definition
for suspected drug overdose was naloxone administration, indication on the
patient care report and/or indication by a review of hospital records.
Resuscitation parameters included chest compression fraction, rate, and
depth and the administration of resuscitation drugs. Demographic and outcome
variables compared by suspected overdose status included age, sex, and
survival to hospital discharge. Results: From 2342 treated out-of-hospital
cardiac arrests, 180 were suspected overdose cases (7.7%) and were compared
to 2162 non-overdose cases. Suspected overdose cases were significantly
younger (45 vs. 65, p<. 0.001), less likely to be witnessed by a bystander
(29% vs. 41%, p<. 0.005), and had a higher rate of survival to hospital
discharge (19% vs. 12%, p=. 0.014) than non-overdoses. Suspected overdose
cases had a higher overall chest compression fraction (0.69 vs. 0.67, p=.
0.018) and higher probability of adrenaline, sodium bicarbonate, and
atropine administration (. p<. 0.001). Suspected overdose status was
predictive of survival to hospital discharge when controlling for other
variables (. p<. 0.001). Conclusion: Patients with suspected
overdose-related out-of-hospital cardiac arrest were younger, received
different resuscitative care, and survived more often than non-overdose
cases.
EMTREE DRUG INDEX TERMS
amiodarone
atropine
bicarbonate
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
out of hospital cardiac arrest
resuscitation
EMTREE MEDICAL INDEX TERMS
adult
aged
article
chest compression fraction
controlled study
electrocardiogram
emergency health service
female
hospital discharge
human
major clinical study
male
medical record review
outcome assessment
survival
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014725651
MEDLINE PMID
24973558 (http://www.ncbi.nlm.nih.gov/pubmed/24973558)
PUI
L53252254
DOI
10.1016/j.resuscitation.2014.05.036
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2014.05.036
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 519
TITLE
Assessing pediatric and young adult substance use through analysis of
prehospital data
AUTHOR NAMES
Seaman E.L.
Levy M.J.
Jenkins J.L.
Godar C.C.
Seaman K.G.
AUTHOR ADDRESSES
(Seaman E.L.) 1Department of Behavioral and Community Health,School of
Public Health,University of Maryland,College Park,MarylandUSA
(Levy M.J.) 2Department of Emergency Medicine,Johns Hopkins University
School of Medicine,Baltimore,MarylandUSA
(Jenkins J.L.) 2Department of Emergency Medicine,Johns Hopkins University
School of Medicine,Baltimore,MarylandUSA
(Godar C.C.) 3Howard County,Department of Fire and Rescue
Services,Columbia,MarylandUSA
(Seaman K.G.) 3Howard County,Department of Fire and Rescue
Services,Columbia,MarylandUSA
SOURCE
Prehospital and disaster medicine (2014) 29:5 (468-472). Date of
Publication: 1 Oct 2014
ISSN
1945-1938 (electronic)
ABSTRACT
INTRODUCTION: Substance use in young adults is a significant and growing
problem. Emergency Medical Services (EMS) personnel often encounter this
problem, yet the use of prehospital data to evaluate the prevalence and
magnitude of substance abuse has been limited.HYPOTHESIS/PROBLEM: This study
evaluated drug and alcohol use through the use of prehospital and EMS data
in one suburban county in Maryland (USA). The primary hypothesis was that
the type of drug being abused is associated with age. The secondary
hypothesis was substance abuse incidence is associated with location. The
tertiary hypothesis was that substance abuse is associated with a history of
mental illness.METHODS: Deidentified patient care reports (PCRs) were
obtained during a 24-month period from October 2010 through September 2012
for patients 0 through 25 years of age. Inclusion criteria included chief
complaint of alcohol overdose, drug overdose, or the use of
naloxone.RESULTS: The primary hypothesis was supported that age was
associated with drug category (P < .001). Younger adolescents were more
likely to use household items, prescription drugs, or over-the-counter
drugs, whereas older adolescents were more likely to use illicit drugs. The
secondary hypothesis was supported that both alcohol (P < .001) and drugs (P
< .001) were associated with location of call. Calls involving alcohol were
more likely to be at a home or business, whereas calls involving drugs were
more likely to be at home or at a public venue. The tertiary hypothesis was
supported that both alcohol (P = .001) and drug use (P < .001) were
associated with history of mental illness. Older adolescents were more
likely to report a history of mental illness. Chi-squared tests indicated
there were significant differences between genders and drug category (P =
.002) and gender and current suicide attempt (P = .004). Females were more
likely to use prescription drugs, whereas males were more likely to use
illicit drugs. Calls involving younger adolescents under 18 were more likely
to be at school or the mall, whereas calls involving older adolescents were
likely to be at a prison, public venue, or a business.CONCLUSION: All three
hypotheses were supported: the type of substance being abused was associated
with both age and location, and substance abuse was associated with a
history of mental illness. This research has important implications for
understanding how EMS resources are utilized for substance use. This
information is valuable in not only the education and training of
prehospital care providers, but also for the targeting of future public
health interventions.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
procedures
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age
child
child health care
drug dependence (epidemiology)
emergency health service
female
human
male
Maryland
retrospective study
sex difference
substance abuse
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25088538 (http://www.ncbi.nlm.nih.gov/pubmed/25088538)
PUI
L612457137
DOI
10.1017/S1049023X1400079X
FULL TEXT LINK
http://dx.doi.org/10.1017/S1049023X1400079X
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 520
TITLE
Physician and nonphysician health-care provider perspectives on
resuscitation of suspected drug-related out-of-hospital cardiac arrest
AUTHOR NAMES
Koller A.C.
Salcido D.D.
Menegazzi J.J.
AUTHOR ADDRESSES
(Koller A.C.; Salcido D.D.; Menegazzi J.J.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2014)
18:4 (483-488). Date of Publication: 1 Oct 2014
ISSN
1545-0066 (electronic)
ABSTRACT
INTRODUCTION: In the United States, out-of-hospital cardiac arrest from drug
overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh
found that OD-OHCA patients differed demographically and in the
resuscitation treatments they received, despite identical AHA resuscitation
guidelines. We hypothesized that health-care provider perceptions affect
decision-making in the treatment of OD-OHCA versus non-OD OHCA.METHODS: We
conducted this survey at the National Association of EMS Physicians 2013
Scientific Assembly. Physicians and non-physician health-care providers were
given one of two surveys containing 19 questions pertaining to the
respondents' affiliated EMS agencies, the estimated proportion of OD-OHCA as
well as the drugs involved, and the respondents' belief about the treatments
for OD versus non-OD OHCA.RESULTS: One hundred ninety-three respondents
participated in this survey. Of the 193, 144 (75%) were physicians and 49
(25%) were nonphysicians. Seventy-nine percent of physicians identified
current status as a medical director and 76% of nonphysicians identified as
a paramedic. Participants estimated the average monthly proportion of all
OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol,
antidepressants, and benzodiazepines as the most commonly utilized agents in
OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA
was not changing while the majority of nonphysicians (53%) felt the
incidence was increasing. Eighty-four percent of all respondents reported
the use of naloxone during OD-OHCA resuscitation, while 13% reported
administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent
of physicians and 67% of nonphysicians indicated that OD-OHCA patients had
different demographics than non-OD OHCA, with primary reported differences
being age, comorbidities, and socioeconomic status. Sixty-three percent of
physicians and 71% of nonphysicians felt that OD-OHCA patients should be
treated differently, with primary differences being the incorporation of
etiology-specific treatments, performing different CPR with a focus on
airway support, and transporting earlier.CONCLUSIONS: When surveyed,
physicians and nonphysician providers report perceiving OD-OHCA treatment,
outcomes, and patient demographics differently than non-OD OHCA and making
different treatment decisions based on these perceptions. This may result in
etiology-oriented resuscitation in the out-of-hospital setting, despite the
lack of OD-specific resuscitation guidelines.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
psychology
resuscitation
EMTREE MEDICAL INDEX TERMS
adult
aged
drug overdose (therapy)
female
health care personnel
health survey
human
incidence
male
middle aged
out of hospital cardiac arrest (therapy)
physician
questionnaire
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24831102 (http://www.ncbi.nlm.nih.gov/pubmed/24831102)
PUI
L604811413
DOI
10.3109/10903127.2014.897780
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2014.897780
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 521
TITLE
Patient recall of health care provider counseling for opioid-acetaminophen
prescriptions
AUTHOR NAMES
Mccarthy D.M.
Cameron K.A.
King J.P.
Mullen R.J.
Bailey S.C.
Jacobson K.L.
Di Francesco L.
Davis T.C.
Parker R.M.
Wolf M.S.
AUTHOR ADDRESSES
(Mccarthy D.M., d-mccarthy2@northwestern.edu; King J.P.; Mullen R.J.; Wolf
M.S.) Feinberg School of Medicine, Northwestern University, Chicago, United
States.
(Cameron K.A.) Division of General Internal Medicine and Geriatrics,
Feinberg School of Medicine, Northwestern University, Chicago, United
States.
(Mccarthy D.M., d-mccarthy2@northwestern.edu) Department of Emergency
Medicine, Feinberg School of Medicine, Northwestern University, Chicago,
United States.
(Wolf M.S.) Department of Learning Sciences, School of Education and Social
Policy, Northwestern University, Evanston, United States.
(Bailey S.C.) Division of Pharmaceutical Outcomes and Policy, Eshelman
School of Pharmacy, University of North Carolina, Chapel Hill, United
States.
(Jacobson K.L.) Department of Health Policy and Management, Rollins School
of Public Health, Emory University, Atlanta, United States.
(Di Francesco L.; Parker R.M.) Division of General Medicine, School of
Medicine, Emory University, Atlanta, United States.
(Davis T.C.) Department of Medicine-Pediatrics, Louisiana State University
Health Sciences Center, Shreveport, United States.
CORRESPONDENCE ADDRESS
D.M. Mccarthy, Department of Emergency Medicine, Feinberg School of
Medicine, Northwestern University, 211 E. Ontario St., Suite 200, Chicago,
United States.
SOURCE
Pain Medicine (United States) (2014) 15:10 (1750-1756). Date of Publication:
1 Oct 2014
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., jnl.info@oup.co.uk
ABSTRACT
Objective: The aim of this study was to determine the frequency and nature
of physician, nurse, and pharmacist verbal counseling at the time of a new
prescription for an opioid-acetaminophen containing medication as recalled
by patients. Design: A mixed methods approach with data from cross
sectional, structured interviews was used. Setting: The settings were one
academic emergency department in Chicago, IL and one outpatient pharmacy at
a public hospital in Atlanta, GA. Patients: One hundred forty-nine patients
receiving a new prescription for an opioid-acetaminophen medication were
enrolled. Methods: Interviews assessed patient recall of counseling they
received from their physician, nurse, and pharmacist upon receiving the new
prescription. Their responses were unitized and assigned to categories.
Results: One hundred forty-nine patients were enrolled; 61.1% African
American and 58.4% female. Seven major categories of responses were noted;
frequencies of patient recall for counseling in these categories were
reported. Four categories related to the content of the counseling
discussion were 1) details of administration (patient recall counseling
from: physician/nurse only 44.3%, pharmacist only 5.4%, both providers
12.8%); 2) activities to avoid and side effects (36.2%, 4.7%, 8.7%); 3)
medication indication (32.9%, 4%, 4%); and 4) addictive potential (9.3%,
1.3%, 0%). Three categories describe patients' recall of the interaction in
broad terms: 5) being referred to print informational material accompanying
the prescription (MD/RN only 7.4%, pharmacist only 20.1%, both providers
2.7%); 6) having questions solicited (0%, 11.4%, 0%); 7) having no
interaction relating to medication counseling (3.4%, 32.2%, 1.3%).
Conclusions: Patients infrequently recall counseling from providers on
topics that are important to prevent harm from opioid-acetaminophen
prescriptions. Future patient-centered clinical research should target
identifying optimal strategies to convey these critical messages.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
paracetamol
EMTREE DRUG INDEX TERMS
non prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug recall
health care personnel
patient counseling
prescription
EMTREE MEDICAL INDEX TERMS
adult
African American
aged
article
cross-sectional study
educational status
female
follow up
human
major clinical study
male
nurse
outpatient department
pharmacist
physician
public hospital
structured interview
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014715085
MEDLINE PMID
25039586 (http://www.ncbi.nlm.nih.gov/pubmed/25039586)
PUI
L53235091
DOI
10.1111/pme.12499
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12499
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 522
TITLE
Naloxone's basic benefit. Why the overdose-reversal drug is worth expanding
beyond just ALS providers
AUTHOR NAMES
Furlano E.
AUTHOR ADDRESSES
(Furlano E.)
SOURCE
EMS world (2014) 43:10 (28-30, 32-4). Date of Publication: 1 Oct 2014
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
emergency health service
human
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
25812292 (http://www.ncbi.nlm.nih.gov/pubmed/25812292)
PUI
L603857655
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 523
TITLE
Pitfalls of intranasal naloxone
AUTHOR NAMES
Zuckerman M.
Weisberg S.N.
Boyer E.W.
AUTHOR ADDRESSES
(Zuckerman M.; Weisberg S.N.; Boyer E.W.)
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2014)
18:4 (550-554). Date of Publication: 1 Oct 2014
ISSN
1545-0066 (electronic)
ABSTRACT
We present a case of failed prehospital treatment of fentanyl induced apnea
with intranasal (IN) naloxone. While IN administration of naloxone is
becoming more common in both lay and pre-hospital settings, older EMS
protocols utilized intravenous (IV) administration. Longer-acting, higher
potency opioids, such as fentanyl, may not be as easily reversed as heroin,
and studies evaluating IN administration in this population are lacking. In
order to contribute to our understanding of the strengths and limitations of
IN administration of naloxone, we present a case where it failed to restore
ventilation. We also describe peer reviewed literature that supports the use
of IV naloxone following heroin overdose and explore possible limitations of
generalizing this literature to opioids other than heroin and to IN routes
of administration.
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction)
naloxone (drug administration, adverse drug reaction)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug administration, adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adult
adult respiratory distress syndrome (drug therapy)
apnea (drug therapy)
bioavailability
blood pressure
breathing rate
case report
chemically induced
drug effects
drug overdose (drug therapy)
emergency health service
heart rate
human
intranasal drug administration
intravenous drug administration
male
miosis (drug therapy)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24830404 (http://www.ncbi.nlm.nih.gov/pubmed/24830404)
PUI
L604811197
DOI
10.3109/10903127.2014.896961
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2014.896961
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 524
TITLE
Acetaminophen plus ibuprofen versus opioids for treatment of
post-tonsillectomy pain in children
AUTHOR NAMES
Mattos J.L.
Robison J.G.
Greenberg J.
Yellon R.F.
AUTHOR ADDRESSES
(Mattos J.L.; Greenberg J.; Yellon R.F., Robert.Yellon@chp.edu) Department
of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh,
United States.
(Robison J.G.) Division of Pediatric Otolaryngology, St. Luke's Children's
Hospital, Boise, United States.
(Yellon R.F., Robert.Yellon@chp.edu) Division of Pediatric Otolaryngology,
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, United States.
CORRESPONDENCE ADDRESS
R.F. Yellon, Division of Pediatric Otolaryngology, Children's Hospital of
Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 7th Floor,
Pittsburgh, United States.
SOURCE
International Journal of Pediatric Otorhinolaryngology (2014) 78:10
(1671-1676). Date of Publication: 1 Oct 2014
ISSN
1872-8464 (electronic)
0165-5876
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Objective: To determine the efficacy and safety of acetaminophen plus
ibuprofen in treatment of post-tonsillectomy pain compared to acetaminophen
plus opioids in children. Study Design: Retrospective medical record review.
Setting: Tertiary-care children's hospital between September 2012 and March
2013. Subjects and Methods: All children undergoing total tonsillectomy (n=
1065). Analysis included descriptive analysis, chi-square testing, and
logistic regression controlling for age, diagnosis, trainee involvement,
concurrent surgical procedures, and Coblator use for differences of
outcomes: (1) post-operative bleeding, (2) emergency department (ED) visits
for pain, dehydration, or bleeding, and (3) nurse phone calls from families.
Results: All patients received acetaminophen. Seventy-four percent received
ibuprofen (n= 783) and 26.5% did not receive ibuprofen (n= 282). In the
ibuprofen group, 32.2% received opioids (n= 252). Over eight percent of
children had post-operative hemorrhage of any amount reported (n= 89).
Forty-eight percent of these required operative intervention (n= 43).
Ibuprofen prescription did not impact post-operative bleeding; operative
intervention for bleeding, ED visits, or nurse phone calls either on
chi-squared or logistic regression testing. Increasing age was found to
increase bleeding risk as well as the likelihood of visiting the ED or
calling the clinic nurses. All patients with multiple bleeding episodes were
in the ibuprofen group. Conclusion: Prescription of ibuprofen did not
increase the risk of bleeding and did not increase the likelihood of a
post-operative ED visit or nurse phone call. Ibuprofen prescription may
possibly increase the risk of multiple bleeding episodes, but further
prospective studies are needed. Increased age increases the risk of
bleeding, ED visits, and nurse phone calls.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydrocodone (drug combination, drug comparison, drug therapy)
ibuprofen (drug combination, drug comparison, drug therapy)
oxycodone (drug combination, drug comparison, drug therapy)
paracetamol (drug combination, drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
hydrocodone (drug combination, drug comparison, drug therapy)
ibuprofen (drug combination, drug comparison, drug therapy)
oxycodone (drug combination, drug comparison, drug therapy)
oxycodone plus paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
postoperative pain (drug therapy, drug therapy)
tonsillectomy
EMTREE MEDICAL INDEX TERMS
adolescent
age
article
child
controlled study
disease association
drug efficacy
drug safety
drug withdrawal
high risk patient
human
major clinical study
medical record review
postoperative hemorrhage (complication)
retrospective study
treatment response
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014706800
MEDLINE PMID
25128450 (http://www.ncbi.nlm.nih.gov/pubmed/25128450)
PUI
L53286344
DOI
10.1016/j.ijporl.2014.07.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijporl.2014.07.017
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 525
TITLE
Responding to opioid overdose in Rhode Island: where the medical community
has gone and where we need to go
AUTHOR NAMES
Green T.C.
Bratberg J.
Dauria E.F.
Rich J.D.
AUTHOR ADDRESSES
(Green T.C.) Assistant Professor of Emergency Medicine and Epidemiology at
the Warren Alpert Medical School of Brown University. She is an affiliated
researcher at The Center for Prisoner Health and Human Rights at the Miriam
Hospital and the Injury Prevention Center at Rhode Island Hospital
(Bratberg J.) Clinical Professor of Pharmacy Practice, University of Rhode
Island College of Pharmacy
(Dauria E.F.) Postdoctoral Fellow in the Department of Psychiatry and Human
Behavior at the Warren Alpert Medical School of Brown University
(Rich J.D.) Attending Physician in the Division of Infectious Diseases, The
Miriam Hospital, co-director of The Center for Health and Human Rights, and
Professor of Medicine and Community Health at the Warren Alpert Medical
School of Brown University
SOURCE
Rhode Island medical journal (2013) (2014) 97:10 (29-33). Date of
Publication: 1 Oct 2014
ISSN
2327-2228 (electronic)
ABSTRACT
The number of opioid overdose events in Rhode Island has increased
dramatically/catastrophically in the last decade; Rhode Island now has one
of the highest per capita overdose death rates in the country. Healthcare
professionals have an important role to play in the reduction of
unintentional opioid overdose events. This article explores the medical
community's response to the local opioid overdose epidemic and proposes
strategies to create a more collaborative and comprehensive response. We
emphasize the need for improvements in preventing, identifying and treating
opioid addiction, providing overdose education and ensuring access to the
rescue medicine naloxone.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
organization and management
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
attitude to health
clinical practice
drug misuse
drug overdose (epidemiology, prevention)
emergency health service
health care delivery
health education
health service
human
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25271657 (http://www.ncbi.nlm.nih.gov/pubmed/25271657)
PUI
L606783365
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 526
TITLE
The Rhode Island community responds to opioid overdose deaths
AUTHOR NAMES
Bowman S.
Engelman A.
Koziol J.
Mahoney L.
Maxwell C.
McKenzie M.
AUTHOR ADDRESSES
(Bowman S.) Evaluator for Maternal and Child Home Visiting, Rhode Island
Department of Health. She is a long-time staff member and now volunteers
with Preventing Overdose and Naloxone Intervention (PONI), The Miriam
Hospital
(Engelman A.) Coordinator and Co-Founder of the Naloxone and Overdose
Prevention Education Program of Rhode Island (NOPE-RI). She is a Critical
Care Paramedic and has worked in public safety for the past ten years
(Koziol J.) Unintentional Injury Prevention Program Coordinator, Rhode
Island Department of Health. She convenes the Drug Overdose Prevention and
Rescue Coalition
(Mahoney L.) Administrator at the Department of Behavioral Health,
Developmental Disabilities and Hospitals. She has 28 years of clinical
experience as a RI provider in various behavioral health treatment settings
(Maxwell C.) Director of Pharmacy Services for Butler Hospital
(McKenzie M.) Director of Preventing Overdose and Naloxone Intervention
(PONI), The Miriam Hospital. She is a Research Associate with the Department
of Medicine, Warren Alpert Medical School, Brown University
SOURCE
Rhode Island medical journal (2013) (2014) 97:10 (34-37). Date of
Publication: 1 Oct 2014
ISSN
2327-2228 (electronic)
ABSTRACT
The challenge of addressing the epidemic of opioid overdose in Rhode Island,
and nationwide, is only possible through collaborative efforts among a wide
breadth of stakeholders. This article describes the range of efforts by
numerous partners that have come together to facilitate community, and
treatment-related approaches to address opioid-involved overdose and
substance use disorder. Strategies to address this crisis have largely
focused on increasing access both to the opioid overdose antidote naloxone
and to high quality and timely treatment and recovery services. [Full text
available at http://rimed.org/rimedicaljournal-2014-10.asp, free with no
login].
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (adverse drug reaction)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mortality
EMTREE MEDICAL INDEX TERMS
clinical practice
community care
cooperation
drug overdose (prevention)
emergency health service
epidemiology
human
opiate addiction (prevention)
organization and management
pharmacy
prescription drug misuse (prevention)
preventive health service
statistics and numerical data
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
25271658 (http://www.ncbi.nlm.nih.gov/pubmed/25271658)
PUI
L606783383
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 527
TITLE
The opioid abuse and misuse epidemic: Implications for pharmacists in
hospitals and health systems
AUTHOR NAMES
Cobaugh D.J.
Gainor C.
Gaston C.L.
Kwong T.C.
Magnani B.
Mcpherson M.L.
Painter J.T.
Krenzelok E.P.
AUTHOR ADDRESSES
(Cobaugh D.J., dcobaugh@ashp.org) ASHP Research and Education Foundation,
Bethesda, United States.
(Gainor C.) Department of Pharmaceutical Sciences, School of Pharmacy,
University of Pittsburgh, Pittsburgh, United States.
(Gaston C.L.) UW Health, Madison, United States.
(Kwong T.C.) Department of Pathology and Laboratory Medicine, University of
Rochester School of Medicine and Dentistry, Rochester, United States.
(Kwong T.C.) Hematology and Chemistry Labs, Strong Memorial Hospital,
University of Rochester Medical Center, Rochester, United States.
(Magnani B.) Department of Pathology and Laboratory Medicine, Tufts Medical
Center, Boston, United States.
(Magnani B.) Department of Anatomic and Clinical Pathology, Tufts University
School of Medicine, Boston, United States.
(Mcpherson M.L.) Department of Pharmacy Practice and Science, University of
Maryland School of Pharmacy, Baltimore, United States.
(Painter J.T.) Department of Pharmaceutical Evaluation and Policy,
University of Arkansas for Medical Sciences, Little Rock, United States.
(Krenzelok E.P.) School of Pharmacy, University of Pittsburgh, Pittsburgh,
United States.
CORRESPONDENCE ADDRESS
D.J. Cobaugh, ASHP Research and Education Foundation, Bethesda, United
States.
SOURCE
American Journal of Health-System Pharmacy (2014) 71:18 (1539-1554). Date of
Publication: 15 Sep 2014
ISSN
1535-2900 (electronic)
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy
ABSTRACT
Purpose. The current epidemic of prescription opioid abuse and misuse in the
United States is discussed, with an emphasis on the pharmacist's role in
ensuring safe and effective opioid use. Summary. U.S. sales of prescription
opioids increased fourfold from 1999 to 2010, with an alarming rise in
deaths and emergency department visits associated with the use of fentanyl,
hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of
opioid toxicity may include altered mental status, hypoventilation,
decreased bowel motility, central nervous system and respiratory depression,
peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and
seizures. In patients receiving long-term opioid therapy for chronic pain,
urine drug testing is an important tool for monitoring and assessment of
therapy; knowledge of opioid metabolic pathways and assay limitations is
essential for appropriate use and interpretation of screening and
confirmatory tests. In recent years, there has been an increase in federal
enforcement actions against pharmacies and prescription drug wholesalers
involved in improper opioid distribution, as well as increased reliance on
state-level prescription drug monitoring programs to track patterns of
opioid use and improper sales. Pharmacies are urged to implement or promote
appropriate guidelines on opioid therapy, including the use of pain
management agreement plans; policies to ensure adequate oversight of opioid
prescribing, dispensing, and waste disposal; and educational initiatives
targeting patients as well as hospital and pharmacy staff. Conclusion.
Pharmacists in hospitals and health systems can play a key role in
recognizing the various forms of opioid toxicity and in preventing
inappropriate prescribing and diversion of opioids.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
dihydrocodeine
fentanyl
hydrocodone
hydromorphone
methadone
morphine
naloxone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
health care system
opiate addiction (epidemiology)
program evaluation
EMTREE MEDICAL INDEX TERMS
chronic pain
drug monitoring
epidemic
hospital policy
human
inappropriate prescribing
intestine motility
liquid chromatography
long term care
mass spectrometry
mental health
pharmacist
prescription
respiration depression
review
United States
urinalysis
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014803194
MEDLINE PMID
25174015 (http://www.ncbi.nlm.nih.gov/pubmed/25174015)
PUI
L600057115
DOI
10.2146/ajhp140157
FULL TEXT LINK
http://dx.doi.org/10.2146/ajhp140157
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 528
TITLE
Prescription of opioid and nonopioid analgesics for dental care in emergency
departments: Findings from the National Hospital Ambulatory Medical Care
Survey
AUTHOR NAMES
Okunseri C.
Okunseri E.
Xiang Q.
Thorpe J.M.
Szabo A.
AUTHOR ADDRESSES
(Okunseri C.; Okunseri E.; Xiang Q.; Thorpe J.M.; Szabo A.) Department of
Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI,
USA
SOURCE
Journal of public health dentistry (2014) 74:4 (283-292). Date of
Publication: 1 Sep 2014
ISSN
1752-7325 (electronic)
ABSTRACT
OBJECTIVES: The aim of this study was to examine trends and associated
factors in the prescription of opioid analgesics, nonopioid analgesics,
opioid and nonopioid analgesic combinations, and no analgesics by emergency
physicians for nontraumatic dental condition (NTDC)-related visits. Our
secondary aim was to investigate whether race/ethnicity is a possible
predictor of receiving a prescription for either type of medication for NTDC
visits in emergency departments (EDs) after adjustment for potential
covariates.METHODS: We analyzed data from the National Hospital Ambulatory
Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial
multivariate logistic regression to estimate the probability of receiving a
prescription for opioid analgesics, nonopioid analgesics, or a combination
of both, compared with receiving no analgesics for NTDC-related
visits.RESULTS: During 1997-2000 and 2003-2007, prescription of opioid
analgesics and combinations of opioid and nonopioid analgesics increased,
and that of no analgesics decreased over time. The prescription rates for
opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic
combinations, and no analgesics for NTDC-related visits in EDs were 43
percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of
patients categorized as having severe pain received prescriptions for
opioids for NTDC-related visits in EDs. After adjusting for covariates,
patients with self-reported dental reasons for visit and severe pain had a
significantly higher probability of receiving prescriptions for opioid
analgesics and opioid and nonopioid analgesic combinations.CONCLUSIONS:
Prescription of opioid analgesics increased over time. ED physicians were
more likely to prescribe opioid analgesics and opioid and nonopioid
analgesic combinations for NTDC-related visits with reported severe pain.
EMTREE DRUG INDEX TERMS
analgesic agent (drug administration)
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
organization and management
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
child
dental procedure
human
infant
information processing
middle aged
newborn
preschool child
United States
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24863407 (http://www.ncbi.nlm.nih.gov/pubmed/24863407)
PUI
L613658300
DOI
10.1111/jphd.12055
FULL TEXT LINK
http://dx.doi.org/10.1111/jphd.12055
COPYRIGHT
Copyright 2016 Medline is the source for the citation and abstract of this
record.
RECORD 529
TITLE
Pain management perceptions among prescription opioid dependent individuals
AUTHOR NAMES
McCauley J.L.
Mercer M.A.
Barth K.S.
Brady K.T.
Back S.E.
AUTHOR ADDRESSES
(McCauley J.L., mccaule@musc.edu; Mercer M.A.; Barth K.S.; Brady K.T.; Back
S.E.) Department of Psychiatry and Behavioral Sciences, Medical University
of South Carolina, Charleston, SC, United States.
(Brady K.T.; Back S.E.) Ralph H. Johnson Veterans Affairs Medical Center,
Charleston, SC, United States.
CORRESPONDENCE ADDRESS
J.L. McCauley, Department of Psychiatry and Behavioral Sciences, Medical
University of South Carolina, 67 President Street - MSC 861, Charleston, SC
29425, United States. Email: mccaule@musc.edu
SOURCE
Drug and Alcohol Dependence (2014) 142 (354-358). Date of Publication: 1 Sep
2014
ISSN
1879-0046 (electronic)
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd
ABSTRACT
Background: Nearly two-thirds of prescription opioid dependent individuals
report chronic pain conditions as both an initial and current motivation for
prescription opioid use. However, to date, limited information exists
regarding perceptions of the adequacy of pain management and pain management
behaviors among prescription opioid dependent individuals with a history of
treatment for chronic pain. Methods: The current study examined perceptions
of the medical management of chronic pain among community-recruited
individuals (N= 39) who met DSM-IV-TR criteria for current prescription
opioid dependence and reported a history of treatment for chronic pain.
Prescription opioid dependence, symptoms of depression, and pain management
perceptions were assessed using the Structured Clinical Interview for DSM
disorders, Beck Depression Inventory, and the Pain Management Questionnaire,
respectively. Results: Reports of insufficient pain management were common
(46.2%), as was utilization of emergency room services for pain management
(56.4%). Nearly half reported a physician as their initial source (46.2%)
and pain management as their primary initial reason for prescription opioid
use (53.8%), whereas 35.9% reported pain relief as their primary reason for
current prescription opioid use. Symptoms of depression were common (51.3%),
as was comorbid abuse of other substances and history of treatment for
substance abuse. Conclusions: Results highlight the complicated clinical
presentation and prevalent perception of the under-treatment of pain among
this population. Findings underscore the importance of interdisciplinary
approaches to managing the complex presentation of chronic pain patients
with comorbid prescription opioid dependence. Implications for future
research are discussed. © 2014.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
opiate addiction
patient attitude
EMTREE MEDICAL INDEX TERMS
adult
article
Beck Depression Inventory
chronic pain (drug therapy)
clinical article
clinical feature
comorbidity
depression
drug dependence treatment
DSM-IV-TR
emergency health service
female
health care utilization
human
male
medical history
Pain Management Questionnaire
patient assessment
prescription
priority journal
questionnaire
Structured Clinical Interview for DSM Disorders
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014527187
MEDLINE PMID
25034899 (http://www.ncbi.nlm.nih.gov/pubmed/25034899)
PUI
L53243199
DOI
10.1016/j.drugalcdep.2014.06.024
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2014.06.024
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 530
TITLE
Trends in opioid analgesic use for headaches in US EDs
AUTHOR NAMES
Mazer-Amirshahi M.
Dewey K.
Mullins P.M.
van den Anker J.
Pines J.M.
Perrone J.
Nelson L.
AUTHOR ADDRESSES
(Mazer-Amirshahi M., maryannmazer@gmail.com; Dewey K.) Department of
Emergency Medicine, MedStar Washington Hospital Center, Washington, DC
(Mazer-Amirshahi M., maryannmazer@gmail.com; van den Anker J.) Department of
Clinical Pharmacology, Children's National Medical Center, Washington, DC
(Mullins P.M.; Pines J.M.) The George Washington University, School of
Medicine and Health Sciences, Washington, DC
(van den Anker J.) Department of Pediatrics, The George Washington
University, Washington, DC
(van den Anker J.) Intensive Care, Erasmus Medical Center-Sophia Children's
Hospital, Rotterdam, the Netherlands
(van den Anker J.) Department of Pediatric Pharmacology, University
Children's Hospital Basel, Switzerland
(Pines J.M.) Department of Emergency Medicine, the George Washington
University, Washington, DC
(Perrone J.) Department of Emergency Medicine, University of Pennsylvania,
Philadelphia, PA
(Nelson L.) Department of Emergency Medicine, New York University, New York,
NY
CORRESPONDENCE ADDRESS
M. Mazer-Amirshahi, 110 Michigan Avenue NW, Washington, DC 20010, . Email:
maryannmazer@gmail.com
SOURCE
American Journal of Emergency Medicine (2014). Date of Publication: 2 Jun
2014
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
Elsevier
ABSTRACT
Objective: Although not recommended as first line therapy by consensus
guidelines, opioid analgesics are commonly used to treat headaches. This
study evaluates trends in opioid use for headaches in US emergency
departments (EDs). Methods: We performed a retrospective review of the
National Hospital Ambulatory Medical Care Survey, 2001 through 2010. Adult
headache-related visits were identified. Medications (opioid and nonopioid)
used for the treatment of headache were categorized based on medication
class. Trends in ED use of the most common opioids (codeine, hydrocodone,
hydromorphone, morphine, and oxycodone) were explored. The proportion of
visits for which each medication was used was tabulated, and trends were
analyzed using survey-weighted logistic regression. Results: Headache visits
during which any opioid was used increased between 2001 (20.6%; 95%
confidence interval [CI], 18.1-23.4) and 2010 (35.0%; 95% CI, 31.8-38.4; P <
.001). Prescribing of hydromorphone, morphine, and oxycodone increased, with
the largest relative increase (461.1%) in hydromorphone (2001, 1.8% [95% CI,
1.2-2.6]; 2010, 10.1% [95% CI, 8.2-12.4]). Codeine use declined, and
hydrocodone use remained stable. Use of opioid alternatives, including
acetaminophen, butalbital, and triptans did not change over the study
period, whereas use of nonsteroidal anti-inflammatory drugs increased from
26.2% (95% CI, 23.0-29.7) to 31.4% (95% CI, 28.6-34.3). Prescribing of
antiemetic agents decreased from 24.1% (95% CI, 19.6-29.2) to 23.5% (95% CI,
21.1-26.0). Intravenous fluid use increased from 20.0% (95% CI, 17.0-23.4)
to 34.5% (95% CI, 31.0-38.2) of visits. Conclusions: Despite limited
endorsement by consensus guidelines, there was increased use of opioid
analgesics to treat headaches in US EDs over the past decade. © 2014
Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
antiemetic agent
butalbital
codeine
hydrocodone
hydromorphone
infusion fluid
morphine
nonsteroid antiinflammatory agent
opiate
oxycodone
paracetamol
triptan derivative
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
headache
EMTREE MEDICAL INDEX TERMS
adult
confidence interval
consensus
drug therapy
emergency ward
hospital
logistic regression analysis
medical care
therapy
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
PUI
L53270348
DOI
10.1016/j.ajem.2014.07.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2014.07.001
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 531
TITLE
Procedural sedation and analgesia for adults in the emergency department
AUTHOR NAMES
Atkinson P.
French J.
Nice C.A.
AUTHOR ADDRESSES
(Atkinson P., Paul.atkinson@dal.ca; French J.) Department of Emergency
Medicine, Dalhousie University, Saint John Regional Hospital, Saint John,
NB, E2L 4L4, Canada.
(Atkinson P., Paul.atkinson@dal.ca) Discipline of Emergency Medicine,
Memorial University of Newfoundland, Saint John Regional Hospital, Saint
John, NB, Canada.
(Nice C.A.) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Saint John Regional Hospital, Saint John,
NB, Canada.
(Nice C.A.) Discipline of Anesthesia, Memorial University of Newfoundland,
Saint John Regional Hospital, Saint John, NB, Canada.
CORRESPONDENCE ADDRESS
P. Atkinson, Department of Emergency Medicine, Dalhousie University, Saint
John Regional Hospital, Saint John, NB, E2L 4L4, Canada. Email:
Paul.atkinson@dal.ca
SOURCE
BMJ (Online) (2014) 348 Article Number: g2965. Date of Publication: 8 May
2014
ISSN
1756-1833 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
EMTREE DRUG INDEX TERMS
alfentanil
barbituric acid derivative
benzodiazepine derivative (drug combination)
etomidate (adverse drug reaction, clinical trial, drug comparison)
fentanyl (adverse drug reaction, drug combination, drug comparison,
intravenous drug administration)
flumazenil
ketamine (adverse drug reaction, clinical trial, drug combination,
intravenous drug administration)
methohexital (adverse drug reaction, drug comparison)
midazolam (adverse drug reaction, drug combination, drug comparison)
morphine (intravenous drug administration)
naloxone
narcotic analgesic agent (adverse drug reaction, drug combination)
nitrous oxide
nitrous oxide plus oxygen
propofol (adverse drug reaction, clinical trial, drug combination, drug
comparison)
remifentanil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
sedation
EMTREE MEDICAL INDEX TERMS
agitation
article
capnometry
cost control
cost effectiveness analysis
deep sedation
drug efficacy
drug safety
hip prosthesis
human
oxygen desaturation
practice guideline
priority journal
prosthesis loosening
relaxation training
respiration depression (side effect)
shoulder dislocation (therapy)
side effect (side effect)
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
nitrous oxide plus oxygen (54510-89-3)
propofol (2078-54-8)
remifentanil (132539-07-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014330199
MEDLINE PMID
24812113 (http://www.ncbi.nlm.nih.gov/pubmed/24812113)
PUI
L373071065
DOI
10.1136/bmj.g2965
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.g2965
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 532
TITLE
The prevalence of opioid-related major potential drug-drug interactions and
their impact on health care costs in chronic pain patients
AUTHOR NAMES
Pergolizzi J.V.
Ma L.
Foster D.R.
Overholser B.R.
Sowinski K.M.
Taylor R.
Summers K.H.
AUTHOR ADDRESSES
(Pergolizzi J.V., jpjmd@msn.com) Department of Medicine, Johns Hopkins
University, Baltimore, United States.
(Ma L.; Summers K.H.) Health Economics and Outcomes Research, Endo
Pharmaceuticals Inc., Malvern, United States.
(Ma L.) University of Pennsylvania, Perelman School of Medicine,
Philadelphia, United States.
(Foster D.R.; Overholser B.R.) College of Pharmacy, Purdue University,
United States.
(Foster D.R.; Overholser B.R.) Indiana University, United States.
(Sowinski K.M.) Department of Pharmacy Practice, College of Pharmacy, Purdue
University, West Lafayette, United States.
(Sowinski K.M.) Indiana University, Bloomington, United States.
(Taylor R.) NEMA Research Inc., Naples, United States.
CORRESPONDENCE ADDRESS
J.V. Pergolizzi, Department of Medicine, Johns Hopkins University, United
States.
SOURCE
Journal of Managed Care and Specialty Pharmacy (2014) 20:5 (467-476). Date
of Publication: 1 May 2014
ISSN
2376-1032 (electronic)
2376-0540
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
Background: Literature has shown that chronic pain patients prescribed
opioids are at an increased risk for experiencing drug-drug interactions as
a result of polypharmacy. In addition, chronic, noncancer pain patients who
experience drug-drug interactions have been shown to have greater health
care utilization and costs. However, no study has focused on the health
economics of major clinically significant drug-drug interactions associated
with long-acting opioids. Objectives: To (a) estimate the prevalence of
major drug-drug interactions among patients prescribed a long-acting opioid
and (b) evaluate the potential impact of major drug-drug interactions on
health care costs. Methods: This study was a retrospective cohort analysis
using claims data from the MarketScan Commercial Claims and Encounter
Database between 2008 and 2010. Patients with at least 1 prescription for a
longacting opioid for = 30 days were placed into cohorts according to the
expected clinical impact of the potential drug-drug interaction: major
versus none. Propensity score matching was used to mitigate differences in
baseline characteristics between the cohorts. Health care costs were based
on payments for all covered health care services, which consisted of
inpatient and outpatient medical, emergency department, and outpatient
prescription costs. Results: Among 57,752 chronic, noncancer pain patients
who met all inclusion and exclusion criteria, 5.7[%] (3,302) were exposed to
a potential major drug-drug interaction. The costs associated with a
potential interaction versus no potential interaction were significantly
more after baseline characteristics of the cohorts were normalized by
propensity score matching. Monthly health care costs in the 90-day
post-index period were significantly greater ($3,366 vs. $2,757, a $609
difference) in patients exposed to a potential drug-drug interaction of
major clinical significance, compared with those not exposed to a drug-drug
interaction. The higher health care costs were mainly driven by outpatient
and inpatient medical costs. Conclusions: Exposure to potential drug-drug
interactions may result in unnecessary and unintended health care costs.
Physicians should be made aware of commonly administered cytochrome P450
(CYP450) metabolized drugs in the chronic pain patient and consider
prescribing non-CYP450 metabolized opioid and nonopioid analgesics. Managed
care's use of utilization management tools to avoid these exposures may
reduce costs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug interaction, drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
amiodarone (drug interaction)
clarithromycin (drug interaction)
codeine
cytochrome P450 (endogenous compound)
diltiazem (drug interaction)
erythromycin (drug interaction)
fentanyl (drug interaction)
fluconazole (drug interaction)
fluoxetine (drug interaction)
hydrocodone (drug interaction)
hydromorphone (drug interaction)
itraconazole (drug interaction)
ketoconazole (drug interaction)
methadone (drug interaction)
mibefradil (drug interaction)
morphine (drug interaction)
oxycodone (drug interaction)
oxymorphone (drug interaction)
paroxetine (drug interaction)
phenytoin (drug interaction)
quinidine (drug interaction)
rifampicin (drug interaction)
ritonavir (drug interaction)
terbinafine (drug interaction)
thioridazine (drug interaction)
tramadol (drug interaction)
troglitazone (drug interaction)
verapamil (drug interaction)
voriconazole (drug interaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
drug interaction
health care cost
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
drug cost
female
health care utilization
human
major clinical study
male
middle aged
prevalence
retrospective study
CAS REGISTRY NUMBERS
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
clarithromycin (81103-11-9)
codeine (76-57-3)
cytochrome P450 (9035-51-2)
diltiazem (33286-22-5, 42399-41-7)
erythromycin (114-07-8, 70536-18-4)
fentanyl (437-38-7)
fluconazole (86386-73-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
itraconazole (84625-61-6)
ketoconazole (65277-42-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
mibefradil (116666-63-8)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paroxetine (61869-08-7)
phenytoin (57-41-0, 630-93-3)
quinidine (56-54-2)
rifampicin (13292-46-1)
ritonavir (155213-67-5)
terbinafine (91161-71-6)
thioridazine (130-61-0, 50-52-2)
tramadol (27203-92-5, 36282-47-0)
troglitazone (97322-87-7)
verapamil (152-11-4, 52-53-9)
voriconazole (137234-62-9)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20170353124
MEDLINE PMID
24761818 (http://www.ncbi.nlm.nih.gov/pubmed/24761818)
PUI
L616207256
DOI
10.18553/jmcp.2014.20.5.467
FULL TEXT LINK
http://dx.doi.org/10.18553/jmcp.2014.20.5.467
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 533
TITLE
Opioid requirements in mechanically ventilated trauma patients receiving
dexmedetomidine versus propofol
AUTHOR NAMES
Aljuhani O.A.
McKinney C.B.
Erstad B.L.
AUTHOR ADDRESSES
(Aljuhani O.A.; McKinney C.B.; Erstad B.L.) Department of Pharmacy Practice
and Science, College of Pharmacy, University of Arizona, Tucson (Drs
Aljuhani, McKinney, and Erstad); University of Arizona Medical Center,
University Campus, Tucson (Drs Aljuhani and McKinney); Department of
Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah,
Saudi Arabia (Dr Aljuhani); and Intermountain Medical Center, Murray, Utah
(Dr McKinney)
SOURCE
Journal of trauma nursing : the official journal of the Society of Trauma
Nurses (2014) 21:3 (111-114). Date of Publication: 1 May 2014
ISSN
1078-7496
ABSTRACT
Proponents of dexmedetomidine often cite the agent's analgesic properties as
one of its main advantages over propofol and benzodiazepines. However, there
are very limited studies utilizing endpoints such as analgesic requirements
to provide supporting evidence for these claims. The primary purpose of this
retrospective study was to compare opioid analgesic requirements in trauma
patients receiving nonconcurrent dexmedetomidine and propofol for sedation
while being weaned from mechanical ventilation. Total analgesic requirements
were similar between dexmedetomidine and propofol within 48 hours of
sedative initiation in adult trauma patients (P > .05).
EMTREE DRUG INDEX TERMS
dexmedetomidine (drug administration, adverse drug reaction)
propofol (drug administration, adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adult
adverse effects
APACHE
artificial ventilation
cohort analysis
comparative study
conscious sedation
emergency health service
female
follow up
human
injury (diagnosis, therapy)
injury scale
intensive care
intensive care unit
male
middle aged
procedures
retrospective study
risk assessment
treatment outcome
CAS REGISTRY NUMBERS
dexmedetomidine (113775-47-6)
propofol (2078-54-8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24828772 (http://www.ncbi.nlm.nih.gov/pubmed/24828772)
PUI
L605884392
DOI
10.1097/JTN.0000000000000041
FULL TEXT LINK
http://dx.doi.org/10.1097/JTN.0000000000000041
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 534
TITLE
DOH issues emergency regulations on expanding use of Narcan to prevent
opioid overdose deaths
AUTHOR ADDRESSES
SOURCE
Rhode Island medical journal (2013) (2014) 97:4 (49). Date of Publication: 1
Apr 2014
ISSN
2327-2228 (electronic)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug legislation
drug overdose (prevention)
government
human
mortality
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24960911 (http://www.ncbi.nlm.nih.gov/pubmed/24960911)
PUI
L605895363
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 535
TITLE
A performance improvement prescribing guideline reduces opioid prescriptions
for emergency department dental pain patients
AUTHOR NAMES
Doyon S.
AUTHOR ADDRESSES
(Doyon S.) Maryland Poison Center, University of Maryland School of
Pharmacy, Baltimore, MD, United States.
CORRESPONDENCE ADDRESS
S. Doyon, Maryland Poison Center, University of Maryland School of Pharmacy,
Baltimore, MD, United States.
SOURCE
Annals of Emergency Medicine (2014) 63:3 (371). Date of Publication: March
2014
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
fentanyl
hydrocodone
opiate
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
practice guideline
prescription
tooth pain
EMTREE MEDICAL INDEX TERMS
drug safety
human
letter
nerve block
priority journal
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014123505
MEDLINE PMID
24528948 (http://www.ncbi.nlm.nih.gov/pubmed/24528948)
PUI
L372405593
DOI
10.1016/j.annemergmed.2013.09.033
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2013.09.033
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 536
TITLE
Postdischarge nonmedical use of prescription opioids in at-risk drinkers
admitted to urban Level i trauma centers
AUTHOR NAMES
Field C.A.
Cochran G.
Caetano R.
Foreman M.
Brown C.V.R.
AUTHOR ADDRESSES
(Field C.A., craig.field@austin.utexas.edu) University of Texas at Austin,
Austin, United States.
(Brown C.V.R.) University Medical Center at Brackenridge, Austin, United
States.
(Cochran G.) University of Texas School of Public Health, University of
Texas Southwestern Medical Center, United States.
(Foreman M.) Baylor University Medical Center, Dallas, TX, United States.
(Caetano R.) University of Pittsburgh, Pittsburgh, PA, United States.
CORRESPONDENCE ADDRESS
C.A. Field, Behavioral Health Services, University Medical Center at
Brackenridge, 601 E 6th St, Austin, TX 78701, United States. Email:
craig.field@austin.utexas.edu
SOURCE
Journal of Trauma and Acute Care Surgery (2014) 76:3 (833-839). Date of
Publication: March 2014
ISSN
2163-0755
2163-0763 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
BACKGROUND: Nonmedical use of prescription opioids (NM-POs) has reached
epidemic proportions in the United States. Unintentional overdose deaths
involving prescription opioids have quadrupled since 1999. Herein, we
examine NM-POs and their associated risk factors among two cohorts of trauma
patients with at-risk drinking. METHODS: This secondary analysis examines
NM-PO from two separate randomized trials that delivered brief alcohol
interventions to patients in urban Level I trauma centers. In the first
study, data were collected from 1,493 injured patients at a single trauma
center, and in the second study, data were collected from 596 injured
patients at two trauma centers. All participants were considered at-risk
drinkers because they were admitted for an alcohol related injury as
indicated by a positive blood alcohol concentration and/or self-reported
heavy drinking. RESULTS: In Study 1, NM-PO nearly doubled from 5.2% before
admission to 9.8% at 6 months after discharge. At 12 months after discharge,
those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval
[CI], 1.28-4.15) and drug use (OR, 2.62, 95% CI, 1.70-4.04) before admission
had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased
from 5.2% before admission to 6.8% at 12 months after discharge. At 12
months after discharge, those who reported NM-PO (OR, 2.71; 95% CI,
1.10-6.66) or drug use (OR, 4.05; 95% CI, 2.00-8.21) before admission had
the highest odds for postdischarge NM-PO. CONCLUSION: The results suggest
that there is an increased risk of postdischarge NM-PO among injured
patients with at-risk drinking, particularly among those with a recent
history of drug use or NM-PO. Cautious, evidence-based opioid prescribing
may reduce exposure to prescription opioids in high-risk patients, risk of
subsequent misuse, and possible diversion. Copyright © 2014 Lippincott
Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
cannabis
cocaine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
nonmedical use of prescription opioid
EMTREE MEDICAL INDEX TERMS
adult
alcoholism (therapy)
article
drinking behavior
emergency health service
female
hospital admission
hospital discharge
human
major clinical study
male
motivational interviewing
prescription
priority journal
risk factor
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014142080
MEDLINE PMID
24553557 (http://www.ncbi.nlm.nih.gov/pubmed/24553557)
PUI
L372470906
DOI
10.1097/TA.0000000000000100
FULL TEXT LINK
http://dx.doi.org/10.1097/TA.0000000000000100
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 537
TITLE
Pediatric patient safety in emergency medical services
AUTHOR NAMES
Meckler G.
Leonard J.
Hoyle J.
AUTHOR ADDRESSES
(Meckler G., Garth.Meckler@cw.bc.ca) Department of Pediatrics, Division of
Pediatric Emergency Medicine, University of British Columbia School of
Medicine, Vancouver, BC, Canada.
(Leonard J.) Department of Pediatrics, Section of Pediatric Emergency
Medicine, Washington University School of Medicine, St Louis, MO, United
States.
(Hoyle J.) Department of Emergency Medicine, Western Michigan University
School of Medicine, Kalamazoo, MI, United States.
CORRESPONDENCE ADDRESS
G. Meckler, 202-2181 West 4th Avenue, Vancouver, BC, V6K 1N7, Canada. Email:
Garth.Meckler@cw.bc.ca
SOURCE
Clinical Pediatric Emergency Medicine (2014) 15:1 (18-27). Date of
Publication: March 2014
ISSN
1522-8401
1558-2310 (electronic)
BOOK PUBLISHER
W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Since the publication of early studies highlighting the prevalence, impact,
and costs of medical errors in the 1990s, patient safety has been the
subject of considerable attention and study, primarily focused on adults and
the inpatient setting. Less progress has been made with regard to pediatric
patient safety and even less in the prehospital environment. This article
reviews the issues and literature around pediatric patient safety within the
emergency medical services system, including patient restraint and safe
transport, the assessment and protection of the pediatric cervical spine,
and prehospital medication errors. © 2014 Elsevier Inc.
EMTREE DRUG INDEX TERMS
atropine
diphenhydramine
epinephrine
glucose
naloxone
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child health care
emergency health service
patient safety
EMTREE MEDICAL INDEX TERMS
article
cervical spine injury
decision making
emergency care
human
medical literature
medication error
patient transport
spinal immobilization
splinting
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diphenhydramine (147-24-0, 58-73-1)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014183053
PUI
L372602239
DOI
10.1016/j.cpem.2014.01.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2014.01.003
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 538
TITLE
The two sides of opioids in cyclical vomiting syndrome
AUTHOR NAMES
Saligram S.
Bielefeldt K.
AUTHOR ADDRESSES
(Saligram S., drsaligram@yahoo.com; Bielefeldt K.) Departments of Medicine
and Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh,
PA, United States.
(Saligram S., drsaligram@yahoo.com) Department of Gastroenterology, Kansas
University School of Medicine, Kansas City, MO, United States.
CORRESPONDENCE ADDRESS
S. Saligram, 3901 Rainbow boulevard, Kansas City, 66160, KS, United States.
Email: drsaligram@yahoo.com
SOURCE
North American Journal of Medical Sciences (2014) 6:3 (114-118). Date of
Publication: March 2014
ISSN
2250-1541
1947-2714 (electronic)
BOOK PUBLISHER
North American Journal of Medical Sciences, T3330-50-B Charlton Ave,
Hamilton, Canada.
ABSTRACT
Background: Cyclical vomiting syndrome is increasingly recognized in adults,
with recent reports suggesting 'coalescing attacks' in one third of the
patients. We hypothesized that the common need for opioid treatment may
contribute to coalescing attacks through development of opioid dependence
and withdrawal, triggering cyclical vomiting syndrome. Aim: This study was
to review iatrogenic opioid dependence as the potential cause for triggering
cyclical vomiting syndrome. Materials and Methods: A retrospective review
was performed to identify patients treated for cyclical vomiting syndrome by
a single physician between Jan and December of 2010. Demographic data,
clinical presentation, treatment, cumulative opioid prescription during
hospitalizations and emergency room visits and days of inpatient stay were
abstracted from the chart. Results: Forty-one patients (mean age 37.5.6 ±
2.6 years; 66% female) were seen within this timeframe. In eleven patients
(27%) with ongoing opioid use, the initial cyclical illness had progressed
and eventually coalesced. A cohort of 23 patients was followed for at least
6 months (12.3 ± 1.7 months). The best single predictor of repeat
hospitalizations was the cumulative opioid dosage. Conclusion: Continued use
of opioid therapy is a poor prognostic marker of cyclical vomiting syndrome
and may contribute to disease coalescence, with dependence and withdrawal
triggering recurrent episodes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
antiemetic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
vomiting (drug therapy, side effect, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
article
clinical article
computer assisted tomography
disease association
endoscopy
female
follow up
gastrointestinal symptom (drug therapy)
hospital patient
hospitalization
human
low back pain (drug therapy)
male
nausea
opiate addiction
retrospective study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Gastroenterology (48)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014179693
PUI
L372594117
DOI
10.4103/1947-2714.128472
FULL TEXT LINK
http://dx.doi.org/10.4103/1947-2714.128472
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 539
TITLE
2014 ACMT Annual Scientific Meeting
AUTHOR ADDRESSES
SOURCE
Journal of Medical Toxicology (2014) 10:1. Date of Publication: March 2014
CONFERENCE NAME
2014 ACMT Annual Scientific Meeting
CONFERENCE LOCATION
Phoenix, AZ, United States
CONFERENCE DATE
2014-03-28 to 2014-03-30
ISSN
1556-9039
BOOK PUBLISHER
Springer New York LLC
ABSTRACT
The proceedings contain 88 papers. The topics discussed include: a 3-year
analysis and comparison of opioid prescribing practices by emergency care
providers for chronic pain; trends in opioid prescribing in us emergency
departments based on provider level of training; buprenorphine/naloxone
pediatric ingestion: exposure rates differ between film and tablet
formulations; sub-anesthetic slow infusion of ketamine for treatment of
depression produces rare but currently unpredictable and potentially serious
psychosomatic effects; survival of swine with nifedipine toxicity treated
with methylene blue; incidence and outcomes of adult cardiac arrest
associated with toxic exposure treated with therapeutic hypothermia
(toxicool); a retrospective analysis of antiretroviral agents and outcomes
from a regional poison center; medical toxicology education in medical
schools in the USA; fentanyl patch ingestion in an infant with endoscopic
retrieval; and severe mercury poisoning in a pediatric patient due to
Mexican facial cream use.
EMTREE DRUG INDEX TERMS
anesthetic agent
antiretrovirus agent
buprenorphine plus naloxone
fentanyl
ketamine
methylene blue
nifedipine
opiate
EMTREE MEDICAL INDEX TERMS
adult
chronic pain
education
emergency care
emergency ward
exposure
heart arrest
human
induced hypothermia
infant
infusion
ingestion
medical school
mercurialism
Mexican
patient
pig
poison center
psychosomatics
survival
tablet formulation
toxicity
toxicology
LANGUAGE OF ARTICLE
English
PUI
L72203003
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 540
TITLE
Two cases of methaemoglobinaemia secondary to amyl nitrate use
AUTHOR NAMES
Nee R.
Fitzgerald M.
AUTHOR ADDRESSES
(Nee R., roisin_nee@yahoo.co.uk; Fitzgerald M.) Department of Anaesthesia,
Cork University Hospital, Wilton, Cork, Ireland.
CORRESPONDENCE ADDRESS
R. Nee, Cork University Hospital, Wilton, Cork, Ireland. Email:
roisin_nee@yahoo.co.uk
SOURCE
Irish Medical Journal (2014) 107:2. Date of Publication: February 2014
ISSN
0332-3102
BOOK PUBLISHER
Irish Medical Association, 10 Fitzwilliam Place, Dublin 2, Ireland.
ABSTRACT
We wish to report two cases of methaemoglobinaemia secondary to amyl nitrate
use. A 55-year-old male presented with saturations in the mid 80s despite
FiO2 of 1.0 and GCS 10 and a 22-year-old female who presented with
fluctuating GCS and a slate grey colour. Both were found to have high levels
of metheamoglobinaemia on ABG, were treated with methylene blue and made
excellent recoveries. These cases illustrate the risk of methaemoglobinaemia
secondary to amyl nitrate. Appropriate and prompt management can lead to
very good outcomes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amyl nitrate (drug toxicity)
hypertensive agent (drug therapy)
methylene blue (drug therapy, intravenous drug administration)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
cytochrome b5 reductase (endogenous compound)
hemoglobin (endogenous compound)
methemoglobin reductase (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
methemoglobinemia (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
alcohol consumption
apnea
arterial gas
article
artificial ventilation
blood gas analysis
case report
collapse
cyanosis
emergency ward
female
gas exchange
Glasgow coma scale
heart rate
hemodynamics
human
hypotension (drug therapy)
intubation
male
metabolic acidosis
middle aged
oxidative stress
oxygen saturation
young adult
CAS REGISTRY NUMBERS
amyl nitrate (1002-16-0)
cytochrome b5 reductase (9032-25-1, 9047-21-6)
hemoglobin (9008-02-0)
methemoglobin reductase (9032-80-8)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014118753
MEDLINE PMID
24654484 (http://www.ncbi.nlm.nih.gov/pubmed/24654484)
PUI
L372378310
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 541
TITLE
Benzodiazepines: A major component in unintentional prescription drug
overdoses with opioid analgesics
AUTHOR NAMES
Jann M.
Kennedy W.K.
Lopez G.
AUTHOR ADDRESSES
(Jann M., jann_mw@mercer.edu; Kennedy W.K.) Mercer University, 3001 Mercer
University Dr, Atlanta, GA 30341, United States.
(Lopez G.) Georgia Poison Control Center, Atlanta, GA, United States.
CORRESPONDENCE ADDRESS
M. Jann, Mercer University, 3001 Mercer University Dr, Atlanta, GA 30341,
United States. Email: jann_mw@mercer.edu
SOURCE
Journal of Pharmacy Practice (2014) 27:1 (5-16). Date of Publication:
February 2014
ISSN
0897-1900
1531-1937 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
The misuse and abuse of prescription medications in the United States
continues to increase despite interventions by health care professionals,
regulatory, and law enforcement agencies. Opioid analgesics are the leading
class of prescription drugs that have caused unintentional overdose deaths.
Benzodiazepines when taken alone are relatively safe agents in overdose.
However, a 5-fold increase in deaths attributed to benzodiazepines occurred
from 1999 to 2009. Emergency department visits related to opioid analgesics
increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the
2 prescriptions drugs with the highest increase in death rates were
oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a
significant impact on prescription drug unintentional overdoses second only
to the opioid analgesics. The combination prescribing of benzodiazepines and
opioid analgesics commonly takes place. The pharmacokinetic drug
interactions between benzodiazepines and opioid analgesics are complex. The
pharmacodynamic actions of these agents differ as their combined effects
produce significant respiratory depression. Physician and pharmacy shopping
by patients occurs, and prescription drug-monitoring programs can provide
important information on benzodiazepine and opioid analgesic prescribing
patterns and patient usage. Health care professionals need to inform
patients and work closely with regulatory agencies and legislatures to stem
the increasing fatalities from prescription drug unintentional overdoses. ©
2013 The Author(s).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (clinical trial, drug concentration, drug
interaction, drug toxicity, pharmacoeconomics, pharmacokinetics,
pharmacology)
opiate (drug interaction, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
alprazolam
chlordiazepoxide
demoxepam
diazepam
fentanyl
hydrocodone
lorazepam
methadone
midazolam
oxazepam
oxycodone
oxymorphone
temazepam
triazolam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
article
drug blood level
drug formulary
drug glucuronidation
drug half life
drug mechanism
drug metabolism
drug misuse
drug monitoring
emergency ward
health care personnel
human
mortality
patient education
pharmacy
prescription
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
chlordiazepoxide (438-41-5, 58-25-3)
demoxepam (963-39-3)
diazepam (439-14-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
lorazepam (846-49-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
midazolam (59467-70-8)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
temazepam (846-50-4)
triazolam (28911-01-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014055149
MEDLINE PMID
24436437 (http://www.ncbi.nlm.nih.gov/pubmed/24436437)
PUI
L372165511
DOI
10.1177/0897190013515001
FULL TEXT LINK
http://dx.doi.org/10.1177/0897190013515001
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 542
TITLE
Acute pain management for patients under opioid maintenance treatment: What
physicians do in emergency departments?
AUTHOR NAMES
Bounes V.
Jouanjus E.
Roussin A.
Lapeyre-Mestre M.
AUTHOR ADDRESSES
(Bounes V., bounes.v@chu-toulouse.fr; Jouanjus E.; Roussin A.;
Lapeyre-Mestre M.) Pharmacoépidémiology, UMR1027, Toulouse University III,
France.
(Bounes V., bounes.v@chu-toulouse.fr; Jouanjus E.; Roussin A.;
Lapeyre-Mestre M.) Department of Clinical Pharmacology,
Pharmacodependence-Evaluation and Information Center (CEIP-A), France.
(Bounes V., bounes.v@chu-toulouse.fr) Emergency Department, University
Hospital of Toulouse, 31059 Toulouse cedex 9, France.
CORRESPONDENCE ADDRESS
V. Bounes, Emergency Department, University Hospital of Toulouse, 31059
Toulouse cedex 9, France. Email: bounes.v@chu-toulouse.fr
SOURCE
European Journal of Emergency Medicine (2014) 21:1 (73-76). Date of
Publication: 2014
ISSN
0969-9546
1473-5695 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
The aim of this study was to analyze the current practices on acute pain
management of patients under opioid maintenance treatment (OMT), that is,
buprenorphine or methadone. A total of 706 physicians were solicited through
a national network to answer a survey about pain perception and analgesic
strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%)
physicians estimated that patients under OMT when exposed to an acute
painful event feel more pain than other patients and 170 (53%) estimated
that the patients felt the same amount of pain. Use of WHO step 1 analgesics
was reported by 283 (88%) prescribers [264 (82%) prescribers reported use of
paracetamol and 178 (55%) reported use of NSAIDs]. Among the second-line
analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most
commonly reported [221 physicians (68%)]. Overall, the results demonstrate
the misconceptions of physicians on the pain tolerance of patients under
OMT. Clinical studies and evidence-based guidelines are necessary to improve
the therapeutic strategies for such patients in an emergency setting. © 2014
Wolters Kluwer Health | Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
methadone (drug therapy)
EMTREE DRUG INDEX TERMS
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
maintenance therapy
nociception
opioid maintenance treatment
EMTREE MEDICAL INDEX TERMS
article
emergency ward
human
pain (drug therapy)
pain assessment
pain threshold
physician
prescription
priority journal
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014022930
MEDLINE PMID
23872995 (http://www.ncbi.nlm.nih.gov/pubmed/23872995)
PUI
L52689545
DOI
10.1097/MEJ.0b013e328363c9e0
FULL TEXT LINK
http://dx.doi.org/10.1097/MEJ.0b013e328363c9e0
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 543
TITLE
Epidemiology of emergency department visits for opioid overdose: A
population-based study
AUTHOR NAMES
Hasegawa K.
Brown D.F.M.
Tsugawa Y.
Camargo Jr. C.A.
AUTHOR ADDRESSES
(Hasegawa K., khasegawa1@partners.org; Brown D.F.M.; Camargo Jr. C.A.)
Department of Emergency Medicine, Massachusetts General Hospital, Harvard
Medical School, 326 Cambridge St, Boston, MA 02114, United States.
(Tsugawa Y.) Harvard Interfaculty Initiative in Health Policy, Cambridge,
MA, United States.
CORRESPONDENCE ADDRESS
K. Hasegawa, Department of Emergency Medicine, Massachusetts General
Hospital, Harvard Medical School, 326 Cambridge St, Boston, MA 02114, United
States. Email: khasegawa1@partners.org
SOURCE
Mayo Clinic Proceedings (2014) 89:4 (462-471). Date of Publication: April
2014
ISSN
1942-5546 (electronic)
0025-6196
BOOK PUBLISHER
Elsevier Ltd
ABSTRACT
Objectives: To evaluate the rate of emergency department (ED) visits for
opioid overdose and to examine whether frequent ED visits for opioid
overdose are associated with more hospitalizations, near-fatal events, and
health care spending. Patients and Methods: Retrospective cohort study of
adults with at least 1 ED visit for opioid overdose between January 1, 2010,
and December 31, 2011, derived from population-based data of State Emergency
Department Databases and State Inpatient Databases for 2 large and diverse
states: California and Florida. Main outcome measures were hospitalizations
for opioid overdose, near-fatal events (overdose involving mechanical
ventilation), and hospital charges during the year after the first ED visit.
Results: The analytic cohort comprised 19,831 unique patients with 21,609 ED
visits for opioid overdose. During a 1-year period, 7% (95% CI, 7%-7%;
n=1389 patients) of the patients had frequent (2 or more) ED visits,
accounting for 15% (95% CI, 14%-15%; n=3167) of all opioid overdose ED
visits. Middle age, male sex, public insurance, lower household income, and
comorbidities (such as chronic pulmonary disease and neurological diseases)
were associated with frequent ED visits (all P<.01). Overall, 53% (95% CI,
52%-54%; n=11,412) of the ED visits for opioid overdose resulted in
hospitalizations; patients with frequent ED visits for opioid overdose had a
higher likelihood of hospitalization (adjusted odds ratio, 3.98; 95% CI,
3.38-4.69). In addition, 10.0% (95% CI, 10%-10%; n=2161) of the ED visits
led to near-fatal events; patients with frequent ED visits had a higher
likelihood of a near-fatal event (adjusted odds ratio, 2.27; 95% CI,
1.96-2.66). Total charges in Florida were $208 million (95% CI, $200- $219
million). Conclusion: In this population-based cohort, we found that
frequent ED visits for opioid overdose were associated with a higher
likelihood of future hospitalizations and near-fatal events. © 2014 Mayo
Foundation for Medical Education and Research.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (disease management, epidemiology, therapy)
opioid overdose (disease management, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
age distribution
aged
article
artificial ventilation
chronic obstructive lung disease
cohort analysis
comorbidity
controlled study
disease association
drug overdose
emergency ward
factual database
female
health care cost
high risk population
hospitalization
human
life event
lowest income group
major clinical study
male
middle aged
mortality
near-fatal event
neurologic disease
population research
public health insurance
retrospective study
sensitivity analysis
sex difference
social status
young adult
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014258838
MEDLINE PMID
24629443 (http://www.ncbi.nlm.nih.gov/pubmed/24629443)
PUI
L53047330
DOI
10.1016/j.mayocp.2013.12.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.mayocp.2013.12.008
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 544
TITLE
Emergency medical services naloxone access: A national systematic legal
review
AUTHOR NAMES
Davis C.S.
Southwell J.K.
Niehaus V.R.
Walley A.Y.
Dailey M.W.
AUTHOR ADDRESSES
(Davis C.S., cdavis@networkforphl.org; Niehaus V.R.) Network for Public
Health Law-Southeastern Region, Carrboro, United States.
(Southwell J.K.) North Carolina Institute for Public Health, Gillings School
of Global Public Health, University of North Carolina at Chapel Hill (JKS),
Chapel Hill, United States.
(Walley A.Y.) Clinical Addiction Research and Education Unit, Boston
University School of Medicine (AYW), Boston, United States.
(Dailey M.W.) Department of Emergency Medicine, Albany Medical Center (MWD),
Albany, United States.
CORRESPONDENCE ADDRESS
C.S. Davis, Network for Public Health Law-Southeastern Region, Carrboro,
United States.
SOURCE
Academic Emergency Medicine (2014) 21:10 (1173-1177). Date of Publication: 1
Oct 2014
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives: Fatal opioid overdose in the United States is at epidemic
levels. Naloxone, an effective opioid antidote, is commonly administered by
advanced emergency medical services (EMS) personnel in the prehospital
setting. While states are rapidly moving to increase access to naloxone for
community bystanders, the EMS system remains the primary source for
out-of-hospital naloxone access. Many communities have limited advanced EMS
response capability and therefore may not have prehospital access to the
medication indicated for opioid overdose reversal. The goal of this research
was to determine the authority of different levels of EMS personnel to
administer naloxone for the reversal of opioid overdose in the United
States, Guam, and Puerto Rico. Methods: The authors systematically reviewed
the scope of practice of EMS personnel regarding administration of naloxone
for the reversal of opioid overdose. All relevant laws, regulations, and
policies from the 50 U. S. states, the District of Columbia, Guam, and
Puerto Rico in effect in November 2013 were identified, reviewed, and coded
to determine the authority of EMS personnel at four levels (in increasing
order of training: emergency medical responders [EMRs], emergency medical
technicians [EMTs], intermediate/advanced EMTs, and paramedics) to
administer naloxone. Where available, protocols governing route and dose of
administration were also identified and analyzed. Results: All 53
jurisdictions license or certify EMS personnel at the paramedic level, and
all permit paramedics to administer naloxone. Of the 48 jurisdictions with
intermediate-level EMS personnel, all but one authorized those personnel to
administer naloxone as of November 2013. Twelve jurisdictions explicitly
permitted EMTs and two permitted EMRs to administer naloxone. At least five
jurisdictions modified law or policy to expand EMT access to naloxone in
2013. There is wide variation between states regarding EMS naloxone dosing
protocol and route of administration. Conclusions: Naloxone administration
is standard for paramedic and intermediate-level EMS personnel, but most
states do not allow basic life support (BLS) personnel to administer this
medication. Standards consistent with available medical evidence for
naloxone administration, dosing, and route of administration should be
implemented at each EMS level of certification.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intramuscular drug administration, intranasal drug
administration, intravenous drug administration)
EMTREE DRUG INDEX TERMS
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
drug use
Guam
health care personnel
health care policy
human
legal aspect
Puerto Rico
review
systematic review
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014851377
MEDLINE PMID
25308142 (http://www.ncbi.nlm.nih.gov/pubmed/25308142)
PUI
L600258540
DOI
10.1111/acem.12485
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12485
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 545
TITLE
Expanded access to naloxone among firefighters, police officers, and
emergency medical technicians in Massachusetts.
AUTHOR NAMES
Davis C.S.
Ruiz S.
Glynn P.
Picariello G.
Walley A.Y.
AUTHOR ADDRESSES
(Davis C.S.) Corey S. Davis is with the Network for Public Health
Law-Southeastern Region, Carrboro, NC. Sarah Ruiz is with the Massachusetts
Department of Health, Bureau of Substance Abuse Services, Boston. Patrick
Glynn is with the Special Investigations and Narcotics Unit, Quincy, MA,
Police Department. Gerald Picariello is with the Revere, MA, Fire
Department. Alexander Y. Walley is with the Clinical Addiction Research and
Education Unit, Boston University School of Medicine and the Massachusetts
Department of Health, Opioid Overdose Prevention Pilot Program, Boston.
(Ruiz S.; Glynn P.; Picariello G.; Walley A.Y.)
CORRESPONDENCE ADDRESS
C.S. Davis,
SOURCE
American journal of public health (2014) 104:8 (e7-9). Date of Publication:
Aug 2014
ISSN
1541-0048 (electronic)
ABSTRACT
Naloxone is a medication that reverses respiratory depression from opioid
overdose if given in time. Paramedics routinely administer naloxone to
opioid overdose victims in the prehospital setting, and many states are
moving to increase access to the medication. Several jurisdictions have
expanded naloxone administration authority to nonparamedic first responders,
and others are considering that step. We report here on policy change in
Massachusetts, where several communities have equipped emergency medical
technicians, law enforcement officers, and firefighters with naloxone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fire fighter
police
rescue personnel
EMTREE MEDICAL INDEX TERMS
article
drug overdose (drug therapy)
emergency
human
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24922133 (http://www.ncbi.nlm.nih.gov/pubmed/24922133)
PUI
L373963584
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 546
TITLE
Differences in Healthcare Utilization and Associated Costs Between Patients
Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency
Department Visit
AUTHOR NAMES
Xie L.
Joshi A.V.
Schaaf D.
Mardekian J.
Harnett J.
Shah N.D.
Baser O.
AUTHOR ADDRESSES
(Xie L., lxie@statinmed.com; Baser O.) STATinMED Research, Ann Arbor, MI,
United States.
(Joshi A.V.) Shire Pharmaceuticals, Wayne, PA, United States.
(Schaaf D.; Mardekian J.; Harnett J.) Pfizer Inc, New York, NY, United
States.
(Shah N.D.) Mayo Clinic, Rochester, MN, United States.
(Baser O.) The University of Michigan, Ann Arbor, MI, United States.
CORRESPONDENCE ADDRESS
L. Xie, Director, Health Economics and Outcomes Research, STATinMED
Research, 211 North 4th Avenue Suite 2B, Ann Arbor, MI 48104, United States.
Email: lxie@statinmed.com
SOURCE
Pain Practice (2014) 14:5 (446-456). Date of Publication: June 2014
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives: Compare healthcare resource utilization (HCRU) and costs between
patients prescribed opioids (RxOP) and those who were not (NoRxOP) during an
emergency department (ED) or inpatient visit. Methods: Retrospective cohort
analysis was performed (January 2006 to September 2010). Continuously
eligible RxOP patients in ED/inpatient settings (January 2007 to September
2009) were included if age was ≥ 12 years by initial prescription date (or
random date between first ED/inpatient admission and September 30, 2009
[NoRxOP patients]). Healthcare resource utilization and costs for 12 months
after initial prescription were compared. Univariate descriptive analyses
were performed for baseline and outcome variables and compared using
appropriate tests. Risk adjustment compared HCRU between RxOP and NoRxOP
cohorts for the postindex period. Results: Of 27,599 eligible patients, RxOP
patients (n = 18,819) were younger, less likely to be male, more likely to
reside in southern United States and to have Preferred Provider Organization
health plans, and had lower comorbidity index scores, compared with NoRxOP
patients (n = 8,780). RxOP patients were less likely to have nonpain-related
comorbidities and more frequently diagnosed with pain-related comorbidities.
Unmatched and propensity-matched RxOP patients experienced higher HCRU and
costs in all subcategories (total, inpatient, outpatient ED, physician,
pharmacy, other outpatient settings). Opioid abuse frequency was low in
patients with common diagnoses/procedures within 3 months before initial
prescription (0.48%). Average time to abuse was < 1 year (201 days).
Conclusion: Most patients were prescribed opioids initially during
ED/inpatient visits and incurred higher HCRU than those not prescribed
opioids. Among those with diagnosed opioid abuse after initiating opioids,
time to diagnosis was rapid (range: 14 to 260 days) for patients with common
diseases and procedures. © 2013 World Institute of Pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacoeconomics)
prescription drug (pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug cost
health care utilization
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
alcohol liver disease
arthritis
article
child
chronic liver disease
cohort analysis
comorbidity
drug abuse
drug intoxication
Elixhauser comorbidity index
emergency care
emergency ward
endocarditis
female
follow up
gastrointestinal hemorrhage
general surgery
gynecologic surgery
health care cost
hospital patient
human
liver cirrhosis
low back pain
major clinical study
male
malignant neoplasm
mental disease
mental health
orthopedic surgery
outpatient
pain
pancreatitis
pharmacy
physician
preferred provider organization
retrospective study
substance abuse
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014375016
MEDLINE PMID
23809064 (http://www.ncbi.nlm.nih.gov/pubmed/23809064)
PUI
L52664146
DOI
10.1111/papr.12098
FULL TEXT LINK
http://dx.doi.org/10.1111/papr.12098
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 547
TITLE
Analysis of buprenorphine/naloxone dosing impact on treatment duration,
resource use and costs in the treatment of opioid-dependent adults: A
retrospective study of US public and private health care claims
AUTHOR NAMES
Khemiri A.
Kharitonova E.
Zah V.
Ruby J.
Toumi M.
AUTHOR ADDRESSES
(Khemiri A.; Kharitonova E.) Creativ-Ceutical, Paris, France.
(Zah V.) ZRx Outcomes Research Inc., Mississauga, Canada.
(Ruby J.) Reckitt Benckiser Pharmaceuticals Inc., Richmond, United States.
(Toumi M., mto@creativ-ceutical.com) University of Aix-Marseille, Université
de la Méditerranée, Laboratoire de Santé Publique, Marseille, France.
CORRESPONDENCE ADDRESS
M. Toumi, University of Aix-Marseille, Université de la Méditerranée,
Laboratoire de Santé Publique, 27 bd Jean Moulin, Marseille, France. Email:
mto@creativ-ceutical.com
SOURCE
Postgraduate Medicine (2014) 126:5 (113-120). Date of Publication: 1 Jan
2014
ISSN
1941-9260 (electronic)
0032-5481
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia, United
States.
ABSTRACT
Objectives: The buprenorphine/naloxone combination is used to treat the
chronic relapsing disorder of opioid dependence. Adequate dosing levels are
important to control cravings, prevent withdrawal syndrome, and maintain
patients in treatment. The objective of this study was to estimate the
impact of dosing on treatment persistence, resource utilization, and total
direct health care costs. Methods: A retrospective cohort analysis was
performed using administrative claims extracted from the MarketScan and
Clinformatics databases from January 2007 to June and November 2012.
Patients initiating treatment with buprenorphine/naloxone were classified
into 2 groups based on the prescribed average dose over the entire treatment
period and matched by multiple criteria. The threshold for differentiating
the dosing groups was set at 15 and 15.7 mg/day for publicly and privately
insured patients, respectively. Resource utilization and related costs were
calculated over the 12-month period after the treatment initiation. Results:
Patient characteristics at baseline were considerably different between the
privately and publicly insured patients. Publicly insured patients were
slightly younger (33.1 vs 34.3 years old for privately insured) and had a
higher prevalence of mental disorders (70.9% vs 64.9%). In both groups,
patients treated with higher doses (> 15 mg and > 15.7 mg per day for
publicly and privately insured patients, respectively) had lower risk of
discontinuation (public: 11% lower; private: 9% lower) and lower probability
of a psychiatric hospitalization than patients treated with lower doses
(public: 17% lower; private: 41% lower). Total costs were comparable between
the 2 groups (public: $14 600; private: $21 000) despite the expected higher
cost of pharmacy in the higher-dose group. Conclusions: Treatment with
higher doses of buprenorphine/naloxone was associated with a longer time to
treatment discontinuation, less resource use, and lower total medical costs
despite higher pharmacy acquisition cost.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health care utilization
opiate addiction (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain
comparative effectiveness
dose response
drug abuse
drug dosage form
drug megadose
drug withdrawal
emergency ward
female
health maintenance organization
hospital patient
hospitalization
human
low drug dose
major clinical study
male
mental disease
outcome assessment
outpatient care
pharmacy
prescription
public health service
retrospective study
time to treatment
treatment duration
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160286612
MEDLINE PMID
25295655 (http://www.ncbi.nlm.nih.gov/pubmed/25295655)
PUI
L609696211
DOI
10.3810/pgm.2014.09.2805
FULL TEXT LINK
http://dx.doi.org/10.3810/pgm.2014.09.2805
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 548
TITLE
Low-dose Ketamine Improves Pain Relief in Patients Receiving Intravenous
Opioids for Acute Pain in the Emergency Department: Results of a Randomized,
Double-blind, Clinical Trial
AUTHOR NAMES
Beaudoin F.L.
Lin C.
Guan W.
Merchant R.C.
AUTHOR ADDRESSES
(Beaudoin F.L., Francesca-Beaudoin@brown.edu; Lin C.; Guan W.; Merchant
R.C.) Department of Emergency Medicine, Rhode Island Hospital, Alpert
Medical School of Brown University, Providence, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, Department of Emergency Medicine, Rhode Island Hospital,
Alpert Medical School of Brown University, Providence, United States.
SOURCE
Academic Emergency Medicine (2014) 21:11 (1194-1202). Date of Publication: 1
Nov 2014
ISSN
1553-2712 (electronic)
1069-6563
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objectives Low-dose ketamine has been used perioperatively for pain control
and may be a useful adjunct to intravenous (IV) opioids in the control of
acute pain in the emergency department (ED). The aim of this study was to
determine the effectiveness of low-dose ketamine as an adjunct to morphine
versus standard care with morphine alone for the treatment of acute moderate
to severe pain among ED patients.Methods A double-blind, randomized,
placebo-controlled trial with three study groups was conducted at a large,
urban academic ED over a 10-month period. Eligible patients were 18 to 65
years old with acute moderate to severe pain (score of at least 5 out of 10
on the numerical pain rating scale [NRS] and pain duration < 7 days) who
were deemed by their treating physician to require IV opioids. The three
study groups were: 1) morphine and normal saline placebo (standard care
group), 2) morphine and 0.15 mg/kg ketamine (group 1), or 3) morphine and
0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120
minutes after study medication administration and received rescue analgesia
as needed to target a 50% reduction in pain. The primary outcome measure of
pain relief, or pain intensity reduction, was derived using the NRS and
calculated as the summed pain-intensity (SPID) difference over 2 hours. The
amount and timing of rescue opioid analgesia was evaluated as a secondary
outcome. The occurrence of adverse events was also measured.Results Sixty
patients were enrolled (n = 20 in each group). There were no differences
between study groups with respect to age, sex, race/ethnicity, preenrollment
analgesia, or baseline NRS. Over the 2-hour poststudy medication
administration period, the SPIDs were higher (greater pain relief) for the
ketamine study groups than the control group (standard care 4.0,
interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and
group 2 7.8, IQR = 4.8 to 12.8; p < 0.02). The SPIDs for the ketamine groups
were similar (p < 0.46). When compared to standard care, group 2 sustained
the reduction in pain intensity up to 2 hours, whereas group 1 was similar
to standard care by 2 hours. Similar numbers of patients received rescue
analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%;
and group 2, four of 20, 20% (p = 0.48). Among those receiving rescue
analgesia, those in the standard care group received analgesia sooner than
either low-dose ketamine group, on average. More participants in the
low-dose ketamine groups reported dysphoria and dizziness.Conclusions
Low-dose ketamine is a viable analgesic adjunct to morphine for the
treatment of moderate to severe acute pain. Dosing of 0.3 mg/kg is possibly
more effective than 0.15 mg/kg, but may be associated with minor adverse
events. Future studies should evaluate additional outcomes, optimum dosing,
and use in specific populations. Resumen Objetivos La ketamina a dosis bajas
se ha utilizado de forma perioperatoria para el control del dolor y puede
ser un coadyuvante útil para los opiáceos intravenosos (IV) en el control
del dolor agudo en el Servicio de Urgencias (SU). El objetivo de este
estudio fue determinar la efectividad de la ketamina a dosis bajas como un
coadyuvante para la morfina frente a la atenciõn estándar con sõlo morfina
para el tratamiento del dolor agudo moderado-grave en los pacientes del SU.
Metodología Se llevõ a cabo un ensayo clínico aleatorizado, controlado y
doble ciego con tres grupos de estudio en un gran SU universitario urbano en
un periodo de 10 meses. Los pacientes candidatos tenían entre 18 y 65 años
de edad, un dolor agudo moderado-grave (puntuaciõn al menos de 5 sobre 10 en
la escala de puntuaciõn del dolor númerica [EPDN] y duraciõn del dolor < 7
días) y se considerõ por los urgenciõlogos que requerían opiáceos IV. Los
tres grupos de estudio fueron: 1) morfina y placebo con suero salino (grupo
atenciõn estándar), 2) morfina y 0,15 mg/kg ketamina (grupo 1), o 3) morfina
y 0,3 mg/kg ketamina (grupo 2). Los participantes se valoraron a los 30, 60
y 120 minutos tras la administraciõn del fármaco del estudio y recibieron
analgesia de rescate si la necesitaba para conseguir el objetivo de una
reducciõn del 50% en el dolor. La medida de resultado principal fue el
alivio del dolor o la reducciõn de la intensidad del dolor que se obtuvo
mediante la EPDN, que se calculõ como la suma de la diferencia de intensidad
del dolor (SDID) en 2 horas. La cantidad y el tiempo de la analgesia con
opiáceos de rescate se evaluaron como resultados secundarios. También se
midiõ la apariciõn de efectos adversos. Resultados Se incluyeron 60
pacientes (n = 20 en cada grupo). No hubo diferencias entre los grupos de
estudio respecto a la edad, sexo, raza/etnia, analgesia preinclusiõn o EPDN
basal. Pasado el periodo de administraciõn del fármaco a las 2 horas del
estudio, los SDID fueron mayores (mayor alivio del dolor) para los grupos de
estudio de ketamina que el grupo control (atenciõn estándar, 4,0 [RIC 1,8 a
6.5]; grupo 1, 7,0 [RIC 4,3 a 10,8]; y grupo 2, 7,8 [RIC 4,8 a 12.8]; p <
0.02). Los SDID para los grupos de ketamina fueron similares (p<0,46).
Cuando se comparõ la atenciõn estándar, el grupo 2 sostuvo la reducciõn en
la intensidad del dolor por encima de las 2 horas, mientras el grupo 1 fue
similar a la atenciõn estándar a las 2 horas. Hubo una tendencia hacia más
pacientes en el grupo de atenciõn estándar (9 de 20, 45%) que recibieron
analgesia de rescate en comparaciõn con aquellos en el grupo 1 (4 de 20,
20%) o en el grupo 2 (4 de 20, 20%) (p < 0,07). Entre aquéllos que
recibieron analgesia de rescate, los del grupo de atenciõn estándar
recibieron la analgesia más pronto que cualquiera de los grupos ketamina a
dosis bajas, en el promedio. Un mayor porcentaje de participantes en los
grupos de ketamina a dosis bajas documentõ disforia y mareo. Conclusiones La
ketamina a dosis bajas es un posible coadyuvante analgésico para la morfina
para el tratamiento del dolor agudo moderado-grave. La dosis de 0,3 mg/kg es
posiblemente más efectiva que la de 0,15 mg/kg, pero puede estar asociada
con efectos adversos menores. Futuros estudios deberían evaluar los
resultados adicionales, la dosis õptima y el uso en poblaciones específicas.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison - placebo, drug therapy)
morphine (adverse drug reaction, clinical trial, drug combination, drug
therapy)
EMTREE DRUG INDEX TERMS
morphine (adverse drug reaction, clinical trial, drug combination, drug
therapy, intravenous drug administration)
placebo
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
clinical assessment
clinical effectiveness
clinical evaluation
comparative effectiveness
confusion (side effect)
controlled study
dizziness (side effect)
double blind procedure
dysphoria (side effect)
emergency ward
female
human
low drug dose
major clinical study
male
nausea (side effect)
numeric rating scale
opioid induced emesis (side effect)
outcome assessment
pain assessment
pain intensity
pain parameters
pain severity
randomized controlled trial
rating scale
self concept
visual disorder (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine (52-26-6, 57-27-2)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014932164
MEDLINE PMID
25377395 (http://www.ncbi.nlm.nih.gov/pubmed/25377395)
PUI
L600595447
DOI
10.1111/acem.12510
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12510
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 549
TITLE
Trends in U.S. Emergency department visits for opioid overdose, 1993-2010
AUTHOR NAMES
Hasegawa K.
Espinola J.A.
Brown D.F.M.
Camargo C.A.
AUTHOR ADDRESSES
(Hasegawa K., khasegawa1@partners.org; Espinola J.A.; Brown D.F.M.; Camargo
C.A.) Department of Emergency Medicine, Harvard Medical School,
Massachusetts General Hospital, Boston, United States.
CORRESPONDENCE ADDRESS
K. Hasegawa, Department of Emergency Medicine, Massachusetts General
Hospital, 326 Cambridge Street, Suite 410, Boston, United States.
SOURCE
Pain Medicine (United States) (2014) 15:10 (1765-1770). Date of Publication:
1 Oct 2014
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: Emergency department (ED) visits for opioid overdose provide an
important marker of acute morbidity. We sought to evaluate national trends
of ED visits for opioid overdose. Design, Setting, and Participants: The
National Hospital Ambulatory Medical Care Survey, 1993-2010, was used to
identify ED visits for opioid overdose. Outcome Measures: Outcome measures
were national ED visit rates for opioid overdose per 100,000 U.S. population
and per 100,000 ED visits. Results: From 1993 to 2010, there were
approximately 731,000 ED visits (95% CI, 586,000-877,000 visits) for opioid
overdose, representing an overall rate of 14 ED visits (95% CI, 12-17
visits) per 100,000 population and 37 ED visits (95% CI, 31-45 visits) per
100,000 ED visits. Of these, 41% (95% CI, 33-50%) were for prescription
opioid overdose. Between 1993 and 2010, the national visit rate increased
from 7 to 27 per 100,000 population (+307%; P(trend)=0.03), and from 19 to
63 per 100,000 ED visits (+235%; P(trend)<0.001). Stratified analyses of the
visit rate per population showed upward, but nonsignificant, trends across
multiple demographic groups and U.S. regions. In stratified analyses of the
visit rate per 100,000 ED visits, the rate increased significantly in
several groups: age <20 years (+1188%; P(trend)=0.002), age 20-29 years
(+155%; P(trend)=0.04), age ≥50 years (+231%; P(trend)=0.04), female (+234%;
P(trend)=0.001), male (+80%; P(trend)=0.04), whites (+187%; P(trend)<0.001),
and patients in the South (+371%; P(trend)<0.001). Conclusion: In a
nationally representative database of U.S. ED visits, we found that the ED
visit rate for opioid overdose quadrupled from 1993 to 2010. Our findings
suggest that previous prevention measures may not be adequate.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
EMTREE MEDICAL INDEX TERMS
adult
article
Black person
Caucasian
drug overdose (side effect)
emergency care
female
groups by age
health survey
human
major clinical study
male
outcome assessment
prescription
sensitivity analysis
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014778515
PUI
L53300315
DOI
10.1111/pme.12461
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12461
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 550
TITLE
A 48-year-old man with severe shortness of breath
AUTHOR NAMES
Yu S.
Cole J.S.
AUTHOR ADDRESSES
(Yu S.; Cole J.S., colejs145@gmail.com) Department of Emergency Medicine,
Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA
15212-4772, United States.
CORRESPONDENCE ADDRESS
J.S. Cole, Department of Emergency Medicine, Allegheny General Hospital, 320
East North Avenue, Pittsburgh, PA 15212-4772, United States. Email:
colejs145@gmail.com
SOURCE
Air Medical Journal (2014) 33:5 (231-234). Date of Publication:
September-October 2014
ISSN
1532-6497 (electronic)
1067-991X
ABSTRACT
A 48-year-old man was found by his neighbor unconscious on the floor at his
residence. Earlier in the day, his neighbor reported noticing the patient
was becoming more short of breath and having some trouble speaking. The
neighbor alerted EMS. Upon EMS arrival, the patient was tachypneic with a
room air O2 saturation in the 60s. A LifeFlight helicopter responded to
transfer this patient to a tertiary care center from his home in a rural
farming community. © 2014 Air Medical Journal Associates.
EMTREE DRUG INDEX TERMS
antibiotic agent (drug therapy, intravenous drug administration)
midazolam
naloxone (intravenous drug administration)
organophosphate pesticide (drug toxicity)
propofol
rocuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dyspnea
organophosphate poisoning (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
aspiration pneumonia (drug therapy)
case report
emergency health service
helicopter
human
intensive care unit
male
mental health
middle aged
patient transport
priority journal
respiratory distress
respiratory failure
review
unconsciousness
CAS REGISTRY NUMBERS
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
rocuronium (119302-91-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014578894
MEDLINE PMID
25179957 (http://www.ncbi.nlm.nih.gov/pubmed/25179957)
PUI
L373867119
DOI
10.1016/j.amj.2014.05.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2014.05.003
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 551
TITLE
Ketamine infusion for sickle cell pain crisis refractory to opioids: A case
report and review of literature
AUTHOR NAMES
Uprety D.
Baber A.
Foy M.
AUTHOR ADDRESSES
(Uprety D., upretydipesh@gmail.com; Baber A.) Internal Medicine, Abington
Memorial Hospital, Abington, PA, United States.
(Foy M.) Palliative Care/Pharmacy, Abington Memorial Hospital, Abington, PA,
United States.
CORRESPONDENCE ADDRESS
D. Uprety, Internal Medicine, Abington Memorial Hospital, Abington, PA,
United States. Email: upretydipesh@gmail.com
SOURCE
Annals of Hematology (2014) 93:5 (769-771). Date of Publication: May 2014
ISSN
1432-0584 (electronic)
0939-5555
BOOK PUBLISHER
Springer Verlag, service@springer.de
ABSTRACT
This article reports a rare case of the use of low-dose ketamine infusion as
an adjuvant to opioids to treat pain in sickle cell disease. A 31-year-old
African-American male with history of sickle cell disease presented to the
emergency department with complaints of chest tightness, multiple joint
pain, and headache for 1 week. His vital signs and physical examination were
unremarkable. His admission lab included hemoglobin of 8.4 g/dl,
reticulocyte count of 16.3 %, bilirubin of 1.7 mg/dl, and LDH of 1,267 U/l.
Chest X-ray showed middle and lower lobe opacity and interstitial
thickening. He was treated for acute pain crisis and community-acquired
pneumonia with intravenous fluids, supplemental oxygen, and intravenous
levofloxacin. He was placed on fentanyl patient-controlled analgesia (PCA),
oxycodone, ketorolac, and methadone with co-analgesic gabapentin and
venlafaxine. Over the course of his hospitalization, his chest pain
resolved, but the joint pains continued. He was then transferred to the ICU
and was discharged a day later after 7 days of ketamine infusion. Ketamine
is a noncompetitive antagonist at the N-methyl-d-aspartate (NMDA) receptor.
This property has been shown to modulate opioid tolerance and opioid-induced
hyperalgesia. There have been a very few published reports on the use of
low-dose ketamine in sickle cell pain management. A PubMed search revealed
four published articles (Table 1). Fourteen out of the 17 cases (82.35 %)
who received ketamine infusion showed improvement in self-reported pain
intensity and significant reduction in opioid dosage. Only one patient (5.9
%) developed serious side effect leading to discontinuation of the drug. A
low-dose ketamine can be an option for pain control in sickle cell disease.
Randomized trial is required to establish this benefit of ketamine over
currently available therapies. © 2013 Springer-Verlag Berlin Heidelberg.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy)
gabapentin (drug therapy)
infusion fluid
ketorolac (drug therapy)
levofloxacin (drug therapy, intravenous drug administration)
methadone (drug therapy)
oxycodone (drug therapy)
oxygen (drug therapy)
venlafaxine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy, therapy)
sickle cell crisis (drug therapy, drug therapy, therapy)
sickle cell pain crisis (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adjuvant therapy
adult
African American
antimicrobial therapy
arthralgia
article
case report
chest tightness
community acquired pneumonia (drug therapy, therapy)
drug treatment failure
emergency ward
headache
hospital admission
hospital discharge
hospitalization
human
intensive care unit
low drug dose
male
oxygen therapy
pain assessment
palliative therapy
patient controlled analgesia
priority journal
thorax pain
thorax radiography
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
gabapentin (60142-96-3)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
levofloxacin (100986-85-4, 138199-71-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxygen (7782-44-7)
venlafaxine (93413-69-5)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014258249
MEDLINE PMID
24232306 (http://www.ncbi.nlm.nih.gov/pubmed/24232306)
PUI
L52868106
DOI
10.1007/s00277-013-1954-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s00277-013-1954-3
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 552
TITLE
ACOEM practice guidelines: Opioids for treatment of acute, subacute,
chronic, and postoperative pain
AUTHOR NAMES
Hegmann K.T.
Weiss M.S.
Bowden K.
Branco F.
DuBrueler K.
Els C.
Mandel S.
McKinney D.W.
Miguel R.
Mueller K.L.
Nadig R.J.
Schaffer M.I.
Studt L.
Talmage J.B.
Travis R.L.
Winters T.
Thiese M.S.
Harris J.S.
AUTHOR ADDRESSES
(Hegmann K.T., kurt.hegmann@hsc.utah.edu) University of Utah Rocky, Mountain
Center for Occupational and Environmental Health, 391 Chipeta Way, Salt Lake
City, United States.
(Weiss M.S.; Bowden K.; Branco F.; DuBrueler K.; Els C.; Mandel S.; McKinney
D.W.; Miguel R.; Mueller K.L.; Nadig R.J.; Schaffer M.I.; Studt L.; Talmage
J.B.; Travis R.L.; Winters T.; Thiese M.S.; Harris J.S.)
CORRESPONDENCE ADDRESS
K.T. Hegmann, University of Utah Rocky, Mountain Center for Occupational and
Environmental Health, 391 Chipeta Way, Salt Lake City, United States.
SOURCE
Journal of Occupational and Environmental Medicine (2014) 56:12 (e143-e159).
Date of Publication: 14 Dec 2014
ISSN
1536-5948 (electronic)
1076-2752
BOOK PUBLISHER
Lippincott Williams and Wilkins, LRorders@phl.lrpub.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
carisoprodol
codeine
dextropropoxyphene
diflunisal
ibuprofen
ketorolac
morphine
oxycodone
paracetamol
pethidine
tramadol
valdecoxib
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
postoperative pain (drug therapy, drug therapy)
practice guideline
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
ankle sprain
cognitive defect
consultation
dose response
drug screening
emergency ward
environmental health
evidence based practice
family history
human
medical history
Medline
pain
physical examination
prescription
publication
review
sleep disordered breathing
CAS REGISTRY NUMBERS
carisoprodol (78-44-4)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diflunisal (22494-42-4)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
valdecoxib (181695-72-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014933549
MEDLINE PMID
25415660 (http://www.ncbi.nlm.nih.gov/pubmed/25415660)
PUI
L600600280
DOI
10.1097/JOM.0000000000000352
FULL TEXT LINK
http://dx.doi.org/10.1097/JOM.0000000000000352
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 553
TITLE
Prolonged apnea, caused by remifentanil, during awakening from anesthesia
for emergency ventriculoperitoneal shunt placement
AUTHOR NAMES
Watanabe T.
Watanabe Y.
Takizawa D.
Hiraoka H.
Petrenko A.B.
Baba H.
AUTHOR ADDRESSES
(Watanabe T., tatsu-w@med.niigata-u.ac.jp; Watanabe Y.; Petrenko A.B.; Baba
H.) Division of Anesthesiology, Niigata University Graduate School of
Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata
951-8510, Japan.
(Takizawa D.) Department of Anesthesiology, Nagaoka Red Cross Hospital,
Nagaoka, Japan.
(Hiraoka H.) At-Home Anesthesia Clinic, Takasaki, Japan.
CORRESPONDENCE ADDRESS
T. Watanabe, Division of Anesthesiology, Niigata University Graduate School
of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata
951-8510, Japan. Email: tatsu-w@med.niigata-u.ac.jp
SOURCE
Journal of Anesthesia (2014) 28:2 (320-321). Date of Publication: April 2014
ISSN
1438-8359 (electronic)
0913-8668
BOOK PUBLISHER
Springer-Verlag Tokyo, orders@springer.jp
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
remifentanil (adverse drug reaction, pharmacokinetics)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration, subcutaneous drug
administration)
propofol
rocuronium
sevoflurane
sugammadex
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia complication (drug therapy, drug therapy)
anesthesia level
apnea (drug therapy, drug therapy)
brain ventricle peritoneum shunt
emergency surgery
prolonged apnea (drug therapy, side effect, drug therapy, side effect)
respiration depression (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
aged
anesthesia induction
breathing pattern
case report
drug treatment failure
drug withdrawal
general anesthesia
human
hydrocephalus (surgery)
letter
male
neurosurgery
operation duration
tracheostomy
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
remifentanil (132539-07-2)
rocuronium (119302-91-9)
sevoflurane (28523-86-6)
sugammadex (343306-79-6, 343306-71-8)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014292804
MEDLINE PMID
24013693 (http://www.ncbi.nlm.nih.gov/pubmed/24013693)
PUI
L52766486
DOI
10.1007/s00540-013-1707-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s00540-013-1707-4
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 554
TITLE
What is causing this man's groin pain?
AUTHOR NAMES
Burgers K.
AUTHOR ADDRESSES
(Burgers K.) Tripler Army Medical Center, Honolulu, HI, United States.
CORRESPONDENCE ADDRESS
K. Burgers, Tripler Army Medical Center, Honolulu, HI, United States.
SOURCE
Consultant (2014) 54:7 (569). Date of Publication: July 2014
ISSN
0010-7069
BOOK PUBLISHER
Cliggott Publishing Co.
EMTREE DRUG INDEX TERMS
buprenorphine (drug combination, drug therapy, oral drug administration)
diamorphine
naloxone (drug combination, drug therapy, oral drug administration)
oxycodone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
inguinal pain (etiology)
inguinal pain (etiology)
EMTREE MEDICAL INDEX TERMS
abdomen
adduction
adult
army
article
case report
computer assisted tomography
consultation
disease exacerbation
drug dependence treatment
emergency ward
erythrocyte sedimentation rate
hand injury (drug therapy)
heroin dependence (drug therapy)
hospital admission
human
injection site scar
leg
leukocytosis
lymphadenopathy
male
medical history
mobilization
nuclear magnetic resonance imaging
pain intensity
pain parameters
pelvis
phlebotomy
platelet count
prescription
primary medical care
priority journal
pubis symphysis
soldier
splenomegaly
thigh
young adult
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Clinical and Experimental Biochemistry (29)
Psychiatry (32)
Drug Literature Index (37)
General Pathology and Pathological Anatomy (5)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014472136
PUI
L373524675
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 555
TITLE
The opioid prescription epidemic and the role of emergency medicine
AUTHOR NAMES
Poon S.J.
Greenwood-Ericksen M.B.
AUTHOR ADDRESSES
(Poon S.J., sjpoon@partners.org; Greenwood-Ericksen M.B.) Harvard Affiliated
Emergency Medicine Residency-Brigham and Women's Hospital, Massachusetts
General Hospital, Boston, United States.
CORRESPONDENCE ADDRESS
S.J. Poon, Harvard Affiliated Emergency Medicine Residency-Brigham and
Women's Hospital, Massachusetts General Hospital, Boston, United States.
SOURCE
Annals of Emergency Medicine (2014) 64:5 (490-495). Date of Publication: 1
Nov 2014
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
controlled substance
prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
drug surveillance program
emergency physician
emergency ward
evidence based medicine
human
opiate addiction
patient satisfaction
residency education
review
work environment
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014712165
MEDLINE PMID
25017821 (http://www.ncbi.nlm.nih.gov/pubmed/25017821)
PUI
L53237528
DOI
10.1016/j.annemergmed.2014.06.016
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.06.016
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 556
TITLE
Clonidine poisoning in a child: A case report
ORIGINAL (NON-ENGLISH) TITLE
Intoxication pédiatrique sévère avec une faible dose de clonidine: À propos
d'un cas
AUTHOR NAMES
Schmitt C.
Kervégant M.
Ajaltouni Z.
Tauber M.
Tichadou L.
de Haro L.
AUTHOR ADDRESSES
(Schmitt C., corinne.schmitt@ap-hm.fr; Kervégant M.; Tichadou L.; de Haro
L.) Centre antipoison de Marseille, Hôpital Sainte-Marguerite, 270,
boulevard Sainte-Marguerite, Marseille, France.
(Ajaltouni Z.; Tauber M.) Service de pédiatrie, Centre hospitalier de
Toulouse, 330, avenue de Grande-Bretagne, Toulouse cedex 9, France.
CORRESPONDENCE ADDRESS
C. Schmitt, Centre antipoison de Marseille, Hôpital Sainte-Marguerite, 270,
boulevard Sainte-Marguerite, Marseille, France.
SOURCE
Archives de Pediatrie (2014) 21:11 (1213-1215). Date of Publication: 2014
ISSN
1769-664X (electronic)
0929-693X
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France. infos@masson.fr
ABSTRACT
Clonidine poisoning's clinical feature is well documented in the medical
literature, but the minimal toxic dose has not yet been established. The
effectiveness of naloxone is also controversial. The authors describe a
clonidine overdose in a 9-year-old boy (25. kg) during a growth hormone
test: he received tenfold the prescribed clonidine dose (0.23. mg instead of
0.023. mg) with 6.2. mg betaxolol. About 40. min later, he became drowsy and
then complained of low blood pressure, bradycardia, and myosis. By
maintaining the Trendelenburg position, administering fluids as well as
salbutamol and naloxone (three doses of 0.2. mg were required), he recovered
and was discharged from the hospital on day 2. The minimal clonidine toxic
dose, the clinical picture, and the effectiveness of naloxone administration
are discussed in this paper.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
clonidine (adverse drug reaction, drug combination, drug toxicity)
naloxone (drug combination, drug therapy)
EMTREE DRUG INDEX TERMS
betaxolol (drug combination)
salbutamol (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
clonidine intoxication (drug therapy, disease management, drug therapy)
drug intoxication (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
body position
bradycardia (side effect)
case report
child
clinical feature
drowsiness (side effect)
drug efficacy
drug overdose
emergency treatment
endocrine function test
fluid therapy
growth hormone test
human
hypotension (side effect)
male
medication error
miosis (side effect)
school child
Trendelenburg position
CAS REGISTRY NUMBERS
betaxolol (63659-18-7, 72424-72-7, 93221-48-8)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2014875698
MEDLINE PMID
25284732 (http://www.ncbi.nlm.nih.gov/pubmed/25284732)
PUI
L600340612
DOI
10.1016/j.arcped.2014.07.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.arcped.2014.07.014
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 557
TITLE
Sodium oxybate for narcolepsy: Explaining untoward effects and recommending
new approaches in light of prevailing receptor pharmacology
AUTHOR NAMES
VanWert A.L.
McCune D.F.
Brown K.M.
Bommareddy A.
Manning D.H.
Roman C.L.
AUTHOR ADDRESSES
(VanWert A.L., adam.vanwert@wilkes.edu; McCune D.F.; Brown K.M.; Bommareddy
A.; Manning D.H.) Nesbitt School of Pharmacy, Wilkes University,
Wilkes-Barre, United States.
(Roman C.L.) St Luke's University Hospital, Bethlehem, United States.
(VanWert A.L., adam.vanwert@wilkes.edu) Department of Pharmaceutical
Sciences, Wilkes University, 84 W South St, Wilkes-Barre, United States.
CORRESPONDENCE ADDRESS
A.L. VanWert, Department of Pharmaceutical Sciences, Wilkes University, 84 W
South St, Wilkes-Barre, United States.
SOURCE
Journal of Pharmacy Technology (2014) 30:6 (240-243). Date of Publication:
2014
ISSN
1549-4810 (electronic)
8755-1225
BOOK PUBLISHER
SAGE Publications Inc., claims@sagepub.com
ABSTRACT
Objective: Gamma-hydroxybutyrate (GHB) has been an abused and illicit
substance for decades, but the antinarcoleptic medication Xyrem (sodium
oxybate), the sodium salt of GHB, was approved just in 2002 for increasing
wakefulness. We present a case of coma induced by co-ingestion of
prescription GHB and ethanol and describe the response to naloxone
treatment, by first responders, without evidence of opiate exposure. The
purpose of this report is to bridge updated knowledge on GHB and ethanol
pharmacology with the clinical sequence of events in a patient co-ingesting
these compounds and to theorize on a potentially better pharmacological
approach to narcolepsy. Case Summary: The patient was a 25-year-old woman
with a history of narcolepsy. She suddenly collapsed at home but became
transiently responsive after being administered naloxone in the ambulance.
She presented to the emergency department with apnea, poor responsiveness
with a Glasgow Coma Score of 7, and urinary incontinence. While undergoing
intubation, the patient spontaneously and abruptly awoke. Labs were
unremarkable except a blood alcohol concentration of 0.123%. The dosage of,
and adherence to, GHB was unknown in this case. Discussion: The case is
described in light of the most recent pharmacological advancements on these
co-ingestants. A conceptual dose-response curve is shown to facilitate
understanding of the complex pharmacology of GHB. Conclusions: Approved and
potential alternatives to GHB, for achieving wakefulness, are discussed.
Potential new strategies should bear low to no risk of coma with accidental
overdose or co-ingestion of ethanol. In addition, promising antidotes for
future consideration are discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (endogenous compound)
oxybate sodium (drug therapy)
EMTREE DRUG INDEX TERMS
glucose (endogenous compound)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug alcohol interaction
drug effect
narcolepsy (drug therapy, drug therapy)
pharmaceutical care
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
apnea
article
case report
collapse
coma
computer assisted tomography
female
Glasgow coma scale
glucose blood level
human
intubation
patient compliance
tachycardia
thorax radiography
urine incontinence
wakefulness
DRUG TRADE NAMES
xyrem
CAS REGISTRY NUMBERS
alcohol (64-17-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
oxybate sodium (502-85-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015933494
PUI
L603835869
DOI
10.1177/8755122514545518
FULL TEXT LINK
http://dx.doi.org/10.1177/8755122514545518
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 558
TITLE
Can monitoring consumer requests for opioid-replacement therapy improve
access to treatment?
AUTHOR NAMES
Harlow W.
Happell B.
Browne G.
Browne M.
AUTHOR ADDRESSES
(Harlow W., warren_harlow@health.qld.gov.au; Happell B.,
b.happell@cqu.edu.au; Browne M., m.browne@cqu.edu.au) Central Queensland
University Australia, Institute for Health and Social Science Research,
Building 5, Bruce Highway Rockhampton, QLD 4702, Australia.
(Harlow W., warren_harlow@health.qld.gov.au) Queensland Health Gold Coast
Alcohol, Tobacco and Other Drugs Services, 2019 Gold Coast Highway, Miami,
QLD 4220, Australia.
(Happell B., b.happell@cqu.edu.au) School of Nursing and Midwifery, Building
5, Bruce Highway Rockhampton, QLD 4702, Australia.
(Browne G., graeme.browne@newcastle.edu.au) University of Newcastle Port
Macquarie, University Drive, Callaghan, NSW 2308, Australia.
CORRESPONDENCE ADDRESS
W. Harlow, Email: warren_harlow@health.qld.gov.au
SOURCE
Australian Health Review (2014) 38:3 (312-317). Date of Publication: 2014
ISSN
0159-5709 (electronic)
0156-5788
ABSTRACT
Objective This study examined data recorded by one urban publicly funded
opioid-replacement therapy clinic (from 2009 to 2011) to identify whether
these data could be used to inform the rostering of clinicians more
effectively to improve access to treatment. Methods Data analysis
incorporated descriptive and inferential methods. Results There were trends
in the times of the year consumers seek opioid-replacement therapy,
similarity and differences between gender requests for treatment and
variation in consumer wait time on triage. Conclusions National reporting of
opioid-replacement therapy triages would help gain a better understanding of
the number of people in need of treatment. If opioid-replacement therapy
providers monitored consumer triages, they could roster more effectively,
have gender-specific clinicians available, acknowledge and inform consumers
of wait time on triage and allow re-orientation of services to lower wait
time. © 2014 AHHA.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (drug therapy)
health care delivery
opiate substitution treatment
EMTREE MEDICAL INDEX TERMS
article
Australia
drug dependence treatment
emergency health service
female
human
male
retrospective study
statistics
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24807739 (http://www.ncbi.nlm.nih.gov/pubmed/24807739)
PUI
L1373271072
DOI
10.1071/AH13212
FULL TEXT LINK
http://dx.doi.org/10.1071/AH13212
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 559
TITLE
The economic burden of diagnosed opioid abuse among commercially insured
individuals
AUTHOR NAMES
Rice J.B.
Kirson N.Y.
Shei A.
Enloe C.J.
Cummings A.K.G.
Birnbaum H.G.
Holly P.
Ben-Joseph R.
AUTHOR ADDRESSES
(Rice J.B., brad.rice@analysisgroup.com; Kirson N.Y.; Shei A.; Enloe C.J.;
Cummings A.K.G.; Birnbaum H.G.) Analysis Group, Inc., Boston, United States.
(Holly P.; Ben-Joseph R.) Purdue Pharma L.P., Stamford, United States.
CORRESPONDENCE ADDRESS
J.B. Rice, Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston,
United States. Email: brad.rice@analysisgroup.com
SOURCE
Postgraduate Medicine (2014) 126:4 (53-58). Date of Publication: 1 Jan 2014
ISSN
1941-9260 (electronic)
0032-5481
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia, United
States.
ABSTRACT
The abuse of prescription opioids imposes a substantial public health and
economic burden. Recent research using administrative claims data has
substantiated the prevalence and cost of opioid abuse among commercially
insured individuals. Although administrative claims data are readily
available and have been used to effectively answer research questions about
the burden of illness for many different conditions, an important issue is
the reliability, replicability, and generalizability of estimates derived
from different databases. Therefore, this study sought to assess whether the
findings of a recently published study of opioid abuse in a commercial
claims database (original analysis) could be replicated in a different
commercial claims database. The original analysis, which analyzed the
prevalence and excess health care costs of diagnosed opioid abuse in the
OptumHealth Reporting and Insights Database, was replicated by applying the
same approach to the Truven MarketScan Commercial Claims and Encounters
Database (replication analysis). In the replication analysis, the prevalence
of diagnosed opioid abuse increased steadily from 15.8 diagnosed opioid
abusers per 10 000 in 2009, to 26.6 diagnosed opioid abusers per 10 000 in
2012. Although the prevalence of diagnosed opioid abuse was higher than
reported in the original analysis, the trend of increasing prevalence over
time was consistent across analyses. Additionally, diagnosed abusers had
excess annual per patient health care costs of $11 376 in the replication
analysis, which was consistent with the excess annual per patient health
care costs of diagnosed abuse of $10 627 reported in the original analysis.
The replication analysis also found an upward trend in the prevalence of
diagnosed opioid abuse over time and substantial excess annual per patient
health care costs of diagnosed opioid abuse among commercially insured
individuals, suggesting that these findings are generalizable to other
commercially insured populations.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
opiate addiction
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
child
comorbidity
drug cost
drug dependence
emergency ward
female
health insurance
hospital patient
human
major clinical study
male
outpatient care
prescription
prevalence
public health problem
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
20160290874
MEDLINE PMID
25141243 (http://www.ncbi.nlm.nih.gov/pubmed/25141243)
PUI
L609719911
DOI
10.3810/pgm.2014.07.2783
FULL TEXT LINK
http://dx.doi.org/10.3810/pgm.2014.07.2783
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 560
TITLE
Urban overdose hotspots: A 12-month prospective study in Dublin ambulance
services
AUTHOR NAMES
Klimas J.
O'Reilly M.
Egan M.
Tobin H.
Bury G.
AUTHOR ADDRESSES
(Klimas J., jan.klimas@ucd.ie; Egan M.; Tobin H.; Bury G.) Centre for
Emergency Medical Science, School of Medicine and Medical Science,
University College Dublin, Dublin, Ireland.
(O'Reilly M.) Dublin Fire Brigade, Dublin, Ireland.
CORRESPONDENCE ADDRESS
J. Klimas, Centre for Emergency Medical Science, School of Medicine and
Medical Science, University College Dublin, Dublin, Ireland.
SOURCE
American Journal of Emergency Medicine (2014) 32:10 (1168-1173). Date of
Publication: 1 Oct 2014
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Background Opioid overdose (OD) is the primary cause of death among drug
users globally. Personal and social determinants of overdose have been
studied before, but the environmental factors lacked research attention.
Area deprivation or presence of addiction clinics may contribute to
overdose. Objectives The objective of the study is to examine the baseline
incidence of all new ODs in an ambulance service and their relationship with
urban deprivation and presence of addiction services.Methods A prospective
chart review of prehospital advanced life support patients was performed on
confirmed OD calls. Demographic, geographic, and clinical information, that
is, presentation, treatment, and outcomes, was collected for each call. The
census data were used to calculate deprivation. Geographical information
software mapped the urban deprivation and addiction services against the
overdose locations.Results There were 469 overdoses, 13 of which were fatal;
most were male (80%), of a young age (32 years), with a high rate of
repeated overdoses (26%) and common polydrug use (9.6%). Most occurred in
daytime (275) and on the streets (212). Overdoses were more likely in more
affluent areas (r =.15; P <.05) and in a 1000-m radius of addiction
services. Residential overdoses were in more deprived areas than street
overdoses (mean difference, 7.8; t(170) = 3.99; P <.001). Street overdoses
were more common in the city center than suburbs (χ(2)(1) = 33.04; P
<.001).Conclusions The identified clusters of increased incidence - urban
overdose hotspots - suggest a link between environment characteristics and
overdoses. This highlights a need to establish overdose education and
naloxone distribution in the overdose hotspots.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
antidepressant agent
benzodiazepine derivative
central stimulant agent
naloxone (drug therapy, intramuscular drug administration, intraosseous drug
administration, subcutaneous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulance
drug intoxication (drug therapy, drug therapy, etiology)
emergency health service
urban area
EMTREE MEDICAL INDEX TERMS
adult
alcohol consumption
article
assisted ventilation
city
collapse
female
first aid
geographic distribution
Glasgow coma scale
human
major clinical study
male
medical record review
methadone treatment
multiple drug abuse
outcome assessment
patient transport
prospective study
residential area
respiration depression
suburban area
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014822527
MEDLINE PMID
25154346 (http://www.ncbi.nlm.nih.gov/pubmed/25154346)
PUI
L600127999
DOI
10.1016/j.ajem.2014.07.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2014.07.017
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 561
TITLE
Expanding access to naloxone in the United States
AUTHOR NAMES
Doyon S.
Aks S.E.
Schaeffer S.
AUTHOR ADDRESSES
(Doyon S.) American Academy of Clinical Toxicology, United States.
(Aks S.E., saks@cookcountyhhs.org) American College of Medical Toxicology,
United States.
(Schaeffer S.) American Association of Poison Control Centers, United
States.
CORRESPONDENCE ADDRESS
S.E. Aks, American College of Medical Toxicology, United States.
SOURCE
Clinical Toxicology (2014) 52:10 (989-992). Date of Publication: 1 Dec 2014
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Informa Healthcare, healthcare.enquiries@informa.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug toxicity)
EMTREE DRUG INDEX TERMS
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care access
EMTREE MEDICAL INDEX TERMS
breathing rate
drug intoxication
drug overdose
emergency ward
food and drug administration
hospitalization
human
lung compliance
medical care
opiate addiction
poison center
prescription
respiration depression
respiratory distress
resuscitation
review
tidal volume
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2015640596
MEDLINE PMID
25283253 (http://www.ncbi.nlm.nih.gov/pubmed/25283253)
PUI
L601095673
DOI
10.3109/15563650.2014.968657
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2014.968657
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 562
TITLE
Adult patients in the pediatric emergency department: Presentation and
disposition
AUTHOR NAMES
Little W.K.
Hirsh D.A.
AUTHOR ADDRESSES
(Little W.K., wendalyn.little@emory.edu) Departments of Pediatrics, Emory
University, School of Medicine, 1645 Tullie Circle NE, Atlanta, United
States.
(Little W.K., wendalyn.little@emory.edu) Departments of Emergency Medicine,
Emory University, School of Medicine, Atlanta, United States.
(Hirsh D.A.) Departments of Pediatric Emergency Medicine, Children's
Healthcare of Atlanta, Atlanta, United States.
(Hirsh D.A.) Pediatric Emergency Medicine Assoc. LLC, Atlanta, United
States.
CORRESPONDENCE ADDRESS
W.K. Little, Departments of Pediatrics, Emory University, School of
Medicine, 1645 Tullie Circle NE, Atlanta, United States.
SOURCE
Pediatric Emergency Care (2014) 30:11 (808-811). Date of Publication: 12 Nov
2014
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, LRorders@phl.lrpub.com
ABSTRACT
BACKGROUND: Pediatric emergency departments (PEDs) are intended to care for
acutely ill and injured children. Adult patients sometimes present to these
facilities as well. Some of these are young adults still under the care of
pediatric specialists, but older adults and those not under the care of
specialists may seek care and may challenge pediatric care providers.
Understanding the spectrum of adult illness encountered in the PED may help
ensure optimum care for this patient population. OBJECTIVE: This study aimed
to describe the presentations of adult patients in 2 high-volume PEDs of a
pediatric health care system. METHODS: This is a retrospective review of
electronic medical record to identify all visits for patients 21 years or
older between 2008 and 2010. Patient demographics, reason for visit,
diagnosis, and treatment details were identified. RESULTS: The combined PEDs
recorded 417,799 total visits with 1097 patients 21 years or older; 188 of
these were still followed by pediatric specialists. For the 907 remaining,
the mean age was 36.5.years (range, 21-88 years); 73% were female. Fifty-one
percent of the patients were triaged into the highest acuity levels.
Fifty-seven percent of the patients were transferred to adult facilities for
definitive care. There were no deaths among these patients at either PED,
but 2 patients did require intubation and 1 received a period of chest
compressions. Reason for presenting to the PED included on-site visitor
(45%), mistakenly presented to children's hospital (34%), and hospital
employee (21%). The most common presenting complaints were neurologic
conditions, trauma/acute injuries, and chest pain. CONCLUSIONS: Adult
patients in PEDs are rare but have relatively high acuity and often require
transfer. Pediatric emergency department clinicians should have adequate,
ongoing training to capably assess and stabilize adult patients across a
spectrum of illness presentation.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (oral drug administration)
adenosine (drug therapy)
analgesic agent (oral drug administration)
benzodiazepine
beta adrenergic receptor stimulating agent
epinephrine (drug therapy)
glyceryl trinitrate (sublingual drug administration)
haloperidol
infusion fluid
methadone
naloxone
narcotic analgesic agent (drug combination, intravenous drug administration,
oral drug administration)
opiate
paracetamol (drug combination, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child health care
emergency care
emergency ward
pediatric hospital
transition to adult care
EMTREE MEDICAL INDEX TERMS
adult
agitation
allergic reaction (drug therapy)
anxiety
article
cerebrovascular accident
compression therapy
dizziness
drug overdose
faintness
female
headache
heart arrhythmia (drug therapy)
human
injury
intubation
major clinical study
male
medical specialist
neurologic disease
obstetrics
seizure
substance use
thorax pain
traffic accident
vagina bleeding
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
benzodiazepine (12794-10-4)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014971376
MEDLINE PMID
25343738 (http://www.ncbi.nlm.nih.gov/pubmed/25343738)
PUI
L600776842
DOI
10.1097/PEC.0000000000000264
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000264
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 563
TITLE
The law of unintended consequences: Illicit for licit narcotic substitution
AUTHOR NAMES
Huecker M.R.
Shoff H.W.
AUTHOR ADDRESSES
(Huecker M.R., martin.huecker@louisville.edu; Shoff H.W.) University of
Louisville, Department of Emergency Medicine, Louisville, United States.
CORRESPONDENCE ADDRESS
M.R. Huecker, University of Louisville Hospital, 530 S. Jackson Street,
Louisville, United States. Email: martin.huecker@louisville.edu
SOURCE
Western Journal of Emergency Medicine (2014) 15:4 (561-563). Date of
Publication: 2014
ISSN
1936-9018 (electronic)
1936-900X
BOOK PUBLISHER
eScholarship, kfilipiak@aaem.org
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic agent
EMTREE DRUG INDEX TERMS
controlled substance
diamorphine
hydrocodone
naloxone
oxycodone
oxymorphone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
analgesia
editorial
emergency ward
heroin dependence
human
law
mortality
prescription
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
20160693657
MEDLINE PMID
25035769 (http://www.ncbi.nlm.nih.gov/pubmed/25035769)
PUI
L612309638
DOI
10.5811/westjem.2014.3.21578
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2014.3.21578
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 564
TITLE
Epidemiological analysis of five years of poisoning in the Emilia Romagna
Region
ORIGINAL (NON-ENGLISH) TITLE
Analisi epidemiologica quinquennale delle intossicazioni nella Regione
Emilia Romagna
AUTHOR NAMES
Bianchi S.
Bianchini E.
Diana P.
Quarta B.
Scanavacca P.
Mazzolani M.
Martelli L.
Zoppellari R.
AUTHOR ADDRESSES
(Bianchi S.; Bianchini E.; Diana P.; Quarta B.; Scanavacca P.) Servizio di
Farmacia, Dipartimento Farmaceutico Interaziendale, Azienda Ospedaliero
Università di Ferrara, Italy.
(Mazzolani M.; Martelli L.) Servizio Politica Del Farmaco Regione Emilia
Romagna, Italy.
(Zoppellari R.) U.O. Anestesia e Rianimazione Ospedaliera, Azienda
Ospedaliero Universitaria di Ferrara, Italy.
SOURCE
Giornale Italiano di Farmacia Clinica (2014) 28:1 (3-15). Date of
Publication: 1 Jan 2014
ISSN
1120-3749
BOOK PUBLISHER
Il Pensiero Scientifico Editore s.r.l., Via Giovanni Valdarno 8, Roma,
Italy. r.bonini@pensiero.it
ABSTRACT
Introduction. The Department of Pharmacy of the University Hospital of
Ferrara (AOUFE) has been identified as Regional Reference Center (CRR) for
the supply of antidotes. The aim of the CRR is to ensure the adjustment of
the budget of antidotes to deal with emergency situations territorial. To
allow the development and rationalization of the management of antidotes was
considered necessary to make an epidemiological survey to highlight the main
types of poisoning regional and treatments undertaken. Method. Multicenter
retrospective and descriptive study performed on medical records of patients
intoxicated in Emilia Romagna region. In the study we included patients with
diagnosis of intoxication in the period of analysis, this patient made an
access to in the hospitals of Emilia Romagna region. For each toxicity data
were required: year, type of intoxication and toxic substance, patient's
features, type of antidote used and treatment period. Assess the type and
incidence of poisoning, types of antidotes used in hospitals in the Emilia
Romagna region. Results. 16 hospitals took part in the analysis. 8151
intoxications were registered and they are grouped as follows: 1704
intoxications in 2005 (21% over the whole 5-year period); 1523 in 2006
(19%); 1593 in 2007 (20%); 1560 in 2008 (19%); 1771 in 2009 (21%).
Classifying poisoning by toxic involved was: 42% is caused by drugs, 18%
ethanol, 6% of psychotropic substances, 4% carbon monoxide; food 4%, 1%
sodium hypochlorite and derivatives; 17 % by poisoning undefined; 6% from
poisoning caused mainly by various detergents, pesticides, animal
poisons.1223 poisoning were treated with the following antidotes: 232 with
activated charcoal associated with gastric lavage, activated charcoal with
132; 151 with naloxone; 144 with flumazenil; 109 with activated charcoal
associated with MgSO4; 76 with hyperbaric oxygen; 80 with metadoxina, 53
with benzodiazepines. Discussion and conclusion. Drug and ethanol poisonings
were the most frequent; non-specific treatments were the most frequently
performed, followed by the use of specific antidotes such as flumazenil and
naloxone.
EMTREE DRUG INDEX TERMS
activated carbon
alcohol
antidote
benzodiazepine derivative
carbon monoxide
detergent
drug
flumazenil
hypochlorite sodium
naloxone
pesticide
psychotropic agent
toxic substance
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (epidemiology)
EMTREE MEDICAL INDEX TERMS
article
defense mechanism
descriptive research
drug intoxication
emergency treatment
food poisoning
human
medical record
retrospective study
stomach lavage
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
carbon monoxide (630-08-0)
flumazenil (78755-81-4)
hypochlorite sodium (7681-52-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Toxicology (52)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
2015418678
PUI
L606252999
DOI
10.1721/1511.16577
FULL TEXT LINK
http://dx.doi.org/10.1721/1511.16577
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 565
TITLE
Perioperative substance use disorder, opioid diversion, and opioid misuse by
a medical professional undergoing orthopedic surgery
AUTHOR NAMES
Maher D.P.
Kissen M.
Danovitch I.
Yumul R.
Louy C.
AUTHOR ADDRESSES
(Maher D.P.; Kissen M.; Yumul R.) Department of Anesthesia and Pain
Medicine, Cedars-Sinai Medical Center, Los Angeles, United States.
(Danovitch I.) Department of Psychiatry and Behavioral Neurosciences,
Cedars-Sinai Medical Center, Los Angeles, United States.
(Louy C.) Inpatient Pain Services, Department of Anesthesia, Cedars-Sinai
Medical Center, Los Angeles, United States.
SOURCE
Journal of Opioid Management (2014) 10:6 (437-440). Date of Publication: 1
Nov 2014
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Patients with substance use disorders can present challenges for effective
perioperative pain management. Healthcare professionals with substance abuse
disorders requiring medical treatment and pain management represent a unique
subpopu-lation. The authors present a case of a nurse undergoing an
orthopedic surgical procedure who was found with two large, organized tackle
boxes of opioid medication in her hospital room. Although the incidence of
substance use disorders in healthcare professionals is thought to be
equivalent to the general population, the presentation, substances of
choice, and inciting factors are unique. Further, treatment options
available to such individuals have been established and proven successful.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (intravenous drug administration)
EMTREE DRUG INDEX TERMS
alcohol
bupivacaine (drug combination)
diphenhydramine (oral drug administration)
fentanyl
hydrocodone bitartrate plus paracetamol
hydromorphone (oral drug administration)
local anesthetic agent
morphine (oral drug administration)
naloxone (intravenous drug administration)
neuroleptic agent
nonsteroid antiinflammatory agent
oxycodone (oral drug administration)
prednisone
sevoflurane (drug combination)
sufentanil (intravenous drug administration)
tricyclic antidepressant agent
vitamin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
orthopedic surgery
perioperative period
prescription drug diversion
substance abuse
EMTREE MEDICAL INDEX TERMS
adult
anesthesia
article
case report
emergency health service
emergency ward
female
health care personnel
hip arthroplasty
hip osteoarthritis (surgery)
hip pain (surgery)
hospital admission
human
incision
middle aged
postoperative pain (complication)
recovery room
tertiary care center
DRUG TRADE NAMES
vicodin
CAS REGISTRY NUMBERS
alcohol (64-17-5)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5, 38396-39-3)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
prednisone (53-03-2)
sevoflurane (28523-86-6)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Arthritis and Rheumatism (31)
Orthopedic Surgery (33)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2015814521
MEDLINE PMID
25531961 (http://www.ncbi.nlm.nih.gov/pubmed/25531961)
PUI
L602888301
DOI
10.5055/jom.20l4.0240
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.20l4.0240
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 566
TITLE
Co-prescription of benzodiazepines and opioids has increased over the last
10 years
AUTHOR NAMES
Walker T.
AUTHOR ADDRESSES
(Walker T.)
CORRESPONDENCE ADDRESS
T. Walker,
SOURCE
Drug Topics (2014) :APR. Date of Publication: 2014
ISSN
1937-8157 (electronic)
0012-6616
BOOK PUBLISHER
Advanstar Communications
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
backache
chronic pain
drug potentiation
emergency ward
general practitioner
health survey
human
note
pain (drug therapy)
physiotherapy
primary medical care
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014254806
PUI
L372819307
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 567
TITLE
Opioid pharmacokinetics depends on lipid solubility
AUTHOR NAMES
Schwartz A.E.
AUTHOR ADDRESSES
(Schwartz A.E.) Department of Anesthesiology, Mount Sinai School of
Medicine, New York, United States.
CORRESPONDENCE ADDRESS
A.E. Schwartz, Department of Anesthesiology, Mount Sinai School of Medicine,
New York, United States.
SOURCE
Annals of Emergency Medicine (2014) 64:6 (685). Date of Publication: 1 Dec
2014
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (pharmacokinetics)
lipid
sufentanil (pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug solubility
lipid solubility
EMTREE MEDICAL INDEX TERMS
analgesia
drug distribution
drug half life
emergency ward
human
letter
obesity
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
lipid (66455-18-3)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014611565
MEDLINE PMID
25454570 (http://www.ncbi.nlm.nih.gov/pubmed/25454570)
PUI
L600976693
DOI
10.1016/j.annemergmed.2014.06.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2014.06.026
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 568
TITLE
The role of opioids in the treatment of primary headache disorders
ORIGINAL (NON-ENGLISH) TITLE
Stellenwert von Opioiden in der Therapie von primären
Kopfschmerzerkrankungen
AUTHOR NAMES
Totzeck A.
Gaul C.
AUTHOR ADDRESSES
(Totzeck A.; Gaul C., c.gaul@migraene-klinik.de) Klinik für Neurologie,
Universitätsklinikum Essen, Essen, Germany.
(Gaul C., c.gaul@migraene-klinik.de) Migräne- und Kopfschmerzklinik
Königstein, Ölmühlweg 31, 61462 Königstein im Taunus, Germany.
CORRESPONDENCE ADDRESS
C. Gaul, Migräne- und Kopfschmerzklinik Königstein, Ölmühlweg 31, 61462
Königstein im Taunus, Germany. Email: c.gaul@migraene-klinik.de
SOURCE
Schmerz (2014) 28:2 (135-140). Date of Publication: 4/1/2014
ISSN
1432-2129 (electronic)
0932-433X
BOOK PUBLISHER
Springer Verlag, service@springer.de
ABSTRACT
There is no sufficient evidence for opioids in the acute treatment of
primary headache disorders. Controlled clinical trials using triptans as
comparator are missing. Data show high frequent headache recurrence, typical
side effects of opioids, increased risk of chronification, and development
of addiction in primary headache patients treated with opioids. Chronic
headache patients with opioid therapy often experience lengthy withdrawal
treatment. On the basis of the current scientific data, opioids should be
avoided in acute and prophylactic treatment of primary headache disorders. ©
2014 Springer-Verlag Berlin Heidelberg.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
primary headache (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
controlled clinical trial (topic)
emergency treatment
human
opiate addiction
prophylaxis
recurrent disease
review
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2014274500
MEDLINE PMID
24500765 (http://www.ncbi.nlm.nih.gov/pubmed/24500765)
PUI
L52993287
DOI
10.1007/s00482-013-1380-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s00482-013-1380-4
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 569
TITLE
Emergence of opiate-induced neonatal abstinence syndrome.
AUTHOR NAMES
Healy D.
English F.
Daniels A.
Ryan C.A.
AUTHOR ADDRESSES
(Healy D.; English F.; Daniels A.; Ryan C.A.)
CORRESPONDENCE ADDRESS
D. Healy,
SOURCE
Irish medical journal (2014) 107:2 (46). Date of Publication: Feb 2014
ISSN
0332-3102
ABSTRACT
Neonatal abstinence syndrome (NAS) is the clinical picture of infants
withdrawing from in-utero substance exposure. The incidence of NAS rose in
Dublin maternity hospitals in the 1970's and '80's in parallel with
increasing in opiate abuse in that city. The purpose of this study was to
determine if a similar pattern was emerging in Cork University Maternity
Hospital. Data from the Erinville Hospital (2000-2007) and CUMH (2008-2011)
were compared. Sixteen cases of NAS were identified, two at Erinville
Hospital (22,987 deliveries; incidence = 0.09/1000 deliveries) and 14 at
CUMH (37,414 deliveries; incidence = 0.38/1000 deliveries; p < 0.01). Five
of the 16 mothers were using heroin, while ten were on methadone
maintenance. All were multi-drug abusers. Newborns requiring pharmacotherapy
for NAS (5/16) had prolonged hospitalisations compared to those requiring
supportive care. NAS in Cork is increasing. Primary, secondary and tertiary
preventative measures are warranted to prevent further escalation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (complication)
pregnancy complication
withdrawal syndrome (epidemiology, etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
comparative study
female
follow up
human
incidence
Ireland (epidemiology)
male
mother
multicenter study
newborn
pregnancy
prognosis
retrospective study
young adult
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24654482 (http://www.ncbi.nlm.nih.gov/pubmed/24654482)
PUI
L372768203
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 570
TITLE
Acute urinary retention secondary to buprenorphine administration
AUTHOR NAMES
Edwards R.T.
McCormick-Deaton C.
Hosanagar A.
AUTHOR ADDRESSES
(Edwards R.T., drzhl@hotmail.com; McCormick-Deaton C.; Hosanagar A.)
Department of Psychiatry, University of Michigan, VA Ann Arbor Health
System, Ann Arbor, MI 48105, United States.
CORRESPONDENCE ADDRESS
Department of Psychiatry, University of Michigan, VA Ann Arbor Health
System, Ann Arbor, MI 48105, United States.
SOURCE
American Journal of Emergency Medicine (2014) 32:1 (109.e1-109.e2). Date of
Publication: January 2014
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Urinary retention is associated with buprenorphine, particularly with
epidural/intrathecal delivery. However, it is rare with oral administration.
This case report illustrates an occurrence of acute urinary retention after
initiation of oral buprenorphine/naloxone. © 2013 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (adverse drug reaction, drug dose, drug therapy, oral drug
administration)
EMTREE DRUG INDEX TERMS
diamorphine
methadone (drug therapy)
opiate
terazosin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute disease (side effect, side effect)
urine retention (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
adult
alcoholism
article
asymptomatic disease (surgery)
bipolar disorder
bladder catheterization
borderline state
case report
catheter removal
cholecystectomy
drug detoxification
drug dose titration
drug substitution
drug withdrawal
emergency ward
Foley balloon catheter
gallstone (surgery)
hospitalization
human
hyperlipidemia
liver cirrhosis
male
medical history
neck injury
opiate addiction (drug therapy)
outpatient care
prescription
priority journal
prostate hypertrophy (drug therapy)
suicide attempt
treatment refusal
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
terazosin (63074-08-8, 63590-64-7)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013794122
MEDLINE PMID
24126024 (http://www.ncbi.nlm.nih.gov/pubmed/24126024)
PUI
L52810056
DOI
10.1016/j.ajem.2013.08.022
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2013.08.022
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 571
TITLE
Transporting children with toxicological emergencies
AUTHOR NAMES
Blake D.
Dalton S.
Gunja N.
AUTHOR ADDRESSES
(Blake D., blake.danielle2014@gmail.com; Dalton S.) Newborn and Paediatric
Emergency Transport Service, Sydney Children's Hospitals Network, Sydney,
NSW, Australia.
(Gunja N.) NSW Poisons Information Centre, Sydney Children's Hospitals
Network, Sydney, NSW, Australia.
(Gunja N.) Discipline of Emergency Medicine, Sydney Medical School,
University of Sydney, Sydney, NSW, Australia.
CORRESPONDENCE ADDRESS
D. Blake, General Paediatrician, Sydney, NSW 2000, Australia. Email:
blake.danielle2014@gmail.com
SOURCE
EMA - Emergency Medicine Australasia (2014) 26:3 (279-285). Date of
Publication: June 2014
ISSN
1742-6723 (electronic)
1742-6731
BOOK PUBLISHER
Blackwell Publishing, info@asia.blackpublishing.com.au
ABSTRACT
Objective: Each year, the Newborn and Paediatric Emergency Transport Service
(NETS) receives over 3600 calls from health professionals regarding the
management and transportation of critically ill children across New South
Wales, with toxicological emergencies making up 1.5% of these calls. The aim
of the present study is to describe the characteristics of patients
transported for toxicological emergencies and their retrieval management.
Methods: A retrospective review of patients referred for management of a
toxicological emergency between 2007 and 2011. Extracted data included
patient demographics, substances involved, consultation with toxicological
expertise, interventions performed and major adverse outcomes. Results: Two
hundred and thirty patients, with 307 toxicological exposures, were referred
to NETS, of whom 169 (73.5%) were subsequently transported. Pharmaceutical
poisonings (223, 72.6%) were the most common, followed by non-pharmaceutical
poisonings (61, 19.9%) and envenomation (23, 7.5%). Psychotropics,
analgesics and chemicals were the most frequently ingested substances. The
most common source of accidentally ingested pharmaceuticals was a family
member. The most frequently given therapies were specific antidotes, in
particular naloxone and N-acetylcysteine. Nearly half (43.2%) of transported
children required only non-invasive monitoring. There was one death during
the retrieval process. Conclusions: Many children with toxicological
emergencies require only non-invasive monitoring, which could be provided by
trained ambulance crews in select scenarios. Involvement of a toxicologist
in the initial consultation to identify these patients might reduce
retrieval numbers and costs. Children on regular medication and those living
with family members on psychotropic or cardiac drugs were identified as
high-risk groups that should be targeted for medication safety education. ©
2014 Australasian College for Emergency Medicine and Australasian Society
for Emergency Medicine.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
alcohol (drug toxicity)
alcohol derivative (drug toxicity)
antiangina pectoris agent (drug toxicity)
antiarrhythmic agent (drug toxicity)
anticonvulsive agent (drug toxicity)
antidepressant agent (drug toxicity)
antidiabetic agent (drug toxicity)
antiemetic agent (drug toxicity)
antihypertensive agent (drug toxicity)
calcium channel blocking agent (drug toxicity)
central stimulant agent (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
clonidine (drug toxicity)
diuretic agent (drug toxicity)
essential oil (drug toxicity)
hydrocarbon (drug toxicity)
hypnotic sedative agent (drug toxicity)
hypocholesterolemic agent (drug toxicity)
laxative (drug toxicity)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
opiate (drug toxicity)
paracetamol (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
intoxication (drug therapy, drug therapy, therapy)
patient transport
EMTREE MEDICAL INDEX TERMS
adolescent
adverse outcome
article
child
consultation
controlled study
death
defibrillation
drug intoxication
envenomation
family
female
fluid therapy
heart pacing
human
infant
intubation
major clinical study
male
medical record review
newborn
observational study
preschool child
priority journal
retrospective study
school child
sedation
snakebite
spider bite
tick bite
waste management
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014380405
MEDLINE PMID
24712399 (http://www.ncbi.nlm.nih.gov/pubmed/24712399)
PUI
L53100635
DOI
10.1111/1742-6723.12221
FULL TEXT LINK
http://dx.doi.org/10.1111/1742-6723.12221
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 572
TITLE
Antidote use in a pediatric emergency department
ORIGINAL (NON-ENGLISH) TITLE
Uso de antídotos en un servicio de urgencias pediátricas
AUTHOR NAMES
Martínez Sánchez L.
Almario Hernández A.F.
Escuredo Argullós L.
Maçao P.
Trenchs Sainz De La Maza V.
Luaces Cubells C.
AUTHOR ADDRESSES
(Martínez Sánchez L., lmartinez@hsjdbcn.org; Almario Hernández A.F.;
Escuredo Argullós L.; Trenchs Sainz De La Maza V.; Luaces Cubells C.)
Servicio de Urgencias de Pediatría, Hospital Sant Joan de Deu, Esplugues de
Llobregat, Barcelona, Spain.
(Maçao P.) Servicio de Pediatría, Hospital Pediátrico de Coimbra, Coimbra,
Portugal.
CORRESPONDENCE ADDRESS
L. Martínez Sánchez, Servicio de Urgencias de Pediatría, Hospital Sant Joan
de Deu, Esplugues de Llobregat, Barcelona, Spain.
SOURCE
Anales de Pediatria (2014) 81:4 (220-225). Date of Publication: 2014
ISSN
1695-9531 (electronic)
1695-4033
BOOK PUBLISHER
Elsevier Doyma, editorial@elsevier.com
ABSTRACT
Introduction Poisoning is an infrequent cause of consultation in a pediatric
emergency department (PED), but it can be potentially serious. Pediatricians
should know how to use the available antidotes properly. Objectives To
analyze the use of antidotes in a PED and to assess the suitability of their
indications. Materials and methods A retrospective review of antidote use in
a PED between January 2008 and June 2012. Inclusion criteria were age
younger than 18 years and consultation for suspicious poisoning by a
substance that could be treated with an antidote. The adequacy of antidote
indication was based on the recommendations of the Spanish Society of
Pediatric Emergencies (SSPE). Results A total of 1728 consultations for
suspicious poisoning (0.4% of the total visits in the PED) were recorded. In
353 cases (20.4%) the involved poison could be treated with an antidote.
Sixty-seven patients received an antidote (3.9% of consultations for
suspicious poisoning), and a total of 69 administrations of an antidote were
made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3),
deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In 3
cases there was no indication for administration: flumazenil without
respiratory depression, and vitamin K following coumarin exposure. As side
effects, agitation was noted after the use of flumazenil, and a decrease in
the prothrombin time during infusion of N-acetylcysteine. Conclusions The
administration of antidotes in this PED is uncommon and, mainly, in
accordance with the SSPE recommendations, and without serious side effects.
The use of flumazenil needs to be limited to the cases with a clear
indication and without any contraindication.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
EMTREE DRUG INDEX TERMS
acetylcysteine (adverse drug reaction, drug therapy)
bicarbonate (drug therapy)
carnitine (drug therapy)
coumarin
deferoxamine (drug therapy)
flumazenil (adverse drug reaction, drug therapy)
naloxone (drug therapy)
oxygen (drug therapy)
vitamin K group (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency ward
pediatrics
EMTREE MEDICAL INDEX TERMS
agitation
article
child
consultation
drug exposure
drug indication
human
intoxication (drug therapy)
major clinical study
prothrombin time
respiration depression
retrospective study
side effect (side effect)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
bicarbonate (144-55-8, 71-52-3)
carnitine (461-06-3, 541-15-1, 56-99-5)
coumarin (91-64-5)
deferoxamine (70-51-9)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2014755184
MEDLINE PMID
24439102 (http://www.ncbi.nlm.nih.gov/pubmed/24439102)
PUI
L52959139
DOI
10.1016/j.anpedi.2013.12.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.anpedi.2013.12.002
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 573
TITLE
The prevalence of opioid-related major potential drug-drug interactions and
their impact on health care costs in chronic pain patients
AUTHOR NAMES
Pergolizzi Jr. J.V.
Ma L.
Foster D.R.
Overholser B.R.
Sowinski K.M.
Taylor R.
Summers K.H.
AUTHOR ADDRESSES
(Pergolizzi Jr. J.V., jpjmd@msn.com) Department of Medicine, Johns Hopkins
University, Baltimore, MD, United States.
(Ma L.) Health Economics and Outcomes Research, Endo Pharmaceuticals Inc.,
Malvern, PA, United States.
(Ma L.) University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA, United States.
(Foster D.R.; Overholser B.R.) College of Pharmacy, Purdue University, West
Lafayette, IN, United States.
(Sowinski K.M.) Indiana University, Bloomington, IN, United States.
(Taylor R.) NEMA Research Inc., Naples, FL, United States.
(Summers K.H.) Health Economics and Outcomes Research, Endo Pharmaceuticals
Inc., Malvern, PA, United States.
CORRESPONDENCE ADDRESS
J.V. Pergolizzi, 840 111th Ave., N., Ste. 9, Naples, FL 34108, United
States. Email: jpjmd@msn.com
SOURCE
Journal of Managed Care Pharmacy (2014) 20:5 (467-476). Date of Publication:
May 2014
ISSN
1083-4087
BOOK PUBLISHER
Academy of Managed Care Pharmacy (AMCP), tfaggen@amcp.org
ABSTRACT
BACKGROUND: Literature has shown that chronic pain patients prescribed
opioids are at an increased risk for experiencing drug-drug interactions as
a result of polypharmacy. In addition, chronic, noncancer pain patients who
experience drug-drug interactions have been shown to have greater health
care utilization and costs. However, no study has focused on the health
economics of major clinically significant drug-drug interactions associated
with long-acting opioids. OBJECTIVES: To (a) estimate the prevalence of
major drug-drug interactions among patients prescribed a long-acting opioid
and (b) evaluate the potential impact of major drug-drug interactions on
health care costs. METHODS: This study was a retrospective cohort analysis
using claims data from the MarketScan Commercial Claims and Encounter
Database between 2008 and 2010. Patients with at least 1 prescription for a
longacting opioid for ≥30 days were placed into cohorts according to the
expected clinical impact of the potential drug-drug interaction: major
versus none. Propensity score matching was used to mitigate differences in
baseline characteristics between the cohorts. Health care costs were based
on payments for all covered health care services, which consisted of
inpatient and outpatient medical, emergency department, and outpatient
prescription costs. RESULTS: Among 57,752 chronic, noncancer pain patients
who met all inclusion and exclusion criteria, 5.7% (3,302) were exposed to a
potential major drug-drug interaction. The costs associated with a potential
interaction versus no potential interaction were significantly more after
baseline characteristics of the cohorts were normalized by propensity score
matching. Monthly health care costs in the 90-day post-index period were
significantly greater ($3,366 vs. $2,757, a $609 difference) in patients
exposed to a potential drug-drug interaction of major clinical significance,
compared with those not exposed to a drug-drug interaction. The higher
health care costs were mainly driven by outpatient and inpatient medical
costs. CONCLUSIONS: Exposure to potential drug-drug interactions may result
in unnecessary and unintended health care costs. Physicians should be made
aware of commonly administered cytochrome P450 (CYP450) metabolized drugs in
the chronic pain patient and consider prescribing non-CYP450 metabolized
opioid and nonopioid analgesics. Managed care's use of utilization
management tools to avoid these exposures may reduce costs. © 2014, Academy
of Managed Care Pharmacy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
EMTREE DRUG INDEX TERMS
amiodarone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
clarithromycin (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
codeine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
cytochrome P450 (endogenous compound)
diltiazem (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
erythromycin (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
fentanyl (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
fluconazole (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
fluoxetine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
hydrocodone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
hydromorphone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
itraconazole (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
ketoconazole (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
methadone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
mibefradil (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
morphine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
oxycodone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
oxymorphone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
paroxetine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
phenytoin (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
quinidine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
rifampicin (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
ritonavir (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
terbinafine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
thioridazine (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
tramadol (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
troglitazone (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
verapamil (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
voriconazole (drug combination, drug interaction, pharmacoeconomics,
pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (disease management)
drug interaction
health care cost
health care utilization
EMTREE MEDICAL INDEX TERMS
adult
age
article
Charlson Comorbidity Index
cohort analysis
controlled study
diabetes mellitus
drug absorption
drug distribution
drug elimination
drug metabolism
female
follow up
health maintenance organization
health service
heart infarction
human
major clinical study
male
patient selection
peripheral vascular disease
prescription
prevalence
propensity score
retrospective study
treatment duration
treatment outcome
CAS REGISTRY NUMBERS
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
clarithromycin (81103-11-9)
codeine (76-57-3)
cytochrome P450 (9035-51-2)
diltiazem (33286-22-5, 42399-41-7)
erythromycin (114-07-8, 70536-18-4)
fentanyl (437-38-7)
fluconazole (86386-73-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
itraconazole (84625-61-6)
ketoconazole (65277-42-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
mibefradil (116666-63-8)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paroxetine (61869-08-7)
phenytoin (57-41-0, 630-93-3)
quinidine (56-54-2)
rifampicin (13292-46-1)
ritonavir (155213-67-5)
terbinafine (91161-71-6)
thioridazine (130-61-0, 50-52-2)
tramadol (27203-92-5, 36282-47-0)
troglitazone (97322-87-7)
verapamil (152-11-4, 52-53-9)
voriconazole (137234-62-9)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014281390
MEDLINE PMID
24761818 (http://www.ncbi.nlm.nih.gov/pubmed/24761818)
PUI
L372911712
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 574
TITLE
Not so fast on naloxone? There's growing support for non-paramedic use, but
keep these cautions in mind.
AUTHOR NAMES
Goodloe J.M.
AUTHOR ADDRESSES
(Goodloe J.M.)
CORRESPONDENCE ADDRESS
J.M. Goodloe,
SOURCE
EMS world (2014) 43:5 (51-52). Date of Publication: May 2014
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
addiction (drug therapy)
article
human
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24937916 (http://www.ncbi.nlm.nih.gov/pubmed/24937916)
PUI
L373626768
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 575
TITLE
Costs of care for persons with opioid dependence in commercial integrated
health systems.
AUTHOR NAMES
Lynch F.L.
McCarty D.
Mertens J.
Perrin N.A.
Green C.A.
Parthasarathy S.
Dickerson J.F.
Anderson B.M.
Pating D.
AUTHOR ADDRESSES
(Lynch F.L., frances.lynch@kpchr.org) Kaiser Permanente Center for Health
Research, 3800 N, Interstate Avenue, Portland, OR 97227, USA.
(McCarty D.; Mertens J.; Perrin N.A.; Green C.A.; Parthasarathy S.;
Dickerson J.F.; Anderson B.M.; Pating D.)
CORRESPONDENCE ADDRESS
F.L. Lynch, Email: frances.lynch@kpchr.org
SOURCE
Addiction science & clinical practice (2014) 9 (16). Date of Publication:
2014
ISSN
1940-0640 (electronic)
ABSTRACT
When used in general medical practices, buprenorphine is an effective
treatment for opioid dependence, yet little is known about how use of
buprenorphine affects the utilization and cost of health care in commercial
health systems. The objective of this retrospective cohort study was to
examine how buprenorphine affects patterns of medical care, addiction
medicine services, and costs from the health system perspective. Individuals
with two or more opioid-dependence diagnoses per year, in two large health
systems (System A: n = 1836; System B: n = 4204) over the time span
2007-2008 were included. Propensity scores were used to help adjust for
group differences. Patients receiving buprenorphine plus addiction
counseling had significantly lower total health care costs than patients
with little or no addiction treatment (mean health care costs with
buprenorphine treatment = $13,578; vs. mean health care costs with no
addiction treatment = $31,055; p < .0001), while those receiving
buprenorphine plus addiction counseling and those with addiction counseling
only did not differ significantly in total health care costs (mean costs
with counseling only: $17,017; p = .5897). In comparison to patients
receiving buprenorphine plus counseling, those with little or no addiction
treatment had significantly greater use of primary care (p < .001), other
medical visits (p = .001), and emergency services (p = .020). Patients with
counseling only (compared to patients with buprenorphine plus counseling)
used less inpatient detoxification (p < .001), and had significantly more PC
visits (p = .001), other medical visits (p = .005), and mental health visits
(p = .002). Buprenorphine is a viable alternative to other treatment
approaches for opioid dependence in commercial integrated health systems,
with total costs of health care similar to abstinence-based counseling.
Patients with buprenorphine plus counseling had reduced use of general
medical services compared to the alternatives.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
commercial phenomena
cost of illness
integrated health care system
multimodality cancer therapy
opiate addiction (rehabilitation)
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
comparative study
counseling
economics
female
health care cost
human
male
middle aged
retrospective study
statistics
United States
utilization review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
25123823 (http://www.ncbi.nlm.nih.gov/pubmed/25123823)
PUI
L373971735
DOI
10.1186/1940-0640-9-16
FULL TEXT LINK
http://dx.doi.org/10.1186/1940-0640-9-16
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 576
TITLE
Managing chronic pain in Primary Care, prescription profile for strong
opioids: Indications, cost and adverse effects
ORIGINAL (NON-ENGLISH) TITLE
Manejo del dolor crónico en Atención Primaria, perfil de prescripción de
opiáceos mayores: Indicación, coste y efectos secundarios
AUTHOR NAMES
Guzmán-Ruiz M.
Mora-Moscoso R.
Delgado-Mediano C.M.
Pérez-Milena A.
Rueda-Rojas M.
Gea-Rodríguez L.A.
AUTHOR ADDRESSES
(Guzmán-Ruiz M., martaguzru_85@hotmail.com; Delgado-Mediano C.M.;
Pérez-Milena A.; Rueda-Rojas M.; Gea-Rodríguez L.A.) Atención Primaria,
Centro de Salud el Valle, Rda. Alcalde García Segovia, s/n, Jaén, Spain.
(Mora-Moscoso R.) Servicio de Anestesiología, Reanimación y Terapia del
Dolor, Complejo Hospitalario Ciudad de Jaén, Jaén, Spain.
CORRESPONDENCE ADDRESS
M. Guzmán-Ruiz, Atención Primaria, Centro de Salud el Valle, Rda. Alcalde
García Segovia, s/n, Jaén, Spain.
SOURCE
Revista de la Sociedad Espanola del Dolor (2014) 21:4 (197-204). Date of
Publication: 1 Jul 2014
ISSN
2254-6189 (electronic)
1134-8046
BOOK PUBLISHER
Ediciones Doyma, S.L., suscripciones@doyma.es
ABSTRACT
Objectives: The main objective of the study was to determine the
characteristics of major opioids prescribing in Primary Care. Material and
methods: A retrospective study was designed through the use of a historical
cohort, assessing patients who have consumed major opiates in all Jaén city
health centers during 2011, by systematic sampling, 215 patients, computing
the sample size for a confidence level of 95%, accuracy 5%, 5% losses
(expanding the 5% sample by reporting bias). Medical records were audited to
collect the following data: Age, sex, medical history, social status, number
of appointments and use of hospital resources, characteristics of opioids
prescription (dose, duration, cost, adverse reaction) and use of other
analgesics/ adjuvants. Data were processed for a descriptive study and a
subsequent comparison according to the prescribed opioid. Results: 215
patients were included (44% of total population) those obtained 323
prescriptions for opiates in the study year (23% of the sample with two
prescriptions of opiates and 13% with three). Most prescribed opioids were
fentanyl (60%) and buprenorphine (22%) and the least prescribed is by 3%
morphine. Buprenorphine is the most used in monotherapy (70%), preferably in
older women and pensioners, especially for joint pain by the general
practitioner. The fentanyl is mainly used in patches (95% of prescriptions
of fentanyl) and hydromorphone is used in younger patients (< 60 years),
prescribed by the Pain and Rheumatology Departments (43% and 20% of total
prescriptions, respectively). Oxycodone is used in patients from areas with
social transformation needs (46% of prescribed opioids in ZNTS) and
exclusively for neuropathic and mixed pain (52% and 48% respectively of
total prescriptions of oxycodone), especially by the Rheumatology and Pain
Unit. Morphine is used orally in cancer patients (46% of prescriptions for
morphine), half in retard formulation (45% of prescriptions for morphine),
and these patients were who have a higher healthcare demands (91% of totals
patients prescribed morphine, go to the emergency department, and 46%
required hospital admission). Conclusions: As improvement measure, after
contrasting the results, we should encourage the prescription of morphine as
an analgesic of choice in both acute and chronic severe pain. An improvement
in the measuring instruments specific to each type of pain considering its
pathogenesis is required, as well as fostering a greater use of rating
scales, both at the start of treatment and during the follow-up of each
patient to assess the evolution of pain and treatment effectiveness.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy, pharmacoeconomics)
buprenorphine (drug therapy, pharmacoeconomics)
fentanyl (drug therapy, pharmacoeconomics)
hydromorphone (drug therapy, pharmacoeconomics)
morphine (drug therapy, oral drug administration, pharmacoeconomics)
oxycodone (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, disease management, drug therapy)
prescription
primary medical care
EMTREE MEDICAL INDEX TERMS
adult
arthralgia
article
cancer patient
cohort analysis
controlled study
drug cost
drug indication
emergency care
female
health care need
hospital admission
human
major clinical study
male
monotherapy
neuropathic pain (drug therapy)
pensioner
retrospective study
treatment duration
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2015682344
PUI
L601570247
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 577
TITLE
Intranasal medications in pediatric emergency medicine
AUTHOR NAMES
Del Pizzo J.
Callahan J.M.
AUTHOR ADDRESSES
(Del Pizzo J., Delpizzoj@email.chop.edu; Callahan J.M.) Division of
Emergency Medicine, Children's Hospital of Philadelphia, Colket
Translational Research Bldg, 9th Floor, 3501 Civic Center Blvd,
Philadelphia, PA 19104, United States.
CORRESPONDENCE ADDRESS
J. Del Pizzo, Division of Emergency Medicine, Children's Hospital of
Philadelphia, Colket Translational Research Bldg, 9th Floor, 3501 Civic
Center Blvd, Philadelphia, PA 19104, United States. Email:
Delpizzoj@email.chop.edu
SOURCE
Pediatric Emergency Care (2014) 30:7 (496-501). Date of Publication: July
2014
ISSN
1535-1815 (electronic)
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, LRorders@phl.lrpub.com
ABSTRACT
Intranasal medication administration in the emergency care of children has
been reported for at least 20 years and is gaining popularity because of
ease of administration, rapid onset of action, and relatively little pain to
the patient. The ability to avoid a needle stick is often attractive to
practitioners, in addition to children and their parents. In time-critical
situations for which emergent administration of medication is needed, the
intranasal route may be associated with more rapid medication
administration. This article reviews the use of intranasal medications in
the emergency care of children. Particular attention will be paid to anatomy
and its impact on drug delivery, pharmacodynamics, medications currently
administered by this route, delivery devices available, tips for use, and
future directions.Copyright © 2014 by Lippincott Williams &Wilkins.
EMTREE DRUG INDEX TERMS
fentanyl (intranasal drug administration)
fluticasone (intranasal drug administration)
hydroxocobalamin (inhalational drug administration, intranasal drug
administration)
influenza vaccine (intranasal drug administration)
ketamine (intranasal drug administration)
lorazepam (intranasal drug administration)
midazolam (intranasal drug administration)
naloxone (intranasal drug administration)
sumatriptan (intranasal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug delivery system
emergency medicine
intranasal drug administration
EMTREE MEDICAL INDEX TERMS
analgesia
human
nebulization
nebulizer
nonhuman
pathological anatomy
review
sedation
DRUG TRADE NAMES
flumist
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
fluticasone (90566-53-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
sumatriptan (103628-46-2)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Pharmacy (39)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014459609
MEDLINE PMID
24987995 (http://www.ncbi.nlm.nih.gov/pubmed/24987995)
PUI
L373484043
DOI
10.1097/PEC.0000000000000171
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0000000000000171
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 578
TITLE
Clinical and economical evaluation of new analgesics for the management of
chronic pain
ORIGINAL (NON-ENGLISH) TITLE
Valutazione clinica ed economica di nuovi analgesici per la gestione del
dolore cronico
AUTHOR NAMES
Coluzzi F.
Ruggeri M.
AUTHOR ADDRESSES
(Coluzzi F., flaminia.coluzzi@uniroma1.it) Dip. Scienze e Biotecnologie
Medico-Chirurgiche, Sapienza Università di Roma, Corso della Repubblica 79,
Latina, Italy.
(Ruggeri M.) ALTEMS, Università Cattolica del Sacro Cuore, Rome, Italy.
CORRESPONDENCE ADDRESS
F. Coluzzi, Dip. Scienze e Biotecnologie Medico-Chirurgiche, Sapienza
Università di Roma, Corso della Repubblica 79, Latina, Italy.
SOURCE
Recenti Progressi in Medicina (2014) 105:11 (415-419). Date of Publication:
2014
ISSN
2038-1840 (electronic)
0034-1193
BOOK PUBLISHER
Il Pensiero Scientifico Editore s.r.l., Via Giovanni Valdarno 8, Roma,
Italy. r.bonini@pensiero.it
ABSTRACT
The management of chronic pain still represent a challenge for physicians.
Opioids are the main stem in the treatment of chronic severe pain, not only
for their potency, but as they act as central drugs. The main limit to their
utilization in clinical practice is the prevalence of side effects, in
particular in the gastrointestinal tract, whose constipation represents the
most common. Two new formulations are nowadays available on the market:
tapentadol PR (TAP PR) and oxycodone/naloxone (OXN). A recent meta-analysis
showed that both drugs have a better tolerability profile than a tradizional
opioid, such as oxycodone CR (OXY CR), but TAP PR reduces by 47% (RR=0.53)
the percentage of patients discontinuing treatment because of side effects,
compared to 24% (RR=0.76) of OXN. A similar advantage has been reported in
the reduction of the risk of developing nausea and/or vomiting: TAP PR
reduces the risk by 47% (RR=0.53), while OXN reduces the risk by only by 10%
(RR=0.90). Both drugs reduced by about 40% the risk of constipation (RR=0.61
for TAP PR and for OXN). These results have been recently confirmed by a
direct comparison of the two formulations (TAP PR vs OXN) in patients with
chronic low back pain with neuropathic component. Both drugs were reported
to be effective in reducing pain intensity and neuropathic symptoms, however
TAP PR resulted superior to OXN in terms of analgesic efficacy, quality of
life, and tolerability, in particular regarding constipation and adherence
to treatment. A pharmacoeconomic analysis can be useful to understand the
costs of these clinical advantages, and can be done by using a probabilistic
analisys and by populating a Markov model that simulates the transition in
time of 100 patients through 4 different possible health states: 1) still on
treatment; 2) presence of adverse events; 3) discontinuation; 4) death. Both
treatments (TAP PR and OXN) have been shown to have an excellent
cost-effectiveness profile. In the case of OXN, in one year, 0.29 QALYs were
gained compared to the use of OXY CR at an additional cost of € 138
resulting in a cost per QALY gained of € 475 (€ 138/0.29). In the case of
TAP PR, instead, 0.31 QALYs were gained with additional savings due to the
reduction of drug side effects, hospitalizations and emergency department
access. Therefore, the use of TAP PR implies an average saving of € 31.6 per
patient. These data are the results of a pharmacoeconomic model and require
a further validation in clinical practice.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone plus oxycodone (adverse drug reaction, clinical trial, drug
therapy, pharmacoeconomics)
opiate (clinical trial, drug therapy, pharmacoeconomics)
oxycodone (adverse drug reaction, clinical trial, drug therapy,
pharmacoeconomics)
tapentadol (adverse drug reaction, clinical trial, drug therapy,
pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical practice
clinical trial
constipation (side effect)
drug cost
drug efficacy
drug tolerability
emergency ward
gastrointestinal tract
hospitalization
human
low back pain
meta analysis
nausea (side effect)
nausea and vomiting (side effect)
neuropathic pain
patient compliance
prevalence
quality adjusted life year
quality of life
review
vomiting
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
2014898222
MEDLINE PMID
25424235 (http://www.ncbi.nlm.nih.gov/pubmed/25424235)
PUI
L600434723
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 579
TITLE
Prescription coverage in indigent patients affects the use of long-acting
opioids in the management of cancer pain
AUTHOR NAMES
Wieder R.
Delarosa N.
Bryan M.
Hill A.M.
Amadio W.J.
AUTHOR ADDRESSES
(Wieder R., wiederro@njms.rutgers.edu; Bryan M.) Department of Medicine, New
Jersey Medical School Cancer Center, Rutgers New Jersey Medical School,
Newark, NJ, United States.
(Delarosa N.) New York University Langone Medical Center, New York, NY,
United States.
(Hill A.M.) Edward J. Bloustein School of Planning and Public Policy,
Rutgers University, New Brunswick, NJ, United States.
(Amadio W.J.) Department of Information Systems and Supply Chain Management,
Rider University, Lawrenceville, NJ, United States.
CORRESPONDENCE ADDRESS
R. Wieder, South Orange Avenue, Cancer Center H-1216, Newark, NJ 07103,
United States. Email: wiederro@njms.rutgers.edu
SOURCE
Pain Medicine (United States) (2014) 15:1 (42-51). Date of Publication:
January 2014
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Purpose: We tested the hypothesis that prescription coverage affects the
prescribing of long-acting opiates to indigent inner city minority patients
with cancer pain. Materials and Methods: We conducted a chart review of 360
patients treated in the Oncology Practice at University of Medicine and
Dentistry of New Jersey University Hospital, who were prescribed opiate pain
medications. Half the patients were charity care or self-pay (CC/SP),
without the benefit of prescription coverage, and half had Medicaid, with
unlimited prescription coverage. We evaluated patients discharged from a
hospitalization, who had three subsequent outpatient follow-up visits. We
compared demographics, pain intensity, the type and dose of opiates,
adherence to prescribed pain regimen, unscheduled emergency department
visits, and unscheduled hospitalizations. Results: There was a significantly
greater use of long-acting opiates in the Medicaid group than in the CC/SP
group. The Medicaid group had significantly more African American patients
and a greater rate of smoking and substance use, and the CC/SP group
disproportionately more Hispanic and Asian patients and less smoking and
substance use. Hispanic and Asian patients were less likely to have
long-acting opiates prescribed to them. Pain levels and adherence were
equivalent in both groups and were not affected by any of these variables
except stage of disease, which was equally distributed in the two groups.
Conclusion: Appropriate use of long-acting opiates for equivalent levels of
cancer pain was influenced only by the availability of prescription
coverage. The group without prescription coverage and receiving fewer
long-acting opiates had disproportionately more Hispanic and Asian patients.
© 2014 Original Research Article Wiley Periodicals, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug therapy, pharmacology)
morphine sulfate (drug therapy, pharmacology)
oxycodone (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy, drug therapy)
cancer palliative therapy
indigent
prescription
prescription coverage
EMTREE MEDICAL INDEX TERMS
adult
African American
age distribution
article
Asian
breast carcinoma
breast sarcoma
cancer patient
cancer staging
colorectal tumor
comparative study
drug use
emergency ward
ethnicity
failure to thrive
female
follow up
gender
germ cell tumor
head and neck tumor
Hispanic
hospital discharge
hospital readmission
hospitalization
human
lung tumor
lymphoma
major clinical study
male
medicaid
medical record review
middle aged
minority group
multiple myeloma
outpatient
pain assessment
pancreas carcinoma
patient compliance
single drug dose
smoking
social welfare
substance abuse
substance use
uterine cervix carcinoma
DRUG TRADE NAMES
duragesic
ms contin , United StatesPurdue
oxycontin , United StatesPurdue
DRUG MANUFACTURERS
(United States)Purdue
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Cancer (16)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014047345
MEDLINE PMID
24106748 (http://www.ncbi.nlm.nih.gov/pubmed/24106748)
PUI
L52814588
DOI
10.1111/pme.12238
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12238
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 580
TITLE
MT-45, a new psychoactive substance associated with hearing loss and
unconsciousness
AUTHOR NAMES
Helander A.
Bäckberg M.
Beck O.
AUTHOR ADDRESSES
(Helander A., anders.helander@ki.se; Beck O.) Department of Laboratory
Medicine, Karolinska Institutet, Laboratory Huddinge, Stockholm, Sweden.
(Helander A., anders.helander@ki.se; Beck O.) Department of Clinical
Pharmacology, Karolinska University Laboratory, Stockholm, Sweden.
(Bäckberg M.) Swedish Poisons Information Centre, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A. Helander, Department of Laboratory Medicine, Karolinska Institutet,
Laboratory Huddinge, Stockholm, Sweden.
SOURCE
Clinical Toxicology (2014) 52:8 (901-904). Date of Publication: 1 Sep 2014
ISSN
1556-9519 (electronic)
1556-3650
BOOK PUBLISHER
Informa Healthcare, healthcare.enquiries@informa.com
ABSTRACT
Background. MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) is an
opioid analgesic drug candidate developed in the 1970s that has recently
been introduced as a new psychoactive substance (NPS) on the "recreational"
drug market. We describe a case series of non-fatal intoxications associated
with MT-45 within the Swedish STRIDA project. Study design. Observational
case series of consecutive patients with admitted or suspected intake of NPS
presenting to hospitals in Sweden from November 2013 to February 2014.
Patients and methods. Blood and urine samples were collected from
intoxicated patients presenting to emergency departments and intensive care
units over the country. NPS analysis was performed by an LC-MS/MS
multi-component method. Clinical data were collected when caregivers
consulted the Poisons Information Centre and also retrieved from medical
records. Case series. Among nine intoxications where MT-45 was detected in
the biological samples, four cases were indicated to only involve MT-45,
while one or several psychoactive substances were found along with MT-45 in
the others. All patients were men aged 17-32 years and they commonly
presented with opioid-like adverse symptoms, such as unconsciousness and
respiratory depression. Naloxone appeared to have utility in the treatment
of MT-45 intoxication in several cases. Three patients complained of
bilateral hearing loss that in one case persisted after two weeks.
Conclusion. MT-45 should be added to the growing list of harmful NPS causing
life-threatening poisonings, and rapid actions taken to make it a controlled
substance.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
[1 cyclohexyl 4 (1,2 diphenylethyl)piperazine] (adverse drug reaction)
opiate (adverse drug reaction)
psychotropic agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bilateral hearing loss (side effect, side effect)
unconsciousness (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
adult
apnea (side effect)
article
balance disorder (side effect)
blood sampling
breathing
breathing rate
case study
clinical article
clinical study
consciousness
cyanosis (side effect)
drug intoxication (drug therapy)
emergency ward
human
intensive care unit
liquid chromatography
male
medical record
miosis (side effect)
observational study
oxygen saturation
paresthesia (side effect)
repeated drug dose
respiration depression (side effect)
Sweden
tandem mass spectrometry
urinalysis
visual impairment (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014797175
MEDLINE PMID
25175898 (http://www.ncbi.nlm.nih.gov/pubmed/25175898)
PUI
L600034367
DOI
10.3109/15563650.2014.943908
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2014.943908
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 581
TITLE
From oxycodone to heroin: two cases of transitioning opioid use in young
Australians
AUTHOR NAMES
Dertadian G.C.
Maher L.
AUTHOR ADDRESSES
(Dertadian G.C.; Maher L.) Institute for Culture and Society, University of
Western Sydney, Penrith, Australia
SOURCE
Drug and alcohol review (2014) 33:1 (102-104). Date of Publication: 1 Jan
2014
ISSN
1465-3362 (electronic)
ABSTRACT
INTRODUCTION AND AIMS: The non-medical use of pharmaceutical opioids is
associated with a range of negative health consequences, including the
development of dependence, emergency room presentations and overdose
deaths.DESIGN AND METHODS: Drawing on life history data from a broader
qualitative study of the non-medical use of painkillers, this brief report
presents two cases of transitions from recreational or non-medical
pharmaceutical opioid use to intravenous heroin use by young adults in
Australia.RESULTS: Although our study was not designed to assess whether
recreational oxycodone use is causally linked to transitions to intravenous
use, polyopioid use places individuals at high risk for progression to
heroin and injecting. Our first case, Jake, used a range of analgesics
before he transitioned to intravenous use, and the first drug he injected
was methadone. Our second case, Emma, engaged in a broad spectrum of
polydrug use, involving a range of opioid preparations, as well as
benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to
intravenous pharmaceutical opioids use and subsequent intravenous heroin
use.DISCUSSION AND CONCLUSIONS: These cases represent the first documented
reports of transitions from the non-medical or recreational use of oxycodone
to intravenous heroin use in Australia. As such, they represent an important
starting point for the examination of pharmaceutical opioids as a pathway to
injecting drug use among young Australians and highlight the need for
further research designed to identify pharmaceutical opioids users at risk
of transitions to injecting and to develop interventions designed to prevent
or delay these transitions.
EMTREE DRUG INDEX TERMS
diamorphine (drug administration)
methadone (drug administration)
oxycodone (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
psychology
self medication
EMTREE MEDICAL INDEX TERMS
adult
Australia
case report
drug use
female
human
intravenous drug administration
male
opiate addiction
substance abuse
young adult
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
oxycodone (124-90-3, 76-42-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
24256365 (http://www.ncbi.nlm.nih.gov/pubmed/24256365)
PUI
L602086314
DOI
10.1111/dar.12093
FULL TEXT LINK
http://dx.doi.org/10.1111/dar.12093
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 582
TITLE
Evaluation of quetiapine abuse and misuse reported to poison centers
AUTHOR NAMES
Klein-Schwartz W.
Schwartz E.K.
Anderson B.D.
AUTHOR ADDRESSES
(Klein-Schwartz W., wkleinsc@rx.umaryland.edu; Schwartz E.K.; Anderson B.D.)
Maryland Poison Center, University of Maryland School of Pharmacy,
Baltimore, United States.
CORRESPONDENCE ADDRESS
W. Klein-Schwartz, 220 Arch Street, Baltimore, MD 21201, United States.
Email: wkleinsc@rx.umaryland.edu
SOURCE
Journal of Addiction Medicine (2014) 8:3 (195-198). Date of Publication:
May-June 2014
ISSN
1935-3227 (electronic)
1932-0620
ABSTRACT
Objective: There are case reports of abuse of quetiapine, but no studies
address quetiapine abuse or misuse. Most literature on the population that
abuses quetiapine describes an older age group with previous substance abuse
history, many of whom are in jail. The objective of this study was to
evaluate national poison center data on misuse/abuse of quetiapine. Methods:
A retrospective study of American Association of Poison Control Centers
National Poison Data System data from 2005 to 2011 on single substance
quetiapine exposures coded as intentional misuse or abuse and followed to
known outcome was performed. Data were evaluated for age,
toxicity,management sites, treatments, andmedical outcomes. Results: There
were 3116 cases meeting inclusion criteria; reason was misuse in 1948 cases
and abuse in 1168 cases. The median age was 23 years. Misuse was reported
most often in adults, whereas abuse occurred most frequently in adolescents.
The male-to-female ratio was 1.7 for abuse and 1.0 for misuse. There were no
deaths. Moderate or major toxicity occurred in 23.7% and 27.1% of misuse and
abuse cases, respectively. Seventy-six percent were treated in the emergency
department and/or received medical admission. Conclusions: Misuse was more
common than abuse, except in adolescents forwhom abusewas more
frequent.Although outcomeswere generally good, significant toxicity occurred
in 25% of cases and more than 75% of the patients were treated in the
emergency department and/or received medical admission. The consequences of
nonmedical use of quetiapine are serious in some patients. Copyright © 2014
American Society of Addiction Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
quetiapine (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon
antihistaminic agent
benzodiazepine derivative
hypertensive factor
infusion fluid
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug misuse
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
child
controlled study
drug dependence treatment
emergency ward
female
human
intensive care unit
intubation
male
outcome assessment
oxygen therapy
poison center
preschool child
priority journal
psychiatric department
retrospective study
sedation
sex ratio
United States
very elderly
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
naloxone (357-08-4, 465-65-6)
quetiapine (111974-72-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014537449
MEDLINE PMID
24662370 (http://www.ncbi.nlm.nih.gov/pubmed/24662370)
PUI
L373745553
DOI
10.1097/ADM.0000000000000020
FULL TEXT LINK
http://dx.doi.org/10.1097/ADM.0000000000000020
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 583
TITLE
Improving care for hospitalized, opioid-dependent patients: A promising
start
AUTHOR NAMES
Kushel M.
AUTHOR ADDRESSES
(Kushel M., Margot.Kushel@ucsf.edu) Division of General Internal Medicine,
University of California, San Francisco General Hospital, Campus Box 1364,
San Francisco, CA 94143-1364, United States.
CORRESPONDENCE ADDRESS
M. Kushel, Division of General Internal Medicine, University of California,
San Francisco General Hospital, Campus Box 1364, San Francisco, CA
94143-1364, United States. Email: Margot.Kushel@ucsf.edu
SOURCE
JAMA Internal Medicine (2014) 174:8 (1377-1378). Date of Publication: August
2014
ISSN
2168-6106
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
methadone (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital care
opiate addiction (drug therapy, drug therapy)
patient care
EMTREE MEDICAL INDEX TERMS
emergency ward
evidence based practice
general practitioner
harm reduction
health care policy
hospital discharge
hospital patient
hospitalization
human
medical care
morbidity
mortality
motivational interviewing
note
primary medical care
priority journal
social work
stigma
substance use
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014538123
MEDLINE PMID
24978013 (http://www.ncbi.nlm.nih.gov/pubmed/24978013)
PUI
L373746250
DOI
10.1001/jamainternmed.2014.728
FULL TEXT LINK
http://dx.doi.org/10.1001/jamainternmed.2014.728
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 584
TITLE
Trends in Ambulatory Physician Opioid Prescription in the United States,
1997-2009
AUTHOR NAMES
Jeffrey Kao M.-C.
Minh L.C.
Huang G.Y.
Mitra R.
Smuck M.
AUTHOR ADDRESSES
(Jeffrey Kao M.-C.; Minh L.C.; Smuck M., msmuck@stanford.edu) Department of
Orthopaedics, Stanford Hospital and Clinics, Palo Alto, CA, United States.
(Huang G.Y.) Department of Orthopaedics, University of California San
Francisco, San Francisco, CA, United States.
(Mitra R.) Department of Rehabilitation, University of Kansas Medical
Center, Kansas City, MO, United States.
CORRESPONDENCE ADDRESS
M. Smuck, M.S. Orthopaedic Surgery, Physical Medicine and Rehabilitation,
Stanford University, Mailcode 6342, 450 Broadway St, Redwood City, CA 94063,
United States. Email: msmuck@stanford.edu
SOURCE
PM and R (2014) 6:7 (575-582.e4). Date of Publication: July 2014
ISSN
1934-1482
BOOK PUBLISHER
Elsevier Inc., usjcs@elsevier.com
ABSTRACT
Objective: To describe the changing practice pattern of opioid medication
prescription by health care providers and its relationship to shifts in the
incidence of back pain, demographics, and health care access. Design:
Retrospective analysis of nationally representative databases. Setting: In
silico. Participants: Patients who presented at a set of randomly selected
health care facilities on the days of data collection. Methods: Nationally
representative surveys from the Centers for Disease Control and Prevention
(National Hospital and Ambulatory Medical Center Survey and National
Ambulatory Medical Center Survey) were investigated for 3 ambulatory
settings-emergency department (ED), primary care physician (PCP), and
specialist physician offices-between the years 1997 and 2009. Diagnoses,
prescription medications, insurance source, and demographics were
determined. Weighted logistic regression modeling with the SAS program (SAS
Institute, Cary, NC) was used to estimate 5-year odds ratios (ORs) and
covariate effects. Main Outcome Measurements: Diagnoses, prescription
medications, insurance source, and demographics were measured. The
relationships between opioid medication prescription and (1) the chief
complaint and (2) back pain diagnoses were studied. Domain analysis was used
to properly account for the stochasticity introduced by subset analyses.
Results: From 1997 to 2009, increasing all-diagnosis opioid prescription was
accompanied by significant shifts in patient demographics and insurance
access. For all-diagnosis opioid prescription, after we adjusted for age,
gender, race, and insurance source, the increase persisted at a 5-year OR of
1.33, 1.29, and 1.53 for ED, PCP clinics, and specialist clinics (95%
confidence interval 1.26-1.41, 1.19-1.40, and 1.37-1.69), respectively. The
increasing prevalence of back pain diagnosis was eclipsed by increasing
opioid prescriptions, estimated at 5-year ORs of 1.35, 1.38, and 1.75 for
ED, PCP clinics, and specialist clinics (95% confidence interval 1.22-1.48,
1.19-1.61, 1.40-2.19), respectively. Conclusions: In the United States, from
1997-2009, (1) variable increases in opioid prescription across ambulatory
care settings were not accounted for by changing demographics and health
care access; (2) significant disparities existed in opioid prescription as a
function of age, gender, race/ethnicity, and payer source; and (3) for back
pain, increasing opioid prescription was not accounted for by changing
incidence. © 2014 American Academy of Physical Medicine and Rehabilitation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate derivative (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
backache (drug therapy, disease management, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age distribution
aged
ambulatory care
article
data base
emergency ward
ethnicity
female
general practitioner
health care access
health insurance
human
incidence
information processing
major clinical study
male
medical specialist
outcome assessment
physician
priority journal
retrospective study
sex difference
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Arthritis and Rheumatism (31)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014488652
MEDLINE PMID
24412267 (http://www.ncbi.nlm.nih.gov/pubmed/24412267)
PUI
L53031126
DOI
10.1016/j.pmrj.2013.12.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pmrj.2013.12.015
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 585
TITLE
Are discharge prescriptions of opioids from the emergency department truly
rising?
AUTHOR NAMES
Kea B.
Fu R.
Deyo R.A.
Sun B.C.
AUTHOR ADDRESSES
(Kea B., kea@ohsu.edu) Center for Policy and Research in Emergency Medicine,
Department of Emergency Medicine, Oregon Health and Science University,
Portland, OR, United States.
(Deyo R.A.; Sun B.C.) Department of Public Health and Preventive Medicine,
Center for Policy and Research in Emergency Medicine, Oregon Health and
Science University, Portland, OR, United States.
(Fu R.) Department of Family Medicine, Oregon Health and Science University,
Portland, OR, United States.
SOURCE
Academic Emergency Medicine (2014) 21:8 (946). Date of Publication: August
2014
ISSN
1553-2712 (electronic)
1069-6563
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
prescription
EMTREE MEDICAL INDEX TERMS
clinical research
emergency ward
health care policy
hospital discharge
human
letter
priority journal
public health
trend study
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014578478
MEDLINE PMID
25156157 (http://www.ncbi.nlm.nih.gov/pubmed/25156157)
PUI
L53308200
DOI
10.1111/acem.12425
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12425
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 586
TITLE
Lifespan adopts ED guidelines to curb opioid misuse and abuse
AUTHOR ADDRESSES
SOURCE
Rhode Island medical journal (2013) (2014) 97:1 (56). Date of Publication: 1
Jan 2014
ISSN
2327-2228 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
practice guideline
EMTREE MEDICAL INDEX TERMS
health care delivery
human
opiate addiction (therapy)
prescription drug misuse (prevention)
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24960870 (http://www.ncbi.nlm.nih.gov/pubmed/24960870)
PUI
L605895947
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 587
TITLE
Using poison center exposure calls to predict prescription opioid abuse and
misuse-related emergency department visits
AUTHOR NAMES
Davis J.M.
Severtson S.G.
Bucher-Bartelson B.
Dart R.C.
AUTHOR ADDRESSES
(Davis J.M., jonathan.davis@ucdenver.edu; Severtson S.G.; Bucher-Bartelson
B.; Dart R.C.) Rocky Mountain Poison and Drug Center, Denver Health and
Hospital Authority, Denver, CO, United States.
(Dart R.C.) Department of Emergency Medicine, University of Colorado Denver,
United States.
CORRESPONDENCE ADDRESS
J.M. Davis, Mountain Poison and Drug Center, Denver Health and Hospital
Authority, 777 Bannock St., MC 0180, Denver, CO 80204, United States. Email:
jonathan.davis@ucdenver.edu
SOURCE
Pharmacoepidemiology and Drug Safety (2014) 23:1 (18-25). Date of
Publication: January 2014
ISSN
1053-8569
1099-1557 (electronic)
BOOK PUBLISHER
John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United
Kingdom.
ABSTRACT
Background: Prescription drug abuse is a critical problem in the USA and has
been linked to more deaths than automobile accidents. Despite this growing
epidemic, the USA lacks a timely early warning system. Poison centers (PCs)
have the potential to act as sentinel reporting entities for prescription
drug abuse and misuse due to near-real-time data reporting and abundant
coverage in the USA. Methods: Data from the Researched Abuse, Diversion and
Addiction-Related Surveillance (RADARS®) System PC program were compared
with data from the Drug Abuse Warning Network (DAWN) from 2004 through 2010.
Population rates of PC call mentions regarding abuse and misuse of
prescription opioids were compared with population rates of emergency
department visit mentions of the same using linear regression. Products
included in the analysis were the following: buprenorphine, fentanyl,
hydrocodone, hydromorphone, methadone, morphine, and oxycodone. Results: The
strength of association between RADARS System PC data and DAWN emergency
department visits regarding all opioids in aggregate was strong (R(2)=0.81,
p<0.001). The correlations between the two programs at the drug class level
also were strong for buprenorphine, hydrocodone, hydromorphone, methadone,
and oxycodone (all R(2)>0.70, all p<0.01), significant for fentanyl
(p=0.05), and moderate for morphine (p=0.09). Conclusions: Data on
prescription opioid drug abuse from the RADARS System PC program correlates
well with emergency room data from DAWN. Due to timeliness of data,
geographic coverage and strong associations with other warning systems, PC
data can be used for sentinel reporting on prescription drug abuse and
misuse in the USA. © 2013 John Wiley & Sons, Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
fentanyl
hydrocodone
hydromorphone
methadone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
opiate addiction
poison center
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug abuse
drug misuse
human
prediction
prescription
priority journal
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014011123
MEDLINE PMID
24130046 (http://www.ncbi.nlm.nih.gov/pubmed/24130046)
PUI
L52826019
DOI
10.1002/pds.3533
FULL TEXT LINK
http://dx.doi.org/10.1002/pds.3533
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 588
TITLE
Opioid use among adolescent patients treated for headache
AUTHOR NAMES
Devries A.
Koch T.
Wall E.
Getchius T.
Chi W.
Rosenberg A.
AUTHOR ADDRESSES
(Devries A., adevries@healthcore.com; Chi W.) HealthCore, Inc., 800 Delaware
Ave., Wilmington, DE 19801, United States.
(Koch T.) American Academy of Pediatrics, Elk Grove Village, IL, United
States.
(Wall E.) American Academy of Family Physicians, Leawood, KS, United States.
(Getchius T.) American Academy of Neurology, Minneapolis, MN, United States.
(Rosenberg A.) WellPoint, Inc., Indianapolis, IN, United States.
CORRESPONDENCE ADDRESS
A. Devries, HealthCore, Inc., 800 Delaware Ave., Wilmington, DE 19801,
United States. Email: adevries@healthcore.com
SOURCE
Journal of Adolescent Health (2014) 55:1 (128-133). Date of Publication:
July 2014
ISSN
1879-1972 (electronic)
1054-139X
BOOK PUBLISHER
Elsevier USA
ABSTRACT
Purpose To determine the pervasiveness of opioid prescribing for adolescents
with headache and patient and provider characteristics associated with
likelihood of opioid prescribing. Methods This observational cohort analysis
used commercial medical and pharmacy claims between January 1, 2007 and
December 31, 2008. Included were adolescents (13-17 years of age) with newly
diagnosed headache, ≥2 distinct claims for headache, and ≥12 months health
plan eligibility preindex and postindex. Adolescents with a trauma diagnosis
at any point were excluded. The primary outcome was current practice
patterns, measured by a number of opioid claims, a percentage of patients
prescribed opioids, a number of opioid prescriptions per year, a length of
opioid therapy, and a frequency of specific comorbidities. A secondary
outcome characterized providers and practice settings, comparing patients
who received opioids with those who did not. Results and conclusions Of
8,373 adolescents with headache, 46% (3,859 patients) received an opioid
prescription. Nearly half (48%) received one opioid prescription during
follow-up; 29% received ≥3 opioid prescriptions. Of those with opioid
prescriptions, 25% (977 patients) had a migraine diagnosis at index date.
Among adolescents who received opioids, 28% (1,076 adolescents) had an
emergency department (ED) visit for headache during follow-up versus 14%
(608 adolescents) who did not receive opioids (p <.01). ED visits with a
headache diagnosis during follow-up were strongly correlated with opioid use
after adjusting for other covariates (odds ratio, 2.02; 95% confidence
interval, 1.79-2.29). Despite the treatment guidelines recommending against
their use, a large proportion of adolescents with headache were prescribed
opioids. ED visits were strongly correlated with opioid prescriptions. ©
2014 Society for Adolescent Health and Medicine. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
headache (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
anxiety
article
asthma
cohort analysis
comorbidity
computer assisted tomography
emergency ward
female
follow up
general practitioner
head injury
health care personnel
human
lumbar puncture
major clinical study
male
migraine (drug therapy)
neurologist
observational study
outcome assessment
pharmacy
prescription
priority journal
retrospective study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014423107
MEDLINE PMID
24581795 (http://www.ncbi.nlm.nih.gov/pubmed/24581795)
PUI
L53025040
DOI
10.1016/j.jadohealth.2013.12.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jadohealth.2013.12.014
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 589
TITLE
Access to treatment for opioid dependence in rural america: Challenges and
future directions
AUTHOR NAMES
Sigmon S.C.
AUTHOR ADDRESSES
(Sigmon S.C., stacey.sigmon@uvm.edu) Department of Psychiatry, University of
Vermont College of Medicine, 1 S Prospect St, Burlington, VT 05401, United
States.
CORRESPONDENCE ADDRESS
S.C. Sigmon, Department of Psychiatry, University of Vermont College of
Medicine, 1 S Prospect St, Burlington, VT 05401, United States. Email:
stacey.sigmon@uvm.edu
SOURCE
JAMA Psychiatry (2014) 71:4 (359-360). Date of Publication: April 2014
ISSN
2168-622X
BOOK PUBLISHER
American Medical Association, smcleod@itsa.ucsf.edu
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
illicit drug
methadone
naltrexone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
opiate addiction
EMTREE MEDICAL INDEX TERMS
detoxification
emergency ward
evidence based practice
general practice
health care cost
human
maintenance therapy
morbidity
mortality
note
psychosocial care
rural population
sustained release formulation
treatment outcome
Western Hemisphere
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014257674
MEDLINE PMID
24500040 (http://www.ncbi.nlm.nih.gov/pubmed/24500040)
PUI
L372833567
DOI
10.1001/jamapsychiatry.2013.4450
FULL TEXT LINK
http://dx.doi.org/10.1001/jamapsychiatry.2013.4450
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 590
TITLE
Reversing tragedy. Proposed legislation will increase access to an antidote
to opioid overdose.
AUTHOR NAMES
Mettner J.
AUTHOR ADDRESSES
(Mettner J.)
CORRESPONDENCE ADDRESS
J. Mettner,
SOURCE
Minnesota medicine (2014) 97:4 (10-11). Date of Publication: Apr 2014
ISSN
0026-556X
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug therapy)
narcotic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
emergency health service
health care delivery
EMTREE MEDICAL INDEX TERMS
article
legal aspect
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24868924 (http://www.ncbi.nlm.nih.gov/pubmed/24868924)
PUI
L373389930
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 591
TITLE
The drugs don't work, they just make you worse
AUTHOR NAMES
Haig S.
Ferguson J.
AUTHOR ADDRESSES
(Haig S., drstevehaig@gmail.com) Great Western Hospital, Marlborough Road,
Swindon, United Kingdom.
(Ferguson J.) ACCS CT1, Great Western Hospital, Swindon, United Kingdom.
CORRESPONDENCE ADDRESS
S. Haig, Great Western Hospital, Marlborough Road, Swindon, United Kingdom.
SOURCE
Resuscitation (2014) 85:10 (1313-1314). Date of Publication: 1 Oct 2014
ISSN
1873-1570 (electronic)
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent
beta adrenergic receptor blocking agent
calcium (endogenous compound)
calcium channel blocking agent
intralipid
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest
EMTREE MEDICAL INDEX TERMS
calcium cell level
carbohydrate metabolism
cardiotoxicity
compression
editorial
emergency health service
emergency physician
hospital discharge
human
hyperglycemia
hypoinsulinemia
insulin resistance
resuscitation
shock
CAS REGISTRY NUMBERS
calcium (7440-70-2, 14092-94-5)
intralipid (68890-65-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014741764
MEDLINE PMID
25047570 (http://www.ncbi.nlm.nih.gov/pubmed/25047570)
PUI
L53255297
DOI
10.1016/j.resuscitation.2014.07.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2014.07.001
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 592
TITLE
Paramedic-supplied 'Take Home' Naloxone: Protocol for cluster randomised
feasibility study
AUTHOR NAMES
Moore C.
Lloyd G.
Oretti R.
Russell I.
Snooks H.
AUTHOR ADDRESSES
(Moore C., Chris.moore@wales.nhs.uk) Medical and Clinical Services
Directorate, Welsh Ambulance Services NHS Trust, Blackweir Ambulance
Station, Cardiff, United Kingdom.
(Lloyd G.) Operational Services, Welsh Ambulance Services NHS Trust,
Blackweir Ambulance Station, Cardiff, United Kingdom.
(Oretti R.) Cardiff Addictions Unit, Cardiff and Vale University Health
Board, Cardiff Royal Infirmary, Cardiff, United Kingdom.
(Russell I.) West Wales Organisation for Rigorous Trials in Health (WWORTH),
Institute of Life Science, College of Medicine, Singleton Park, Swansea,
United Kingdom.
(Snooks H.) Thematic Research Network for Emergency, Unscheduled and Trauma
Care (TRUST), College of Medicine, Swansea University, Singleton Park,
Swansea, United Kingdom.
CORRESPONDENCE ADDRESS
C. Moore, Medical and Clinical Services Directorate, Welsh Ambulance
Services NHS Trust, Blackweir Ambulance Station, Cardiff, United Kingdom.
Email: Chris.moore@wales.nhs.uk
SOURCE
BMJ Open (2014) 4:3 Article Number: e004712. Date of Publication: 2014
ISSN
2044-6055 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Introduction: 'Take Home' Naloxone (THN) kits for use by peers in the event
of an opioid overdose may reduce further overdose and deaths, but
distribution through Drugs Services may not reach those at highest risk.
Attendance by paramedics at emergency calls for patients who have suffered
an overdose presents an opportunity to distribute THN kits. In this
feasibility study we will assess the acceptability of this intervention, and
gather data to inform definitive trial planning. Methods and analysis:
Cluster randomised trial with staggered allocation of paramedics (clusters)
to groups. We will invite paramedics in an urban area of south Wales, UK to
take part. We will randomly allocate those that accept to training sessions
during the first 4 months of the trial. Patients attended by paramedics who
have been trained and issued THN kits will fall into the intervention group.
Patients attended by paramedics following usual practice (until they receive
their training and THN kits) will fall into the control group. We will
gather data about processes and outcomes of care: numbers of patients
eligible for intervention, offered and accepted THN, attended emergency
department, suffered further overdose, died within 3 months and about
follow-up rates: numbers of patients consented, completed (postal or
telephone) questionnaire. We will gather qualitative data about
acceptability to patients and paramedics through interviews and focus
groups. Ethics and dissemination: Ethical approval for this study was
granted on 7 December 2011, by South East Wales Research Ethics Committee,
Panel C. Results of this study will be reported through peer-reviewed
scientific journals, conference presentations and internal organisational
report. We will also seek to report our findings through local and national
substance misuse networks and publications. Trial registration number:
ISRCTN98216498.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (clinical trial)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
paramedical personnel
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug efficacy
drug safety
emergency care
emergency ward
feasibility study
follow up
human
interview
major clinical study
questionnaire
randomized controlled trial
United Kingdom
urban area
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
CLINICAL TRIAL NUMBERS
ISRCTN (ISRCTN98216498)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014238301
MEDLINE PMID
24650810 (http://www.ncbi.nlm.nih.gov/pubmed/24650810)
PUI
L372764305
DOI
10.1136/bmjopen-2013-004712
FULL TEXT LINK
http://dx.doi.org/10.1136/bmjopen-2013-004712
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 593
TITLE
Armed with naloxone.
AUTHOR NAMES
Goodloe J.M.
Dailey M.W.
Heightman A.J.
AUTHOR ADDRESSES
(Goodloe J.M.; Dailey M.W.; Heightman A.J.)
CORRESPONDENCE ADDRESS
J.M. Goodloe,
SOURCE
JEMS : a journal of emergency medical services (2014) 39:8 (28-33). Date of
Publication: Aug 2014
ISSN
0197-2510
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
opiate addiction (epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
article
human
organization and management
United States (epidemiology)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
25204112 (http://www.ncbi.nlm.nih.gov/pubmed/25204112)
PUI
L373982236
COPYRIGHT
Copyright 2014 Medline is the source for the citation and abstract of this
record.
RECORD 594
TITLE
Opioid use and depression in chronic pelvic pain
AUTHOR NAMES
Steele A.
AUTHOR ADDRESSES
(Steele A., steeleac@slu.edu) Obstetrics, Gynecology and Women's Health,
Surgery, Saint Louis University, 6420 Clayton Road, St Louis, MO 63117,
United States.
CORRESPONDENCE ADDRESS
A. Steele, Obstetrics, Gynecology and Women's Health, Surgery, Saint Louis
University, 6420 Clayton Road, St Louis, MO 63117, United States. Email:
steeleac@slu.edu
SOURCE
Obstetrics and Gynecology Clinics of North America (2014) 41:3 (491-501).
Date of Publication: September 2014
ISSN
1558-0474 (electronic)
0889-8545
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Opioid pain medications and antidepressants are commonly prescribed to
patients for chronic non-cancer pain. However, little evidence exists for
their effectiveness in most pain states, including chronic pelvic pain.
Whenever possible, initiation of opioid pain medications in chronic
non-cancer pain should be avoided. If patients present for evaluation of
disease states such as endometriosis or interstitial cystitis already using
regular narcotics, physicians should be aware of ways to mediate misuse and
diversion. Women with chronic pain should be screened for depression as well
as a history of prior sexual abuse, and treatment or referral initiated when
indicated. © 2014 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
amitriptyline (drug therapy)
codeine (drug therapy)
duloxetine (drug therapy)
hydromorphone (drug therapy)
morphine derivative (drug therapy)
nortriptyline (drug therapy)
oxycodone (drug therapy)
serotonin noradrenalin reuptake inhibitor (drug therapy)
tricyclic antidepressant agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
depression (drug therapy, drug therapy)
pelvis pain syndrome (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
conception
daily life activity
drug misuse
emergency ward
endometriosis
female
high risk patient
human
interstitial cystitis
irritable colon
mental health
nociception
patient referral
pregnancy
primary medical care
priority journal
questionnaire
review
screening test
sensitivity and specificity
sexual abuse
skill
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
codeine (76-57-3)
duloxetine (116539-59-4, 136434-34-9)
hydromorphone (466-99-9, 71-68-1)
nortriptyline (72-69-5, 894-71-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Psychiatry (32)
Orthopedic Surgery (33)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014562584
MEDLINE PMID
25155127 (http://www.ncbi.nlm.nih.gov/pubmed/25155127)
PUI
L53222764
DOI
10.1016/j.ogc.2014.04.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ogc.2014.04.005
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 595
TITLE
The implementation and evaluation of an evidence-based statewide prehospital
pain management protocol developed using the national prehospital
evidence-based guideline model process for emergency medical services.
AUTHOR NAMES
Brown K.M.
Hirshon J.M.
Alcorta R.
Weik T.S.
Lawner B.
Ho S.
Wright J.L.
AUTHOR ADDRESSES
(Brown K.M.) from the Department of Pediatrics and Emergency Medicine,
George Washington School of Medicine , Washington, DC (KMB) ; Emergency
Department, Children's National Medical Center , Washington, DC (KMB) ;
Maryland Institute for Emergency Medical Services Systems , Baltimore,
Health, University of Maryland , Baltimore, Maryland (JMH) .
(Hirshon J.M.; Alcorta R.; Weik T.S.; Lawner B.; Ho S.; Wright J.L.)
CORRESPONDENCE ADDRESS
K.M. Brown,
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2014) 18
Suppl 1 (45-51). Date of Publication: 2014
ISSN
1545-0066 (electronic)
ABSTRACT
In 2008, the National Highway Traffic Safety Administration funded the
development of a model process for the development and implementation of
evidence-based guidelines (EBGs) for emergency medical services (EMS). We
report on the implementation and evaluation of an evidence-based prehospital
pain management protocol developed using this model process. An
evidence-based protocol for prehospital management of pain resulting from
injuries and burns was reviewed by the Protocol Review Committee (PRC) of
the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The
PRC recommended revisions to the Maryland protocol that reflected
recommendations in the EBG: weight-based dosing and repeat dosing of
morphine. A training curriculum was developed and implemented using
Maryland's online Learning Management System and successfully accessed by
3,941 paramedics and 15,969 BLS providers. Field providers submitted
electronic patient care reports to the MIEMSS statewide prehospital
database. Inclusion criteria were injured or burned patients transported by
Maryland ambulances to Maryland hospitals whose electronic patient care
records included data for level of EMS provider training during a 12-month
preimplementation period and a 12-month postimplementation period from
September 2010 through March 2012. We compared the percentage of patients
receiving pain scale assessments and morphine, as well as the dose of
morphine administered and the use of naloxone as a rescue medication for
opiate use, before and after the protocol change. No differences were seen
in the percentage of patients who had a pain score documented or the percent
of patients receiving morphine before and after the protocol change, but
there was a significant increase in the total dose and dose in mg/kg
administered per patient. During the postintervention phase, patients
received an 18% higher total morphine dose and a 14.9% greater mg/kg dose.
We demonstrated that the implementation of a revised statewide prehospital
pain management protocol based on an EBG developed using the National
Prehospital Evidence-based Guideline Model Process was associated with an
increase in dosing of narcotic pain medication consistent with that
recommended by the EBG. No differences were seen in the percentage of
patients receiving opiate analgesia or in the documentation of pain scores.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (drug administration)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
burn (complication, drug therapy)
emergency health service
evidence based emergency medicine
injury (complication, drug therapy)
pain (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
clinical protocol
female
human
male
methodology
middle aged
organization and management
pain assessment
practice guideline
program development
program evaluation
sex ratio
standard
United States
utilization review
young adult
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24134543 (http://www.ncbi.nlm.nih.gov/pubmed/24134543)
PUI
L563083506
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 596
TITLE
Clinical care for opioid-using pregnant and postpartum women: The role of
obstetric providers
AUTHOR NAMES
Jones H.E.
Deppen K.
Hudak M.L.
Leffert L.
McClelland C.
Sahin L.
Starer J.
Terplan M.
Thorp Jr. J.M.
Walsh J.
Creanga A.A.
AUTHOR ADDRESSES
(Jones H.E., hendree_jones@med.unc.edu; McClelland C.; Thorp Jr. J.M.)
Department of Obstetrics and Gynecology, UNC School of Medicine, University
of North Carolina at Chapel Hill, Carrboro, NC, United States.
(Deppen K.) Department of Family Medicine, Grant Medical Center, Columbus,
OH, United States.
(Hudak M.L.) Department of Pediatrics, University of Florida College of
Medicine-Jacksonville, FL, United States.
(Leffert L.) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, United States.
(Sahin L.) Pediatric and Maternal Health Staff, Maternal Health Team, Office
of New Drugs, Food and Drug Administration, Silver Spring, MD, United
States.
(Starer J.) Addiction Recovery Program, Brigham and Women's Faulkner
Hospital, Boston, MA, United States.
(Terplan M.) Department of Obstetrics, Gynecology and Reproductive Sciences,
Department of Epidemiology and Public Health, University of Maryland School
of Medicine, Baltimore, MD, United States.
(Walsh J.) Addiction Recovery Service, Swedish Medical Center, Seattle, WA,
United States.
(Creanga A.A.) Division of Reproductive Health, Centers for Disease Control
and Prevention, Atlanta, GA, United States.
CORRESPONDENCE ADDRESS
H.E. Jones, UNC Horizons, 400 Roberson St., Carrboro, NC 27510, United
States. Email: hendree_jones@med.unc.edu
SOURCE
American Journal of Obstetrics and Gynecology (2014) 210:4 (302-310). Date
of Publication: April 2014
ISSN
1097-6868 (electronic)
0002-9378
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
ABSTRACT
We review clinical care issues that are related to illicit and therapeutic
opioid use among pregnant women and women in the postpartum period and
outline the major responsibilities of obstetrics providers who care for
these patients during the antepartum, intrapartum, and postpartum periods.
Selected patient treatment issues are highlighted, and case examples are
provided. Securing a strong rapport and trust with these patients is crucial
for success in delivering high-quality obstetric care and in coordinating
services with other specialists as needed. Obstetrics providers have an
ethical obligation to screen, assess, and provide brief interventions and
referral to specialized treatment for patients with drug use disorders.
Opioid-dependent pregnant women often can be treated effectively with
methadone or buprenorphine. These medications are classified as pregnancy
category C medications by the Food and Drug Administration, and their use in
the treatment of opioid-dependent pregnant patients should not be considered
"off-label." Except in rare special circumstances, medication-assisted
withdrawal during pregnancy should be discouraged because of a high relapse
rate. Acute pain management in this population deserves special
consideration because patients who use opioids can be hypersensitive to pain
and because the use of mixed opioid-agonist/ antagonists can precipitate
opioid withdrawal. In the absence of other indications, pregnant women who
use opioids do not require more intense medical care than other pregnant
patients to ensure adequate treatment and the best possible outcomes.
Together with specialists in pain and addiction medicine, obstetricians can
coordinate comprehensive care for pregnant women who use opioids and women
who use opioids in the postpartum period. © 2014 Mosby, Inc. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
illicit drug
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine
buprenorphine (drug therapy)
buprenorphine plus naloxone (drug therapy)
butorphanol
codeine
diamorphine
fentanyl
ketorolac
methadone (drug therapy)
morphine
nalbuphine
opiate agonist
opiate antagonist
oxycodone
oxymorphone
paracetamol
phenylephrine
zolpidem
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug traffic
intrapartum care
obstetric procedure
pregnant woman
prenatal care
EMTREE MEDICAL INDEX TERMS
analgesia
article
clinical assessment
doctor patient relation
emergency health service
emergency ward
food and drug administration
health care quality
human
hypersensitivity
labor
medical specialist
obstetric delivery
obstetrician
off label drug use
opiate addiction (drug therapy)
pain
patient controlled analgesia
patient referral
postoperative pain
priority journal
puerperium
relapse
screening test
trust
withdrawal syndrome
DRUG TRADE NAMES
suboxone Reckitt Benckiser
subutex , United StatesReckitt Benckiser
DRUG MANUFACTURERS
(United States)Reckitt Benckiser
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
butorphanol (42408-82-2)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
ketorolac (74103-06-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paracetamol (103-90-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
zolpidem (82626-48-0)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014223833
MEDLINE PMID
24120973 (http://www.ncbi.nlm.nih.gov/pubmed/24120973)
PUI
L52869168
DOI
10.1016/j.ajog.2013.10.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajog.2013.10.010
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 597
TITLE
Utilization management in toxicology
AUTHOR NAMES
Zhang Y.
Kwong T.C.
AUTHOR ADDRESSES
(Zhang Y., yan1_zhang@urmc.rochester.edu; Kwong T.C.) Department of
Pathology and Laboratory Medicine, University of Rochester Medical Center,
Rochester, NY, United States.
CORRESPONDENCE ADDRESS
Y. Zhang, Department of Pathology and Laboratory Medicine, University of
Rochester Medical Center, 601 Elmwood Avenue Box 608, Rochester, NY 14642,
United States. Email: yan1_zhang@urmc.rochester.edu
SOURCE
Clinica Chimica Acta (2014) 427 (158-166). Date of Publication: 1 Jan 2014
ISSN
0009-8981
1873-3492 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Recent upward trends in the prevalence of abuse of prescription drugs and
illicit substances have resulted in increased demands for toxicology testing
to support the emergency department and drug treatment in pain management
programs. This review will discuss the challenges faced by clinical
laboratories to manage the utilization of toxicology tests, particularly
those ordered in managing poisoned patients in the emergency department and
chronic pain patients on opioid therapy.Optimal utilization of toxicology
tests to support the emergency department relies on selecting the
appropriate tests for the patient, and the availability of the results in a
timely fashion. Two tiers of toxicology testing systems with different
requirements for turnaround time will be discussed. In patients with chronic
pain urine drug testing, including screening and confirmation testing are
used extensively in pain management to monitor patient compliance. A
thorough understanding of the performance characteristics of the test
methodologies and drug metabolism is a key to making a proper analytical and
clinical interpretation of the test results and will contribute to effective
utilization of these tests. In addition, the reimbursement system is an
important factor in the decision making process for test selection
utilization as significant costs can be incurred by both payers and
patients.Collaboration, trust, and effective communication among clinicians,
patients, and clinical laboratory professionals are essential for effective
utilization of toxicology testing. © 2013 Elsevier B.V.
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
alcohol
amphetamine derivative
barbituric acid derivative
benzodiazepine derivative
cannabis
carbamazepine
carboxyhemoglobin
cocaine
deferoxamine
dextropropoxyphene
digoxin
ethylene glycol
lithium
methadone
methanol
naloxone
opiate (drug therapy)
opiate derivative
oxycodone
phencyclidine
phenobarbital
quinoline derived antiinfective agent
salicylic acid
theophylline
tricyclic antidepressant agent
valproic acid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care utilization
laboratory test
toxicity testing
toxicology
utilization management
EMTREE MEDICAL INDEX TERMS
analgesia
article
blood examination
cancer pain (drug therapy)
chromatography
chromatography based multidrug screen
chronic non cancer pain (drug therapy)
chronic non cancer pain (drug therapy)
chronic pain (drug therapy)
clinical laboratory
cost benefit analysis
cost effectiveness analysis
drug abuse
drug misuse
drug monitoring
drug screening
emergency ward
false negative result
false positive result
health service
hospital laboratory
human
immunoassay
liquid chromatography
physical disease by body function
point of care testing
practice guideline
prescription
priority journal
reimbursement
tandem mass spectrometry
toxidrome
urinalysis
urine drug testing
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
carbamazepine (298-46-4, 8047-84-5)
carboxyhemoglobin (9061-29-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
deferoxamine (70-51-9)
dextropropoxyphene (1639-60-7, 469-62-5)
digoxin (20830-75-5, 57285-89-9)
ethylene glycol (107-21-1)
lithium (7439-93-2)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
phencyclidine (77-10-1, 956-90-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
salicylic acid (63-36-5, 69-72-7)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013762774
MEDLINE PMID
24091099 (http://www.ncbi.nlm.nih.gov/pubmed/24091099)
PUI
L52807432
DOI
10.1016/j.cca.2013.09.039
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cca.2013.09.039
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 598
TITLE
Takotsubo cardiomyopathy associated with opiate withdrawal
AUTHOR NAMES
Sarcon A.
Ghadri J.-R.
Wong G.
Lüscher T.F.
Templin C.
Amsterdam E.
AUTHOR ADDRESSES
(Sarcon A.; Wong G.; Amsterdam E.) Division of Cardiovascular Medicine,
University of California (Davis) School of Medicine and Medical Center,
Sacramento, CA, United States.
(Ghadri J.-R., jelena-rima.ghadri@usz.ch; Lüscher T.F.; Templin C.)
University Heart Center, Department of Cardiology, University Hospital
Zurich, Zurich, Switzerland.
CORRESPONDENCE ADDRESS
J.-R. Ghadri, University Heart Center Zurich, Department of Cardiology, 8091
Zurich, Switzerland. Email: jelena-rima.ghadri@usz.ch
SOURCE
QJM (2014) 107:4 (301-302) Article Number: hct219. Date of Publication:
April 2014
ISSN
1460-2393 (electronic)
1460-2725
BOOK PUBLISHER
Oxford University Press, jnl.info@oup.co.uk
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate
EMTREE DRUG INDEX TERMS
morphine
nitroprusside sodium
troponin I (endogenous compound)
vasodilator agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
takotsubo cardiomyopathy
EMTREE MEDICAL INDEX TERMS
abdominal discomfort
adult
akinesia
article
blood pressure measurement
breathing rate
cardiovascular risk
case report
chill
chronic pain
diaphoresis
distress syndrome
diuresis
echocardiography
electrocardiography
emergency ward
female
heart catheterization
heart left ventricle ejection fraction
heart left ventricle enddiastolic pressure
heart ventriculography
hepatitis C
human
hypertension
hypokinesia
intensive care
lung edema
major depression
middle aged
nausea and vomiting
priority journal
smoking
ST segment elevation
T wave inversion
thorax pain
vital sign
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
nitroprusside sodium (14402-89-2, 15078-28-1)
troponin I (77108-40-8)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2014221143
MEDLINE PMID
24170890 (http://www.ncbi.nlm.nih.gov/pubmed/24170890)
PUI
L372721915
DOI
10.1093/qjmed/hct219
FULL TEXT LINK
http://dx.doi.org/10.1093/qjmed/hct219
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 599
TITLE
Central nervous system toxicity
AUTHOR NAMES
Ruha A.-M.
Levine M.
AUTHOR ADDRESSES
(Ruha A.-M., Michelle.ruha@bannerhealth.com) Department of Medical
Toxicology, Banner Good Samaritan Medical Center, Center for Toxicology and
Pharmacology Education and Research, University of Arizona College of
Medicine, 925 East McDowell Road, Phoenix, AZ 85006, United States.
(Levine M.) Section of Medical Toxicology, Department of Emergency Medicine,
University of Southern California, 1200 North State Street, Los Angeles, CA
90033, United States.
(Levine M.) Department of Medical Toxicology, Banner Good Samaritan Medical
Center, 925 East McDowell Road, Phoenix, AZ 85006, United States.
CORRESPONDENCE ADDRESS
A.-M. Ruha, Department of Medical Toxicology, Banner Good Samaritan Medical
Center, Center for Toxicology and Pharmacology Education and Research,
University of Arizona College of Medicine, 925 East McDowell Road, Phoenix,
AZ 85006, United States. Email: Michelle.ruha@bannerhealth.com
SOURCE
Emergency Medicine Clinics of North America (2014) 32:1 (205-221). Date of
Publication: February 2014
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Central nervous system toxicity caused by xenobiotic exposure is a common
reason for presentation to the emergency department. Sources of exposure may
be medicinal, recreational, environmental, or occupational; the means of
exposure may be intentional or unintended. Toxicity may manifest as altered
thought content resulting in psychosis or confusion; may affect arousal,
resulting in lethargy, stupor, or coma; or may affect both elements of
consciousness. Seizures may also occur. © 2014 Elsevier Inc.
EMTREE DRUG INDEX TERMS
4 aminobutyric acid A receptor stimulating agent (adverse drug reaction)
4 hydroxybutyric acid (adverse drug reaction)
adrenergic receptor stimulating agent (adverse drug reaction)
alcohol derivative (drug toxicity)
alpha 2 adrenergic receptor stimulating agent (adverse drug reaction)
amfebutamone (adverse drug reaction, drug therapy)
anticonvulsive agent (adverse drug reaction)
baclofen (adverse drug reaction)
benzodiazepine derivative (drug therapy)
carbon monoxide (drug toxicity)
cyanide (drug toxicity)
dextropropoxyphene (adverse drug reaction)
essential oil (drug toxicity)
hydrogen sulfide (drug toxicity)
isoniazid (adverse drug reaction)
lithium salt (adverse drug reaction, drug therapy, drug toxicity)
methylxanthine (drug toxicity)
midazolam (drug therapy)
muscarinic receptor blocking agent (adverse drug reaction)
naloxone (drug therapy, intravenous drug administration)
neuroleptic agent (adverse drug reaction)
nonsteroid antiinflammatory agent (adverse drug reaction)
opiate agonist (adverse drug reaction)
pesticide (drug toxicity)
pethidine (adverse drug reaction)
salicylic acid (adverse drug reaction)
serotonin agonist (adverse drug reaction)
solvent (drug toxicity)
tramadol (adverse drug reaction)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
central nervous system disease (drug therapy, side effect, diagnosis, drug
therapy, side effect)
central nervous system toxicity (side effect, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
agitation
anxiety
bipolar disorder (drug therapy)
blood analysis
bradycardia (side effect)
central nervous system depression
clinical feature
clonus (side effect)
coma (side effect)
confusion
consciousness disorder (side effect)
continuous infusion
delirium (drug therapy, side effect)
depression (drug therapy)
diaphoresis
diarrhea (side effect)
differential diagnosis
dizziness (side effect)
drug exposure
drug overdose
electrocardiogram
electrocardiography
epileptic state (side effect)
fever (side effect)
flushing
hallucination (side effect)
heart arrhythmia (side effect)
human
hyperactivity (side effect)
hyperreflexia (side effect)
hypertension (side effect)
hypotension (side effect)
hypothermia (side effect)
intestine motility
laboratory test
lethargy (side effect)
medical history
metabolic acidosis (side effect)
miosis (side effect)
muscle rigidity (side effect)
mydriasis (side effect)
myoclonus (side effect)
nausea (side effect)
paradoxical drug reaction (side effect)
patient care
priority journal
psychosis
pyridoxine deficiency (side effect)
radiodiagnosis
respiration depression (side effect)
review
sedation
seizure (drug therapy, side effect)
serotonin syndrome (side effect)
shivering (side effect)
side effect (side effect)
sweat gland disease (side effect)
tachycardia (side effect)
tonic clonic seizure
tremor (side effect)
unconsciousness
urinalysis
urine retention (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
amfebutamone (31677-93-7, 34911-55-2)
baclofen (1134-47-0)
carbon monoxide (630-08-0)
cyanide (57-12-5)
dextropropoxyphene (1639-60-7, 469-62-5)
hydrogen sulfide (15035-72-0, 7783-06-4)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
methylxanthine (28109-92-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
salicylic acid (63-36-5, 69-72-7)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013738965
MEDLINE PMID
24275175 (http://www.ncbi.nlm.nih.gov/pubmed/24275175)
PUI
L370323765
DOI
10.1016/j.emc.2013.09.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2013.09.004
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 600
TITLE
Management of the acute painful crisis in sickle cell disease- a
re-evaluation of the use of opioids in adult patients
AUTHOR NAMES
Telfer P.
Bahal N.
Lo A.
Challands J.
AUTHOR ADDRESSES
(Telfer P., paul.telfer@bartshealth.nhs.uk) Department of Haematology, Royal
London Hospital, Barts Health NHS Trust, London, United Kingdom.
(Bahal N.) Department of Anaesthetics, Royal London Hospital, Barts Health
NHS Trust, London, United Kingdom.
(Lo A.) Department of Pharmacy, Royal London Hospital, Barts Health NHS
Trust, London, United Kingdom.
(Challands J.) Department of Paediatric Anaesthetics, Royal London Hospital,
Barts Health NHS Trust, London, United Kingdom.
CORRESPONDENCE ADDRESS
P. Telfer, Royal London Hospital, Barts Health NHS Trust, Pathology and
Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom. Email:
paul.telfer@bartshealth.nhs.uk
SOURCE
British Journal of Haematology (2014) 166:2 (157-164). Date of Publication:
July 2014
ISSN
1365-2141 (electronic)
0007-1048
BOOK PUBLISHER
Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com
ABSTRACT
Management of the acute painful crisis (APC) of sickle cell disease (SCD)
remains unsatisfactory despite advances in the understanding and management
of acute pain in other clinical settings. One reason for this is an
unsophisticated approach to the use of opioid analgesics for pain
management. This applies to haematologists who are responsible for
developing acute sickle pain management protocols for their patients, and to
health care staff in the acute care setting. The objective of this article
is to evaluate the evidence for use of opioids in APC management. We have
highlighted the possibilities for improving management by using alternatives
to morphine, and intranasal (IN) or transmucosal routes of administration
for rapid onset of analgesia in the emergency department (ED). We suggest
how experience gained in managing acute sickle pain in children could be
extrapolated to adolescents and young adults. We have also questioned
whether patients given strong opioids in the acute setting are being safely
monitored and what resources are required to ensure efficacy, safety and
patient satisfaction. We also identify aspects of care where there are
significant differences of opinion, which require further study by
randomized controlled trial. © 2014 John Wiley & Sons Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
codeine (drug therapy, pharmacokinetics, pharmacology)
diamorphine (drug combination, drug therapy, intranasal drug administration)
fentanyl (drug combination, drug comparison, drug therapy, intravenous drug
administration, pharmacology, sublingual drug administration, transdermal
drug administration)
fentanyl citrate (buccal drug administration, drug therapy)
hydromorphone (drug therapy)
morphine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intravenous drug administration, oral drug administration,
pharmacokinetics, pharmacology)
morphine sulfate (drug combination, drug therapy)
oxycodone (adverse drug reaction, drug comparison, drug therapy, oral drug
administration, pharmacokinetics, pharmacology, subcutaneous drug
administration)
pethidine (drug therapy, pharmacokinetics, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute painful crisis (drug therapy, drug therapy, epidemiology, etiology,
therapy)
pain (drug therapy, drug therapy, epidemiology, etiology, therapy)
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
acupuncture
adult
analgesia
cancer pain (drug therapy)
cognitive therapy
drug efficacy
drug fatality (side effect)
drug mechanism
drug metabolism
drug safety
drug substitution
drug use
drug withdrawal
dysphoria (side effect)
evidence based medicine
experience
history
human
jaundice (side effect)
massage
nausea (side effect)
pathophysiology
patient satisfaction
priority journal
respiration depression (side effect)
review
sedation
time to maximum plasma concentration
transition to adult care
unspecified side effect (side effect)
DRUG TRADE NAMES
abstral , United KingdomProStrakan
actiq , United KingdomCephalon
effentora , United KingdomCephalon
oramorph
oxycontin
oxynorm , United KingdomNapp
DRUG MANUFACTURERS
(United Kingdom)Cephalon
(United Kingdom)Napp
(United Kingdom)ProStrakan
CAS REGISTRY NUMBERS
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Hematology (25)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014445812
MEDLINE PMID
24750050 (http://www.ncbi.nlm.nih.gov/pubmed/24750050)
PUI
L53117014
DOI
10.1111/bjh.12879
FULL TEXT LINK
http://dx.doi.org/10.1111/bjh.12879
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 601
TITLE
Assessment of the trends in medical use and misuse of opioid analgesics from
2004 to 2011
AUTHOR NAMES
Atluri S.
Sudarshan G.
Manchikanti L.
AUTHOR ADDRESSES
(Atluri S., saiatluri@gmail.com) Tri-State Spine Care Institute, Cincinnati,
OH, United States.
(Sudarshan G.) Cincinnati Pain Management Consultants, Cincinnati, OH,
United States.
(Manchikanti L.) Pain Management Center of Paducah, Paducah, KY, United
States.
(Manchikanti L.) University of Louisville, Louisville, KY, United States.
CORRESPONDENCE ADDRESS
S. Atluri, Tri-State Spine Care Institute, 7655 Five Mile Road, Suite 117,
Cincinnati, OH 45230, United States. Email: saiatluri@gmail.com
SOURCE
Pain Physician (2014) 17:2 (E119-E128). Date of Publication: March/April
2014
ISSN
1533-3159
BOOK PUBLISHER
Association of Pain Management Anesthesiologists, editor@aopma.org
ABSTRACT
Background: The epidemic of medical use and abuse of opioid analgesics is
linked to the economic burden of opioid-related abuse and fatalities in the
United States. Multiple studies have estimated the extent to which
prescription opioid analgesics contribute to the national drug abuse
problem; studies also assessing the trends in medical use and abuse of
opioid analgesics have confirmed the relationship between increasing medical
use of opioids and increasing fatalities. The available data is limited
until 2002. Study Design: Retrospective analysis of data from 2004 to 2011
from 2 databases: Automation of Reports and Consolidated Orders System
(ARCOS) for opioid use data and Drug Abuse Warning Network (DAWN) for drug
misuse data. Objective: To determine the proportion of drug abuse related to
opioid analgesics and the various trends in the medical use and abuse of 8
opioid analgesics commonly used to treat pain: buprenorphine, codeine,
fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone.
Methods: The data obtained from DAWN is a nationally representative sample
of hospital emergency department admissions resulting from drug abuse. Main
outcome measure was the identification of trends in the medical use and
misuse of opioid analgesics from 2004 to 2011. Results: From 2004 to 2011,
there was an increase in the medical use of all opioids except for a 20%
decrease in codeine. The abuse of all opioids including codeine increased
during this period. Increases in medical use ranged from 2,318% for
buprenorphine to 35% for fentanyl, including 140% for hydromorphone, 117%
for oxycodone, 73% for hydrocodone, 64% for morphine, and 37% for methadone.
The misuse increased 384% for buprenorphine with available data from 2006 to
2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263%
for oxycodone, 146% for morphine, 107% for hydrocodone, 104% for fentanyl,
82% for methadone, and 39% for codeine. Comparison of opioid use showed an
overall increase of 1,448% from 1996 to 2011, with increases if 690% from
1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more
dramatically: 4,680% from 1996 to 2011, with increases of 1,372% from 1996
through 2004 and 245% from 2004 to 2011. The number of patients seeking
rehabilitation for substance abuse also increased 187% for opioids, whereas
it increased 87% for heroin, 40% for marijuana, and decreased 7% for
cocaine. Limitations: Limitations of this assessment include the lack of
data from 2003, lack of data available on meperidine, and that the aggregate
data systems used in the study did not identify specific formulations or
commercial products. Conclusion: The present trend of continued increase in
the medical use of opioid analgesics appears to contribute to increases in
misuse, resulting in multiple health consequences.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine
codeine
fentanyl
hydrocodone
hydromorphone
methadone
morphine
narcotic analgesic agent
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
drug use
EMTREE MEDICAL INDEX TERMS
article
cannabis addiction
cocaine dependence
detoxification
drug monitoring
heroin dependence
human
medical assessment
rehabilitation
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014205771
MEDLINE PMID
24658483 (http://www.ncbi.nlm.nih.gov/pubmed/24658483)
PUI
L372671025
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 602
TITLE
Prescription opioid misuse among ED patients discharged with opioids
AUTHOR NAMES
Beaudoin F.L.
Straube S.
Lopez J.
Mello M.J.
Baird J.
AUTHOR ADDRESSES
(Beaudoin F.L., flb@brown.edu; Straube S.; Lopez J.; Mello M.J.; Baird J.)
Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical
School of Brown University, Providence, RI 02903, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, Department of Emergency Medicine, Rhode Island Hospital,
Alpert Medical School of Brown University, Providence, RI 02903, United
States. Email: flb@brown.edu
SOURCE
American Journal of Emergency Medicine (2014) 32:6 (580-585). Date of
Publication: June 2014
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Study Objectives The purposes of this study were to determine the prevalence
of prescription opioid misuse in a cohort of discharged emergency department
(ED) patients who received prescription opioids and to examine factors
predictive of misuse. Methods This prospective observational study enrolled
a sample of ED patients aged 18 to 55 years who were discharged with a
prescription opioid. Participants completed surveys at baseline in the ED,
then 3 and 30 days later. Follow-up surveys contained questions about opioid
use and misuse, including screening questions from the National
Epidemiologic Survey on Alcohol and Related Conditions. Patients were
categorized as misusers if they (1) self-escalated their dose, (2) obtained
additional prescription opioids without a prescription, or (3) used for a
reason besides pain. Results Of the 85 patients who completed follow-ups, 36
(42%) reported misuse at either 3 or 30 days. There was no difference in
demographic variables, pain scores, analgesic treatment, or discharge
diagnoses between misusers and nonmisusers. Self-escalation of dose was the
most common category of misuse (33/36; 92%). Taking prescription opioids
without a doctor's prescription was reported by 39% (14/36), and taking pain
medications for a reason other than pain was reported by 36% (13/36). The
presence of disability, chronic pain, preexisting prescription opioid use,
oxycodone use, and past 12-month risk of substance abuse were associated
with misuse. Conclusions Prescription opioid misuse was prevalent among this
cohort of ED patients. A heterogeneous mixture of behaviors was captured.
Future research should focus on the etiologies of misuse with directed
screening and interventions to decrease misuse. © 2014 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE DRUG INDEX TERMS
hydrocodone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain (drug therapy)
disability
emergency care
female
human
major clinical study
male
middle aged
prevalence
priority journal
self concept
substance abuse
young adult
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014371314
MEDLINE PMID
24726759 (http://www.ncbi.nlm.nih.gov/pubmed/24726759)
PUI
L53095124
DOI
10.1016/j.ajem.2014.02.030
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2014.02.030
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 603
TITLE
The epidemiology and management of adult poisonings admitted to the
short-stay ward of a large scottish emergency department
AUTHOR NAMES
Teo A.I.C.
Cooper J.G.
AUTHOR ADDRESSES
(Teo A.I.C., alison.teo.05@aberdeen.ac.uk; Cooper J.G.) Emergency
Department, Aberdeen Royal Infirmary, United Kingdom.
(Teo A.I.C., alison.teo.05@aberdeen.ac.uk; Cooper J.G.) University of
Aberdeen Medical School, United Kingdom.
CORRESPONDENCE ADDRESS
A. Teo, Emergency Department, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN,
United Kingdom. Email: alison.teo.05@aberdeen.ac.uk
SOURCE
Scottish Medical Journal (2013) 58:3 (149-153). Date of Publication: 2013
ISSN
0036-9330
BOOK PUBLISHER
SAGE Publications Ltd, 55 City Road, London, United Kingdom.
ABSTRACT
Background and aims: The emergency department of Aberdeen Royal Infirmary
receives around 68,000 new adult admissions annually. All poisoning cases
are admitted to a 14-bedded short-stay ward, except those admitted to
intensive care or immediately discharged. This study aimed to analyse
epidemiological trends and management of short-stay ward admissions for
poisonings. Method and results: Adult (>13 years) poisoning presentations
admitted to the emergency department short-stay ward of Aberdeen Royal
Infirmary from 1 January-31 December 2009 were retrospectively reviewed
using patient discharge summaries. During 2009, there were 1062 poisoning
cases, of which repeat episodes were responsible for 15%. The mean age of
presentation was 33.9 years (SD 14.4) and there was a female preponderance
(62%). Almost half of poisonings were polypharmacy, alcohol was involved in
40% of cases and overdoses most commonly involved paracetamol (43%).
Management involved basic observations only (66%), N-acetylcysteine (24%),
naloxone (4%) and activated charcoal (1%). Liaison psychiatry reviewed 84%
presentations and admitted 9% to the psychiatric unit. Conclusions: The
short-stay ward is important for acute management of poisonings and the data
gained from this study should help to direct patient services appropriately.
© The Author(s) 2013.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
alcohol
antidepressant agent
benzodiazepine derivative
naloxone (drug therapy)
nonsteroid antiinflammatory agent
opiate
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
self poisoning (drug therapy, drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
acute stress disorder
adolescent
adult
aged
article
depression
drug misuse
emergency ward
female
follow up
human
liaison psychiatry
major clinical study
male
polypharmacy
retrospective study
scoring system
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013787644
MEDLINE PMID
23960053 (http://www.ncbi.nlm.nih.gov/pubmed/23960053)
PUI
L370461667
DOI
10.1177/0036933013496951
FULL TEXT LINK
http://dx.doi.org/10.1177/0036933013496951
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 604
TITLE
The impact of neighborhood socioeconomic status and race on the prescribing
of opioids in emergency departments throughout the united states
AUTHOR NAMES
Joynt M.
Train M.K.
Robbins B.W.
Halterman J.S.
Caiola E.
Fortuna R.J.
AUTHOR ADDRESSES
(Joynt M.; Train M.K.; Robbins B.W.; Caiola E.; Fortuna R.J.,
Robert_Fortuna@urmc.rochester.edu) Center for Primary Care, Culver Medical
Group, University of Rochester School of Medicine and Dentistry, 913 Culver
Road, Rochester, NY 14609, United States.
(Joynt M.; Train M.K.; Robbins B.W.; Caiola E.; Fortuna R.J.,
Robert_Fortuna@urmc.rochester.edu) Department of Internal Medicine,
University of Rochester School of Medicine and Dentistry, Rochester, NY,
United States.
(Robbins B.W.; Halterman J.S.; Fortuna R.J.,
Robert_Fortuna@urmc.rochester.edu) Strong Children's Research Center,
Department of Pediatrics, University of Rochester School of Medicine and
Dentistry, Rochester, NY, United States.
CORRESPONDENCE ADDRESS
R.J. Fortuna, Center for Primary Care, Culver Medical Group, University of
Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY
14609, United States. Email: Robert_Fortuna@urmc.rochester.edu
SOURCE
Journal of General Internal Medicine (2013) 28:12 (1604-1610). Date of
Publication: December 2013
ISSN
0884-8734
1525-1497 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
ABSTRACT
BACKGROUND: Racial and ethnic disparities in opioid prescribing in the
emergency department (ED) are well described, yet the influence of
socioeconomic status (SES) remains unclear. OBJECTIVES: (1) To examine the
effect of neighborhood SES on the prescribing of opioids for moderate to
severe pain; and (2) to determine if racial disparities in opioid
prescribing persist after accounting for SES. DESIGN: We used
cross-sectional data from the National Hospital Ambulatory Medical Care
Survey between 2006 and 2009 to examine the prescribing of opioids to
patients presenting with moderate to severe pain (184 million visits). We
used logistic regression to examine the association between the prescribing
of opioids, SES, and race. Models were adjusted for age, sex, pain-level,
injury-status, frequency of emergency visits, hospital type, and region.
MAIN MEASURES: Our primary outcome measure was whether an opioid was
prescribed during a visit for moderate to severe pain. SES was determined
based on income, percent poverty, and educational level within a patient's
zip code. RESULTS: Opioids were prescribed more frequently at visits from
patients of the highest SES quartile compared to patients in the lowest
quartile, including percent poverty (49.0 % vs. 39.4 %, P < 0.001),
household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3
% vs. 42.5 %, P = 0.01). Black patients were prescribed opioids less
frequently than white patients across all measures of SES. In adjusted
models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from
poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive
opioids after accounting for pain-level, age, injury-status, and other
covariates. CONCLUSIONS: Patients presenting to emergency departments from
lower SES regions were less likely to receive opioids for equivalent levels
of pain than those from more affluent areas. Black and Hispanic patients
were also less likely to receive opioids for equivalent levels of pain than
whites, independent of SES. © 2013 Society of General Internal Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neighborhood
race
social status
EMTREE MEDICAL INDEX TERMS
adult
aged
article
cross-sectional study
disease severity
educational status
emergency ward
ethnicity
female
Hispanic
household
human
income
major clinical study
male
outcome assessment
pain (drug therapy)
patient care
poverty
prescription
race difference
self report
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013794717
MEDLINE PMID
23797920 (http://www.ncbi.nlm.nih.gov/pubmed/23797920)
PUI
L52720243
DOI
10.1007/s11606-013-2516-z
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-013-2516-z
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 605
TITLE
Opioids can be useful in the treatment of headache
AUTHOR NAMES
Finocchi C.
Viani E.
AUTHOR ADDRESSES
(Finocchi C., cfinocchi@neurologia.unige.it; Viani E.) Dipartimento di
Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze
Materno-Infantili, University of Genova, Largo Daneo 3, 16132 Genova, Italy.
CORRESPONDENCE ADDRESS
C. Finocchi, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia,
Genetica e Scienze Materno-Infantili, University of Genova, Largo Daneo 3,
16132 Genova, Italy. Email: cfinocchi@neurologia.unige.it
SOURCE
Neurological Sciences (2013) 34:SUPPL. 1 (S119-S124). Date of Publication:
2013
ISSN
1590-1874
1590-3478 (electronic)
BOOK PUBLISHER
Springer Milan, Via Podgora 4, Milan, Italy.
ABSTRACT
The use of opioids in headache treatment is very controversial. In the
migraine acute attack use of short-acting opioids is not recommended by the
principal guidelines but is frequent in North American emergency
departments. Their efficacy in migraine acute attack has not been
extensively studied but seems to be similar to nonsteroidal
anti-inflammatory drugs and metoclopramide. Opioids have been never compared
to triptans. The principal concerns about the use of opioids regard the
possible association with an increased risk of medication-overuse headache
and chronic migraine and the risk of abuse and dependence. These risks have
to be considered but not overestimated. The association between frequent use
and increased risk of chronic migraine has been observed for almost all
categories of acute migraine attack drugs. Compared to the reference
category of acetaminophen, risk of chronic migraine for opioid use is only
moderately higher (with an OR = 1.48). In some cases, when treatment with
triptans, non-steroidal anti-inflammatory drugs, or ergotamines is
contraindicated or simply in effective, a judicious prescription of a
short-acting opioid for severe migraine attacks can be considered. Chronic
migraine is a highly disabling condition. Although the options for
prophylaxis therapy of migraine have expanded and improved considerably over
recent years, chronic migraine remains very difficult to treat. The results
coming from small clinical series are described, suggesting that in expert
hands daily long-acting opioids provide an option for the treatment of some
individuals with chronic intractable headaches. © Springer-Verlag Italia
2013.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (clinical trial, drug comparison, drug therapy, parenteral drug
administration)
EMTREE DRUG INDEX TERMS
amitriptyline (drug therapy)
antiemetic agent (clinical trial, drug comparison, drug therapy)
botulinum toxin A (clinical trial, drug therapy)
dihydroergotamine (clinical trial, drug comparison, drug therapy)
ergotamine derivative (drug therapy)
gabapentin (drug therapy)
hydroxyzine (clinical trial, drug comparison, drug therapy)
ketorolac (clinical trial, drug comparison, drug therapy)
lamotrigine (drug therapy)
levomepromazine (clinical trial, drug comparison, drug therapy)
magnesium (drug therapy)
melatonin (drug therapy)
methadone (drug therapy)
metoclopramide (clinical trial, drug comparison, drug therapy)
nalbuphine (clinical trial, drug comparison, drug therapy)
neuroleptic agent (clinical trial, drug comparison, drug therapy)
nonsteroid antiinflammatory agent (drug comparison, drug therapy)
paracetamol (drug comparison, drug therapy)
pethidine (clinical trial, drug comparison, drug therapy)
placebo
propranolol (drug therapy)
topiramate (clinical trial)
tramadol (drug therapy, pharmacology)
triptan derivative (drug therapy, parenteral drug administration)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
headache (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
article
brain region
disease exacerbation
drug contraindication
drug efficacy
emergency ward
evidence based medicine
health care quality
human
migraine (drug therapy)
narcotic dependence
nerve stimulation
pathophysiology
phase 3 clinical trial (topic)
prescription
prophylaxis
randomized controlled trial (topic)
risk factor
transformed migraine (drug therapy, prevention, therapy)
treatment response
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
botulinum toxin A (1309378-01-5, 93384-43-1)
dihydroergotamine (511-12-6)
gabapentin (60142-96-3)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ketorolac (74103-06-3)
lamotrigine (84057-84-1)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
magnesium (7439-95-4)
melatonin (73-31-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
nalbuphine (20594-83-6, 23277-43-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
topiramate (97240-79-4)
tramadol (27203-92-5, 36282-47-0)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014075182
MEDLINE PMID
23695059 (http://www.ncbi.nlm.nih.gov/pubmed/23695059)
PUI
L372218138
DOI
10.1007/s10072-013-1416-7
FULL TEXT LINK
http://dx.doi.org/10.1007/s10072-013-1416-7
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 606
TITLE
Controversies in migraine treatment: Opioids should be avoided
AUTHOR NAMES
Casucci G.
Cevoli S.
AUTHOR ADDRESSES
(Casucci G., gerardocasucci@tin.it) Casa di Cura S. Francesco, Viale Europa
21, 82037 Telese Terme, Italy.
(Cevoli S.) IRCCS of Neurological Sciences of Bologna, Bellaria Hospital,
Via Altura 3, 40139 Bologna, Italy.
CORRESPONDENCE ADDRESS
G. Casucci, Casa di Cura S. Francesco, Viale Europa 21, 82037 Telese Terme,
Italy. Email: gerardocasucci@tin.it
SOURCE
Neurological Sciences (2013) 34:SUPPL. 1 (S125-S128). Date of Publication:
2013
ISSN
1590-1874
1590-3478 (electronic)
BOOK PUBLISHER
Springer Milan, Via Podgora 4, Milan, Italy.
ABSTRACT
The use of opioids for migraine is still controversial. Evidence-based
guidelines do not recommend opioids as first-line treatment of migraine
attacks, while clinical and epidemiological surveys demonstrate that the use
of opioids is associated with more severe headache related disability,
symptomology and comorbidities, and greater health-care resource
utilization. There are concerns that opioids may be misused or abused,
leading to opioid abuse or dependence and migraineurs are particularly prone
and at risk for the development of chronic daily headache from opioids
overuse. Since clinical and preclinical studies evidence a
pathophysiological role of opioids in migraine progression, opioids should
be avoided in migraine patients. © Springer-Verlag Italia 2013.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
barbituric acid derivative (drug therapy)
calcitonin gene related peptide (endogenous compound)
chlorpromazine (drug comparison, drug therapy)
dihydroergotamine (drug comparison, drug therapy)
droperidol (drug comparison, drug therapy)
ergot alkaloid (drug therapy)
ketorolac (drug comparison, drug therapy, intramuscular drug administration)
metoclopramide (drug comparison, drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
paracetamol (drug therapy)
pethidine (drug comparison, drug therapy, intramuscular drug administration)
substance P (endogenous compound)
triptan derivative (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
migraine (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
brain region
chronic daily headache
comorbidity
disability
drug induced headache
drug misuse
emergency ward
evidence based practice
health care utilization
human
hyperalgesia
nociception
nonhuman
opiate addiction
pathophysiology
practice guideline
symptomatology
transformed migraine
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
calcitonin gene related peptide (83652-28-2)
chlorpromazine (50-53-3, 69-09-0)
dihydroergotamine (511-12-6)
droperidol (548-73-2)
ergot alkaloid (12126-57-7)
ketorolac (74103-06-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
substance P (33507-63-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014075183
MEDLINE PMID
23695060 (http://www.ncbi.nlm.nih.gov/pubmed/23695060)
PUI
L372218139
DOI
10.1007/s10072-013-1395-8
FULL TEXT LINK
http://dx.doi.org/10.1007/s10072-013-1395-8
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 607
TITLE
Promethazine and treatment refractory agitation in Clonidine Toxicity
AUTHOR NAMES
Teimoory M.
Arefi M.
Behnoush B.
Bastani B.
AUTHOR ADDRESSES
(Teimoory M., maryamteimoory87@yahoo.com; Arefi M.; Behnoush B.) Department
of Forensic Medicine and Toxicology, Tehran University of Medical Sciences,
Tehran, Iran.
(Bastani B.) Department of Forensic Medicine and Toxicology, Shahid Beheshti
University of Medical Sciences, Tehran, Iran.
CORRESPONDENCE ADDRESS
M. Teimoory, Department of Forensic Medicine and Toxicology, Tehran
University of Medical Sciences, Tehran, Iran. Email:
maryamteimoory87@yahoo.com
SOURCE
International Journal of Medical Toxicology and Forensic Medicine (2013) 3:3
(96-98). Date of Publication: 2013
ISSN
2251-8770
2251-8762 (electronic)
BOOK PUBLISHER
Shahid Beheshti University of Medical Sciences, Tehran, Iran.
ABSTRACT
Background: Delirium is an acute and transient turmoil disorder in
consciousness which is often caused by drugs.One of the adverse effects of
clonidine is agitation. Clonidine is an agonist of α2-receptor which
functionally overlaps with μ-receptor of opioids. Promethazine is
H1-receptor antagonist and has antipsychotic properties. The necessary dose
for initial control of agitation is 25-50 milligrams. Case Presentation: A
27 year old man has been sent to emergency department following consumption
of clonazepam 1 milligram, clonidine 0.1 milligram and alprazolam 0.5
milligram. Upon arrival at the toxicity emergency of the hospital, the
patient's pulse rate suddenly dropped to 20 per min along with widening of
QRS and increase of QTc as well as severe agitation. At the end of the
second day due to continuous bradycardia pace maker was devised. The patient
showed hallucination. In the third day, the patient's delirium increased.
Due to no control of agitation by benzodiazepine, haloperidol, Promethazine
25 milligram was injected then slept after 5 minute. Conclusion: In such
patient with above restrictions, prescription of promethazine not only
maintained blood pressure and caused no disorder in electrocardiogram, but
also it immediately and certainly controlled patient's agitation. © 2013
Forensic Medicine and Toxicology Department.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
clonidine (adverse drug reaction, drug toxicity)
promethazine (drug therapy)
EMTREE DRUG INDEX TERMS
alprazolam
atropine
benzodiazepine
clonazepam
glucagon
haloperidol
midazolam
naloxone
noradrenalin
thiopental
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitation
delirium (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
arterial gas
article
bradycardia
case report
drug use
emergency ward
hallucination
human
hypotension
male
metabolic alkalosis
pulse rate
respiratory acidosis
side effect (side effect)
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
clonazepam (1622-61-3)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
haloperidol (52-86-8)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
promethazine (58-33-3, 60-87-7)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014139851
PUI
L372464596
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 608
TITLE
Does the sedation regimen affect adverse events during procedural sedation
and analgesia in injection drug users?
AUTHOR NAMES
Scheuermeyer F.X.
Andolfatto G.
Qian H.
Grafstein E.
AUTHOR ADDRESSES
(Scheuermeyer F.X., frank.scheuermeyer@gmail.com; Qian H.) Department of
Emergency Medicine, St. Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada.
(Andolfatto G.) Department of Emergency Medicine, Lions Gate Hospital,
University of British Columbia, North Vancouver, BC, Canada.
(Grafstein E.) Department of Emergency Medicine, Mount St. Joseph's
Hospital, University of British Columbia, Vancouver, BC, Canada.
CORRESPONDENCE ADDRESS
F. X. Scheuermeyer, Department of Emergency Medicine, St. Paul's Hospital,
1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Email:
frank.scheuermeyer@gmail.com
SOURCE
Canadian Journal of Emergency Medicine (2013) 15:5 (279-288). Date of
Publication: 2013
ISSN
1481-8035
BOOK PUBLISHER
Decker Publishing, 111 S. Independence Mall East, Suite 630, Philadelphia,
United States.
ABSTRACT
Objectives: Injection drug users (IDUs) often undergo procedural sedation
and analgesia (PSA) as part of emergency department (ED) treatment. We
compared adverse events (AEs) using a variety of sedation regimens. Methods:
This was a retrospective analysis of a PSA safety audit in two urban EDs.
Consecutive self-reported IDUs were identified, and structured data
describing comorbidities, vital signs, sedation regimens (propofol [P],
propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1
ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected.
The primary outcome was the proportion of patients in each sedation group
having an AE; the secondary outcome was the proportion of patients having a
cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs
(78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95%
CI 4.0- 10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%,
respectively, with propofol having a significantly lower rate (Pearson
coefficient 14.9, p 5 0.007). The cardiovascular/ respiratory AE rates were
significantly different as well, with P, KP, and KF having the lowest rates
(Pearson coefficient 13.3, p 5 0.01). Conclusions: For IDU PSA, the overall
AE rate was 6.5%, and propofol appeared to have a significantly lower rate.
© Canadian Association of Emergency Physicians.
EMTREE DRUG INDEX TERMS
amphetamine
cocaine
diamorphine
fentanyl (adverse drug reaction, drug combination)
flumazenil (drug therapy)
ketamine (adverse drug reaction, drug combination)
metoclopramide (drug therapy, intravesical drug administration)
midazolam (adverse drug reaction, drug combination, drug therapy)
morphine
naloxone (drug therapy)
propofol (adverse drug reaction, drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
intravenous drug abuse
sedation
EMTREE MEDICAL INDEX TERMS
adult
agitation
airway obstruction (side effect)
apnea (drug therapy, side effect)
article
behavior disorder (drug therapy)
Canada
cardiovascular disease (complication)
comorbidity
controlled study
drug fatality (side effect)
drug safety
emergency care
female
human
hypotension (side effect)
hypoxia (drug therapy, side effect)
major clinical study
male
middle aged
myoclonus (side effect)
nausea (side effect)
patient safety
respiratory tract disease (complication)
retrospective study
self report
unspecified side effect (side effect)
urban area
vital sign
vomiting (drug therapy, side effect)
CAS REGISTRY NUMBERS
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2013701042
MEDLINE PMID
23972133 (http://www.ncbi.nlm.nih.gov/pubmed/23972133)
PUI
L370196903
DOI
10.2310/8000.2013.130933
FULL TEXT LINK
http://dx.doi.org/10.2310/8000.2013.130933
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 609
TITLE
The Toxicology Investigators Consortium Case Registry-The 2012 Experience
AUTHOR NAMES
Wiegand T.
Wax P.
Smith E.
Hart K.
Brent J.
AUTHOR ADDRESSES
(Wiegand T., Timothy_Wiegand@URMC.Rochester.edu) The University of Rochester
Medical Center and Strong Memorial Hospital, Rochester, United States.
(Wax P.; Smith E.) University of Texas Southwestern Medical Center, Dallas,
TX, United States.
(Hart K.) Hartford Hospital, Hartford, CT, United States.
(Hart K.) CT Poison Control Center, University of CT Health Center,
Farmington, CT, United States.
(Brent J.) University of Colorado School of Medicine, Aurora, CO, United
States.
(Brent J.) Colorado School of Public Health, Aurora, CO, United States.
CORRESPONDENCE ADDRESS
T. Wiegand, The University of Rochester Medical Center and Strong Memorial
Hospital, Rochester, United States. Email:
Timothy_Wiegand@URMC.Rochester.edu
SOURCE
Journal of Medical Toxicology (2013) 9:4 (380-404). Date of Publication:
December 2013
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
ABSTRACT
In 2010, the American College of Medical Toxicology (ACMT) established its
Case Registry, the Toxicology Investigators Consortium (ToxIC). All cases
are entered prospectively and include only suspected and confirmed toxic
exposures cared for at the bedside by board-certified or board-eligible
medical toxicologists at its participating sites. The primary aims of
establishing this Registry include the development of a realtime
toxico-surveillance system in order to identify and describe current or
evolving trends in poisoning and to develop a research tool in toxicology.
ToxIC allows for extraction of data from medical records from multiple sites
across a national and international network. All cases seen by medical
toxicologists at participating institutions were entered into the database.
Information characterizing patients entered in 2012 was tabulated and data
from the previous years including 2010 and 2011 were included so that
cumulative numbers and trends could be described as well. The current report
includes data through December 31st, 2012. During 2012, 38 sites with 68
specific institutions contributed a total of 7,269 cases to the Registry.
The total number of cases entered into the Registry at the end of 2012 was
17,681. Emergency departments remained the most common source of
consultation in 2012, accounting for 61 % of cases. The most common reason
for consultation was for pharmaceutical overdose, which occurred in 52 % of
patients including intentional (41 %) and unintentional (11 %) exposures.
The most common classes of agents were sedative-hypnotics (1,422 entries in
13 % of cases) non-opioid analgesics (1,295 entries in 12 % of cases),
opioids (1,086 entries in 10 % of cases) and antidepressants (1,039 entries
in 10 % of cases). N-acetylcysteine (NAC) was the most common antidote
administered in 2012, as it was in previous years, followed by the opioid
antagonist naloxone, sodium bicarbonate, physostigmine and flumazenil.
Anti-crotalid Fab fragments were administered in 109 cases or 82 % of cases
in which a snake envenomation occurred. There were 57 deaths reported in the
Registry in 2012. The most common associated agent alone or in combination
was the non-opioid analgesic acetaminophen, being reported in 10 different
cases. Other common agents and agent classes involved in death cases
included ethanol, opioids, the anti-diabetic agent metformin,
sedatives-hypnotics and cardiovascular agents, in particular amlodipine.
There were significant trends identified during 2012. Abuse of
over-the-counter medications such as dextromethorphan remains prevalent.
Cases involving dextromethorphan continued to be reported at frequencies
higher than other commonly abused drugs including many stimulants,
phencyclidine, synthetic cannabinoids and designer amphetamines such as bath
salts. And, while cases involving synthetic cannabinoids and psychoactive
bath salts remained relatively constant from 2011 to 2012 several designer
amphetamines and novel psychoactive substances were first reported in the
Registry in 2012 including the NBOME compounds or "N-bomb" agents. LSD cases
also spiked dramatically in 2012 with an 18-fold increase from 2011 although
many of these cases are thought to be ultra-potent designer amphetamines
misrepresented as "synthetic" LSD. The 2012 Registry included over 400
Adverse Drug Reactions (ADRs) involving 4 % of all Registry cases with 106
agents causing at least 2 ADRs. Additional data including supportive cares,
decontamination, and chelating agent use are also included in the 2012
annual report. The Registry remains a valuable toxico-surveillance and
research tool. The ToxIC Registry is a unique tool for identifying and
characterizing confirmed cases of significant or potential toxicity or
complexity to require bedside care by a medical toxicologist. © 2013
American College of Medical Toxicology.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction)
adrenergic receptor stimulating agent (adverse drug reaction)
amfebutamone (adverse drug reaction)
amitriptyline (adverse drug reaction)
amlodipine (adverse drug reaction)
benzodiazepine (adverse drug reaction)
carbamazepine (adverse drug reaction)
cholinergic receptor blocking agent (adverse drug reaction)
cholinergic receptor stimulating agent (adverse drug reaction)
citalopram (adverse drug reaction)
clonazepam (adverse drug reaction)
domperidone (adverse drug reaction)
doxepin (adverse drug reaction)
gabapentin (adverse drug reaction)
hydrocodone (adverse drug reaction)
hydroxyzine (adverse drug reaction)
hypnotic sedative agent (adverse drug reaction)
ibuprofen (adverse drug reaction)
lamotrigine (adverse drug reaction)
lisinopril (adverse drug reaction)
metformin (adverse drug reaction)
metoprolol (adverse drug reaction)
opiate (adverse drug reaction)
paracetamol (adverse drug reaction)
paroxetine (adverse drug reaction)
quetiapine (adverse drug reaction)
serotonin agonist (adverse drug reaction)
tramadol (adverse drug reaction)
unindexed drug
zolpidem (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
disease registry
toxicology
EMTREE MEDICAL INDEX TERMS
alcohol abuse
article
consultation
death
drug abuse
drug exposure
drug fatality (side effect)
drug intoxication
envenomation
fluid resuscitation
human
international cooperation
intoxication (side effect)
medical record
pharmaceutical care
side effect (side effect)
ventilator
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
amfebutamone (31677-93-7, 34911-55-2)
amitriptyline (50-48-6, 549-18-8)
amlodipine (103129-82-4, 736178-83-9, 88150-42-9)
benzodiazepine (12794-10-4)
carbamazepine (298-46-4, 8047-84-5)
citalopram (59729-33-8)
clonazepam (1622-61-3)
domperidone (57808-66-9)
doxepin (1229-29-4, 1668-19-5)
gabapentin (60142-96-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
lamotrigine (84057-84-1)
lisinopril (76547-98-3, 83915-83-7)
metformin (1115-70-4, 657-24-9)
metoprolol (37350-58-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paroxetine (61869-08-7)
quetiapine (111974-72-2)
tramadol (27203-92-5, 36282-47-0)
zolpidem (82626-48-0)
EMBASE CLASSIFICATIONS
Toxicology (52)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013770735
MEDLINE PMID
24178902 (http://www.ncbi.nlm.nih.gov/pubmed/24178902)
PUI
L52846721
DOI
10.1007/s13181-013-0352-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-013-0352-5
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 610
TITLE
Capsule commentary on Joynt et al., the impact of neighborhood socioeconomic
status and race on the prescribing of opioids in emergency departments
throughout the United States
AUTHOR NAMES
Simon L.
AUTHOR ADDRESSES
(Simon L., Lorna.simon@umassmed.edu) Center for Mental Health Services
Research, University of Massachusetts Medical School, Worcester, MA 01655,
United States.
CORRESPONDENCE ADDRESS
L. Simon, Center for Mental Health Services Research, University of
Massachusetts Medical School, Worcester, MA 01655, United States. Email:
Lorna.simon@umassmed.edu
SOURCE
Journal of General Internal Medicine (2013) 28:12 (1647). Date of
Publication: December 2013
ISSN
0884-8734
1525-1497 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
neighborhood
prescription
race
social status
EMTREE MEDICAL INDEX TERMS
African American
drug abuse
ethnic group
ethnicity
health care
health care delivery
Hispanic
human
minority group
note
pain (drug therapy)
perception
physician
stereotypy
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013794729
MEDLINE PMID
23925802 (http://www.ncbi.nlm.nih.gov/pubmed/23925802)
PUI
L52720244
DOI
10.1007/s11606-013-2547-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s11606-013-2547-5
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 611
TITLE
Associations between pain clinic density and distributions of opioid pain
relievers, drug-related deaths, hospitalizations, emergency department
visits, and neonatal abstinence syndrome in Florida
AUTHOR NAMES
Sauber-Schatz E.K.
Mack K.A.
Diekman S.T.
Paulozzi L.J.
AUTHOR ADDRESSES
(Sauber-Schatz E.K., ige7@cdc.gov; Mack K.A.; Diekman S.T.; Paulozzi L.J.)
Division of Unintentional Injury Prevention, National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention, 4770
Buford Highway, N.E., Mailstop F62, Atlanta, GA 30341, United States.
CORRESPONDENCE ADDRESS
E.K. Sauber-Schatz, Division of Unintentional Injury Prevention, National
Center for Injury Prevention and Control, Centers for Disease Control and
Prevention, 4770 Buford Highway, N.E., Mailstop F62, Atlanta, GA 30341,
United States. Email: ige7@cdc.gov
SOURCE
Drug and Alcohol Dependence (2013) 133:1 (161-166). Date of Publication: 1
Nov 2013
ISSN
0376-8716
1879-0046 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: Community-level associations between pain clinics and
drug-related outcomes have not been empirically demonstrated. Methods: To
explore these associations we correlated overdose death rates,
hospital-discharge rates for drug-related hospitalizations including
neonatal abstinence syndrome, and emergency department rates for
drug-related visits with registered pain clinic density and rate of opioid
pills dispensed per person at the county-level Florida in 2009. Negative
binomial regression was used to model the crude associations and
associations adjusted for exposure measures and county demographic
characteristics. Results: An estimated 732 pain clinics operated in Florida
in 2009, a rate of 3.9/100,000 people. Among the 67 counties in Florida, 23
(34.3%) had no pain clinics, and three had 90 or more. Adjusted negative
binomial regression determined no significant association between pain
clinic rate and drug-related outcomes. However, rates of drug-caused,
opioid-caused, and oxycodone-caused death correlated significantly with
rates of opioid and oxycodone pills dispensed per person in adjusted
analyses. For every increase of one pill in the rate of oxycodone pills per
person, there was a 6% increase in the rate of oxycodone-related overdose
death. Conclusions: Although pain clinics, some of which are "pill mills,"
are clearly a source of drugs used nonmedically, their impact on health
outcomes might be difficult to quantify because the pills they prescribe
might be consumed in other counties or states. The impact of "pill mill"
laws might be better measured by more proximal measures such as the number
of such facilities. © 2013 .
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
oxycodone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug fatality
emergency ward
hospitalization
pain clinic
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age distribution
aged
article
child
drug overdose
female
hospital discharge
human
infant
major clinical study
male
preschool child
priority journal
school child
United States
CAS REGISTRY NUMBERS
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013595668
MEDLINE PMID
23769424 (http://www.ncbi.nlm.nih.gov/pubmed/23769424)
PUI
L52630582
DOI
10.1016/j.drugalcdep.2013.05.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2013.05.017
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 612
TITLE
Nonmedical prescription opioid and sedative use among adolescents in the
emergency department
AUTHOR NAMES
Whiteside L.K.
Walton M.A.
Bohnert A.S.B.
Blow F.C.
Bonar E.E.
Ehrlich P.
Cunningham R.M.
AUTHOR ADDRESSES
(Whiteside L.K., laurenkw@u.washington.edu) Division of Emergency Medicine,
University of Washington, Seattle, WA, United States.
(Walton M.A.; Bohnert A.S.B.; Bonar E.E.; Ehrlich P.; Cunningham R.M.)
Injury Center, University of Michigan, Ann Arbor, MI, United States.
(Walton M.A.; Bohnert A.S.B.; Blow F.C.; Bonar E.E.) Department of
Psychiatry, University of Michigan, Ann Arbor, MI, United States.
(Bohnert A.S.B.; Blow F.C.) Veterans Affairs Health Services Research and
Development, Ann Arbor, MI, United States.
(Ehrlich P.; Cunningham R.M.) Department of Pediatric Surgery, University of
Michigan, Ann Arbor, MI, United States.
(Cunningham R.M.) Department of Emergency Medicine, University of Michigan,
Ann Arbor, MI, United States.
CORRESPONDENCE ADDRESS
L.K. Whiteside, Division of Emergency Medicine, University of Washington,
Seattle, WA, United States. Email: laurenkw@u.washington.edu
SOURCE
Pediatrics (2013) 132:5 (825-832). Date of Publication: 1 Nov 2013
ISSN
1098-4275 (electronic)
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
OBJECTIVES: Nonmedical prescription opiate use (NPOU) and nonmedical
prescription sedative use (NPSU) are serious public health concerns. The
objectives of this study were to determine the prevalence and emergency
department (ED) visit characteristics and other correlates associated with
past-year NPOU and NPSU among adolescents and young adults using the ED.
METHODS: Participants aged 14 to 20 presenting to the ED at the University
of Michigan Medical Center between September 2010 and September 2011 were
systematically recruited. A computerized self-report screening survey with
validated items measuring past-year NPOU, NPSU, substance use, and violence
was delivered to participants, and a retrospective chart review was
performed. RESULTS: Of the 2135 participants (86.0% response rate), 222
(10.4%) reported either NPOU or NPSU. Among the 185 (8.7%) participants that
reported NPOU, 14.6% had a current home prescription for an opioid and among
the 115 (5.4%) with NPSU, 12.3% had a current home prescription for a
sedative. After controlling for demographics (age, gender, race, public
assistance), correlates of NPOU or NPSU included other substance use, and
drinking and driving or riding with a drinking driver. Additional correlates
of NPOU included receiving an intravenous opioid in the ED and for NPSU,
dating violence, presenting to the ED for a noninjury complaint, and
previous ED visit in the past year. CONCLUSIONS: Nearly 1 in 10 young people
who use the ED for care report NPOU or NPSU, and only 12.3% and 14.6% report
having current home prescriptions for sedatives and opioids. The ED
represents a key location for screening and intervention efforts. Pediatrics
2013;132:825-832. Copyright © 2013 by the American Academy of Pediatrics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, intravenous drug administration)
sedative agent (drug dose)
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug dose)
alprazolam (drug dose)
buprenorphine (drug dose)
buprenorphine plus naloxone (drug dose)
chlordiazepoxide (drug dose)
diazepam (drug dose)
fentanyl (drug dose)
flunitrazepam (drug dose)
hydrocodone (drug dose)
lorazepam (drug dose)
methadone (drug dose)
oxazepam (drug dose)
oxycodone (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age
article
automation
correlation analysis
dating violence
drug overdose
drunken driving
emergency ward
female
human
major clinical study
male
medical record review
prescription
prevalence
priority journal
race difference
self report
substance abuse
United States
violence
DRUG TRADE NAMES
ativan
librium
rohypnol
serepax
suboxone
valium
xanax
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
alprazolam (28981-97-7)
buprenorphine (52485-79-7, 53152-21-9)
chlordiazepoxide (438-41-5, 58-25-3)
diazepam (439-14-5)
fentanyl (437-38-7)
flunitrazepam (1622-62-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
lorazepam (846-49-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Pediatrics and Pediatric Surgery (7)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT01051141)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013698481
MEDLINE PMID
24167166 (http://www.ncbi.nlm.nih.gov/pubmed/24167166)
PUI
L370188640
DOI
10.1542/peds.2013-0721
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2013-0721
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 613
TITLE
Aberrant intrathecal pump refill ultrasound-Guided aspiration of a
substantial quantity of subcutaneous hydromorphone
AUTHOR NAMES
Peccora C.D.
Ross E.L.
Hanna G.M.
AUTHOR ADDRESSES
(Peccora C.D.; Ross E.L.) Department of Anesthesiology, Perioperative, and
Pain Medicine, Brigham and Women's Hospital, United States.
(Hanna G.M., ghanna2@partners.org) Department of Anesthesia, Critical Care
and Pain Medicine, Massachusetts General Hospital, Boston, United States.
CORRESPONDENCE ADDRESS
G.M. Hanna, Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, United States. Email:
ghanna2@partners.org
SOURCE
Regional Anesthesia and Pain Medicine (2013) 38:6 (544-546). Date of
Publication: November-December 2013
ISSN
1098-7339
1532-8651 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Intrathecal drug delivery systems are an effective and increasingly common
pain treatment modality for certain patient populations. Pumps are
surgically inserted in a subcutaneous abdominal pocket and refilled with
highly concentrated medication at regular intervals. Inadvertent injection
of medication outside the pump is a known complication of the refill
procedure. We describe the injection of hydromorphone into the pump's
surrounding subcutaneous pocket, subsequent opioid overdose, and the novel
application of ultrasound to visualize and aspirate the subcutaneous drug.
Ultrasonography can be used as an effective modality for rapid diagnosis and
treatment of an accidental pocket fill. © 2013 by American Society of
Regional Anesthesia and Pain Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (drug therapy, subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
gabapentin (drug therapy, oral drug administration)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aspiration
echography
intrathecal pump
EMTREE MEDICAL INDEX TERMS
aged
ambulatory care
anxiety
article
blood pressure
breathing rate
case report
consciousness
depression
emergency health service
emergency ward
female
heart rate
human
hypopnea index
low back pain
medical history
morbid obesity
oxygen saturation
postoperative pain (drug therapy)
prediction
priority journal
somnolence
syringe
DEVICE TRADE NAMES
8840 SynchroMed II B, Model 8637-40 , United StatesMedtronic
DEVICE MANUFACTURERS
(United States)Medtronic
CAS REGISTRY NUMBERS
gabapentin (60142-96-3)
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Radiology (14)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013781294
MEDLINE PMID
24121607 (http://www.ncbi.nlm.nih.gov/pubmed/24121607)
PUI
L370445750
DOI
10.1097/AAP.0000000000000008
FULL TEXT LINK
http://dx.doi.org/10.1097/AAP.0000000000000008
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 614
TITLE
Postobstructive pulmonary edema in a 40-year-old man after suffocation by a
swimming pool cover
AUTHOR NAMES
Tsung A.H.
Slish J.H.
Lisenbee N.P.
Allen B.R.
AUTHOR ADDRESSES
(Tsung A.H.; Slish J.H.; Lisenbee N.P.; Allen B.R.) Department of Emergency
Medicine, University of Florida Health, Gainesville, FL, United States.
CORRESPONDENCE ADDRESS
A.H. Tsung, 1329-SW 16 Street, Gainesville, FL 32610-0186, United States.
SOURCE
Journal of Emergency Medicine (2013) 45:5 (670-673). Date of Publication:
November 2013
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background Postobstructive pulmonary edema (POPE) is a form of sudden onset,
noncardiogenic pulmonary edema that can occur after the relief of an upper
airway obstruction. Objective Since POPE is an uncommon diagnosis made in
the emergency department (ED), this case is presented to increase emergency
physicians' awareness of the etiology, pathophysiology, and management of
this type of edema. Case Report This is a case of bilateral POPE in a
40-year-old man with no history of cardiac or pulmonary disease who
experienced near suffocation due to the vacuum effect of a swimming pool
cover. On presentation to the ED, the patient's symptoms included bilateral
pleuritic pain over the anterior chest, shortness of breath, and inspiratory
cough. He was tachycardic and tachypneic, with an oxygen saturation of 92%
on room air. Pertinent physical examination findings included shallow
breathing and right-sided rhonchi. The initial arterial blood gas on room
air demonstrated a PaO(2)/FiO (2) ratio of 304 mm Hg. Cardiac enzymes and
the electrocardiogram result were normal. The patient's chest radiograph was
interpreted as having marked bilateral pulmonary edema. The patient was
admitted to the Medicine Intensive Care Unit and placed on noninvasive
positive pressure ventilation (NIPPV). The patient was clinically
asymptomatic and was discharged after 72 h. Conclusions Emergency physicians
should consider the diagnosis of POPE in a symptomatic patient if there is
evidence of pulmonary edema immediately after a history of hanging,
suffocation, strangulation, choking, naloxone administration, or other forms
of upper airway obstruction. Rapid initiation of NIPPV with or without
diuretics, steroids, or fluid restriction can lead to symptom resolution
within 24 to 48 h. Copyright © 2013 Elsevier Inc.
EMTREE DRUG INDEX TERMS
diuretic agent (drug therapy)
steroid (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
lung edema (drug therapy, complication, diagnosis, drug therapy, etiology,
therapy)
postobstructive pulmonary edema (drug therapy, complication, diagnosis, drug
therapy, etiology, therapy)
suffocation
EMTREE MEDICAL INDEX TERMS
adult
article
case report
coughing
dyspnea
emergency ward
human
intensive care unit
male
oxygen saturation
pathophysiology
pleurisy
positive end expiratory pressure
priority journal
swimming pool
symptomatology
tachycardia
tachypnea
thorax radiography
upper respiratory tract obstruction
vacuum
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013690666
MEDLINE PMID
23993938 (http://www.ncbi.nlm.nih.gov/pubmed/23993938)
PUI
L52752320
DOI
10.1016/j.jemermed.2013.04.045
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2013.04.045
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 615
TITLE
“Healthcare Cost, Quality, and Policy: Driving Stakeholder Innovation in
Process and Practice”
AUTHOR ADDRESSES
SOURCE
Journal of Population Therapeutics and Clinical Pharmacology (2014) 21:1
(e116). Date of Publication: 5 Apr 2014
CONFERENCE NAME
“Healthcare Cost, Quality, and Policy: Driving Stakeholder Innovation in
Process and Practice”
CONFERENCE LOCATION
Toronto, ON, Canada
CONFERENCE DATE
2013-11-17 to 2013-11-19
ISSN
1710-6222
BOOK PUBLISHER
Canadian Society of Pharmacology and Therapeutics
ABSTRACT
The proceedings contain 62 papers. The special focus in this conference is
on Stakeholders Innovation in Process and Practice. The topics include:
Psychotropic medication use and 10-year incident fracture risk in men and
women ages 50 and older in the population-based Canadian multicentre
osteoporosis study (CaMoS); the impact of recent generic drug price policies
on pharmaceutical innovation; a qualitative assessment of patients’ beliefs
about adherence to oral anti-diabetes drug treatment; current management and
associated cost of metastatic castration-resistant prostate cancer in
Canada; glucocorticoid-induced osteoporosis management among seniors; time
series methods applied in drug utilization research; methods for survival
extrapolation within costeffectiveness analyses that address concerns raised
in pCODR reviews; use of product listing agreements by Canadian provincial
drug benefit plans; development and validation of severity criteria for
drug-related problems in chronic kidney disease patients; population-level
costs and resource utilization of homecare for persons with Alzheimer’s
disease; appraisal of non-inferiority margins in assessing study quality;
safety and effectiveness of dabigatran versus warfarin in economic
evaluations; comparative gastrointestinal safety of bisphosphonates; cost
effectiveness of a systematic guidelines-based approach to the prevention
and management of vascular disease in a primary care setting;
hospitalization for hemorrhage among warfarin recipients prescribed
amiodarone; creation of a reference set of the health preference values in
oncology; systematic review of cost-of-illness studies in chronic ulcer
population; the health care resource utilization of recently spinal cord
injured; implementation and evaluation of pharmacy services through a
practice-based research network (PBRN); consistencies in cancer therapy
reimbursement recommendations made in Canada, Australia, Sweden, and United
Kingdom; cost-sharing for health care services; economic evaluation of
collagenase clostridium histolyticum injection for the treatment of
dupuytren’s contracture in Canada; the impact of ProFiL program on the
progression of chronic kidney disease (CKD) and its risk factors; the impact
of ProFiL program on the community pharmacists’ knowledge and competencies
and the quality of pharmacotherapy of their chronic kidney disease (CKD)
patients; a self-management program for osteoarthritis patients and primary
care clinicians supported by a group of interdisciplinary regional team of
clinicians; socio-economic status and non-adherence to antihypertensive
medications; antimalarial drug use during pregnancy and the risk of low
birth weight (LBW); validation of the telephone-administered Age and stage
questionnaire and the revised pre-screening Denver questionnaire; long-term
oral anticoagulant management associated with routine medical care (RMC) in
patients with Non-Valvular Atrial Fibrillation (NVAF) in Canada; estimation
of outpatient versus inpatient adverse drug reactions (ADRS) reporting using
ecology of medical care data; Cost-effectiveness analysis of apixaban
compared to warfarin for stroke prevention in atrial fibrillation (SPAF) in
Canada; Preliminary results of the impact of the use of pillbox on the
stabilization of the INR among patients initiating warfarin treatment from a
prospective cohort; Validity of self-reported regimen of dose by patient
initiating warfarin treatment from a prospective cohort; Cost-effectiveness
of insulin glargine versus sitagliptin in insulin naïve patients with type 2
diabetes mellitus; Transfusion-related costs before and after treatment with
azacitidine in higher-risk myelodysplastic syndrome; targeting postprandial
glucose (PPG) with the addition of a rapid acting meal time insulin is more
efficient to lower A1C after 12 weeks than optimization of basal insulin in
patients with type 2 diabetes (T2D); targeting breakfast for type 2 diabetes
(T2D) therapy appears more likely to succeed based on a subanalysis of START
and INSIGHT studies; prescribing pattern of novel oral anticoagulants
following regulatory approval for atrial fibrillation in Ontario, Canada;
retrospective study of persistence and healthcare costs among
opioid-dependent patients treated with buprenorphine/naloxone and methadone
using a large US Medicaid database; validation of a Canadian primary care
electronic medical record database; using anonymized longitudinal patient
data to monitor the impact of reimbursement policies on patient compliance;
potential impact of days supply errors in pharmacy data on measurement of
compliance with osteoporosis medications; the benefit of an automated step
therapy program to manage diabetes medication use meta-analysis of the use
of assisted reproductive technologies and the risk of multiple birth and
major congenital malformations; cost-effectiveness of a physician-nurse
supplementary triage assistance team (MDRNSTAT) in an Ontario academic
emergency department; diffusion of methodological innovation in
pharmacoepidemiology; time savings with trastuzumab subcutaneous (SC)
injection vs. trastuzumab intravenous (IV) infusion; Establishing a database
to prospectively track health technology assessments - a case study of the
pan-Canadian Oncology Drug Review (pCODR); lessons learned from the
dedicated oncology drug review process in Canada; interim results from the
burden of bowel dysfunction in spinal cord injury study; a comparison of
resource utilization and costs in patients with pemphigus and pemphigoid 6
months before and 6 months after rituximab treatment; utilization of
economic evaluations and organizational impact analysis in formulary
decision making; a survey of a local health integration network (LHIN) in
Ontario; anticoagulation control with daily low dose vitamin K to reduce
clinically adverse outcomes and INR variability; the early challenges of
facilitating the transformation of interprofessional practices to prevent
cardiovascular diseases in primary care; impact of mandatory generic
substitution policies on Canadian private payer drug plan costs and
patients; using retrospective chart review methodology to characterize
patients, treatment patterns and resource utilization in a cohort of
patients with multicentric castleman’s disease; costs and survival of
patients with metastatic melanoma; homecare utilization and costs in
colorectal cancer; exploring homecare services for persons with Alzheimer’s
disease; drug utilization and safety evaluations; facilitation in primary
care and physician experience with rituximab to treat pemphigus vulgaris in
Canada.
EMTREE DRUG INDEX TERMS
amiodarone
anticoagulant agent
antihypertensive agent
antimalarial agent
apixaban
azacitidine
bisphosphonic acid derivative
buprenorphine plus naloxone
clostridiopeptidase A
dabigatran
generic drug
glucocorticoid
glucose
insulin
insulin glargine
methadone
opiate
rituximab
sitagliptin
trastuzumab
vitamin K group
warfarin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
policy
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
adverse outcome
anticoagulation
atrial fibrillation
Australia
bleeding
Canada
cancer therapy
cardiovascular disease
case study
castration resistant prostate cancer
cerebrovascular accident
chronic kidney failure
colorectal cancer
congenital malformation
contracture
cost
cost effectiveness analysis
cost of illness
data base
decision making
diabetes mellitus
diffusion
drug therapy
drug use
drug utilization
ecology
economic evaluation
electronic medical record
emergency health service
emergency ward
feeding behavior
female
fracture
health
health care
health service
home care
hospital department
hospital patient
hospitalization
human
injection
international normalized ratio
intestine
intravenous drug administration
low birth weight
low drug dose
male
meal
medicaid
medical care
medical record review
meta analysis
meta analysis (topic)
metastatic melanoma
methodology
myelodysplastic syndrome
non insulin dependent diabetes mellitus
nurse
oncology
osteoarthritis
osteoporosis
outpatient
patient
patient coding
patient compliance
pemphigoid
pemphigus
pemphigus vulgaris
pharmacist
pharmacoepidemiology
pharmacy
physician
population
pregnancy
prevention
primary medical care
publication
questionnaire
recipient
reimbursement
retrospective study
risk
risk factor
safety
screening
self care
spinal cord
spinal cord injury
subcutaneous drug administration
survival
Sweden
systematic review
systematic review (topic)
technology
telephone
therapy
time series analysis
transfusion
ulcer
United Kingdom
validity
vascular disease
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
PUI
L75005894
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 616
TITLE
Association between opioid use and health care utilization as measured by
emergency room visits and hospitalizations among persons living with HIV
AUTHOR NAMES
Koeppe J.
Lyda K.
Armon C.
AUTHOR ADDRESSES
(Koeppe J., john.koeppe@ucdenver.edu) Division of General Internal Medicine,
School of Medicine, University of Colorado, Aurora, CO, United States.
(Lyda K.) Department of Medicine, School of Medicine, University of
Colorado, Aurora, CO, United States.
(Armon C.) Department of Epidemiology, Children's Hospital, Aurora, CO,
United States.
CORRESPONDENCE ADDRESS
J. Koeppe, Department of Medicine, School of Medicine, University of
Colorado, 1635 Aurora Court, F-729, Aurora, CO 80045, United States. Email:
john.koeppe@ucdenver.edu
SOURCE
Clinical Journal of Pain (2013) 29:11 (957-961). Date of Publication:
November 2013
ISSN
0749-8047
1536-5409 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
BACKGROUND: Epidemiologic studies in the non-human immunodeficiency virus
(HIV) positive population have shown greater health care utilization among
persons with chronic non-cancer pain on opioid therapy. However, we are not
aware of any similar data in the HIV positive population. METHODS: We
evaluated health care utilization, as measured by emergency room (ER) visits
and hospitalizations, among persons with HIV and chronic pain seen at an
academic medical center, during the calendar year 2005. We compared these
outcomes between patients on chronic opioid therapy with those not on
opioids. RESULTS: In univariate models chronic opioid therapy was associated
with both ER visits and hospitalization: ER visits odds ratio (OR)=2.18 (95%
confidence interval [CI], 1.30-3.66), hospitalization OR=1.90 (95% CI,
1.03-3.51). After multivariate analyses only nonsignificant trends remain:
ER visits OR=1.71 (95% CI, 0.95-3.08); hospitalization OR=1.28 (95% CI,
0.66-2.49). CONCLUSIONS: In our study HIV positive individuals with chronic
pain were more likely to be seen in the ER and be hospitalized if they were
on opioids. However, after controlling for other variables, the association
with opioids no longer remained significant. Copyright © 2013 by Lippincott
Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care utilization
hospitalization
Human immunodeficiency virus infection
EMTREE MEDICAL INDEX TERMS
adult
article
chronic pain (drug therapy)
emergency ward
female
human
major clinical study
male
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013644210
MEDLINE PMID
23370078 (http://www.ncbi.nlm.nih.gov/pubmed/23370078)
PUI
L52421136
DOI
10.1097/AJP.0b013e31827c7b05
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0b013e31827c7b05
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 617
TITLE
Bet 3: Is nebulised naloxone effective in opioid overdose?
AUTHOR NAMES
Ishiyama D.
AUTHOR ADDRESSES
(Ishiyama D.) Grand Rapids Medical Education Program, Michigan State
University, East Lansing, MI, United States.
CORRESPONDENCE ADDRESS
D. Ishiyama, Grand Rapids Medical Education Program, Michigan State
University, East Lansing, MI, United States.
SOURCE
Emergency Medicine Journal (2013) 30:10 (860). Date of Publication: October
2013
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
A shortcut review was carried out to establish whether nebulised naloxone is
a safe and effective alternative to intravenous naloxone in patients with
suspected opioid overdose. 18 papers were found using the reported searches,
of which two presented the best evidence to answer the clinical question.
The author, date and country of publication, patient group studied, study
type, relevant outcomes, results and study weaknesses of these papers are
tabulated. It is concluded that nebulised naloxone is a safe and effective
firstline alternative to parenteral naloxone in spontaneously breathing
patients with suspected opioid overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intramuscular drug administration, intranasal drug
administration, intravenous drug administration)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
opioid overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
breathing
case report
drug efficacy
drug overdose
drug safety
emergency ward
female
Glasgow coma scale
hepatitis C
human
intravenous drug abuse
nebulization
outcome assessment
pain
priority journal
publication
somnolence
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013601780
MEDLINE PMID
24014692 (http://www.ncbi.nlm.nih.gov/pubmed/24014692)
PUI
L369879422
DOI
10.1136/emermed-2013-203100.3
FULL TEXT LINK
http://dx.doi.org/10.1136/emermed-2013-203100.3
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 618
TITLE
The Economic Burden of Opioid-Related Poisoning in the United States
AUTHOR NAMES
Inocencio T.J.
Carroll N.V.
Read E.J.
Holdford D.A.
AUTHOR ADDRESSES
(Inocencio T.J.) Avalere Health, Washington, DC, United States.
(Carroll N.V.; Holdford D.A., daholdfo@vcu.edu) School of Pharmacy,
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth
University, Richmond, VA, United States.
(Read E.J.) School of Medicine, Department of Emergency Medicine, Virginia
Commonwealth University, Richmond, VA, United States.
CORRESPONDENCE ADDRESS
D.A. Holdford, School of Pharmacy, Department of Pharmacotherapy and
oOutcomes Science, Virginia Commonwealth University, 410 N 12th Street, P.O.
Box 980533, Richmond, VA 23298-0533, United States. Email: daholdfo@vcu.edu
SOURCE
Pain Medicine (United States) (2013) 14:10 (1534-1547). Date of Publication:
October 2013
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Objective: To estimate the yearly economic burden of opioid-related
poisoning in the United States. Background: Rates of opioid poisoning and
related mortality have increased substantially over the past decade.
Although previous studies have measured the costs of misuse and abuse, costs
related specifically to opioid poisoning have not been quantified. This
study quantifies the economic burden of opioid poisoning in the United
States to help evaluate the economic case for efforts to reverse or prevent
opioid poisoning and its associated morbidity and mortality. Methods: Mean
costs and prevalence estimates were estimated using publically available
datasets. A societal perspective was assumed and accordingly estimated
direct medical and productivity costs. Direct medical costs included
treatment for opioid poisoning in the emergency department (ED) and
inpatient settings, along with emergency transport and drug costs.
Productivity costs were estimated using the human capital method and
included lost wages due to mortality and absenteeism costs from ED visits
and hospitalizations. All costs were inflated to 2011 U.S. dollars. Results:
In 2009, total costs were estimated at approximately $20.4 billion with
indirect costs constituting 89% of the total. Direct medical costs were
approximately $2.2 billion. ED costs and inpatient costs were estimated to
be $800 million and $1.3 billion, respectively. Absenteeism costs were $335
million and lost future earnings due to mortality were $18.2 billion.
Conclusion: Opioid-related poisoning causes a substantial burden to the
United States each year. Costs related to mortality account for the majority
of costs. Interventions designed to prevent or reverse opioid-related
poisoning can have significant impacts on cost, especially where death is
prevented. © 2013 American Academy of Pain Medicine 14 10 October 2013
10.1111/pme.12183 OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION Original
Research Articles Original Research Article Wiley Periodicals, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
codeine (drug toxicity, pharmacoeconomics)
dextropropoxyphene (drug toxicity, pharmacoeconomics)
diamorphine (drug toxicity, pharmacoeconomics)
fentanyl (drug toxicity, pharmacoeconomics)
hydrocodone (drug toxicity, pharmacoeconomics)
hydromorphone (drug toxicity, pharmacoeconomics)
methadone (drug toxicity, pharmacoeconomics)
morphine (drug toxicity, pharmacoeconomics)
naloxone (drug toxicity, pharmacoeconomics)
narcotic analgesic agent (drug toxicity, pharmacoeconomics)
opiate derivative (drug toxicity, pharmacoeconomics)
oxycodone (drug toxicity, pharmacoeconomics)
psychedelic agent (drug toxicity, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (disease management, epidemiology)
health care cost
opioid poisoning (disease management, epidemiology)
EMTREE MEDICAL INDEX TERMS
absenteeism
adult
article
controlled study
cost benefit analysis
drug cost
economic aspect
emergency ward
hospital patient
hospitalization
human
major clinical study
morbidity
mortality
patient transport
prescription
prevalence
productivity
risk factor
society
United States
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013658722
MEDLINE PMID
23841538 (http://www.ncbi.nlm.nih.gov/pubmed/23841538)
PUI
L52677724
DOI
10.1111/pme.12183
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12183
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 619
TITLE
Toxicologic emergencies in the intensive care unit: Management using
reversal agents and antidotes
AUTHOR NAMES
Patel S.R.
AUTHOR ADDRESSES
(Patel S.R., sruti53@gmail.com) Emergency Department, John Peter Smith
Hospital, 1500 S Main St, Fort Worth, TX 76104, United States.
CORRESPONDENCE ADDRESS
S.R. Patel, Emergency Department, John Peter Smith Hospital, 1500 S Main St,
Fort Worth, TX 76104, United States. Email: sruti53@gmail.com
SOURCE
Critical Care Nursing Quarterly (2013) 36:4 (335-344). Date of Publication:
October-December 2013
ISSN
0887-9303
1550-5111 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
PURPOSE:: To review the most common drugs implicated in overdoses admitted
to the intensive care unit focusing on antidotes and reversal agents used in
their management. SUMMARY:: Poisonings and overdoses due to pharmaceutical
agents result in more than 100 000 critical care unit admissions each year.
Ingestion of toxic alcohols, calcium channel blockers, beta-adrenergic
antagonists, benzodiazepines, opioids, acetaminophen, tricyclic
antidepressants, and salicylates are associated with a high rate of
morbidity and mortality. Reviewing the mechanism of toxicity due to specific
agents along with the mechanism of action, dosing, and adverse effects of
appropriate antidotes is important for the successful management of these
patients within the critical care unit. CONCLUSION:: Understanding the most
prevalent overdoses and their management using reversal agents and antidotes
is essential to the overall treatment of these critically ill patients.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug development, drug therapy, intravenous drug administration,
oral drug administration, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (adverse drug reaction, drug comparison, drug therapy,
pharmacology)
acetylcysteine (adverse drug reaction, drug administration, drug therapy,
intravenous drug administration, oral drug administration)
acetylsalicylic acid (pharmacokinetics)
alcohol (drug comparison, drug toxicity, pharmacology)
alcohol derivative
atropine (drug development, drug therapy)
benzodiazepine derivative (drug toxicity, pharmacology)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (pharmacology)
bupivacaine (drug toxicity)
calcium (drug development, drug therapy)
calcium channel blocking agent
flumazenil (pharmacology)
glucagon (pharmacology)
glucose
hypertensive factor
insulin
lipid emulsion (adverse drug reaction, drug development, drug therapy,
intravenous drug administration, pharmacology)
local anesthetic agent (drug toxicity)
naloxone (pharmacokinetics, pharmacology)
opiate
paracetamol (drug toxicity)
pig insulin (drug administration)
placebo
salicylic acid (drug toxicity)
salicylic acid derivative (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
verapamil (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
add on therapy
alcohol intoxication (drug therapy)
anaphylaxis (side effect)
continuous infusion
critically ill patient
dizziness (side effect)
drowsiness (side effect)
drug mechanism
drug overdose
fat embolism (side effect)
fulminant hepatic failure (drug therapy)
headache (side effect)
hospital readmission
human
hyperinsulinemia
hyperlipidemia (side effect)
intensive care unit
loading drug dose
morbidity
mortality
nausea (side effect)
nausea and vomiting (side effect)
nonhuman
review
taste disorder (side effect)
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bupivacaine (18010-40-7, 2180-92-9, 38396-39-3, 55750-21-5)
calcium (14092-94-5, 7440-70-2)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pig insulin (12584-58-6)
salicylic acid (63-36-5, 69-72-7)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013584084
MEDLINE PMID
24002424 (http://www.ncbi.nlm.nih.gov/pubmed/24002424)
PUI
L369826189
DOI
10.1097/CNQ.0b013e3182a10cbd
FULL TEXT LINK
http://dx.doi.org/10.1097/CNQ.0b013e3182a10cbd
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 620
TITLE
Pediatric office emergencies
AUTHOR NAMES
Fuchs S.
AUTHOR ADDRESSES
(Fuchs S., s-fuchs@northwestern.edu) Division of Emergency Medicine, Ann and
oRobert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue,
Box 62, Chicago, IL 60611, United States.
CORRESPONDENCE ADDRESS
S. Fuchs, Division of Emergency Medicine, Ann and oRobert H. Lurie
Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL
60611, United States. Email: s-fuchs@northwestern.edu
SOURCE
Pediatric Clinics of North America (2013) 60:5 (1153-1161). Date of
Publication: October 2013
ISSN
0031-3955
1557-8240 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Pediatricians regularly see emergencies in the office, or children that
require transfer to an emergency department, or hospitalization. An office
self-assessment is the first step in determining how to prepare for an
emergency. The use of mock codes and skill drills make office personnel feel
less anxious about medical emergencies. Emergency information forms provide
valuable, quick information about complex patients for emergency medical
services and other physicians caring for patients. Furthermore, disaster
planning should be part of an office preparedness plan. © 2013 Elsevier Inc.
EMTREE DRUG INDEX TERMS
activated carbon (oral drug administration)
ceftriaxone (intramuscular drug administration)
dexamethasone (oral drug administration)
diazepam (rectal drug administration)
diphenhydramine (intravenous drug administration)
epinephrine (drug therapy, intramuscular drug administration, intravenous
drug administration, subcutaneous drug administration)
glucagon (drug therapy)
hydrocortisone (drug therapy)
ibuprofen (oral drug administration)
lorazepam (intravenous drug administration)
methylprednisolone (oral drug administration)
naloxone (intramuscular drug administration)
oxygen
paracetamol (oral drug administration, rectal drug administration)
salbutamol (inhalational drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
pediatric hospital
pediatrics
EMTREE MEDICAL INDEX TERMS
allergic reaction (drug therapy)
anaphylaxis (drug therapy)
bag mask ventilation
breathing disorder
cardiac resuscitator
clinical competence
coding
congenital adrenal hyperplasia (drug therapy)
cyanosis
defibrillator
disaster planning
face mask
fever
first aid
health care personnel
human
hypoglycemia (drug therapy)
hypopituitarism (drug therapy)
intravenous catheter
laryngeal mask
lethargy
life support equipment
mask
medical education
metered dose inhaler
mock code
nasogastric tube
pediatric advanced life support
pediatrician
pulse oximeter
rapid response team
respiration control
review
seizure
self evaluation
sphygmomanometer
splint
suction
test strip
urine reagent strip test
Yankauer suction catheter
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
ceftriaxone (73384-59-5, 74578-69-1)
dexamethasone (50-02-2)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydrocortisone (50-23-7)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
paracetamol (103-90-2)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013615071
MEDLINE PMID
24093901 (http://www.ncbi.nlm.nih.gov/pubmed/24093901)
PUI
L52684481
DOI
10.1016/j.pcl.2013.06.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pcl.2013.06.008
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 621
TITLE
Management of the poisoned patient
AUTHOR NAMES
McGlone M.M.
Teece S.C.
AUTHOR ADDRESSES
(McGlone M.M.; Teece S.C.) Monklands District General Hospital, Airdrie,
United Kingdom.
CORRESPONDENCE ADDRESS
Monklands District General Hospital, Airdrie, United Kingdom.
SOURCE
Anaesthesia and Intensive Care Medicine (2013) 14:10 (453-456). Date of
Publication: October 2013
ISSN
1472-0299
1878-7584 (electronic)
BOOK PUBLISHER
Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom.
ABSTRACT
Poisoning is a common reason for attendance to emergency departments,
medical assessment and critical care areas. This in the main is due to
deliberate self-harm. However, there is an increasing concern that toxins
may be deliberately released as part of a terrorist attack. In many cases it
can be unclear from the history the exact toxins responsible. Knowledge of
toxidromes, a group of symptom clusters identified by the receptors
targeted, may guide further management. Management of overdose utilizes
methods of gastric decontamination to prevent toxin absorption along with
supportive measures for the patient and, where available, the use of
specific antidotes. In the response to deliberate release toxins there is a
risk to treating staff by contamination with the poisons used. Key to the
management is the use of personal protective equipment and the
decontamination of casualties before invasive medical care begins. There are
a small number of expected chemical agents likely to be used in deliberate
release; each has its own clinical characteristics and management. © 2013
Elsevier Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy)
acetylcysteine (drug therapy)
alcohol (drug therapy)
antidote (drug therapy)
atropine (drug therapy)
bicarbonate (drug therapy)
calcium (drug therapy)
charcoal (drug therapy)
cobalt edetate (drug therapy)
deferoxamine (drug therapy)
digoxin antibody (drug therapy)
edetate calcium disodium (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
glucose (drug therapy)
hydroxocobalamin (drug therapy)
insulin (drug therapy)
naloxone (drug therapy)
ovalbumin (drug therapy)
pralidoxime (drug therapy)
sodium nitrite (drug therapy)
sodium thiosulfate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
article
gastric decontamination
human
oxygen therapy
priority journal
stomach lavage
therapy
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (14092-94-5, 7440-70-2)
charcoal (16291-96-6)
cobalt edetate (14931-83-0, 36499-65-7)
deferoxamine (70-51-9)
edetate calcium disodium (62-33-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
ovalbumin (77466-29-6)
pralidoxime (6735-59-7)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013602542
PUI
L369881167
DOI
10.1016/j.mpaic.2013.07.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.mpaic.2013.07.010
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 622
TITLE
Benzodiazepine use during buprenorphine treatment for opioid dependence:
Clinical and safety outcomes
AUTHOR NAMES
Schuman-Olivier Z.
Hoeppner B.B.
Weiss R.D.
Borodovsky J.
Shaffer H.J.
Albanese M.J.
AUTHOR ADDRESSES
(Schuman-Olivier Z., zschuman@partners.org; Hoeppner B.B.; Weiss R.D.;
Shaffer H.J.; Albanese M.J.) Harvard Medical School, United States.
(Schuman-Olivier Z., zschuman@partners.org; Hoeppner B.B.) Massachussets
General Hospital, United States.
(Borodovsky J.) Tufts University, United States.
(Weiss R.D.) McLean Hospital, United States.
(Borodovsky J.; Shaffer H.J.; Albanese M.J.) Cambridge Health Alliance,
United States.
CORRESPONDENCE ADDRESS
Z. Schuman-Olivier, Center for Addiction Medicine, Massachusetts General
Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA
02114, United States. Email: zschuman@partners.org
SOURCE
Drug and Alcohol Dependence (2013) 132:3 (580-586). Date of Publication: 1
Oct 2013
ISSN
0376-8716
1879-0046 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: Prescribing benzodiazepines during buprenorphine treatment is a
topic of active discussion. Clinical benefit is unclear. Overdose,
accidental injury, and benzodiazepine misuse remain concerns. We examine the
relationship between benzodiazepine misuse history, benzodiazepine
prescription, and both clinical and safety outcomes during buprenorphine
treatment. Methods: We retrospectively examined outpatient buprenorphine
treatment records, classifying patients by past-year benzodiazepine misuse
history and approved benzodiazepine prescription at intake. Primary clinical
outcomes included 12-month treatment retention and urine toxicology for
illicit opioids. Primary safety outcomes included total emergency department
(ED) visits and odds of an ED visit related to overdose or accidental injury
during treatment. Results: The 12-month treatment retention rate for the
sample (N=328) was 40%. Neither benzodiazepine misuse history nor
benzodiazepine prescription was associated with treatment retention or
illicit opioid use. Poisson regressions of ED visits during buprenorphine
treatment revealed more ED visits among those with a benzodiazepine
prescription versus those without (p<0.001); benzodiazepine misuse history
had no effect. The odds of an accidental injury-related ED visit during
treatment were greater among those with a benzodiazepine prescription (OR:
3.7, p<. 0.01), with an enhanced effect among females (OR: 4.7, p<. 0.01).
Overdose was not associated with benzodiazepine misuse history or
prescription. Conclusions: We found no effect of benzodiazepine
prescriptions on opioid treatment outcomes; however, benzodiazepine
prescription was associated with more frequent ED visits and accidental
injuries, especially among females. When prescribing benzodiazepines during
buprenorphine treatment, patients need more education about accidental
injury risk. Alternative treatments for anxiety should be considered when
possible, especially among females. © 2013 Elsevier Ireland Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine (drug toxicity)
buprenorphine (drug therapy)
EMTREE DRUG INDEX TERMS
illicit drug (adverse drug reaction)
opiate (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
accidental injury
adult
article
controlled study
drug efficacy
drug misuse
drug overdose
drug safety
emergency care
female
human
major clinical study
male
nephrotoxicity (side effect)
outpatient
patient compliance
prescription
priority journal
treatment duration
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013561986
MEDLINE PMID
23688843 (http://www.ncbi.nlm.nih.gov/pubmed/23688843)
PUI
L52588499
DOI
10.1016/j.drugalcdep.2013.04.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2013.04.006
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 623
TITLE
Benzodiazepines in Long-Term Opioid Therapy
AUTHOR NAMES
Reisfield G.M.
Webster L.R.
AUTHOR ADDRESSES
(Reisfield G.M.) Pain Management Services, Divisions of Addiction Medicine
and Forensic Psychiatry, Department of Psychiatry, University of Florida
College of Medicine, Gainesville, FL, United States.
(Webster L.R.) American Academy of Pain Medicine, United States.
(Webster L.R.) CRI Lifetree, Salt Lake City, UT, United States.
CORRESPONDENCE ADDRESS
G.M. Reisfield, Pain Management Services, Divisions of Addiction Medicine
and Forensic Psychiatry, Department of Psychiatry, University of Florida
College of Medicine, Gainesville, FL, United States.
SOURCE
Pain Medicine (United States) (2013) 14:10 (1441-1446). Date of Publication:
October 2013
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative
EMTREE DRUG INDEX TERMS
alprazolam
antidepressant agent
benzodiazepine
methadone
morphine (oral drug administration)
muscle relaxant agent
opiate
prescription drug
sedative agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
long term care
long term opioid therapy
EMTREE MEDICAL INDEX TERMS
anxiety disorder
apnea hypopnea index
article
central sleep apnea syndrome
chronic pain
confusion
depression
drug monitoring
emergency ward
falling
generalized anxiety disorder
hip fracture
human
insomnia
low drug dose
major depression
mood disorder
morbidity
mortality
panic
posttraumatic stress disorder
sleep disordered breathing
substance abuse
traffic accident
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
benzodiazepine (12794-10-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013658712
MEDLINE PMID
24010730 (http://www.ncbi.nlm.nih.gov/pubmed/24010730)
PUI
L52770741
DOI
10.1111/pme.12236
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12236
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 624
TITLE
Opioid prescribing guidelines for Oklahoma emergency departments (ED) and
urgent care clinics (UCC).
AUTHOR NAMES
Brandenburg M.A.
Subera L.
Doran-Redus A.
Archer P.
Oklahoma Workgroup
AUTHOR ADDRESSES
(Brandenburg M.A., mbrand2435@aol.com) Bristow Medical Center, 700 W. 7th
St., Bristow, Oklahoma 74010, USA.
(Subera L.; Doran-Redus A.; Archer P.; Oklahoma Workgroup)
CORRESPONDENCE ADDRESS
M.A. Brandenburg, Bristow Medical Center, 700 W. 7th St., Bristow, Oklahoma
74010, USA. Email: mbrand2435@aol.com
SOURCE
The Journal of the Oklahoma State Medical Association (2013) 106:10
(391-397). Date of Publication: Oct 2013
ISSN
0030-1876
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
emergency health service
outpatient department
EMTREE MEDICAL INDEX TERMS
article
human
inappropriate prescribing
practice guideline
standard
statistics
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24404674 (http://www.ncbi.nlm.nih.gov/pubmed/24404674)
PUI
L372447877
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 625
TITLE
Coma, metabolic acidosis, and methemoglobinemia in a patient with
acetaminophen toxicity
AUTHOR NAMES
Kanji H.D.
Mithani S.
Boucher P.
Dias V.C.
Yarema M.C.
AUTHOR ADDRESSES
(Kanji H.D.) Department of Critical Care Medicine, University of British
Columbia, Vancouver, BC, Canada.
(Kanji H.D.; Mithani S.; Yarema M.C., mark.yarema@albertahealthservices.ca)
Department of Emergency Medicine, University of Alberta, Edmonton, AB,
Canada.
(Boucher P.; Yarema M.C., mark.yarema@albertahealthservices.ca) Department
of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
(Dias V.C.) Department of Pathology and Laboratory Medicine, University of
Calgary, Calgary, AB, Canada.
(Yarema M.C., mark.yarema@albertahealthservices.ca) Department of Emergency
Medicine, University of Calgary, Calgary, AB, Canada.
(Yarema M.C., mark.yarema@albertahealthservices.ca) Department of Physiology
and Pharmacology, University of Calgary, Calgary, AB, Canada.
(Yarema M.C., mark.yarema@albertahealthservices.ca) Poison and Drug
Information Service, Alberta Health Services, Calgary, AB, Canada.
CORRESPONDENCE ADDRESS
M. C. Yarema, Department of Emergency Medicine, University of Alberta,
Edmonton, AB, Canada. Email: mark.yarema@albertahealthservices.ca
SOURCE
Journal of Population Therapeutics and Clinical Pharmacology (2013) 20:3
(e207-e211). Date of Publication: 2013
ISSN
1710-6222
BOOK PUBLISHER
Canadian Soceity of Clinical Pharmacology, St. Joseph's Healthcare Hamilton,
105 Main Street E. Level 1. Hamilton, Ontario, Canada.
ABSTRACT
We present a case of early coma, metabolic acidosis and methemoglobinemia
after substantial acetaminophen toxicity in the absence of hepatic failure.
A 77-year-old female presented to the emergency department with a decreased
level of consciousness. She was found unresponsive by a family member in her
bed, and was reported to be acting normally when she was last seen eight
hours earlier. Laboratory results on arrival were: pH 7.19, sodium 139
mmol/L, chloride 106 mmol/L, potassium 3.3 mmol/L, CO(2) 8 mmol/L, and an
anion gap of 25. Both venous lactate (10.2 mmol/L) and methemoglobin (9.4 %)
were elevated. The patient's acetaminophen concentration was markedly
elevated at 7138 μmol/L (1078 μg/ml). Hepatic enzymes and coagulation tests
were normal [alanine transaminase (ALT) 8 U/L, international normalized
ratio (INR) 1.0]. Intravenous N-acetylcysteine (NAC) was initiated at a dose
of 150 mg/kg over 15 minutes, followed by 50 mg/kg over the next four hours,
followed by 100 mg/kg over the next 16 hours. Twenty-four hours after
admission, the anion gap metabolic acidosis had resolved, and the
methemoglobin was 2.1%. Aminotransferases peaked at 44 U/L and INR peaked at
1.9. A urine 5-oxoproline assay performed five days after admission was
negative, suggesting no evidence of a 5-oxoprolinase deficiency. We describe
the pathophysiology and discuss the literature on acetaminophen-induced coma
and metabolic acidosis in the absence of hepatic injury; and propose
mechanisms for associated methemoglobinemia. © 2013 Canadian Society of
Pharmacology and Therapeutics. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
paracetamol (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy, intravenous drug administration)
alanine aminotransferase (endogenous compound)
ciprofloxacin (drug therapy)
lactic acid (endogenous compound)
methemoglobin (endogenous compound)
naloxone
noradrenalin
triacylglycerol lipase (endogenous compound)
zopiclone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
metabolic acidosis (drug therapy, drug therapy)
methemoglobinemia
EMTREE MEDICAL INDEX TERMS
aged
article
case report
consciousness disorder
female
human
international normalized ratio
Klebsiella
Klebsiella infection (drug therapy)
mass fragmentography
urine culture
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alanine aminotransferase (9000-86-6, 9014-30-6)
ciprofloxacin (85721-33-1)
lactic acid (113-21-3, 50-21-5)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
paracetamol (103-90-2)
triacylglycerol lipase (9001-62-1)
zopiclone (43200-80-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Hematology (25)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013591598
MEDLINE PMID
24077426 (http://www.ncbi.nlm.nih.gov/pubmed/24077426)
PUI
L369846443
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 626
TITLE
Randomized clinical trial of an intravenous hydromorphone titration protocol
versus usual care for management of acute pain in older emergency department
patients
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Davitt M.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K., achang3@yahoo.com; Bijur P.E.; Davitt M.; Gallagher E.J.)
Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein
College of Medicine Rosenthal, Red Zone, Bronx NY 10467, United States.
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Montefiore Medical Center,
Albert Einstein College of Medicine Rosenthal, Red Zone, Bronx NY 10467,
United States. Email: achang3@yahoo.com
SOURCE
Drugs and Aging (2013) 30:9 (747-754). Date of Publication: Septembert 2013
ISSN
1170-229X
1179-1969 (electronic)
BOOK PUBLISHER
Springer International Publishing AG, Gewerbestrasse 11, Cham (ZG),
Switzerland.
ABSTRACT
Background and Objectives: Opioid titration is an effective strategy for
treating pain; however, titration is generally impractical in the busy
emergency department (ED) setting. Our objective was to test a rapid,
two-step, hydromorphone titration protocol against usual care in older
patients presenting to the ED with acute severe pain. Methods: This was a
prospective, randomized clinical trial of patients 65 years of age and older
presenting to an adult, urban, academic ED with acute severe pain. The study
was registered at http://www.clinicaltrials.gov (NCT01429285). Patients
randomized to the hydromorphone titration protocol initially received 0.5 mg
intravenous hydromorphone. Patients randomized to usual care received any
dose of any intravenous opioid. At 15 min, patients in both groups were
asked, 'Do you want more pain medication?' Patients in the hydromorphone
titration group who answered 'yes' received a second dose of 0.5 mg
intravenous hydromorphone. Patients in the usual care group who answered
'yes' had their ED attending physician notified, who then could administer
any (or no) additional medication. The primary efficacy outcome was
satisfactory analgesia defined a priori as the patient declining additional
analgesia at least once when asked at 15 or 60 min after administration of
the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1
mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse
opioid effects was the primary safety outcome. Results: 83.0 % of 153
patients in the hydromorphone titration group achieved satisfactory
analgesia compared with 82.5 % of 166 patients in the usual care group (p =
0.91). Patients in the hydromorphone titration group received lower mean
initial doses of opioids at baseline than patients in the usual care group
(3.5 MEU vs. 4.7 MEU, respectively; p ≤ 0.001) and lower total opioids
through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone.
Conclusions: Low-dose titration of intravenous hydromorphone in increments
of 0.5 mg provides comparable analgesia to usual care with less opioid over
60 min. © 2013 Springer International Publishing Switzerland.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, clinical trial, drug comparison, drug
dose, drug therapy, intravenous drug administration)
morphine (adverse drug reaction, clinical trial, drug comparison, drug
therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency patient
emergency ward
geriatric patient
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
aged
analgesia
clinical protocol
controlled study
disease severity
drug dose increase
drug dose regimen
drug dose titration
drug efficacy
drug safety
female
human
hypotension (side effect)
low drug dose
major clinical study
male
nausea (side effect)
outcome assessment
oxygen blood level
pain assessment
patient care
patient satisfaction
priority journal
prospective study
pruritus (side effect)
randomized controlled trial
review
side effect (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Adverse Reactions Titles (38)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT01429285)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013544507
MEDLINE PMID
23846749 (http://www.ncbi.nlm.nih.gov/pubmed/23846749)
PUI
L369697134
DOI
10.1007/s40266-013-0103-y
FULL TEXT LINK
http://dx.doi.org/10.1007/s40266-013-0103-y
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 627
TITLE
A performance improvement prescribing guideline reduces opioid prescriptions
for emergency department dental pain patients
AUTHOR NAMES
Fox T.R.
Li J.
Stevens S.
Tippie T.
AUTHOR ADDRESSES
(Fox T.R.; Li J., jamesli@remotemedicine.org; Stevens S.; Tippie T.) Miles
Memorial Hospital, Department of Emergency Medicine, Damariscotta, ME,
United States.
CORRESPONDENCE ADDRESS
J. Li, Miles Memorial Hospital, Department of Emergency Medicine,
Damariscotta, ME, United States. Email: jamesli@remotemedicine.org
SOURCE
Annals of Emergency Medicine (2013) 62:3 (237-240). Date of Publication:
September 2013
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: In an effort to reduce prescription opioid abuse
originating from our institution, we implement and measure the effect of a
prescribing guideline on the rate of emergency department (ED) opioid
prescriptions written for patients presenting with dental pain, a complaint
previously associated with drug-seeking behavior. Methods: After
implementing a departmental guideline on controlled substance prescriptions,
we performed a structured before-and-after chart review of dental pain
patients aged 16 and older. Results: Before the guideline, the rate of
opioid prescription was 59% (302/515). After implementation, the rate was
42% (65/153). The absolute decrease in rates was 17% (95% confidence
interval 7% to 25%). Additionally, in comparing the 12-month period before
and after implementation, the dental pain visit rate decreased from 26 to 21
per 1,000 ED visits (95% confidence interval of decrease 2 to 9
visits/1,000). Conclusion: A performance improvement program involving a
departmental prescribing guideline was associated with a reduction in the
rate of opioid prescriptions and visits for ED patients presenting with
dental pain. © 2013 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
tooth pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
female
human
major clinical study
male
medical record review
practice guideline
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013532703
MEDLINE PMID
23374416 (http://www.ncbi.nlm.nih.gov/pubmed/23374416)
PUI
L52415878
DOI
10.1016/j.annemergmed.2012.11.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2012.11.020
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 628
TITLE
Multidisciplinary intervention decreases the use of opioid medication
discharge packs from 2 urban EDs
AUTHOR NAMES
Gugelmann H.
Shofer F.S.
Meisel Z.F.
Perrone J.
AUTHOR ADDRESSES
(Gugelmann H., hallamg@gmail.com; Shofer F.S.; Meisel Z.F.; Perrone J.)
Department of Emergency Medicine, Hospital of the University of
Pennsylvania, 3400 Spruce St, Ground Silverstein, Philadelphia, PA 19140,
United States.
CORRESPONDENCE ADDRESS
H. Gugelmann, Department of Emergency Medicine, Hospital of the University
of Pennsylvania, 3400 Spruce St, Ground Silverstein, Philadelphia, PA 19140,
United States. Email: hallamg@gmail.com
SOURCE
American Journal of Emergency Medicine (2013) 31:9 (1343-1348). Date of
Publication: September 2013
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Prescription opioid overdoses and deaths constitute a public health
epidemic, and recent studies show that emergency department (ED) prescribers
may contribute to this crisis. We hypothesized that a multidisciplinary
educational intervention would decrease ED opioid packs dispensed at
discharge. Methods: This prospective study implemented a "bundle" of
interdisciplinary educational modalities: lectures, journal clubs, case
discussions, and an electronic medical record decision support tool.
Implementation occurred in 2 urban EDs in the same health system at
different times ("affiliate," September 2011; "primary," January 2012) to
better distinguish its effects. The primary outcome was
preintervention/postintervention change in opioid discharge packs dispensed
to all patients treated and discharged through August 2012 and was assessed
by 2-way analysis of variance. The secondary outcome was bivariate analysis
(using Fisher exact test) of change in opioid dispensing among patients with
known risk factors for prescription opioid dependence: age less than 65
years, history of substance abuse, chronic pain, or psychiatric disorders.
Results: A total of 71,512 and 45,746 patients were evaluated and discharged
from primary and affiliate EDs, respectively. Orders for opioid discharge
packs decreased from 13.9% to 8.4% and 4.7% to 1.9% at the primary and
affiliate hospitals (P <.0001). Dispensing among individuals at risk for
opioid dependence at the primary ED decreased from 21.8% to 13.9%.
Conclusions: A staged, multidisciplinary intervention targeting nurses,
residents, nurse practitioners, and attending physicians was associated with
decreased orders for opioid discharge packs in 2 urban EDs. Opioid discharge
pack orders decreased slightly more among patients with risk factors for
prescription opioid dependence. © 2013 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
oxycodone plus paracetamol
psychotropic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health education
medical information system
prescription
EMTREE MEDICAL INDEX TERMS
adult
aged
article
bivariate analysis
chronic pain
clinical practice
decision support system
drug misuse
electronic medical record
emergency health service
emergency ward
female
hospital discharge
human
major clinical study
male
opiate addiction (etiology)
practice guideline
priority journal
risk factor
urban area
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013570364
MEDLINE PMID
23906621 (http://www.ncbi.nlm.nih.gov/pubmed/23906621)
PUI
L52705984
DOI
10.1016/j.ajem.2013.06.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2013.06.002
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 629
TITLE
Side effects from oral opioids in older adults during the first week of
treatment for acute musculoskeletal pain
AUTHOR NAMES
Hunold K.M.
Esserman D.A.
Isaacs C.G.
Dickey R.M.
Pereira G.F.
Fillingim R.B.
Sloane P.D.
McLean S.A.
Platts-Mills T.F.
AUTHOR ADDRESSES
(McLean S.A.; Platts-Mills T.F., tplattsm@med.unc.edu) Department of
Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill,
NC, United States.
(Dickey R.M.; Pereira G.F.; McLean S.A.; Platts-Mills T.F.,
tplattsm@med.unc.edu) Department of Anesthesiology, University of North
Carolina Chapel Hill, Chapel Hill, NC, United States.
(Hunold K.M.; Esserman D.A.) Department of Biostatistics, University of
North Carolina Chapel Hill, Chapel Hill, NC, United States.
(Esserman D.A.) Division of General Medicine and Clinical Epidemiology,
University of North Carolina Chapel Hill, Chapel Hill, NC, United States.
(Isaacs C.G.) School of Medicine, University of North Carolina Chapel Hill,
Chapel Hill, NC, United States.
(Sloane P.D.) Department of Family Medicine, University of North Carolina
Chapel Hill, Chapel Hill, NC, United States.
(Fillingim R.B.) College of Dentistry, University of Florida, Gainesville,
FL, United States.
CORRESPONDENCE ADDRESS
T.F. Platts-Mills, Department of Emergency Medicine, University of North
Carolina Chapel Hill, Chapel Hill, NC, United States. Email:
tplattsm@med.unc.edu
SOURCE
Academic Emergency Medicine (2013) 20:9 (873-879). Date of Publication:
September 2013
ISSN
1069-6563
1553-2712 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives The authors sought to describe the frequency of short-term side
effects experienced by older adults initiating treatment with
opioid-containing analgesics for acute musculoskeletal pain. Methods This
was a cross-sectional study of individuals age 65 years or older initiating
analgesic treatment following emergency department (ED) visits for acute
musculoskeletal pain. Patients were called by phone 4 to 7 days after their
ED visits to assess the intensity of six common opioid-related side effects
using a 0 to 10 scale and to assess medication discontinuation due to side
effects. Propensity score matching was used to compare side effects among
patients initiating treatment with any opioid-containing analgesics to side
effects among those initiating treatment with only nonopioids. Results Of
104 older patients initiating analgesic treatment following ED visits for
musculoskeletal pain, 71 patients took opioid-containing analgesics, 15 took
acetaminophen, and 18 took ibuprofen. Among the patients who took opioids,
at least one side effect of moderate or severe intensity (score ≥ 4) was
reported by 62%. Among patients with matching propensity scores, those
taking opioids were more likely to have had moderate or severe side effects
than those taking only nonopioids (62%, 95% confidence interval [CI] = 48%
to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have
discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%,
95% CI = 0% to 13%). The most common side effects due to opioids were
tiredness, nausea, and constipation. Conclusions Among older adults
initiating treatment with opioid-containing analgesics for musculoskeletal
pain, side effects were common and sometimes resulted in medication
discontinuation. © 2013 by the Society for Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate derivative (adverse drug reaction, drug therapy, oral drug
administration)
EMTREE DRUG INDEX TERMS
nonsteroid antiinflammatory agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute disease (drug therapy, drug therapy)
adult disease (drug therapy, drug therapy)
drug induced disease (side effect, side effect)
musculoskeletal pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
aged
article
constipation (side effect)
controlled study
cross-sectional study
dizziness (side effect)
fatigue (side effect)
female
human
male
nausea (side effect)
priority journal
unsteadiness (side effect)
vomiting (side effect)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013598997
MEDLINE PMID
24033733 (http://www.ncbi.nlm.nih.gov/pubmed/24033733)
PUI
L52751082
DOI
10.1111/acem.12212
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12212
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 630
TITLE
Relationship of opioid prescription sales and overdoses, North Carolina
AUTHOR NAMES
Modarai F.
Mack K.
Hicks P.
Benoit S.
Park S.
Jones C.
Proescholdbell S.
Ising A.
Paulozzi L.
AUTHOR ADDRESSES
(Modarai F., vqy8@cdc.gov; Mack K.; Jones C.; Paulozzi L.) Centers for
Disease Control and Prevention, National Center for Injury Prevention and
Control, Division of Unintentional Injury Prevention, 4770 Buford Hwy,
Mailstop F-62, Atlanta, GA 30341, United States.
(Hicks P.; Benoit S.; Park S.) Centers for Disease Control and Prevention,
Public Health Surveillance and Informatics Program Office, Office of
Surveillance, Epidemiology, Laboratory Services, 4770 Buford Hwy, Atlanta,
GA 30341, United States.
(Proescholdbell S.) North Carolina Division of Public Health, Chronic
Disease and Injury Section, Injury and Violence Prevention Branch, 5605 Six
Forks Road, Raleigh, NC 27609, United States.
(Ising A.) Carolina Center for Health Informatics, UNC Department of
Emergency Medicine, 170 Manning Drive, Chapel Hill, NC 27599, United States.
(Park S.) McKing Consulting Corporation, 2810 Old Lee Highway, Suite 300,
Fairfax, VA 22031, United States.
CORRESPONDENCE ADDRESS
F. Modarai, Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control, Division of Unintentional Injury Prevention,
4770 Buford Hwy, Mailstop F-62, Atlanta, GA 30341, United States. Email:
vqy8@cdc.gov
SOURCE
Drug and Alcohol Dependence (2013) 132:1-2 (81-86). Date of Publication: 1
Sep 2013
ISSN
0376-8716
1879-0046 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: In the United States, fatal drug overdoses have tripled since
1991. This escalation in deaths is believed to be driven primarily by
prescription opioid medications. This investigation compared trends and
patterns in sales of opioids, opioid drug overdoses treated in emergency
departments (EDs), and unintentional overdose deaths in North Carolina (NC).
Methods: Our ecological study compared rates of opioid sales, opioid related
ED overdoses, and unintentional drug overdose deaths in NC. Annual sales
data, provided by the Drug Enforcement Administration, for select opioids
were converted into morphine equivalents and aggregated by zip code. These
opioid drug sales rates were trended from 1997 to 2010. In addition, opioid
sales were correlated and compared to opioid related ED visits, which came
from a Centers for Disease Control and Prevention syndromic surveillance
system, and unintentional overdose deaths, which came from NC Vital
Statistics, from 2008 to 2010. Finally, spatial cluster analysis was
performed and rates were mapped by zip code in 2010. Results: Opioid sales
increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly
rates of opioid drug overdoses treated in EDs and opioid sales correlated
(r= 0.68, p= 0.02). Specific regions of the state, particularly in the
southern and western corners, had both high rates of prescription opioid
sales and overdoses. Conclusions: Temporal trends in sales of prescription
opioids correlate with trends in opioid related ED visits. The spatial
correlation of opioid sales with ED visit rates shows that opioid sales data
may be a timely way to identify high-risk communities in the absence of
timely ED data. © 2013 Elsevier Ireland Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
buprenorphine
fentanyl
hydrocodone
hydromorphone
methadone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS
accidental death
article
cluster analysis
drug overdose
emergency health service
human
mortality
prescription
priority journal
spatial analysis
trend study
United States
urban rural difference
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013517532
MEDLINE PMID
23399467 (http://www.ncbi.nlm.nih.gov/pubmed/23399467)
PUI
L52429660
DOI
10.1016/j.drugalcdep.2013.01.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2013.01.006
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 631
TITLE
Centering the pendulum: The evolution of emergency medicine opioid
prescribing guidelines
AUTHOR NAMES
Weiner S.G.
Perrone J.
Nelson L.S.
AUTHOR ADDRESSES
(Weiner S.G.) Department of Emergency Medicine, Tufts Medical Center, Tufts
University School of Medicine, Boston, MA, United States.
(Perrone J.) Department of Emergency Medicine, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, United States.
(Nelson L.S., lewis.nelson@nyumc.org) Department of Emergency Medicine, New
York University School of Medicine, New York, NY, United States.
CORRESPONDENCE ADDRESS
L.S. Nelson, Department of Emergency Medicine, New York University School of
Medicine, New York, NY, United States. Email: lewis.nelson@nyumc.org
SOURCE
Annals of Emergency Medicine (2013) 62:3 (241+243). Date of Publication:
September 2013
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
ibuprofen
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
editorial
emergency physician
emergency ward
human
patient care
priority journal
tooth pain (drug therapy)
CAS REGISTRY NUMBERS
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013532695
MEDLINE PMID
23541629 (http://www.ncbi.nlm.nih.gov/pubmed/23541629)
PUI
L52514033
DOI
10.1016/j.annemergmed.2013.02.028
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2013.02.028
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 632
TITLE
A 9-state analysis of designer stimulant, "bath salt," hospital visits
reported to poison control centers
AUTHOR NAMES
Warrick B.J.
Hill M.
Hekman K.
Christensen R.
Goetz R.
Casavant M.J.
Wahl M.
Mowry J.B.
Spiller H.
Anderson D.
Aleguas A.
Gummin D.
Thomas R.
Nezlek C.
Smolinske S.
AUTHOR ADDRESSES
(Warrick B.J., brandon_warrick@hotmail.com; Hill M.; Christensen R.; Thomas
R.; Nezlek C.; Smolinske S.) Children's Hospital of Michigan Regional Poison
Center, Detroit, MI, United States.
(Hekman K.) Michigan Department of Community Health, Lansing, MI, United
States.
(Goetz R.) Cincinnati Poison Center, Cincinnati, OH, United States.
(Casavant M.J.) Central Ohio Poison Center, Columbus, OH, United States.
(Wahl M.) Illinois Poison Center, Chicago, IL, United States.
(Mowry J.B.) Indiana Poison Center, Indianapolis,IN, United States.
(Spiller H.) Kentucky Poison Center, Lexington, KY, United States.
(Anderson D.) Hennepin Regional Poison Center, Minneapolis, MN, United
States.
(Aleguas A.) Northern Ohio Poison Center, Cleveland, OH, United States.
(Gummin D.) Wisconsin Poison Center, Milwaukee, WI, United States.
CORRESPONDENCE ADDRESS
B.J. Warrick, Children's Hospital of Michigan Regional Poison Center,
Detroit, MI, United States. Email: brandon_warrick@hotmail.com
SOURCE
Annals of Emergency Medicine (2013) 62:3 (244-251). Date of Publication:
September 2013
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: A new generation of designer stimulants marketed as "bath
salts" emerged in late 2010. The goal is to describe the epidemiologic
emergence of designer stimulants in 9 states in the Midwest. Methods: A
retrospective review of the National Poison Data System was performed
between November 1, 2010, and November 30, 2011. Inclusion criteria were
health care-evaluated bath salts or other synthetic stimulants exposures.
Cases were excluded if the exposure was unrelated to a designer stimulant.
Demographic and clinical characteristics of cases were calculated and
differences in outcome and exposure by generation were examined. Results:
One thousand six hundred thirty-three patients met the inclusion criteria.
Age ranged from 1 day to 61 years (mean=29.2 years), with 67.9% male
patients. The most common clinical features were agitation (62.2%),
tachycardia (55.2%), and hallucinations (32.7%). In addition to 15.5% of
patients having a major medical effect, 0.6% died. Reason for use was
primarily intentional abuse (88.5%). However, 0.7% of patients reported
withdrawal. Treatment involved primarily benzodiazepines (58.5%), with 8.7%
of patients being intubated. Baby Boomers were more likely to have a major
medical outcome (24.2%) and to report injection as the method of
administration (8.6%-12.9%). Conclusion: Synthetic stimulants rapidly swept
across the Midwest, resulting in more than 1,600 patients seeking medical
care. Serious medical effects or death was observed in 16.1% of cases. Older
generations were more likely to inject and to have a major medical outcome.
© 2013 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bath salt (drug analysis, drug toxicity, inhalational drug administration,
oral drug administration)
central stimulant agent (drug analysis, drug toxicity, inhalational drug
administration, oral drug administration)
EMTREE DRUG INDEX TERMS
acetylcysteine
alcohol
antihistaminic agent
antihypertensive agent
barbituric acid derivative
benzodiazepine derivative (drug therapy)
bicarbonate
cannabinoid
cannabis
hypertensive factor
methylenedioxypyrovalerone
methylone
naloxone
neuroleptic agent
opiate
propofol
tetrahydrocannabinol
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
outcome assessment
poison center
EMTREE MEDICAL INDEX TERMS
adolescent
adult
agitation
article
autopsy
baby boomer
child
clinical feature
coma
drug abuse
drug dependence
drug exposure
drug intoxication
drug marketing
drug screening
emergency ward
female
fever
groups by age
hallucination
heart conduction
human
hypertension
infant
injection
intubation
major clinical study
male
mortality
newborn
paranoia
preschool child
priority journal
risk factor
school child
sedation
seizure
suicidal ideation
tachycardia
withdrawal syndrome (drug therapy)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
bicarbonate (144-55-8, 71-52-3)
cannabis (8001-45-4, 8063-14-7)
methylone (186028-79-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
propofol (2078-54-8)
tetrahydrocannabinol (1972-08-3)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013532701
MEDLINE PMID
23540815 (http://www.ncbi.nlm.nih.gov/pubmed/23540815)
PUI
L52509862
DOI
10.1016/j.annemergmed.2012.12.017
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2012.12.017
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 633
TITLE
The management of poisoning
AUTHOR NAMES
Anderson M.
AUTHOR ADDRESSES
(Anderson M.) National Poisons Information Service, Great North Children's
Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon
Tyne, United Kingdom.
CORRESPONDENCE ADDRESS
M. Anderson, National Poisons Information Service, Great North Children's
Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon
Tyne, United Kingdom.
SOURCE
Paediatrics and Child Health (United Kingdom) (2013) 23:9 (380-384). Date of
Publication: September 2013
ISSN
1751-7222
1878-206X (electronic)
BOOK PUBLISHER
Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United
Kingdom.
ABSTRACT
Ingestion of a potentially toxic substance is a common reason for children
and young people to attend the emergency department or primary care.
Fortunately, mortality and significant morbidity is very low and the vast
majority of children require little more than observation. The challenge for
the paediatrician is to identify those children at risk of severe symptoms
and manage them appropriately. This review aims to provide an overview of
the recognition, evaluation and management of the poisoned child or young
person. © 2013 Elsevier Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
toxic substance (drug toxicity)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy, pharmacology)
acetylcysteine (drug therapy, pharmacology)
alcohol (drug therapy, pharmacology)
antiarrhythmic agent (drug toxicity)
antidote (drug therapy, pharmacology)
antimalarial agent (drug toxicity)
benzodiazepine derivative (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
bleaching agent (drug toxicity)
calcium channel blocking agent (drug toxicity)
carvone (drug toxicity)
clozapine (drug toxicity)
codeine phosphate (drug toxicity)
deferoxamine (drug therapy, pharmacology)
digoxin specific antibody fragment (drug therapy, pharmacology)
domestic chemical (drug toxicity)
flumazenil (drug therapy, pharmacology)
glucagon (drug therapy, pharmacology)
ibuprofen (drug toxicity)
iron (drug toxicity)
morphine (drug toxicity)
naloxone (drug therapy, pharmacology)
opiate (drug toxicity)
oral antidiabetic agent (drug toxicity)
paracetamol (drug toxicity)
salicylic acid derivative (drug toxicity)
theophylline (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
turpentine (drug toxicity)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
drug mechanism
electric battery
human
review
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
alcohol (64-17-5)
carvone (99-49-0)
clozapine (5786-21-0)
codeine phosphate (52-28-8)
deferoxamine (70-51-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
iron (14093-02-8, 53858-86-9, 7439-89-6)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
turpentine (9005-90-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013527728
PUI
L52644886
DOI
10.1016/j.paed.2013.05.011
FULL TEXT LINK
http://dx.doi.org/10.1016/j.paed.2013.05.011
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 634
TITLE
Can Mu-opioid Receptor A118G Gene Polymorphism be Predictive of Acute
Poisoning Severity in the Emergency Department?
AUTHOR NAMES
Peoc'h K.
Megarbane B.
AUTHOR ADDRESSES
(Peoc'h K.; Megarbane B., bruno-megarbane@wanadoo.fr) INSERM U705,
Lariboisière Hospital, Paris-Diderot University, Paris, France.
CORRESPONDENCE ADDRESS
B. Megarbane, INSERM U705, Lariboisière Hospital, Paris-Diderot University,
Paris, France. Email: bruno-megarbane@wanadoo.fr
SOURCE
Journal of Medical Toxicology (2013) 9:3 (292-293). Date of Publication:
September 2013
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
mu opiate receptor (endogenous compound)
EMTREE DRUG INDEX TERMS
alanine (endogenous compound)
glycine (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute toxicity
genetic polymorphism
mu opiate receptor gene
EMTREE MEDICAL INDEX TERMS
allele
disease severity
emergency ward
ethnic difference
gene frequency
genetic association
heart arrest
human
letter
respiratory arrest
withdrawal syndrome
CAS REGISTRY NUMBERS
alanine (56-41-7, 6898-94-8)
glycine (56-40-6, 6000-43-7, 6000-44-8)
EMBASE CLASSIFICATIONS
Human Genetics (22)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013571886
MEDLINE PMID
23860727 (http://www.ncbi.nlm.nih.gov/pubmed/23860727)
PUI
L52685030
DOI
10.1007/s13181-013-0317-8
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-013-0317-8
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 635
TITLE
Prescription opioid mortality trends in New York City, 1990-2006: Examining
the emergence of an epidemic
AUTHOR NAMES
Cerdá M.
Ransome Y.
Keyes K.M.
Koenen K.C.
Tracy M.
Tardiff K.J.
Vlahov D.
Galea S.
AUTHOR ADDRESSES
(Cerdá M., mc3226@columbia.edu; Keyes K.M.; Koenen K.C.; Tracy M.; Galea S.)
Department of Epidemiology, Columbia University Mailman School of Public
Health, New York, NY 10032, United States.
(Ransome Y.) Department of Sociomedical Sciences, Columbia University
Mailman School of Public Health, New York, NY 10032, United States.
(Tardiff K.J.) Cornell University Weill School of Medicine, New York, NY
10065, United States.
(Vlahov D.) School of Nursing, University of California, San Francisco
94143, United States.
CORRESPONDENCE ADDRESS
M. Cerdá, Columbia University Mailman School of Public Health, 722 W168th
Street, New York, NY 10032, United States. Email: mc3226@columbia.edu
SOURCE
Drug and Alcohol Dependence (2013) 132:1-2 (53-62). Date of Publication: 1
Sep 2013
ISSN
0376-8716
1879-0046 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: The drug overdose mortality rate tripled between 1990 and 2006;
prescription opioids have driven this epidemic. We examined the period
1990-2006 to inform our understanding of how the current prescription opioid
overdose epidemic emerged in urban areas. Methods: We used data from the
Office of the Chief Medical Examiner to examine changes in demographic and
spatial patterns in overdose fatalities induced by prescription opioids
(i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and
what factors were associated with death from prescription opioids vs.
heroin, historically the most prevalent form of opioid overdose in urban
areas. Results: Analgesic-induced overdose fatalities were the only types of
overdose fatalities to increase in 1990-2006 in NYC; the fatality rate
increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006.
Whites and Latinos were the only racial/ethnic groups to exhibit an increase
in overdose-related mortality. Relative to heroin overdose decedents,
analgesic and methadone overdose decedents were more likely to be female and
to concurrently use psychotherapeutic drugs, but less likely to concurrently
use alcohol or cocaine. Analgesic overdose decedents were less likely to be
Black or Hispanic, while methadone overdose decedents were more likely to be
Black or Hispanic in contrast to heroin overdose decedents. Conclusions: The
distinct epidemiologic profiles exhibited by analgesic and methadone
overdose fatalities highlight the need to define drug-specific public health
prevention efforts. © 2013 Elsevier Ireland Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug combination, drug dose, drug toxicity)
narcotic analgesic agent (drug combination, drug dose, drug toxicity)
prescription drug (drug combination, drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
cocaine
diamorphine (drug toxicity)
psychotropic agent (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mortality
EMTREE MEDICAL INDEX TERMS
adolescent
adult
African American
alcoholism
article
Caucasian
cocaine dependence
controlled study
correlation analysis
drug overdose
epidemic
ethnic group
fatality
female
gender
Hispanic
human
major clinical study
male
priority journal
race difference
United States
urban area
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013517528
MEDLINE PMID
23357743 (http://www.ncbi.nlm.nih.gov/pubmed/23357743)
PUI
L52411288
DOI
10.1016/j.drugalcdep.2012.12.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2012.12.027
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 636
TITLE
A somnolent 2-year-old boy with a hyperactive brother
AUTHOR NAMES
Fontane E.
Shiber J.
AUTHOR ADDRESSES
(Fontane E.; Shiber J., shiberj@bellsouth.net) 655 W Eighth St,
Jacksonville, FL 32209, United States.
CORRESPONDENCE ADDRESS
J. Shiber, 655 W Eighth St, Jacksonville, FL 32209, United States. Email:
shiberj@bellsouth.net
SOURCE
Pediatric Emergency Care (2013) 29:9 (1033-1036). Date of Publication:
September 2013
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
EMTREE DRUG INDEX TERMS
guanfacine (drug toxicity)
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
somnolence
EMTREE MEDICAL INDEX TERMS
article
attention deficit disorder
case report
child
clinical feature
consciousness level
drug intoxication
emergency ward
heart murmur
human
intensive care unit
male
preschool child
sinus arrhythmia
sinus bradycardia
CAS REGISTRY NUMBERS
guanfacine (29110-47-2, 29110-48-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013640309
MEDLINE PMID
24201989 (http://www.ncbi.nlm.nih.gov/pubmed/24201989)
PUI
L369994041
DOI
10.1097/PEC.0b013e3182a4748f
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e3182a4748f
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 637
TITLE
Comparative safety of benzodiazepines and opioids among veterans affairs
patients with posttraumatic stress disorder
AUTHOR NAMES
Hawkins E.J.
Malte C.A.
Grossbard J.
Saxon A.J.
Imel Z.E.
Kivlahan D.R.
AUTHOR ADDRESSES
(Hawkins E.J., Eric.Hawkins@va.gov; Malte C.A.; Grossbard J.; Saxon A.J.;
Imel Z.E.; Kivlahan D.R.) Puget Sound Health Care System-Seattle Division,
1660 S. Columbian Way, Seattle, WA 98108, United States.
CORRESPONDENCE ADDRESS
E.J. Hawkins, Puget Sound Health Care System-Seattle Division, 1660 S.
Columbian Way, Seattle, WA 98108, United States. Email: Eric.Hawkins@va.gov
SOURCE
Journal of Addiction Medicine (2013) 7:5 (354-362). Date of Publication:
September-October 2013
ISSN
1932-0620
1935-3227 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom.
ABSTRACT
Objectives: Although Veterans Affairs (VA) patients with posttraumatic
stress disorder (PTSD) are prescribed benzodiazepines and opioids in
addition to recommended pharmacotherapies, little is known about the safety
of these medications. This study compared the 2-year incidence of adverse
events among VA patients with PTSD exposed to combinations of selective
serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake
inhibitors (SNRIs), benzodiazepines, and opioids. Methods: This
retrospective cohort study used VA administrative data from 2004 to 2010 to
identify and follow 5236 VA patients with PTSD with new episodes of (1)
SSRIs/SNRIs only; (2) concurrent SSRIs/SNRIs and benzodiazepines; and (3)
concurrent SSRIs/SNRIs, benzodiazepines, and opioids. Outcome measures were
the 2-year incidence and adjusted hazard ratios (AHR) ofmental health and
medicine/surgery hospitalizations, emergency department visits, harmful
events (eg, injuries and death), and any adverse event after adjustment for
demographics, clinical covariates, and adverse event history. Results:
Comparedwith SSRIs/SNRIs only, the adjusted risk ofmental health
hospitalizations (AHR: 1.87; 95% confidence interval [CI]: 1.37-2.53) was
greater among patients prescribed SSRIs/SNRIs and benzodiazepines
concurrently. The AHR of mental health hospitalizations (AHR: 2.00; 95% CI:
1.35-2.98), medicine/surgery hospitalizations (AHR: 4.86; 95% CI:
3.30-7.14), emergency department visits (AHR: 2.01; 95% CI: 1.53-2.65), any
harmful event (2.92; 95% CI: 2.21-3.84), and any adverse event (AHR: 2.65;
95% CI: 2.18-3.23) were all significantly greater among patients prescribed
SSRIs/SNRIs, benzodiazepines, and opioids than among those prescribed
SSRIs/SNRIs only. Conclusions: Concurrently prescribing SSRIs/SNRIs,
benzodiazepines, and opioids among patients with PTSD is associated with
adverse events. Although efforts are warranted to monitor patients who are
prescribed combinations of these medications to prevent adverse events,
these results should be interpreted with caution until they are replicated.
© 2013 American Society of Addiction Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (adverse drug reaction, drug combination, drug
comparison, drug therapy, oral drug administration)
narcotic analgesic agent (adverse drug reaction, drug combination, drug
comparison, drug therapy)
EMTREE DRUG INDEX TERMS
serotonin noradrenalin reuptake inhibitor (adverse drug reaction, drug
combination, drug therapy)
serotonin uptake inhibitor (adverse drug reaction, drug combination, drug
therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
posttraumatic stress disorder (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
comparative study
drug safety
female
hospitalization
human
major clinical study
male
outcome assessment
priority journal
retrospective study
risk assessment
unspecified side effect (side effect)
veteran
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013728206
MEDLINE PMID
24091764 (http://www.ncbi.nlm.nih.gov/pubmed/24091764)
PUI
L370296756
DOI
10.1097/ADM.0b013e31829e3957
FULL TEXT LINK
http://dx.doi.org/10.1097/ADM.0b013e31829e3957
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 638
TITLE
Estimates of charges associated with emergency department and hospital
inpatient care for opioid abuse-related events
AUTHOR NAMES
Chandwani H.S.
Strassels S.A.
Rascati K.L.
Lawson K.A.
Wilson J.P.
AUTHOR ADDRESSES
(Wilson J.P.) Health Outcomes and Pharmacy Practice, University of Texas at
Austin College of Pharmacy, Austin, TX, United States.
(Chandwani H.S., chandwanihitesh@utexas.edu) 2409 University Avenue, Stop
A1930, Austin, TX 78712, United States.
(Strassels S.A.; Rascati K.L.; Lawson K.A.)
CORRESPONDENCE ADDRESS
H.S. Chandwani, 2409 University Avenue, Stop A1930, Austin, TX 78712, United
States. Email: chandwanihitesh@utexas.edu
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2013) 27:3 (206-213).
Date of Publication: August 2013
ISSN
1536-0288
1536-0539 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
ABSTRACT
The economic burden of prescription opioid abuse is substantial; however, no
study has estimated the monetary burden of hospital services (emergency
department [ED] and inpatient) using a single, nationally representative
database. We sought to estimate total and average (adjusted for demographic
and clinical factors) charges billed for opioid abuse-related events, and
magnitude of difference in charges between ED visits resulting in inpatient
admission to the same hospital and treat-and-release ED visits in the United
States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and
Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to
identify events and charges assigned opioid abuse, dependence, or poisoning
ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical
Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02,
965.09). Using methods to account for the complex sampling design of the
NEDS and a log-linked gamma regression model, we estimated national total
and mean charges (in 2010 USD). Total charges were $9.8, $9.6, and $9.5
billion for 2006, 2007, and 2008, respectively. Medicaid-covered events had
the highest total charges ($3 billion), followed by events covered by
Medicare ($2 billion) for each year. The national estimate of adjusted,
mean, per-event charges, was $18,891 (95% confidence interval [CI] =
$18,167-$19,616). Compared with events covered by private insurance, mean
charges for Medicare- and Medicaid-covered events were higher (t = 28.14, P
< .001; t = 6.42, P < .001, respectively), whereas self-paid events had
significantly lower charges (t = -11.14, P < .001). ED visits resulting in
subsequent inpatient admission had approximately 6 times higher charges than
treat-and-release visits. This study provides estimates of differences in
hospital costs of opioid abuse by insurance status, resulting in a better
understanding of the economic burden of opioid abuse on the health care
system. © 2013 Informa Healthcare USA, Inc.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
hospital charge
hospital patient
opiate addiction (disease management)
EMTREE MEDICAL INDEX TERMS
adult
article
female
health care system
health insurance
hospital admission
hospital cost
human
major clinical study
male
medicaid
medicare
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013565827
MEDLINE PMID
23879214 (http://www.ncbi.nlm.nih.gov/pubmed/23879214)
PUI
L369778841
DOI
10.3109/15360288.2013.803511
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2013.803511
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 639
TITLE
Opioid prescribing in emergency departments: The prevalence of potentially
inappropriate prescribing and misuse
AUTHOR NAMES
Logan J.
Liu Y.
Paulozzi L.
Zhang K.
Jones C.
AUTHOR ADDRESSES
(Logan J., ffa3@cdc.gov; Liu Y.; Paulozzi L.; Zhang K.; Jones C.) Centers
for Disease Control and Prevention (CDC), National Center for Injury
Prevention and Control (NCIPC), Division of Unintentional Injury Prevention,
4770 Buford Highway, Atlanta, GA 30341-3724, United States.
CORRESPONDENCE ADDRESS
J. Logan, Centers for Disease Control and Prevention (CDC), National Center
for Injury Prevention and Control (NCIPC), Division of Unintentional Injury
Prevention, 4770 Buford Highway, Atlanta, GA 30341-3724, United States.
Email: ffa3@cdc.gov
SOURCE
Medical Care (2013) 51:8 (646-653). Date of Publication: August 2013
ISSN
0025-7079
1537-1948 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
OBJECTIVE:: Emergency departments (EDs) routinely provide care for patients
seeking treatment for painful conditions; however, they are also targeted by
people seeking opioid analgesics for nonmedical use. This study determined
the prevalence of indicators of potential ED opioid misuse and inappropriate
prescription practices by ED providers in a large, commercially insured,
adult population. RESEARCH DESIGN AND INDICATORS:: We analyzed the 2009
Truven Health MarketScan Research Databases to examine the ED visits of
enrollees aged 18-64 years. Indicators used to mark potential inappropriate
use included opioid prescriptions overlapping by one week or more;
overlapping opioid and benzodiazepine prescriptions; high daily doses (≥100
morphine milligram equivalents); long-acting/extended-release (LA/ER)
opioids for acute pain, and overlapping LA/ER opioids. Analyses were
stratified by sex. RESULTS:: We identified 400,288 enrollees who received at
least one ED opioid prescription. At least one indicator applied to 10.3% of
enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had
opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were
for acute pain, and 14.6% were overlapping. Females were more likely to have
at least one indicator. CONCLUSIONS:: In some instances, the prescribing of
opioid analgesics in EDs might not be optimal in terms of minimizing the
risk of their misuse. Guidelines for the cautious use of opioid analgesics
in EDs and timely data from prescription drug monitoring programs could help
EDs treat patients with pain while reducing the risk of nonmedical use.
Copyright © 2013 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug combination)
benzodiazepine
chloride
codeine phosphate (drug combination)
dextropropoxyphene
dihydrocodeine (drug combination)
fentanyl (transdermal drug administration)
fentanyl citrate
homatropine
hydrocodone
hydromorphone
ibuprofen (drug combination)
indicator
methadone
morphine
morphine sulfate
nalbuphine
oxycodone (drug combination)
oxymorphone
paracetamol (drug combination)
pethidine (drug combination)
prescription drug
promethazine (drug combination)
tapentadol
tramadol (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
inappropriate prescribing
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
data base
drug misuse
drug monitoring
embryo
emergency care
female
human
male
pain (drug therapy, therapy)
practice guideline
prevalence
priority journal
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
benzodiazepine (12794-10-4)
chloride (16887-00-6)
codeine phosphate (52-28-8)
dextropropoxyphene (1639-60-7, 469-62-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
homatropine (51-56-9, 87-00-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
nalbuphine (20594-83-6, 23277-43-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
tapentadol (175591-09-0, 175591-23-8)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013470704
MEDLINE PMID
23632597 (http://www.ncbi.nlm.nih.gov/pubmed/23632597)
PUI
L52561791
DOI
10.1097/MLR.0b013e318293c2c0
FULL TEXT LINK
http://dx.doi.org/10.1097/MLR.0b013e318293c2c0
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 640
TITLE
An overdose of extended-release guanfacine
AUTHOR NAMES
Fein D.M.
Hafeez Z.F.
Cavagnaro C.
AUTHOR ADDRESSES
(Fein D.M., danfein@gmail.com; Cavagnaro C.) Division of Pediatric Emergency
Medicine, Albert Einstein College of Medicine, Children's Hospital at
Montefiore, 3315 Rochambeau Ave, Bronx, NY 10467, United States.
(Hafeez Z.F.) Department of Pediatrics, St Christopher's Hospital for
Children, Albert Einstein Medical Center, Philadelphia, PA, United States.
CORRESPONDENCE ADDRESS
D.M. Fein, Division of Pediatric Emergency Medicine, Albert Einstein College
of Medicine, Children's Hospital at Montefiore, 3315 Rochambeau Ave, Bronx,
NY 10467, United States. Email: danfein@gmail.com
SOURCE
Pediatric Emergency Care (2013) 29:8 (929-931). Date of Publication: August
2013
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Extended-release guanfacine is a centrally acting α2-adrenergic agonist that
was recently approved for treatment of attention-deficit/ hyperactivity
disorder. The following is a case discussion of a 12-year-old boy with
attention-deficit/hyperactivity disorder and Tourette syndrome, who
presented 18 hours after ingestion of 3 times his usual dose of
extended-release guanfacine. On presentation, he was lethargic, bradycardic,
and hypertensive with an otherwise nonfocal neurological examination. He
remained hypertensive until administration of an intravenous
antihypertensive agent (nicardipine) 24 hours after ingestion. After
cessation of the calcium-channel blocker, he continued to have intermittent
episodes of symptomatic hypotension for the next 21/2 days. This extremely
protracted course of hypertension followed by prolonged symptomatic
hypotension is rare with ingestions of centrally acting α2-adrenergic
agonists. As this drug is increasingly prescribed for treatment of a disease
with increasing prevalence, it is imperative that emergency physicians
become familiar with the varying presentations of its toxicity. Copyright ©
2013 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
guanfacine (drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
dexmethylphenidate
naloxone (drug therapy, intravenous drug administration)
nicardipine (adverse drug reaction, drug therapy, intravenous drug
administration)
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
controlled drug release
drug intoxication (drug therapy, drug therapy)
extended drug release
EMTREE MEDICAL INDEX TERMS
anion gap
article
attention deficit disorder (drug therapy)
blood pressure
bradycardia
breathing rate
case report
child
computer assisted tomography
continuous infusion
dizziness
drug withdrawal
electrocardiogram
emergency physician
emergency ward
evening dosage
Gilles de la Tourette syndrome (drug therapy)
glucose assay
heart rate
hospital admission
hospital discharge
human
hypertension (drug therapy)
hypotension (side effect)
intensive care unit
lethargy
male
mental health
neuroimaging
neurologic examination
oxygen nasal cannula
QT interval
school child
sinus rhythm
social worker
somnolence
standing
CAS REGISTRY NUMBERS
dexmethylphenidate (19262-68-1, 35652-13-2, 40431-64-9)
guanfacine (29110-47-2, 29110-48-3)
naloxone (357-08-4, 465-65-6)
nicardipine (54527-84-3, 55985-32-5)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013547725
MEDLINE PMID
23925253 (http://www.ncbi.nlm.nih.gov/pubmed/23925253)
PUI
L369706127
DOI
10.1097/PEC.0b013e31829ec525
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e31829ec525
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 641
TITLE
Medical outcomes associated with nonmedical use of methadone and
buprenorphine
AUTHOR NAMES
Lee S.
Klein-Schwartz W.
Welsh C.
Doyon S.
AUTHOR ADDRESSES
(Lee S.; Klein-Schwartz W.; Welsh C.; Doyon S.) University of Maryland
School of Medicine, School of Pharmacy, Office Level 1, 220 Arch Street,
Baltimore, MD 21201, United States.
CORRESPONDENCE ADDRESS
S. Doyon, University of Maryland School of Medicine, School of Pharmacy,
Office Level 1, 220 Arch Street, Baltimore, MD 21201, United States.
SOURCE
Journal of Emergency Medicine (2013) 45:2 (199-205). Date of Publication:
August 2013
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: There exists a significant amount of misinformation regarding
methadone and buprenorphine, and a belief that toxicity associated with
nonmedical use of methadone and nonmedical use of buprenorphine is similar
in severity and outcomes. Objective: The objective of this study is to
compare outcomes associated with nonmedical use of methadone vs. nonmedical
use of buprenorphine in patients presenting to the Emergency Department (ED)
and reported to poison centers. Methods: This was a retrospective cohort
study using data from the American Association of Poison Control Centers
from January 1, 2003 to December 31, 2009 (7 years). Inclusion criteria were
nonmedical use of methadone or buprenorphine (or buprenorphine/naloxone) as
a single substance by history, age 18 years or older, ingestions only,
evaluated in an ED. Outcome measures were clinical effects, treatments,
disposition, and final medical outcomes. Results: Of 1,920 cases, 1,594 were
in the methadone group and 326 were in the buprenorphine group. Frequently
reported clinical effects were lethargy, 59.2% vs. 29.4%, and respiratory
depression, 28.7% vs. 2.5%, for methadone and buprenorphine groups,
respectively. Hospitalization rates were 67.4% in the methadone group and
32.2% in the buprenorphine group. Half of all patients in the methadone
group were admitted to the intensive care unit (ICU) vs. only 15% of all the
patients in the buprenorphine group. Twenty-six patients in the methadone
group died vs. no deaths in the buprenorphine group. There were significant
differences in the distribution of clinical effects, disposition, and
medical outcomes (p < 0.001). Conclusions: Patients who use methadone
nonmedically have higher hospitalization rates, greater ICU utilization
rates, and considerably worse medical outcomes when compared with patients
who use buprenorphine nonmedically. Copyright © 2013 Elsevier Inc. Printed
in the USA. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug toxicity)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
creatine kinase
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
agitation
article
coma
controlled study
cyanosis
death
depression
diaphoresis
drowsiness
female
heart arrest
hospitalization
human
hypotension
intensive care unit
lethargy
major clinical study
male
medical record review
miosis
outcome assessment
pneumonia
priority journal
respiration depression
retrospective study
vomiting
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
creatine kinase (9001-15-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013492374
MEDLINE PMID
23669129 (http://www.ncbi.nlm.nih.gov/pubmed/23669129)
PUI
L52577477
DOI
10.1016/j.jemermed.2012.11.104
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2012.11.104
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 642
TITLE
Voluntary guidelines for emergency physicians: clarifying New York city's
efforts to curb opioid misuse
AUTHOR NAMES
Huffman A.
AUTHOR ADDRESSES
(Huffman A.)
SOURCE
Annals of emergency medicine (2013) 62:2 (13A-14A). Date of Publication: 1
Aug 2013
ISSN
1097-6760 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
prevention and control
standards
EMTREE MEDICAL INDEX TERMS
emergency medicine
human
inappropriate prescribing
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
24083312 (http://www.ncbi.nlm.nih.gov/pubmed/24083312)
PUI
L603766681
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 643
TITLE
Buprenorphine and buprenorphine/naloxone intoxication in children - how
strong is the risk?
AUTHOR NAMES
Soyka M.
AUTHOR ADDRESSES
(Soyka M., Michael.Soyka@privatklinik-meiringen.ch) Department of
Psychiatry, University of Munich, Nussbaumstr. 7, 80336 Munich, Germany.
(Soyka M., Michael.Soyka@privatklinik-meiringen.ch) Private Hospital
Meiringen, Willigen, 3860 Meiringen, Switzerland.
CORRESPONDENCE ADDRESS
M. Soyka, Private Hospital Meiringen, P.O. Box 612, CH 3860 Meiringen,
Switzerland. Email: Michael.Soyka@privatklinik-meiringen.ch
SOURCE
Current Drug Abuse Reviews (2013) 6:1 (63-70). Date of Publication: 2013
ISSN
1874-4737
1874-4745 (electronic)
BOOK PUBLISHER
Bentham Science Publishers B.V., P.O. Box 294, Bussum, Netherlands.
ABSTRACT
Opioid maintenance therapy with methadone or buprenorphine is an established
and first-line treatment for opioid dependence. Risk of diversion and
toxicity of opioid prescription drugs, including buprenorphine, causes
significant concerns. This is particularly the case in the United States,
where the number of related emergency visits is increasing, especially in
children. A systematic literature research (Medline, Pubmed) was performed
to assess the risk associated with buprenorphine. The search, which was not
limited to particular publication years, was performed with the key words
buprenorphine AND toxicity (114 counts) AND children (4 counts) and
buprenorphine AND mortality AND children (5 counts). In addition, the author
obtained information from relevant websites (NIDA, SAMSHA) and
pharmacovigilance data from the manufacturer of buprenorphine. Clinical and
toxicological data suggest a low risk for fatal intoxications associated
with bupreorphine in adults. Data from emergency units indicate a dramatic,
20-fold increase in buprenorphine exposure in children over the past decade,
mostly in those under 6. The US 'Researched Abuse, Diversion and
Addiction-Related Surveillance' (RADARS) system indicates a lower risk of
severe opioid intoxications with buprenorphine than with other opioids, with
no fatal outcomes recorded. Correspondingly, data from spontaneous reports
to the surveillance programme of the manufacturer of buprenorphine (13,600
buprenorphine exposures, 4879 of these in children under six) show a serious
medical outcome in 34% of children under the age of six but only one fatal
outcome. Although exposure to buprenorphine and other opioids remains a
significant concern in children, the drug seems rather to be safe with
respect to severe outcomes, in particular death. © 2013 Bentham Science
Publishers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug concentration, drug therapy, drug toxicity, intravenous
drug administration, pharmacokinetics)
buprenorphine plus naloxone (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
agitation
article
childhood mortality
chronic pain (drug therapy)
coma
drowsiness
drug blood level
drug clearance
drug efficacy
drug exposure
drug misuse
drug overdose
drug safety
drug surveillance program
human
irritability
lethargy
maintenance therapy
mortality
opiate addiction (drug therapy)
pallor
priority journal
respiration depression
risk assessment
vomiting
DRUG TRADE NAMES
suboxone
subutex
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013442876
PUI
L369323246
DOI
10.2174/18744737112059990010
FULL TEXT LINK
http://dx.doi.org/10.2174/18744737112059990010
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 644
TITLE
Estimating the Prevalence of Opioid Diversion by "Doctor Shoppers" in the
United States
AUTHOR NAMES
McDonald D.C.
Carlson K.E.
AUTHOR ADDRESSES
(McDonald D.C., doug_mcdonald@abtassoc.com; Carlson K.E.) US Health
Division, Abt Associates Inc., Cambridge, MA, United States.
CORRESPONDENCE ADDRESS
D. C. McDonald, US Health Division, Abt Associates Inc., Cambridge, MA,
United States. Email: doug_mcdonald@abtassoc.com
SOURCE
PLoS ONE (2013) 8:7 Article Number: e69241. Date of Publication: 17 Jul 2013
ISSN
1932-6203 (electronic)
BOOK PUBLISHER
Public Library of Science, 185 Berry Street, Suite 1300, San Francisco,
United States.
ABSTRACT
Background:Abuse of prescription opioid analgesics is a serious threat to
public health, resulting in rising numbers of overdose deaths and admissions
to emergency departments and treatment facilities. Absent adequate patient
information systems, "doctor shopping" patients can obtain multiple opioid
prescriptions for nonmedical use from different unknowing physicians. Our
study estimates the prevalence of doctor shopping in the US and the amounts
and types of opioids involved.Methods and Findings:The sample included
records for 146.1 million opioid prescriptions dispensed during 2008 by 76%
of US retail pharmacies. Prescriptions were linked to unique patients and
weighted to estimate all prescriptions and patients in the nation. Finite
mixture models were used to estimate different latent patient populations
having different patterns of using prescribers. On average, patients in the
extreme outlying population (0.7% of purchasers), presumed to be doctor
shoppers, obtained 32 opioid prescriptions from 10 different prescribers.
They bought 1.9% of all opioid prescriptions, constituting 4% of weighed
amounts dispensed.Conclusions:Our data did not provide information to make a
clinical diagnosis of individuals. Very few of these patients can be
classified with certainty as diverting drugs for nonmedical purposes.
However, even patients with legitimate medical need for opioids who use
large numbers of prescribers may signal dangerously uncoordinated care. To
close the information gap that makes doctor shopping and uncoordinated care
possible, states have created prescription drug monitoring programs to
collect records of scheduled drugs dispensed, but the majority of physicians
do not access this information. To facilitate use by busy practitioners,
most monitoring programs should improve access and response time, scan
prescription data to flag suspicious purchasing patterns and alert
physicians and pharmacists. Physicians could also prevent doctor shopping by
adopting procedures to screen new patients for their risk of abuse and to
monitor patients' adherence to prescribed treatments. © 2013 McDonald,
Carlson.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
codeine
dextropropoxyphene
dihydrocodeine
fentanyl
hydrocodone
methadone
oxycodone
oxymorphone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
opiate addiction
prevalence
EMTREE MEDICAL INDEX TERMS
article
controlled study
mathematical model
population model
prescription
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013457915
MEDLINE PMID
23874923 (http://www.ncbi.nlm.nih.gov/pubmed/23874923)
PUI
L369378589
DOI
10.1371/journal.pone.0069241
FULL TEXT LINK
http://dx.doi.org/10.1371/journal.pone.0069241
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 645
TITLE
Vital signs: Overdoses of prescription opioid pain relievers and other drugs
among women - united states, 1999-2010
AUTHOR NAMES
Mack K.A.
Jones C.M.
Paulozzi L.J.
AUTHOR ADDRESSES
(Mack K.A., kmack@cdc.gov; Jones C.M.; Paulozzi L.J.) Div of Unintentional
Injury Prevention, National Center for Injury Prevention and Control, CDC,
United States.
CORRESPONDENCE ADDRESS
K. A. Mack, Div of Unintentional Injury Prevention, National Center for
Injury Prevention and Control, CDC, United States. Email: kmack@cdc.gov
SOURCE
Morbidity and Mortality Weekly Report (2013) 62:26 (537-542). Date of
Publication: 5 Jul 2013
ISSN
0149-2195
1545-861X (electronic)
BOOK PUBLISHER
Department of Health and Human Services, 1600 Clifton Rd, Atlanta, United
States.
ABSTRACT
Background: Overdose deaths have increased steadily over the past decade.
This report describes drug-related deaths and emergency department (ED)
visits among women. Methods: CDC analyzed rates of fatal drug overdoses and
drug misuse- or abuse-related ED visits among women using data from the
National Vital Statistics System (1999-2010) and the Drug Abuse Warning
Network (2004-2010). Results: In 2010, a total of 15,323 deaths among women
were attributed to drug overdose, a rate of 9.8 per 100,000 population.
Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and
2010 for women; OPR deaths among men increased 3.6 times. In 2010, there
were 943,365 ED visits by women for drug misuse or abuse. The highest ED
visit rates were for cocaine or heroin (147.2 per 100,000 population),
benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or
abuse of OPR among women more than doubled between 2004 and 2010.
Conclusions: Although more men die from drug overdoses than women, the
percentage increase in deaths since 1999 is greater among women. More women
have died each year from drug overdoses than from motor vehicle-related
injuries since 2007. Deaths and ED visits related to OPR continue to
increase among women. The prominent involvement of psychotherapeutic drugs,
such as benzodiazepines, among overdoses provides insight for prevention
opportunities. Implications for Public Health Practice: Health-care
providers should follow guidelines for responsible prescribing, including
screening and monitoring for substance abuse and mental health problems,
when prescribing OPR. Health-care providers who treat women for pain should
use their state's prescription drug monitoring program and regularly screen
patients for psychological disorders and use of psychotherapeutic drugs,
with or without a prescription.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug toxicity)
prescription drug (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency health service
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
female
human
middle aged
mortality
statistics
United States (epidemiology)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
23820967 (http://www.ncbi.nlm.nih.gov/pubmed/23820967)
PUI
L369244470
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 646
TITLE
Primary meningococcal arthritis leading to Neisseria meningitidies purpura
fulminans
AUTHOR NAMES
Michel M.D.
Kao L.W.
Sloan B.K.
AUTHOR ADDRESSES
(Michel M.D., mimichel@iupui.edu; Kao L.W.; Sloan B.K.) Department of
Emergency Medicine, Indiana University, 1701 N. Senate Blvd, B401,
Indianapolis, IN 46202, United States.
CORRESPONDENCE ADDRESS
M.D. Michel, Department of Emergency Medicine, Indiana University, 1701 N.
Senate Blvd, B401, Indianapolis, IN 46202, United States. Email:
mimichel@iupui.edu
SOURCE
Western Journal of Emergency Medicine (2013) 14:2 (165-167). Date of
Publication: 2013
ISSN
1936-900X
1936-9018 (electronic)
BOOK PUBLISHER
University of California Irvine, 101 The City Dr,Rte 128-01, Orange,, United
States.
EMTREE DRUG INDEX TERMS
ceftriaxone (drug therapy)
colchicine (drug combination, drug therapy)
drotrecogin (drug combination, drug therapy)
enoxaparin (drug therapy)
hydrocodone bitartrate plus paracetamol (drug combination, drug therapy)
ibuprofen (drug combination, drug therapy)
ketorolac (drug therapy)
meropenem (drug combination, drug therapy)
naloxone
noradrenalin (drug combination, drug therapy)
uric acid (endogenous compound)
vancomycin (drug combination, drug therapy)
warfarin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterial arthritis (drug therapy, drug therapy)
fulminating purpura (complication)
meningococcosis (complication)
primary meningococcal arthritis (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
acute kidney failure
adult
ankle edema
ankle pain (drug therapy)
arthrocentesis
article
bacterium culture
bladder catheterization
blood culture
blood transfusion
case report
CD4 lymphocyte count
cerebrospinal fluid culture
debridement
drug treatment failure
emergency ward
fever
follow up
general condition deterioration
gout (drug therapy)
hearing impairment
HIV test
hospital discharge
hospital infection
hospital readmission
human
Human immunodeficiency virus infection
hydronephrosis
hypertension
inappropriate vasopressin secretion
intensive care unit
joint aspiration
joint swelling (drug therapy)
knee pain (drug therapy)
leg edema
leukocyte count
male
malnutrition (therapy)
mental deterioration
nutritional support
physical examination
rheumatoid arthritis
septic shock (drug therapy)
tachycardia
upper extremity deep vein thrombosis (drug therapy)
uric acid blood level
urinary tract infection
wound infection (drug therapy)
wrist pain (drug therapy)
CAS REGISTRY NUMBERS
ceftriaxone (73384-59-5, 74578-69-1)
colchicine (64-86-8)
drotrecogin (357194-87-7)
enoxaparin (679809-58-6)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
ketorolac (74103-06-3)
meropenem (96036-03-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
uric acid (69-93-2)
vancomycin (1404-90-6, 1404-93-9)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
General Pathology and Pathological Anatomy (5)
Urology and Nephrology (28)
Arthritis and Rheumatism (31)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013382816
PUI
L369130222
DOI
10.5811/westjem.2012.10.12906
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2012.10.12906
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 647
TITLE
Hypokalemic periodic paralysis: Two cases of profound weakness
AUTHOR NAMES
Turcotte J.
White D.
Tilney P.V.R.
AUTHOR ADDRESSES
(Turcotte J.; White D.; Tilney P.V.R., tilneype@cmhc.org)
SOURCE
Air Medical Journal (2013) 32:4 (181-183+189). Date of Publication:
July-August 2013
ISSN
1067-991X
1532-6497 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
diphenhydramine
hydrocodone (drug therapy)
naloxone (intravenous drug administration)
paracetamol (drug therapy)
prednisone
propranolol (drug therapy)
thiamazole (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hypokalemic periodic paralysis (diagnosis)
weakness
EMTREE MEDICAL INDEX TERMS
acute respiratory failure (diagnosis)
adult
bradypnea
case report
emergency health service
female
human
hyperthyroidism (drug therapy)
hypokalemia (diagnosis)
lung ventilation
male
patient transport
point of care testing
postoperative pain (drug therapy)
priority journal
review
vomiting
CAS REGISTRY NUMBERS
diphenhydramine (147-24-0, 58-73-1)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
prednisone (53-03-2)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
thiamazole (60-56-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013416818
MEDLINE PMID
23816210 (http://www.ncbi.nlm.nih.gov/pubmed/23816210)
PUI
L369232456
DOI
10.1016/j.amj.2013.04.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2013.04.006
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 648
TITLE
Emergency management and treatment of the poisoned small animal patient
AUTHOR NAMES
Lee J.A.
AUTHOR ADDRESSES
(Lee J.A., jlee@safetycall.com) Pet Poison Helpline, A division of
SafetyCall International, PPLC, 3600 American Boulevard West, Suite 725,
Minneapolis, MN 55431, United States.
CORRESPONDENCE ADDRESS
J.A. Lee, Pet Poison Helpline, A division of SafetyCall International, PPLC,
3600 American Boulevard West, Suite 725, Minneapolis, MN 55431, United
States. Email: jlee@safetycall.com
SOURCE
Veterinary Clinics of North America - Small Animal Practice (2013) 43:4
(757-771). Date of Publication: July 2013
ISSN
0195-5616
1878-1306 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
This article reviews management of the acutely poisoned veterinary patient,
including initial telephone triage, appropriate communication and history
gathering from the pet owner, decontamination methods (including the use of
appropriate emetic agents and dosing of activated charcoal), and general
treatment of the poisoned patient. Symptomatic and supportive care of the
poisoned patient includes the use of fluid therapy, gastrointestinal support
(eg, antacids), central nervous system support (eg, muscle relaxants,
anticonvulsants), sedatives/reversal agents (eg, phenothiazines, naloxone,
flumazenil), hepatoprotectants, and miscellaneous antidotal therapy. © 2013
Elsevier Inc.
EMTREE DRUG INDEX TERMS
activated carbon
antidote (drug therapy)
beta adrenergic receptor blocking agent (drug therapy)
liver protective agent (drug therapy)
sedative agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
animal care
emergency treatment
intoxication (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
animal well-being
aspiration pneumonia (complication)
detoxification
diagnostic test
drug intoxication (drug therapy)
fluid therapy
hypoxemia (complication)
mouth injury (complication)
nonhuman
review
stomach lavage
tachycardia (drug therapy)
treatment contraindication
treatment indication
veterinary medicine
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013374733
MEDLINE PMID
23747259 (http://www.ncbi.nlm.nih.gov/pubmed/23747259)
PUI
L52558210
DOI
10.1016/j.cvsm.2013.03.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cvsm.2013.03.010
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 649
TITLE
Opioid use and effectiveness of its prescription at discharge in an acute
pain relief and palliative care unit
AUTHOR NAMES
Mercadante S.
Prestia G.
Ranieri M.
Giarratano A.
Casuccio A.
AUTHOR ADDRESSES
(Mercadante S., terapiadeldolore@lamaddalenanet.it; Prestia G.) Pain Relief
and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312,
90146 Palermo, Italy.
(Mercadante S., terapiadeldolore@lamaddalenanet.it; Ranieri M.; Giarratano
A.) Palliative Medicine Teaching, University of Palermo, Palermo, Italy.
(Casuccio A.) Department of Experimental Biomedicine and Clinical
Neuroscience, University of Palermo, Palermo, Italy.
CORRESPONDENCE ADDRESS
S. Mercadante, Pain Relief and Palliative Care Unit, La Maddalena Cancer
Center, Via San Lorenzo 312, 90146 Palermo, Italy. Email:
terapiadeldolore@lamaddalenanet.it
SOURCE
Supportive Care in Cancer (2013) 21:7 (1853-1859). Date of Publication: July
2013
ISSN
0941-4355
1433-7339 (electronic)
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
The aim of this study was to present how opioids are used in an acute pain
relief and palliative care unit (APRPCU), where many patients with difficult
pain conditions are admitted from GPs, home palliative care programs,
oncology departments, other hospitals or emergency units, and other regional
places. From a consecutive sample of cancer patients admitted to an APRPCU
for a period of 6 months, patients who had been administered opioids were
included in this survey. Basic information was collected as well as opioid
therapy prescribed at admission and, subsequently, during admission and at
time of discharge. Patients were discharged once stabilization of pain and
symptoms were obtained and the treatment was considered to be optimized. One
week after being discharged, patients or relatives were contacted by phone
to gather information about the availability of opioids at dosages
prescribed at time of discharge. One hundred eighty six of 231 patients were
specifically admitted for uncontrolled pain, with a mean pain intensity of
6.8 (SD 2.5). The mean dose of oral morphine equivalents in patients
receiving opioids before admission was 45 mg/day (range 10-500 mg). One
hundred seventy five patients (75.7 %) were prescribed around the clock
opioids at admission. About one third of patients changed treatment (opioid
or route). Forty two of 175 (24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4
(50 %) patients were receiving more than 200 mg of oral morphine
equivalents, as maximum dose of the first, second, third, and fourth opioid
prescriptions, respectively. The pattern of opioids changed, with the
highest doses administered with subsequent line options. The mean final dose
of opioids, expressed as oral morphine equivalents, for all patients was 318
mg/day (SD 798), that is more than six times the doses of pre-admission
opioid doses. One hundred eighty six patients (80.5 %) were prescribed a
breakthrough cancer pain (BTcP) medication at admission. Sixty five patients
changed their BTcP prescription, and further 27 patients changed again.
Finally, eight patients were prescribed a fourth BTcP medication. Of 46
patients available for interview, the majority of them (n = 39, 84 %) did
not have problems with their GPs, who facilitated prescription and
availability of opioids at the dosages prescribed at discharge. For patients
with severe distress, APRPCUs may guarantee a high-level support to optimize
pain and symptom intensities providing intensive approach and resolving
highly distressing situations in a short time by optimizing the use of
opioids. © 2013 Springer-Verlag Berlin Heidelberg.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug combination, drug dose, drug therapy,
intrathecal drug administration)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
buprenorphine (drug therapy, transdermal drug administration)
codeine (drug combination, drug therapy)
fentanyl (buccal drug administration, drug therapy, intranasal drug
administration, sublingual drug administration, transdermal drug
administration)
fentanyl citrate (drug therapy, oral drug administration)
hydromorphone (drug therapy, oral drug administration)
ketorolac (drug therapy)
local anesthetic agent (drug combination, drug therapy)
methadone (drug therapy, oral drug administration)
morphine (drug dose, drug therapy, intrathecal drug administration,
intravenous drug administration, oral drug administration, parenteral drug
administration, subcutaneous drug administration)
oxycodone (drug therapy, oral drug administration)
oxycodone plus paracetamol (drug therapy, oral drug administration)
paracetamol (drug combination, drug therapy)
tapentadol (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute pain relief and palliative care unit
cancer pain (drug therapy, complication, drug therapy)
drug use
hospital subdivisions and components
EMTREE MEDICAL INDEX TERMS
adult
article
breakthrough pain (drug therapy)
cancer palliative therapy
cancer patient
disease severity
distress syndrome
drug efficacy
drug megadose
female
general practitioner
health care availability
home care
hospital admission
hospital discharge
human
length of stay
major clinical study
male
oncology ward
pain assessment
prescription
priority journal
telemonitoring
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
hydromorphone (466-99-9, 71-68-1)
ketorolac (74103-06-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
tapentadol (175591-09-0, 175591-23-8)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Cancer (16)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013361622
MEDLINE PMID
23400316 (http://www.ncbi.nlm.nih.gov/pubmed/23400316)
PUI
L52438938
DOI
10.1007/s00520-013-1740-8
FULL TEXT LINK
http://dx.doi.org/10.1007/s00520-013-1740-8
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 650
TITLE
EMS runs for suspected opioid overdose: implications for surveillance and
prevention.
AUTHOR NAMES
Knowlton A.
Weir B.W.
Hazzard F.
Olsen Y.
McWilliams J.
Fields J.
Gaasch W.
AUTHOR ADDRESSES
(Knowlton A., aknowlto@jhsph.edu) Johns Hopkins University Bloomberg School
of Public Health, Baltimore, MD 21205 , USA.
(Weir B.W.; Hazzard F.; Olsen Y.; McWilliams J.; Fields J.; Gaasch W.)
CORRESPONDENCE ADDRESS
A. Knowlton, Johns Hopkins University Bloomberg School of Public Health,
Baltimore, MD 21205 , USA. Email: aknowlto@jhsph.edu
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2013)
17:3 (317-329). Date of Publication: 2013 Jul-Sep
ISSN
1545-0066 (electronic)
ABSTRACT
Opioid (including prescription opiate) abuse and overdose rates in the
United States have surged in the past decade. The dearth and limitations of
opioid abuse and overdose surveillance systems impede the development of
interventions to address this epidemic. Objective. We explored evidence to
support the validity of emergency medical services (EMS) data on naloxone
administration as a possible proxy for estimating incidence of opioid
overdose. We reviewed data from Baltimore City Fire Department EMS patient
records matched with dispatch records over a 13-month time period
(2008-2009) based on 2008 Census data. We calculated incidence rates and
patient demographic and temporal patterns of naloxone administration, and
examined patient evaluation data associated with naloxone administration.
Results were compared with the demographic distributions of the EMS patient
and city populations and with prior study findings. Of 116,910 EMS incidents
during the study period for patients aged 15 years and older, EMS providers
administered naloxone 1,297 times (1.1% of incidents), an average of 100
administrations per month. The overall incidence was 1.87 administrations
per 1,000 residents per year. Findings indicated that naloxone
administration peaked in the summer months (31% of administrations), on
weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was
a trend toward peaking in the first week of the month. The incidence of
suspected opioid overdose was highest among male patients, white patients,
and those in the 45-54-year age group. Findings on temporal patterns were
comparable with findings from prior studies. Demographic patterns of
suspected opioid overdose were similar to medical examiner reports of
demographic patterns of fatal drug- or alcohol-related overdoses in
Baltimore in 2008-2009 (88% of which involved opioids). The findings on
patient evaluation data suggest some inconsistencies with previously
recommended clinical indications of opioid overdose. While our findings
suggest limitations of EMS naloxone administration data as a proxy indicator
of opioid overdose, the results provide partial support for using these data
for estimating opioid overdose incidence and suggest ways to improve such
data. The study findings have implications for an EMS role in conducting
real-time surveillance and treatment and prevention of opioid abuse and
overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (drug therapy, epidemiology)
drug overdose (drug therapy, epidemiology)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
female
human
incidence
male
retrospective study
risk factor
treatment outcome
United States (epidemiology)
utilization review
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23734988 (http://www.ncbi.nlm.nih.gov/pubmed/23734988)
PUI
L563036966
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 651
TITLE
Prescription history of emergency department patients prescribed opioids
AUTHOR NAMES
Hoppe J.A.
Houghland J.
Yaron M.
Heard K.
AUTHOR ADDRESSES
(Hoppe J.A., jason.hoppe@ucdenver.edu; Yaron M.; Heard K.) Department of
Emergency Medicine, University of Colorado School of Medicine, Denver, CO,
United States.
(Houghland J.) Denver Health Residency in Emergency Medicine, Denver, CO,
United States.
(Heard K.) Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO,
United States.
CORRESPONDENCE ADDRESS
J.A. Hoppe, Department of Emergency Medicine, University of Colorado School
of Medicine, Mail Stop B215, Aurora, CO 80045, United States. Email:
jason.hoppe@ucdenver.edu
SOURCE
Western Journal of Emergency Medicine (2013) 14:3 (247-252). Date of
Publication: 2013
ISSN
1936-900X
1936-9018 (electronic)
BOOK PUBLISHER
University of California Irvine, 101 The City Dr,Rte 128-01, Orange,, United
States.
ABSTRACT
Introduction: To use Colorado's prescription drug monitoring program (PDMP)
to describe the recent opioid prescription history of patients discharged
from our emergency department (ED) with a prescription for opioid pain
medications. Methods: Retrospective cohort study of 300 adult ED patients
who received an opioid prescription. We abstracted prescription histories
for the six months prior to the ED visit from the PDMP, and abstracted
clinical and demographic variables from the chart. Results: There were 5,379
ED visits during the study month, 3,732 of which were discharged. Providers
wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30%) of the
patients. Median age was 36 years. Thirty-nine percent were male. Patients
were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4%
other. These were similar to our overall ED population. There was
substantial variability in the number of prescriptions, prescribers and
total number of pills. A majority (205/296) of patients had zero or one
prescription. The 90th percentile for number of prescriptions was seven,
while the 10th percentile was zero. Patients in the highest decile tended to
be older, with a higher proportion of Caucasians and females. Patients in
the lowest decile resembled the general ED population. The most common
diagnoses associated with opioid prescriptions were abdominal pain (11.5%),
cold/flu symptoms (9.5%), back pain (5.4%), flank pain (5.0%) and motor
vehicle crash (4.7%). Conclusion: Substantial variability exists in the
opioid prescription histories of ED patients, but a majority received zero
or one prescription in the preceding six months. The top decile of patients
averaged more than two prescriptions per month over the six months prior to
ED visit, written by more than 6 different prescribers. There was a trend
toward these patients being older, Caucasian and female.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
hydrocodone bitartrate plus paracetamol
oxycodone
oxycodone plus paracetamol
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adult
article
backache (drug therapy)
common cold symptom
drug surveillance program
emergency ward
ethnicity
female
flank pain (drug therapy)
flu like syndrome (drug therapy)
hospital discharge
human
major clinical study
male
medical history
medical record review
opiate addiction
risk factor
traffic accident
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013382834
PUI
L369130240
DOI
10.5811/westjem.2012.2.6915
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2012.2.6915
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 652
TITLE
Guidelines for opioid prescription: Why emergency physicians need support
AUTHOR NAMES
Kunins H.V.
Farley T.A.
Dowell D.
AUTHOR ADDRESSES
(Kunins H.V.; Farley T.A.; Dowell D.) New York City Department of Health and
Mental Hygiene, 42-09 28th Street, Queens, NY 11101, United States.
CORRESPONDENCE ADDRESS
New York City Department of Health and Mental Hygiene, 42-09 28th Street,
Queens, NY 11101, United States.
SOURCE
Annals of Internal Medicine (2013) 158:11 (841-842). Date of Publication: 4
Jun 2013
ISSN
0003-4819
1539-3704 (electronic)
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
article
emergency ward
human
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013362560
MEDLINE PMID
23567824 (http://www.ncbi.nlm.nih.gov/pubmed/23567824)
PUI
L369071122
DOI
10.7326/0003-4819-158-11-201306040-00631
FULL TEXT LINK
http://dx.doi.org/10.7326/0003-4819-158-11-201306040-00631
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 653
TITLE
Guidelines for opioid prescription: The devil is in the details
AUTHOR NAMES
Rosenau A.M.
AUTHOR ADDRESSES
(Rosenau A.M., alex.rosenau@gmail.com) Lehigh Valley Health Network, JDMCC
214, I-78, Cedar Crest Boulevard, Allentown, PA 18103, United States.
CORRESPONDENCE ADDRESS
A. M. Rosenau, Lehigh Valley Health Network, JDMCC 214, I-78, Cedar Crest
Boulevard, Allentown, PA 18103, United States. Email: alex.rosenau@gmail.com
SOURCE
Annals of Internal Medicine (2013) 158:11 (843-844). Date of Publication: 4
Jun 2013
ISSN
0003-4819
1539-3704 (electronic)
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
article
emergency ward
human
priority journal
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013362561
MEDLINE PMID
23567867 (http://www.ncbi.nlm.nih.gov/pubmed/23567867)
PUI
L369071123
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 654
TITLE
A comparison of ultrasound-guided three-in-one femoral nerve block versus
parenteral opioids alone for analgesia in emergency department patients with
hip fractures: A randomized controlled trial
AUTHOR NAMES
Beaudoin F.L.
Haran J.P.
Liebmann O.
AUTHOR ADDRESSES
(Beaudoin F.L., Francesca_Beaudoin@brown.edu; Haran J.P.; Liebmann O.)
Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical
School of Brown University, Providence RI, United States.
(Haran J.P.) Department of Emergency Medicine, University of Massachusetts
Medical School, Worcester MA, United States.
CORRESPONDENCE ADDRESS
F.L. Beaudoin, Department of Emergency Medicine, Rhode Island Hospital,
Alpert Medical School of Brown University, Providence RI, United States.
Email: Francesca_Beaudoin@brown.edu
SOURCE
Academic Emergency Medicine (2013) 20:6 (584-591). Date of Publication: June
2013
ISSN
1069-6563
1553-2712 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives The primary objective was to compare the efficacy of ultrasound
(US)-guided three-in-one femoral nerve blocks to standard treatment with
parenteral opioids for pain control in elderly patients with hip fractures
in the emergency department (ED). Methods A randomized controlled trial was
conducted at a large urban academic ED over an 18-month period. A
convenience sample of older adults (age ≥ 55 years) with confirmed hip
fractures and moderate to severe pain (numeric rating score ≥ 5) were
randomized to one of two treatment arms: US-guided three-in-one femoral
nerve block plus morphine (FNB group) or standard care, consisting of
placebo (sham injection) plus morphine (SC group). Intravenous (IV) morphine
was prescribed and dosed at the discretion of the treating physician;
physicians were advised to target a 50% reduction in pain or per-patient
request. The primary outcome measure of pain relief, or pain intensity
reduction, was derived using the 11-point numerical rating scale (NRS) and
calculated as the summed pain-intensity difference (SPID) over 4 hours.
Secondary outcome measures included the amount of rescue analgesia and
occurrence of adverse events (respiratory depression, hypotension, nausea,
or vomiting). Outcome measures were compared between groups using analysis
of variance for continuous variables and Fisher's exact test for categorical
data. Results Thirty-six patients (18 in each arm) completed the study.
There was no difference between treatment groups with respect to age, sex,
fracture type, vital signs (baseline and at 4 hours), ED length of stay
(LOS), pre-enrollment analgesia, or baseline pain intensity. In comparing
pain intensity at the end of the study period, NRS scores at 4 hours were
significantly lower in the FNB group (p < 0.001). Over the 4-hour study
period, patients in the FNB group experienced significantly greater overall
pain relief than those in the SC group, with a median SPID of 11.0
(interquartile range [IQR] = 4.0 to 21.8) in the FNB group versus 4.0 (IQR =
-2.0 to 5.8) in the SC group (p = 0.001). No patient in the SC group
achieved a clinically significant reduction in pain. Moreover, patients in
the SC group received significantly more IV morphine than those in the FNB
group (5.0 mg, IQR = 2.0 to 8.4 mg vs. 0.0 mg, IQR = 0.0 to 1.5 mg; p =
0.028). There was no difference in adverse events between groups.
Conclusions Ultrasound-guided femoral nerve block as an adjunct to SC
resulted in 1) significantly reduced pain intensity over 4 hours, 2)
decreased amount of rescue analgesia, and 3) no appreciable difference in
adverse events when compared with SC alone. Furthermore, standard pain
management with parenteral opioids alone provided ineffective pain control
in our study cohort of patients with severe pain from their hip fractures.
Regional anesthesia has a role in the ED, and US-guided femoral nerve blocks
for pain management in older adults with hip fractures should routinely be
considered, particularly in cases of refractory or severe pain. © 2013 by
the Society for Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, clinical trial, drug therapy, intravenous
drug administration, parenteral drug administration)
EMTREE DRUG INDEX TERMS
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency care
emergency patient
hip fracture
nerve block
ultrasound guided three in one femoral nerve block
EMTREE MEDICAL INDEX TERMS
adult
aged
article
clinical article
comparative effectiveness
comparative study
controlled study
convenience sample
elderly care
emergency ward
female
hospitalization
human
hypotension (side effect)
length of stay
male
nausea and vomiting (side effect)
outcome assessment
pain (drug therapy)
pain assessment
priority journal
randomized controlled trial
respiration depression (side effect)
standard
vital sign
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT01701414)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013378556
MEDLINE PMID
23758305 (http://www.ncbi.nlm.nih.gov/pubmed/23758305)
PUI
L369116922
DOI
10.1111/acem.12154
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12154
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 655
TITLE
Prescription opioid guidelines and the emergency department
AUTHOR NAMES
Wattana M.K.
Nelson L.S.
Todd K.H.
AUTHOR ADDRESSES
(Wattana M.K.) Oncologic Emergency Medicine, University of Texas MD Anderson
Cancer Center, Houston TX, United States.
(Nelson L.S.) Department for Academic Affairs, Department of Emergency
Medicine, New York University School of Medicine, United States.
(Todd K.H., khtodd@mdanderson.org) Department of Emergency Medicine,
University of Texas MD Anderson Cancer Center, Unit 1468, 1400 Pressler,
Houston, TX 77030, United States.
CORRESPONDENCE ADDRESS
K.H. Todd, Department of Emergency Medicine, University of Texas MD Anderson
Cancer Center, Unit 1468, 1400 Pressler, Houston, TX 77030, United States.
Email: khtodd@mdanderson.org
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2013) 27:2 (155-162).
Date of Publication: June 2013
ISSN
1536-0288
1536-0539 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
ABSTRACT
On January 10, 2013, Mayor Michael Bloomberg announced a set of
recommendations intended to guide opioid analgesic prescribing in New York
City emergency departments. The intent and scope of these guidelines are
discussed through an interview bu an emergency medicine fellow with an
expert in emergency medicine pain management and one of the authors of the
guidelines. The guidelines are appended to the commentary. © 2013 Informa
Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid plus oxycodone plus oxycodone terephthalate
codeine
fentanyl (transdermal drug administration)
hydrocodone
hydrocodone bitartrate plus paracetamol
hydromorphone
methadone
morphine
morphine sulfate
oxycodone
oxycodone plus paracetamol
oxymorphone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
addiction (side effect)
analgesia
cancer pain
chronic pain (drug therapy)
emergency medicine
emergency physician
human
intoxication (side effect)
physician
practice guideline
review
United States
DRUG TRADE NAMES
avinza
dilaudid
dolophine
duragesic
exalgo
kadian
lorcet
lortab
ms contin
norco
opana er
oramorph sr
oxycontin
percocet
percodan
vicodin
CAS REGISTRY NUMBERS
acetylsalicylic acid plus oxycodone plus oxycodone terephthalate
(64336-56-7)
codeine (76-57-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013397723
MEDLINE PMID
23713906 (http://www.ncbi.nlm.nih.gov/pubmed/23713906)
PUI
L369178588
DOI
10.3109/15360288.2013.788602
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2013.788602
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 656
TITLE
Toxicity following laundry detergent pod ingestion
AUTHOR NAMES
Schneir A.B.
Rentmeester L.
Clark R.F.
Cantrell F.L.
AUTHOR ADDRESSES
(Schneir A.B., aschneir@ucsd.edu; Rentmeester L.; Clark R.F.) UC San Diego
Health System, UC San Diego Medical Center, 200 W Arbor Dr, San Diego, CA
92103, United States.
(Schneir A.B., aschneir@ucsd.edu; Rentmeester L.; Clark R.F.; Cantrell F.L.)
San Diego Division, California Poison Control System, San Diego, United
States.
(Cantrell F.L.) Dept. of Clinical Pharmacy, University of California-San
Francisco School of Pharmacy, San Francisco, CA, United States.
CORRESPONDENCE ADDRESS
A.B. Schneir, UC San Diego Health System, UC San Diego Medical Center, 200 W
Arbor Dr, San Diego, CA 92103, United States. Email: aschneir@ucsd.edu
SOURCE
Pediatric Emergency Care (2013) 29:6 (741-742). Date of Publication: June
2013
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Laundry detergent pods (LDPs) have only recently become available in the
United States, and there has been increasing concern regarding pediatric
ingestions of them. We describe a 15-month-old female infant who ingested an
LDP and had a depressed level of consciousness, metabolic acidosis,
pulmonary toxicity, and swallowing difficulties. It is currently unclear
what the exact etiologic agent(s) is responsible for the toxicity associated
with LDPs. The case demonstrates the potential for significant toxicity
following the ingestion of an LDP. Clearly, measures should be taken to
avoid ingestions of these products. Copyright © 2013 Lippincott Williams &
Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
detergent
laundry detergent pod
EMTREE DRUG INDEX TERMS
alcohol derivative
bronchodilating agent
carbon
ceftriaxone
clindamycin
dexamethasone
glycerol
indicator
naloxone
propylene glycol
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ingestion
laundry
toxicity
EMTREE MEDICAL INDEX TERMS
ambient air
arterial gas
article
aspiration pneumonia
blood culture
blood pressure
body temperature
breathing rate
bronchospasm
case report
child
concentration (parameters)
consciousness level
coughing
depression
dysphagia
emergency health service
emergency ward
esophagogastroduodenoscopy
extubation
face mask
female
follow up
gastric suction
hospital discharge
hospitalization
human
infant
intensive care unit
Klebsiella pneumoniae
laboratory test
laryngoscopy
lower esophagus sphincter
metabolic acidosis
miosis
nasal cannula
oxygen desaturation
pH
physical examination
pleura effusion
preschool child
pulse oximeter
pulse rate
thorax radiography
urine culture
vital sign
vomiting
wheezing
CAS REGISTRY NUMBERS
carbon (7440-44-0)
ceftriaxone (73384-59-5, 74578-69-1)
clindamycin (18323-44-9)
dexamethasone (50-02-2)
glycerol (56-81-5)
naloxone (357-08-4, 465-65-6)
propylene glycol (57-55-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013429464
MEDLINE PMID
23736068 (http://www.ncbi.nlm.nih.gov/pubmed/23736068)
PUI
L369278285
DOI
10.1097/PEC.0b013e318294eb1d
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e318294eb1d
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 657
TITLE
Household "hazMat": A pair of SUDSy siblings
AUTHOR NAMES
Heppner J.
Vohra R.
AUTHOR ADDRESSES
(Heppner J.) Department of Emergency Medicine, UCSF-Fresno Medical Education
Program, Fresno, CA, United States.
(Vohra R., raisvohra@hotmail.com) Department of Emergency Medicine,
UCSF-Fresno Medical Education Program, Fresno-Madera Division, 718 E Serena
Ave, Fresno, CA 93720, United States.
CORRESPONDENCE ADDRESS
R. Vohra, Department of Emergency Medicine, UCSF-Fresno Medical Education
Program, Fresno-Madera Division, 718 E Serena Ave, Fresno, CA 93720, United
States. Email: raisvohra@hotmail.com
SOURCE
Pediatric Emergency Care (2013) 29:6 (773-777). Date of Publication: June
2013
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
detergent (drug toxicity)
EMTREE DRUG INDEX TERMS
beclometasone (drug therapy)
bicarbonate (endogenous compound)
cefalexin (drug therapy)
fentanyl
hemoglobin (endogenous compound)
midazolam
naloxone (drug therapy)
oxygen
salbutamol (drug therapy, inhalational drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
home accident
intoxication (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
artificial ventilation
assisted ventilation
bicarbonate blood level
breathing
bronchospasm (complication, drug therapy)
case report
child
computer assisted tomography
coughing
crying
dyspnea (drug therapy)
emergency health service
endotracheal intubation
female
fever
follow up
gastric suction
Glasgow coma scale
human
lethargy
male
mental health
methicillin susceptible Staphylococcus aureus
note
oxygen saturation
oxygen therapy
pneumonia (drug therapy)
preschool child
pulse rate
respiratory tract infection (drug therapy)
sibling
stomach content
thorax radiography
treatment duration
vomiting
wheezing
CAS REGISTRY NUMBERS
beclometasone (4419-39-0)
bicarbonate (144-55-8, 71-52-3)
cefalexin (15686-71-2, 23325-78-2)
fentanyl (437-38-7)
hemoglobin (9008-02-0)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013429472
MEDLINE PMID
23736077 (http://www.ncbi.nlm.nih.gov/pubmed/23736077)
PUI
L369278293
DOI
10.1097/PEC.0b013e318295436e
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e318295436e
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 658
TITLE
Opioid Receptor Polymorphism A118G Associated with Clinical Severity in a
Drug Overdose Population
AUTHOR NAMES
Manini A.F.
Jacobs M.M.
Vlahov D.
Hurd Y.L.
AUTHOR ADDRESSES
(Manini A.F., alex.manini@mountsinai.org) Division of Medical Toxicology,
Department of Emergency Medicine, Mount Sinai School of Medicine, Elmhurst
Hospital Center, One Gustave Levy Place, Box 1620, NY, NY, 10029, United
States.
(Jacobs M.M.; Hurd Y.L.) Departments of Psychiatry and Neuroscience, Mount
Sinai School of Medicine, NY, NY, United States.
(Vlahov D.) School of Nursing, University of California, San Francisco, CA,
United States.
CORRESPONDENCE ADDRESS
A. F. Manini, Division of Medical Toxicology, Department of Emergency
Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, One
Gustave Levy Place, Box 1620, NY, NY, 10029, United States. Email:
alex.manini@mountsinai.org
SOURCE
Journal of Medical Toxicology (2013) 9:2 (148-154). Date of Publication:
June 2013
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
ABSTRACT
Genetic variations in the human mu-opioid receptor gene (OPRM1) mediate
individual differences in response to pain and opiate addiction. We studied
whether the common A118G (rs1799971) mu-opioid receptor single nucleotide
polymorphism (SNP) was associated with overdose severity in humans. In
addition, we examined an SNP responsible for alternative splicing of OPRM1
(rs2075572). We assessed allele frequencies of the above SNPs and
associations with clinical severity in patients presenting to the emergency
department (ED) with acute drug overdose. This work was designed as an
observational cohort study over a 12-month period at an urban teaching
hospital. Participants consisted of consecutive adult ED patients with
suspected acute drug overdose for whom discarded blood samples were
available for analysis. Specimens were linked with clinical variables
(demographics, urine toxicology screens, clinical outcomes) then
deidentified prior to genetic SNP analysis. Blinded genotyping was performed
after standard DNA purification and whole genome amplification. In-hospital
severe outcomes were defined as either respiratory arrest (RA; defined by
mechanical ventilation) or cardiac arrest (CA; defined by loss of pulse). We
analyzed 179 patients (61% male, median age 32) who overall suffered 15 RAs
and four CAs, of whom three died. The 118G allele conferred 5.3-fold
increased odds of CA/RA (p<0.05), while the rs2075572 variant allele was not
associated with CA/RA. The 118G variant allele in the OPRM1 gene is
associated with worse clinical severity in patients with acute drug
overdose. These findings mark the first time that the 118G variant allele is
linked with clinical drug overdose vulnerability. © 2013 American College of
Medical Toxicology.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
mu opiate receptor (endogenous compound)
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent
alcohol
antidepressant agent
benzodiazepine
DNA (endogenous compound)
methadone
neuroleptic agent
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
disease severity
drug overdose
single nucleotide polymorphism
EMTREE MEDICAL INDEX TERMS
adult
alternative RNA splicing
article
artificial ventilation
blood sampling
cohort analysis
controlled study
demography
DNA purification
emergency patient
emergency ward
female
gene amplification
gene frequency
genetic variability
genotype
heart arrest
human
major clinical study
male
observational study
opiate addiction
outcome assessment
pain
prospective study
receptor gene
respiratory arrest
teaching hospital
CAS REGISTRY NUMBERS
DNA (9007-49-2)
alcohol (64-17-5)
benzodiazepine (12794-10-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Human Genetics (22)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013327796
MEDLINE PMID
23318993 (http://www.ncbi.nlm.nih.gov/pubmed/23318993)
PUI
L52394240
DOI
10.1007/s13181-012-0286-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-012-0286-3
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 659
TITLE
Drugs of abuse in hair: Application in pediatric patients
AUTHOR NAMES
Fucci N.
Vetrugno G.
De Giovanni N.
AUTHOR ADDRESSES
(Fucci N., nadiafucci@rm.unicatt.it; Vetrugno G.; De Giovanni N.) Institute
of Legal Medicine, Catholic University of Sacred Heart, Rome, Italy.
(Fucci N., nadiafucci@rm.unicatt.it) Institute of Legal Medicine, Catholic
University of Sacred Heart, L.go F. Vito, 1, 00168 Rome, Italy.
CORRESPONDENCE ADDRESS
N. Fucci, Institute of Legal Medicine, Catholic University of Sacred Heart,
L.go F. Vito, 1, 00168 Rome, Italy. Email: nadiafucci@rm.unicatt.it
SOURCE
Therapeutic Drug Monitoring (2013) 35:3 (411-413). Date of Publication: June
2013
ISSN
0163-4356
1536-3694 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Background: We are describing a case of pediatric maltreatment. A 3-year-old
boy was brought to the emergency room because of drowsiness that was caused
by what his parents described as an 'accidental' intake of a powder
contained in a plastic wrapper that was found in a park. Methods: Urine
immunochemical screening for drugs of abuse showed a positive result for
opiate exposure. Despite the described 'accident,' the physician suspected
abuse and ordered a hair analysis to verify possible intake of drugs of
abuse. The child's hair was analyzed along its whole length for drugs of
abuse using gas chromatography mass spectrometry in accordance with
international guidelines. Results and Discussion: Morphine and
6-Acetylmorphine were identified, and the doctor informed the city's
juvenile court. The boy's family was involved with social services for a
period of observation to confirm suspected prolonged abuse. Hair analysis
proves to be a useful tool for periodical examination of drug exposure to
protect children from significant health and social risks. © 2013 by
Lippincott Williams and Wilkins.
EMTREE DRUG INDEX TERMS
diamorphine
morphine
morphine 6 acetate
naloxone (drug therapy, intravenous drug administration)
opiate
plastic
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
hair analysis
EMTREE MEDICAL INDEX TERMS
article
case report
child
drowsiness
drug exposure
drug intoxication (drug therapy)
fluid therapy
hair
health hazard
human
immunochemistry
male
mass fragmentography
pain
powder
preschool child
priority journal
restlessness
risk
social work
stomach lavage
urinalysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
morphine 6 acetate (2784-73-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013436899
MEDLINE PMID
23666584 (http://www.ncbi.nlm.nih.gov/pubmed/23666584)
PUI
L52576903
DOI
10.1097/FTD.0b013e31828b8e12
FULL TEXT LINK
http://dx.doi.org/10.1097/FTD.0b013e31828b8e12
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 660
TITLE
Pharmacy and opioid dependence treatments
AUTHOR NAMES
Sclavos K.
AUTHOR ADDRESSES
(Sclavos K.)
CORRESPONDENCE ADDRESS
K. Sclavos,
SOURCE
Australian Journal of Pharmacy (2013) 94:1117 (28). Date of Publication:
June 2013
ISSN
0311-8002
BOOK PUBLISHER
Australian Pharmaceutical Publishing Company Ltd, 40 Burwood Road, Hawthorn,
Australia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
buprenorphine plus naloxone (drug therapy)
methadone (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
Australia
drug dependence treatment
drug overdose
emergency health service
health program
health service
human
note
patient monitoring
pharmacist
pharmacy
prescription
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013375352
PUI
L369108740
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 661
TITLE
Recurrent Seizures and Serotonin Syndrome Following "2C-I" Ingestion
AUTHOR NAMES
Bosak A.
LoVecchio F.
Levine M.
AUTHOR ADDRESSES
(Bosak A.; LoVecchio F.; Levine M., mdlevine@usc.edu) Department of Medical
Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, United
States.
(Levine M., mdlevine@usc.edu) Department of Emergency Medicine, Section of
Medical Toxicology, University of Southern California, Los Angeles, CA,
United States.
CORRESPONDENCE ADDRESS
M. Levine, Department of Emergency Medicine, Section of Medical Toxicology,
University of Southern California, Los Angeles, CA, United States. Email:
mdlevine@usc.edu
SOURCE
Journal of Medical Toxicology (2013) 9:2 (196-198). Date of Publication:
June 2013
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
ABSTRACT
The phenethylamines, including 2, 5 dimethoxy-4-iodophenethylamine, commonly
referred to as 2C-I, have recently emerged as a new class of designer drugs.
Cases of toxicity from these drugs are not well described in the literature.
This case report describes a 19 year-old male who insufflated 2C-I.
Following the ingestion, the patient developed recurrent seizures, and was
taken to the emergency department, where he was noted to be hyperadrenergic
and had recurrent seizures. The patient was diagnosed with serotonin
syndrome and experienced prolonged respiratory failure, although he
ultimately made a full recovery. Comprehensive drug testing revealed the
presence of 2C-I. The pharmacologic properties of 2C-I are also discussed. ©
2013 American College of Medical Toxicology.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2,5 dimethoxy 4 iodophenethylamine (drug toxicity)
phenethylamine (drug toxicity)
EMTREE DRUG INDEX TERMS
cyproheptadine (drug combination, drug dose, drug therapy)
designer drug
lorazepam (drug therapy, intravenous drug administration)
midazolam (drug therapy, intravenous drug administration)
naloxone (intravenous drug administration)
phenobarbital (drug combination, drug therapy)
propofol (drug combination, drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
serotonin syndrome
tonic clonic seizure (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical evaluation
coma
disease course
emergency ward
follow up
human
ingestion
inhalation
intensive care unit
laboratory test
male
muscle rigidity (drug therapy)
outcome assessment
patient transport
recurrent disease
respiratory failure
sedation
CAS REGISTRY NUMBERS
cyproheptadine (129-03-3, 969-33-5)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
phenethylamine (64-04-0)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Epilepsy Abstracts (50)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013327803
MEDLINE PMID
23378129 (http://www.ncbi.nlm.nih.gov/pubmed/23378129)
PUI
L52433763
DOI
10.1007/s13181-013-0287-x
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-013-0287-x
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 662
TITLE
Understanding overdose. Opioids are a secret and leading cause of death.
AUTHOR NAMES
Snyder S.R.
Kivlehan S.M.
Collopy K.T.
AUTHOR ADDRESSES
(Snyder S.R.) Public Safety Training Center in the Emergency Care Program,
Santa Rosa Junior College, CA, USA.
(Kivlehan S.M.; Collopy K.T.)
CORRESPONDENCE ADDRESS
S.R. Snyder, Public Safety Training Center in the Emergency Care Program,
Santa Rosa Junior College, CA, USA. Email: scottrsnyder@me.com
SOURCE
EMS world (2013) 42:6 (57-61). Date of Publication: Jun 2013
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
article
cause of death
emergency health service
human
mortality
United States (epidemiology)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23822044 (http://www.ncbi.nlm.nih.gov/pubmed/23822044)
PUI
L369508889
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 663
TITLE
Controlling opioid abuse in the emergency department: Legitimate public
policy or "legislative medicine"?
AUTHOR NAMES
Huffman A.
AUTHOR ADDRESSES
(Huffman A.)
CORRESPONDENCE ADDRESS
A. Huffman,
SOURCE
Annals of Emergency Medicine (2013) 61:6 (13A-15A). Date of Publication:
June 2013
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
emergency ward
EMTREE MEDICAL INDEX TERMS
drug fatality
drug legislation
drug monitoring
drug overdose
emergency physician
euphoria
health care
human
legal aspect
medical history
physical examination
physician attitude
prescription
priority journal
review
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013325659
MEDLINE PMID
23828953 (http://www.ncbi.nlm.nih.gov/pubmed/23828953)
PUI
L368965621
DOI
10.1016/j.annemergmed.2013.04.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2013.04.007
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 664
TITLE
We can make opioids safer
AUTHOR NAMES
Lipman A.G.
AUTHOR ADDRESSES
(Lipman A.G.)
CORRESPONDENCE ADDRESS
A.G. Lipman,
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2013) 27:2 (112-113).
Date of Publication: June 2013
ISSN
1536-0288
1536-0539 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
generic drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug safety
EMTREE MEDICAL INDEX TERMS
cause of death
decision making
drug abuse
drug fatality
drug manufacture
editorial
emergency ward
food and drug administration
government regulation
health care personnel
human
pain
patient care
policy
postgraduate education
prescription
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013397726
MEDLINE PMID
23688516 (http://www.ncbi.nlm.nih.gov/pubmed/23688516)
PUI
L369178591
DOI
10.3109/15360288.2013.788609
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2013.788609
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 665
TITLE
A response to the opioid overdose epidemic: Naloxone nasal spray
AUTHOR NAMES
Wermeling D.P.
AUTHOR ADDRESSES
(Wermeling D.P., dwermel@uky.edu) University of Kentucky College of
Pharmacy, 789 South Limestone Street, Lexington, KY, 40536-0596, United
States.
CORRESPONDENCE ADDRESS
D. P. Wermeling, University of Kentucky College of Pharmacy, 789 South
Limestone Street, Lexington, KY, 40536-0596, United States. Email:
dwermel@uky.edu
SOURCE
Drug Delivery and Translational Research (2013) 3:1 (63-74). Date of
Publication: 2013
ISSN
2190-393X
2190-3948 (electronic)
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
Opioid overdose morbidity and mortality is recognized to have epidemic
proportions. Medical and public health agencies are adopting opioid harm
reduction strategies to reduce the morbidity and mortality associated with
overdose. One strategy developed by emergency medical services and public
health agencies is to deliver the opioid antidote naloxone injection
intranasally to reverse the effects of opioids. Paramedics have used this
route to quickly administer naloxone in a needle-free system and avoiding
needlestick injuries and contracting a blood-born pathogen disease such as
hepatitis or human immunodeficiency virus. Public health officials advocate
broader lay person access since civilians are likely witnesses or first
responders to an opioid overdose in a time-acute setting. The barrier to
greater use of naloxone is that a suitable and optimized needle-free drug
delivery system is unavailable. The scientific basis for design and study of
an intranasal naloxone product is described. Lessons from nasal delivery of
opioid analgesics are applied to the consideration of naloxone nasal spray.
© 2012 Controlled Release Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug therapy, intraduodenal drug
administration, intramuscular drug administration, intranasal drug
administration, intravenous drug administration, pharmaceutics,
pharmacokinetics, subcutaneous drug administration)
opiate (intranasal drug administration)
EMTREE DRUG INDEX TERMS
butorphanol
hydromorphone
naltrexone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
anesthesia
animal experiment
animal model
controlled study
drug formulation
epidemic
hepatitis virus
Human immunodeficiency virus
male
needlestick injury
nonhuman
nose
pharmaceutics
priority journal
public health
rat
review
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013202703
PUI
L368610829
DOI
10.1007/s13346-012-0092-0
FULL TEXT LINK
http://dx.doi.org/10.1007/s13346-012-0092-0
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 666
TITLE
Barriers to medical provider support for prescription naloxone as overdose
antidote for lay responders
AUTHOR NAMES
Green T.C.
Bowman S.E.
Zaller N.D.
Ray M.
Case P.
Heimer R.
AUTHOR ADDRESSES
(Green T.C.; Bowman S.E.; Zaller N.D.; Ray M.; Case P.; Heimer R.) The
Warren Alpert Medical School of Brown University, Providence, Rhode Island
02903, USA. traci.c.green@brown.edu
SOURCE
Substance use & misuse (2013) 48:7 (558-567). Date of Publication: 1 May
2013
ISSN
1532-2491 (electronic)
ABSTRACT
Poisonings are the leading cause of adult injury death in the United States.
Over 12 weeks in 2011, 143 key informant interviews were conducted using a
structured interview guide in three study sites in New England. This
analysis focuses on the 24 interviews with emergency department providers,
substance use treatment providers, pain specialists, and generalist/family
medicine practitioners. Using an iterative coding process, we analyzed
statements regarding support and concern about naloxone prescription for
pain patients and drug users. The study's implications and limitations are
discussed and future research suggested. The Centers for Disease Control and
Prevention funded this study.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health personnel attitude
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
human
prescription
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
23647168 (http://www.ncbi.nlm.nih.gov/pubmed/23647168)
PUI
L604543951
DOI
10.3109/10826084.2013.787099
FULL TEXT LINK
http://dx.doi.org/10.3109/10826084.2013.787099
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 667
TITLE
Drug seeking or pain crisis? Responsible prescribing of opioids in the
emergency department.
AUTHOR NAMES
Pentin P.L.
AUTHOR ADDRESSES
(Pentin P.L.) University of Washington School of Medicine, Seattle, WA, USA.
CORRESPONDENCE ADDRESS
P.L. Pentin, University of Washington School of Medicine, Seattle, WA, USA.
SOURCE
The virtual mentor : VM (2013) 15:5 (410-415). Date of Publication: May 2013
ISSN
1937-7010 (electronic)
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction
analgesia
clinical competence
emergency health service
pain (drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
article
ethics
human
social behavior
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23680561 (http://www.ncbi.nlm.nih.gov/pubmed/23680561)
PUI
L563011550
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 668
TITLE
National audit of antidote stocking in acute hospitals in the UK
AUTHOR NAMES
Thanacoody R.H.K.
Aldridge G.
Laing W.
Dargan P.I.
Nash S.
Thompson J.P.
Vale A.
Bateman N.
Thomas S.
AUTHOR ADDRESSES
(Thanacoody R.H.K., ruben.thanacoody@nuth.nhs.uk; Thomas S.) National
Poisons Information Service (Newcastle), Newcastle-upon-Tyne, United
Kingdom.
(Aldridge G.; Thompson J.P.) National Poisons Information Service (Cardiff),
Cardiff, United Kingdom.
(Laing W.; Bateman N.) National Poisons Information Service (Edinburgh),
Edinburgh, United Kingdom.
(Dargan P.I.) Guys and St. Thomas NHS Foundation Trust, London, United
Kingdom.
(Nash S.) College of Emergency Medicine, London, United Kingdom.
(Vale A.) National Poisons Information Service (Birmingham), Birmingham,
United Kingdom.
CORRESPONDENCE ADDRESS
R.H.K. Thanacoody, National Poisons Information Unit (Newcastle), 24
Claremont Road, Newcastle-upon-Tyne NE2 4HH, United Kingdom. Email:
ruben.thanacoody@nuth.nhs.uk
SOURCE
Emergency Medicine Journal (2013) 30:5 (393-396). Date of Publication: May
2013
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Background: Inadequate stocking of essential antidotes in hospitals for the
treatment of poisoned patients has been reported worldwide. Joint National
Poisons Information Service (NPIS)/College of Emergency Medicine (CEM)
guidelines for antidote stocking in UK emergency departments and acute
hospitals were published in 2008. Aim: To determine the impact of these
guidelines by surveying the availability of antidotes in acute hospitals in
the UK. Methods: A two-page questionnaire consisting of antidote stocking
information was distributed in 2010 to the Chief Pharmacist in all acute
hospitals in the UK. The availability of 28 antidotes in the NPIS/CEM
antidote guidelines as well as that of Intralipid was surveyed. Results
Surveys were completed for 196 of the 224 (87.5%) hospitals. Over 90% of
hospitals had acetylcysteine, activated charcoal, dantrolene,
desferrioxamine, naloxone, flumazenil and vitamin K available within the
recommended time period. Pralidoxime was reported to be held in only 33% of
hospitals, though pralidoxime is supplied by the Department of Health to 95
hospitals in the UK that act as holding centres. Cyproheptadine and viper
venom antiserum were held in around 50% of acute hospitals. For the
treatment of cyanide and toxic alcohol poisoning, more than one antidote is
available. For cyanide poisoning, most hospitals held at least one antidote
(usually dicobalt edetate) but 9 (5%) held none of the four antidotes. For
toxic alcohol and glycol poisoning, most hospitals held ethanol for
intravenous use but not fomepizole and 30 (15%) did not stock any antidote
for toxic alcohol poisoning. Conclusion: Stocking of less commonly used
antidotes is inconsistent. This is likely to result in delayed access to
treatment and worse patient outcomes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy, intravenous drug administration)
acetylcysteine
activated carbon
alcohol (intravenous drug administration, oral drug administration)
botulinum antiserum
cobalt edetate (drug therapy)
cyproheptadine
dantrolene
deferoxamine
digoxin antibody F(ab) fragment
edetate calcium disodium
flumazenil
folinate calcium
glucagon
gluconate calcium
hydroxocobalamin
intralipid
macrogol
methylene blue
naloxone
octreotide
phytomenadione
pralidoxime
snake venom antiserum
sodium nitrite
sodium thiosulfate
succimer
unithiol
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical audit
drug stocking
drug storage
United Kingdom
EMTREE MEDICAL INDEX TERMS
alcohol intoxication (drug therapy)
article
cyanide poisoning (drug therapy)
glycol poisoning (drug therapy)
glycol poisoning (drug therapy)
health survey
hospital
human
intoxication (drug therapy)
major clinical study
practice guideline
priority journal
questionnaire
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
cobalt edetate (14931-83-0, 36499-65-7)
cyproheptadine (129-03-3, 969-33-5)
dantrolene (14663-23-1, 7261-97-4)
deferoxamine (70-51-9)
edetate calcium disodium (62-33-9)
flumazenil (78755-81-4)
folinate calcium (1492-18-8, 51057-63-7)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
intralipid (68890-65-3)
macrogol (25322-68-3)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime (6735-59-7)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
unithiol (4076-02-2, 74-61-3)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013296994
MEDLINE PMID
22875840 (http://www.ncbi.nlm.nih.gov/pubmed/22875840)
PUI
L52161351
DOI
10.1136/emermed-2012-201224
FULL TEXT LINK
http://dx.doi.org/10.1136/emermed-2012-201224
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 669
TITLE
Drug seeking or pain crisis? Responsible prescribing of opioids in the
emergency department
AUTHOR NAMES
Pentin P.L.
AUTHOR ADDRESSES
(Pentin P.L.) University of Washington School of Medicine, Seattle, WA, USA
SOURCE
The virtual mentor : VM (2013) 15:5 (410-415). Date of Publication: 1 May
2013
ISSN
1937-7010 (electronic)
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction
analgesia
clinical competence
emergency health service
prescription
EMTREE MEDICAL INDEX TERMS
ethics
human
pain (drug therapy)
social behavior
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
23680561 (http://www.ncbi.nlm.nih.gov/pubmed/23680561)
PUI
L603056618
DOI
10.1001/virtualmentor.2013.15.5.ecas2-1305
FULL TEXT LINK
http://dx.doi.org/10.1001/virtualmentor.2013.15.5.ecas2-1305
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 670
TITLE
Barriers to medical provider support for prescription naloxone as overdose
antidote for lay responders.
AUTHOR NAMES
Green T.C.
Bowman S.E.
Zaller N.D.
Ray M.
Case P.
Heimer R.
AUTHOR ADDRESSES
(Green T.C., traci.c.green@brown.edu) The Warren Alpert Medical School of
Brown University, Providence, Rhode Island 02903, USA.
(Bowman S.E.; Zaller N.D.; Ray M.; Case P.; Heimer R.)
CORRESPONDENCE ADDRESS
T.C. Green, The Warren Alpert Medical School of Brown University,
Providence, Rhode Island 02903, USA. Email: traci.c.green@brown.edu
SOURCE
Substance use & misuse (2013) 48:7 (558-567). Date of Publication: May 2013
ISSN
1532-2491 (electronic)
ABSTRACT
Poisonings are the leading cause of adult injury death in the United States.
Over 12 weeks in 2011, 143 key informant interviews were conducted using a
structured interview guide in three study sites in New England. This
analysis focuses on the 24 interviews with emergency department providers,
substance use treatment providers, pain specialists, and generalist/family
medicine practitioners. Using an iterative coding process, we analyzed
statements regarding support and concern about naloxone prescription for
pain patients and drug users. The study's implications and limitations are
discussed and future research suggested. The Centers for Disease Control and
Prevention funded this study.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
health personnel attitude
EMTREE MEDICAL INDEX TERMS
article
human
prescription
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23647168 (http://www.ncbi.nlm.nih.gov/pubmed/23647168)
PUI
L563011954
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 671
TITLE
Does opiate use in traumatically injured individuals worsen pain and
psychological outcomes
AUTHOR NAMES
Trevino C.M.
De Roon-Cassini T.
Brasel K.
AUTHOR ADDRESSES
(Trevino C.M., ctrevino@mcw.edu; De Roon-Cassini T.; Brasel K.) Division of
Trauma and Critical Care, Department of Surgery, Medical College of
Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, United States.
CORRESPONDENCE ADDRESS
C.M. Trevino, Division of Trauma and Critical Care, Department of Surgery,
Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226,
United States. Email: ctrevino@mcw.edu
SOURCE
Journal of Pain (2013) 14:4 (424-430). Date of Publication: April 2013
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
Opiate use for chronic pain is becoming increasingly controversial. There
has been a shift away from supporting the use of opiates for treatment of
chronic pain. In addition to lack of effectiveness, concerns for adverse
clinical outcomes, addiction, and death have provided the impetus for this
change. The purpose of this study was to investigate the percent of trauma
patients still using opiates, their pain levels, and psychological outcomes
4 months posttrauma. This was a study to evaluate chronic pain at 4 months
posttrauma in 101 participants from a single level 1 trauma center. Eighty
of the 101 participants developed chronic pain 4 months after their initial
traumatic injury (79%). Of those who developed chronic pain, 27 (26%) were
still using opiates. Those using narcotics at 4 months posttrauma had
significantly more pain, life interference, depression, and anxiety.
Posttraumatic stress disorder (PTSD) was not significantly influenced by
narcotic use in this analysis. However, the mean associated with those using
narcotics was higher and diagnostic for PTSD. Those taking opiates did not
have significantly better relief from their pain using treatments or
medications than those not using opiates (F = 8, P = .08). These findings
bring into question the appropriate use of opiates for chronic pain and the
possible exacerbating effects on pain and psychopathology in traumatically
injured patients. Perspective: This article identifies data that provide
evidence that narcotic pain medication needs to be used carefully in
traumatically injured patients with chronic pain, especially in those
individuals with comorbid psychological pathology. © 2013 by the American
Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic agent (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol abuse
alcohol consumption
American Indian
anxiety disorder
article
Brief Pain Inventory
controlled study
crush trauma
depression
disease exacerbation
emergency health service
female
follow up
gunshot injury
Hispanic
hospital admission
Hospital Anxiety and Depression Scale
hospital patient
human
injury
injury severity
major clinical study
male
marriage
McGill Pain Questionnaire
middle aged
outcome assessment
pain
pain assessment
posttraumatic stress disorder
scoring system
self report
stab wound
symptomatology
traffic accident
visual analog scale
young adult
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014063719
MEDLINE PMID
23548492 (http://www.ncbi.nlm.nih.gov/pubmed/23548492)
PUI
L372185745
DOI
10.1016/j.jpain.2012.12.016
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2012.12.016
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 672
TITLE
Opioid overdose: What hospital pharmacists should know
AUTHOR NAMES
Hovestreydt L.R.
AUTHOR ADDRESSES
(Hovestreydt L.R.) New York-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, United States.
CORRESPONDENCE ADDRESS
L. R. Hovestreydt, New York-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, United States.
SOURCE
U.S. Pharmacist (2013) 38:4. Date of Publication: April 2013
ISSN
0148-4818
BOOK PUBLISHER
Jobson Publishing Corporation, 100 Avenue of the Americas, New York, United
States.
ABSTRACT
Opioid overdose continues to occur at staggering rates in the United States,
posing numerous challenges to clinicians. The use of opioid painkillers for
both medical and nonmedical purposes has increased markedly in recent years.
Pharmacists in all health care venues will likely be exposed to cases of
intentional and unintentional opioid overdose, and should be able to
recognize the risk factors and signs of overdose, as well as understand the
strategies of pharmacologic management. Furthermore, regulatory oversight of
opioids is intensifying, with multiple FDA-mandated risk management programs
that pharmacists should be familiar with.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
buprenorphine (adverse drug reaction, pharmacology)
catecholamine
cocaine
diamorphine
fentanyl
fentanyl citrate
hydromorphone
methadone (adverse drug reaction, pharmacology)
morphine sulfate
morphine sulfate plus naltrexone
mu opiate receptor agonist
naloxone (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration, pharmacology, subcutaneous
drug administration)
opiate receptor
oxycodone
oxymorphone
tapentadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
opioid overdose
EMTREE MEDICAL INDEX TERMS
allergic reaction (side effect)
article
cancer pain
central nervous system depression
central nervous system disease (side effect)
depression (side effect)
drug mechanism
drug misuse
drug receptor binding
emergency ward
fatality
health hazard
heart arrest (side effect)
heart ventricle fibrillation (side effect)
hepatitis (side effect)
high risk behavior
hospital admission
human
hypotension (side effect)
maintenance drug dose
maintenance therapy
mortality
oxygen saturation
patient counseling
patient education
patient monitoring
pharmacist
prescription
QT prolongation (side effect)
receptor down regulation
recommended drug dose
respiration control
respiration depression (side effect)
side effect (side effect)
symptom
withdrawal syndrome
DRUG TRADE NAMES
abstral
actiq
avinza
butrans
dolophine
duragesic
embeda
exalgo
fentora
kadian
lazanda
ms contin
nucynta er
onsolis
opana er
oxycontin
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013256594
PUI
L368774124
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 673
TITLE
Opioid overdose: What hospital pharmacists should know
AUTHOR NAMES
Hovestreydt L.R.
AUTHOR ADDRESSES
(Hovestreydt L.R.) New York-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, United States.
CORRESPONDENCE ADDRESS
L. R. Hovestreydt, New York-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, United States.
SOURCE
U.S. Pharmacist (2013) 38:4. Date of Publication: April 2013
ISSN
0148-4818
BOOK PUBLISHER
Jobson Publishing Corporation, 100 Avenue of the Americas, New York, United
States.
ABSTRACT
Opioid overdose continues to occur at staggering rates in the United States,
posing numerous challenges to clinicians. The use of opioid painkillers for
both medical and nonmedical purposes has increased markedly in recent years.
Pharmacists in all health care venues will likely be exposed to cases of
intentional and unintentional opioid overdose, and should be able to
recognize the risk factors and signs of overdose, as well as understand the
strategies of pharmacologic management. Furthermore, regulatory oversight of
opioids is intensifying, with multiple FDA-mandated risk management programs
that pharmacists should be familiar with.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (pharmacokinetics)
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
fentanyl (drug therapy)
fentanyl citrate (drug therapy)
hydromorphone (drug therapy)
methadone (drug therapy)
morphine sulfate (drug therapy)
morphine sulfate plus naltrexone (drug therapy)
naloxone (adverse drug reaction, drug therapy, inhalational drug
administration, intramuscular drug administration, intranasal drug
administration, intraosseous drug administration, intravenous drug
administration, subcutaneous drug administration)
oxycodone (drug therapy)
oxymorphone (drug therapy)
tapentadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pharmacist
EMTREE MEDICAL INDEX TERMS
agitation
anxiety
apnea
article
continuous infusion
diaphoresis
drug overdose (drug therapy)
emergency ward
hospital admission
human
hypertension (side effect)
insomnia
irritability
lacrimation
long term exposure
miosis
mydriasis
nausea and vomiting
respiration depression
side effect (side effect)
stupor
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
tapentadol (175591-09-0, 175591-23-8)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013256596
PUI
L368774126
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 674
TITLE
Leftover prescription opioids and nonmedical use among high school seniors:
A multi-cohort national study
AUTHOR NAMES
McCabe S.E.
West B.T.
Boyd C.J.
AUTHOR ADDRESSES
(McCabe S.E., plius@umich.edu; Boyd C.J.) Institute for Research on Women
and Gender, University of Michigan, 204 S. State Street, Ann Arbor, MI
48109-1290, United States.
(McCabe S.E., plius@umich.edu; Boyd C.J.) Substance Abuse Research Center,
University of Michigan, Ann Arbor, MI, United States.
(West B.T.) Center for Statistical Consultation and Research, University of
Michigan, Ann Arbor, MI, United States.
(West B.T.) Survey Research Center, Institute for Social Research,
University of Michigan, Ann Arbor, MI, United States.
CORRESPONDENCE ADDRESS
S.E. McCabe, Institute for Research on Women and Gender, University of
Michigan, 204 S. State Street, Ann Arbor, MI 48109-1290, United States.
Email: plius@umich.edu
SOURCE
Journal of Adolescent Health (2013) 52:4 (480-485). Date of Publication:
April 2013
ISSN
1054-139X
1879-1972 (electronic)
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Purpose: To (1) estimate the proportion of nonmedical users of prescription
opioids (i.e., used prescription opioids in the past year without a doctor's
orders) who used leftover medications from their own previous prescriptions;
(2) assess substance use behaviors as a function of diversion source; and
(3) identify the sources for these prescribed opioids. Methods: We analyzed
data collected via self-administered questionnaires from nationally
representative samples of high school seniors (modal age, 18 years) as a
part of the Monitoring the Future (MTF) study. The sample consisted of four
cohorts (senior years of 2007-2010, n = 8,888), including 647 high school
seniors who reported past-year nonmedical use of prescription opioids, of
whom 53% were estimated to be women. Results: An estimated 36.9% of
past-year nonmedical users of prescription opioids obtained these opioid
medications from their own previous prescriptions. Logistic regression
analyses indicated that nonmedical users who used leftover medications from
their previous prescriptions were primarily motivated to relieve physical
pain, whereas nonmedical users who obtained medications from other sources
had significantly higher odds of prescription opioid abuse and other
substance use behaviors. Based on a subanalysis of nonmedical users who
obtained prescription opioids from their previous prescriptions in 2010 (n =
51), approximately 27.1% obtained them from a dentist, 45.0% obtained them
from an emergency room physician, and 38.3% obtained them from another
physician. Conclusions: Leftover prescription opioids from previous
prescriptions represent a major source of nonmedical use of prescription
opioids among high school seniors. These findings indicate that enhanced
vigilance is needed when prescribing and monitoring prescription opioids
among adolescents, to reduce leftover medications and nonmedical use. © 2013
Society for Adolescent Health and Medicine. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
prescription
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
dentist
emergency physician
female
human
major clinical study
male
prevalence
priority journal
questionnaire
self ad
sex ratio
substance abuse
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013188300
MEDLINE PMID
23298996 (http://www.ncbi.nlm.nih.gov/pubmed/23298996)
PUI
L52313621
DOI
10.1016/j.jadohealth.2012.08.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jadohealth.2012.08.007
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 675
TITLE
Randomized clinical trial of the effect of supplemental opioids in
procedural sedation with propofol on serum catecholamines
AUTHOR NAMES
Miner J.R.
Moore J.C.
Plummer D.
Gray R.O.
Patel S.
Ho J.D.
AUTHOR ADDRESSES
(Miner J.R., miner015@umn.edu; Moore J.C.; Plummer D.; Gray R.O.; Patel S.;
Ho J.D.) Department of Emergency Medicine, Hennepin County Medical Center,
Minneapolis, MN, United States.
CORRESPONDENCE ADDRESS
J.R. Miner, Department of Emergency Medicine, Hennepin County Medical
Center, Minneapolis, MN, United States. Email: miner015@umn.edu
SOURCE
Academic Emergency Medicine (2013) 20:4 (330-337). Date of Publication:
April 2013
ISSN
1069-6563
1553-2712 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives The objective was to assess the effect on stress biomarkers of
supplemental opioid to a standard propofol dosing protocol for emergency
department (ED) procedural sedation (PS). The hypothesis was that there is
no difference in the change in serum catecholamines between PS using
propofol with or without supplemental alfentanil. Methods This was a
randomized, nonblinded pilot study of adult patients undergoing PS in the ED
for the reduction of fractures and dislocations. Patients with pain before
the procedure were treated with intravenous (IV) morphine sulfate until
their pain was adequately treated for at least 20 minutes before starting
the procedure. Patients were randomized to receive either 10 μg/kg
alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3
minutes as needed, or propofol only, dosed in similar fashion without
supplemental alfentanil. Doses, vital signs, nasal end-tidal CO(2)
(ETCO(2)), pulse oximetry, and bispectral electroencephalogram (EEG)
analysis scores were recorded. Subclinical respiratory depression was
defined as a change in ETCO(2) > 10 mm Hg, an oxygen saturation of < 92% at
any time, or an absent ETCO(2) waveform at any time. Clinical events related
to respiratory depression were noted during the procedure, including the
addition of or increase in the flow rate of supplemental oxygen, the use of
a bag-valve-mask apparatus, airway repositioning, or stimulation to induce
breathing. Blood was drawn 1 minute prior to the administration of the
medications for PS and again 1 minute after completion of the procedure for
which the patient was sedated. Serum was tested for total catecholamines,
epinephrine, norepinephrine, and dopamine. Postprocedure, patients were
asked to report any pain perceived during the procedure. Data were analyzed
using descriptive statistics, Wilcoxon rank sum tests, and chi-square tests,
as appropriate. Results Twenty patients were enrolled; 10 received propofol
and 10 received propofol with alfentanil. No clinically significant
complications were noted. Subclinical respiratory depression was seen in
four of 10 (40%) patients in the propofol group and five of 10 (50%)
patients in the propofol/alfentanil group (effect size = -10%, 95%
confidence interval [CI] = -53% to 33%). There was no difference in the rate
of clinical signs of respiratory depression between the two groups. Pain
during the procedure was reported by two of 10 (20%) patients in the
propofol group and five of 10 (50%) patients in the propofol/alfentanil
group (effect size = -30%, 95% CI = -70% to 10%). Recall of some part of the
procedure was reported by 0 of 10 (0%) patients in the propofol group and
five of 10 (50%) of patients in the propofol/alfentanil group (effect size =
-50%, 95% CI = -81% to -19%). There was no difference in the baseline or
postprocedure catecholamine levels between the groups. Conclusions No
difference in serum catecholamines was detected immediately after PS between
patients who receive propofol with and without supplemental opioid in this
small pilot study. PS using propofol only without supplemental opioid did
not appear to induce markers of physiologic stress in this small pilot
study. © 2013 by the Society for Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alfentanil (clinical trial)
catecholamine (endogenous compound)
dopamine (endogenous compound)
epinephrine (endogenous compound)
noradrenalin (endogenous compound)
propofol
EMTREE DRUG INDEX TERMS
morphine sulfate (drug therapy, intravenous drug administration)
opiate (clinical trial)
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
catecholamine blood level
sedation
EMTREE MEDICAL INDEX TERMS
add on therapy
adrenalin blood level
adult
article
blood analysis
chi square test
clinical article
clinical feature
clinical protocol
controlled study
dopamine blood level
electroencephalogram
emergency ward
end tidal carbon dioxide tension
female
flow rate
fracture dislocation (therapy)
fracture reduction
human
male
noradrenalin blood level
oxygen saturation
oxygen supply
pain (drug therapy)
priority journal
pulse oximetry
randomized controlled trial
rank sum test
respiration depression
vital sign
waveform
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alfentanil (69049-06-5, 71195-58-9)
dopamine (51-61-6, 62-31-7)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013251140
MEDLINE PMID
23701339 (http://www.ncbi.nlm.nih.gov/pubmed/23701339)
PUI
L368758710
DOI
10.1111/acem.12110
FULL TEXT LINK
http://dx.doi.org/10.1111/acem.12110
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 676
TITLE
Improving opioid prescribing: The New York City recommendations
AUTHOR NAMES
Juurlink D.N.
Dhalla I.A.
Nelson L.S.
AUTHOR ADDRESSES
(Juurlink D.N., david.juurlink@ices.on.ca; Dhalla I.A.) Department of
Medicine, University of Toronto, Toronto, ON, Canada.
(Juurlink D.N., david.juurlink@ices.on.ca) Department of Pediatrics,
University of Toronto, Toronto, ON, Canada.
(Juurlink D.N., david.juurlink@ices.on.ca; Dhalla I.A.) Institute of Health
Policy, Management and Evaluation, University of Toronto, Toronto, ON,
Canada.
(Juurlink D.N., david.juurlink@ices.on.ca) Sunnybrook Research Institute,
St. Michael's Hospital, Toronto, ON, Canada.
(Dhalla I.A.) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada.
(Nelson L.S.) Department of Emergency Medicine, New York University School
of Medicine, New York, NY, United States.
CORRESPONDENCE ADDRESS
D.N. Juurlink, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, G-106,
Toronto, ON M4N 3M5, Canada. Email: david.juurlink@ices.on.ca
SOURCE
JAMA - Journal of the American Medical Association (2013) 309:9 (879-880).
Date of Publication: 6 Mar 2013
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
morphine
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
analgesia
drug fatality
drug formulation
drug misuse
drug overdose
drug surveillance program
emergency ward
health program
human
opiate addiction
pain (drug therapy)
patient satisfaction
priority journal
short survey
United States
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013146159
MEDLINE PMID
23462783 (http://www.ncbi.nlm.nih.gov/pubmed/23462783)
PUI
L368467672
DOI
10.1001/jama.2013.1139
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2013.1139
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 677
TITLE
Opioid overdose fatality prevention
AUTHOR NAMES
Leece P.
Orkin A.
AUTHOR ADDRESSES
(Leece P., pamela.leece@mail.utoronto.ca; Orkin A.) University of Toronto,
Toronto, ON, Canada.
CORRESPONDENCE ADDRESS
P. Leece, University of Toronto, Toronto, ON, Canada. Email:
pamela.leece@mail.utoronto.ca
SOURCE
JAMA - Journal of the American Medical Association (2013) 309:9 (873-874).
Date of Publication: 6 Mar 2013
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug fatality (prevention)
drug overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
emergency health service
health program
human
letter
medical information
medical research
morbidity
mortality
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2013146173
MEDLINE PMID
23462778 (http://www.ncbi.nlm.nih.gov/pubmed/23462778)
PUI
L368467686
DOI
10.1001/jama.2013.375
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2013.375
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 678
TITLE
Use and efficacy of nebulized naloxone in patients with suspected opioid
intoxication
AUTHOR NAMES
Baumann B.M.
Patterson R.A.
Parone D.A.
Jones M.K.
Glaspey L.J.
Thompson N.M.
Stauss M.P.
Haroz R.
AUTHOR ADDRESSES
(Baumann B.M., baumann-b@cooperhealth.edu; Patterson R.A.; Parone D.A.;
Jones M.K.; Glaspey L.J.; Thompson N.M.; Stauss M.P.; Haroz R.) Department
of Emergency Medicine, Cooper Medical School, Rowan University, One Cooper
Plaza, Camden, NJ 08103, United States.
(Patterson R.A.) Department of Emergency Medicine, St. Luke's University
Hospital, Bethlehem, PA 18015, United States.
CORRESPONDENCE ADDRESS
B.M. Baumann, Department of Emergency Medicine, Cooper Medical School, Rowan
University, One Cooper Plaza, Camden, NJ 08103, United States. Email:
baumann-b@cooperhealth.edu
SOURCE
American Journal of Emergency Medicine (2013) 31:3 (585-588). Date of
Publication: March 2013
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Objective: To describe the use and efficacy of nebulized naloxone in
patients with suspected opioid intoxication. Methods: This was an
observational study conducted at an inner city emergency department.
Patients were eligible if they had self-reported or suspected opioid
intoxication and a spontaneous respiratory rate ≥ 6 breaths/minute.
Nebulized naloxone (2 mg in 3 mL normal saline) was administered through a
standard face mask at the discretion of the treating physician. Structured
data collection included demographics, vital signs pre and post naloxone
administration and adverse events. The primary outcome was level of
consciousness, which was recorded pre and 15 minutes postnaloxone
administration using the Glasgow Coma Scale (GCS) and the Richmond Agitation
Sedation Scale (RASS). Results: Of the 73 patients who presented with
suspected opioid intoxication and were given naloxone over the study period,
26 were initially treated with nebulized naloxone. After nebulized naloxone
administration, median GCS improved from 11 [interquartile range (IQR) 3.5]
to 13 (IQR, 2.5), P =.001. Median RASS improved from - 3.0 (IQR, - 1.0) to -
2.0 (IQR, - 1.5), P <.0001. Need for supplemental oxygen decreased from 81%
to 50%, P =.03. Vital signs did not differ pre/post therapy. There were few
adverse effects from nebulized naloxone administration: 12% experienced
moderate-severe agitation, 8% were diaphoretic and none vomited. Eleven
required subsequent administrations of naloxone, nine of whom self-reported
using either heroin, methadone or both. Of these, 5 underwent urine drug
screening and all 5 tested positive for either opiates or methadone.
Conclusions: Nebulized naloxone was well-tolerated and led to a reduction in
the need for supplemental oxygen as well as improved median GCS and RASS
scores in patients with suspected opioid intoxication. © 2013 Elsevier Inc.
All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intravenous drug administration)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine
methadone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
nebulizer
EMTREE MEDICAL INDEX TERMS
adult
agitation
article
breathing rate
consciousness
controlled study
demography
diaphoresis
drug efficacy
drug screening
drug tolerability
drug use
emergency ward
face mask
female
Glasgow coma scale
human
major clinical study
male
nebulization
observational study
oxygen supply
physician
priority journal
randomized controlled trial
Richmond Agitation Sedation Scale
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013195309
MEDLINE PMID
23347721 (http://www.ncbi.nlm.nih.gov/pubmed/23347721)
PUI
L368590705
DOI
10.1016/j.ajem.2012.10.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2012.10.004
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 679
TITLE
Opioid substitution therapy clients' preferences for targeted versus general
primary health-care outlets
AUTHOR NAMES
Islam M.M.
Topp L.
Conigrave K.M.
Day C.A.
AUTHOR ADDRESSES
(Islam M.M., mikhokan143@yahoo.com) School of Public Health and Community
Medicine, University of New South Wales, Sydney, Australia.
(Islam M.M., mikhokan143@yahoo.com; Conigrave K.M.) Drug Health Service,
Royal Prince Alfred Hospital, Sydney, Australia.
(Topp L.) Viral Hepatitis Epidemiology and Prevention Program, Kirby
Institute, University of New South Wales, Sydney, Australia.
(Conigrave K.M.; Day C.A.) Discipline of Addiction Medicine, Central
Clinical School (C39), University of Sydney, Sydney, Australia.
(Conigrave K.M.) National Drug and Alcohol Research Centre, University of
New South Wales, Sydney, Australia.
CORRESPONDENCE ADDRESS
M.M. Islam, Drug Health Services, Royal Prince Alfred Hospital, Level 6, KGV
Bld, Missenden Road, Camperdown, NSW 2050, Australia. Email:
mikhokan143@yahoo.com
SOURCE
Drug and Alcohol Review (2013) 32:2 (211-214). Date of Publication: March
2013
ISSN
0959-5236
1465-3362 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
Introduction and Aims.: Opioid substitution therapy (OST) ideally
constitutes a window of opportunity for the provision of essential primary
health care (PHC) for OST clients. In the absence of such opportunities,
however, OST clients access PHC from existing outlets, either general
services or those targeted to specific groups. This study examined OST
clients' current main source and preferred future outlets of PHC services
and correlates of preferences. Design and Methods.: Anonymous interviews
conducted with n=257 clients of two public OST clinics in Sydney's
inner-west. Results.: Overall, 61% (n=158) of participants reported
currently accessing PHC primarily from general outlets (general
practitioners or medical centres: 51%, hospital/emergence departments: 10%)
and the remainder (39%, n=99) from outlets that target specific groups (e.g.
Aboriginal Medical Services, OST prescriber/clinics, drug user-targeted
PHCs). Twenty-two percent reported discomfort disclosing drug use to their
current PHC providers. However, the majority were satisfied with the care
they received and reported a preference to remain with their current PHC
providers for a range of reasons, most commonly familiarity with and trust
in staff (56%) and not feeling judged about their drug use (49%).
Nevertheless, 28% reported that they would access PHC through their OST
clinic if it were available. Discussion and Conclusions.: PHC outlets that
target specific groups appear to have an ongoing and important role in
providing accessible health care to OST clients. © 2012 Australasian
Professional Society on Alcohol and other Drugs.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
opiate substitution treatment
outpatient department
patient preference
primary health care
EMTREE MEDICAL INDEX TERMS
adult
article
comparative study
female
human
male
methodology
middle aged
multicenter study
psychological aspect
self report
young adult
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
22925410 (http://www.ncbi.nlm.nih.gov/pubmed/22925410)
PUI
L52185531
DOI
10.1111/j.1465-3362.2012.00498.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1465-3362.2012.00498.x
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 680
TITLE
Risk factors for 48-hours mortality after prehospital treatment of opioid
overdose
AUTHOR NAMES
Wichmann S.
Nielsen S.L.
Siersma V.D.
Rasmussen L.S.
AUTHOR ADDRESSES
(Wichmann S., sinewichmann@gmail.com; Nielsen S.L.; Rasmussen L.S.)
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark.
(Nielsen S.L.) Mobile Emergency Care Unit, Copenhagen, Denmark.
(Siersma V.D.) Department of Public Health, Research Unit for General
Practice and Section of General Practice, University of Copenhagen,
Copenhagen, Denmark.
CORRESPONDENCE ADDRESS
S. Wichmann, Department of Anaesthesia, Centre of Head and Orthopaedics,
Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Email:
sinewichmann@gmail.com
SOURCE
Emergency Medicine Journal (2013) 30:3 (223-225). Date of Publication: March
2013
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Introduction: Opioid overdose is commonly treated by prehospital emergency
services and the majority of the patients are discharged immediately after
treatment and a short observation period. There is a minor risk for rebound
opioid toxicity and other life-threatening conditions might occur after such
episodes. The authors describe the short-term outcome and identify risk
factors for death within 48 h after prehospital treatment of opioid overdose
in Copenhagen, the capital of Denmark. Methods: Data on all cases of opioid
overdose treated by the medical emergency care unit between 1994 and 2003
were recorded prospectively. Risk factors for death within 48 h after
initial medical emergency care unit contact were analysed in a multivariable
logistic regression analysis. Results: The authors recorded 4762 episodes of
opioid overdose, covering 1967 unique identified patients. A total of 78
patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period
1999-2003, and 85% (66/78) of these had cardiac arrest and died. The authors
found age >50 years and overdose during the weekend significantly associated
with 48-h mortality. Gender, former episodes of opioid overdose, time of the
day, month or year were not significantly associated with increased
mortality. Conclusions: The author found a 48-hours mortality of 8.4%.
Advanced age and opioid overdose in the weekends were significant risk
factors. Release on scene after treatment was associated with a very small
risk. Copyright © 2013 BMJ Publishing Group Ltd and the College of Emergency
Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
mortality
risk factor
EMTREE MEDICAL INDEX TERMS
adult
age
article
artificial ventilation
emergency care
female
gender
human
major clinical study
male
outcome assessment
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013144097
MEDLINE PMID
22505303 (http://www.ncbi.nlm.nih.gov/pubmed/22505303)
PUI
L51965945
DOI
10.1136/emermed-2012-201124
FULL TEXT LINK
http://dx.doi.org/10.1136/emermed-2012-201124
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 681
TITLE
Of pills, plants, and paraquat: The relevance of poison centers in emergency
medicine
AUTHOR NAMES
Schaper A.
Ceschi A.
Deters M.
Kaiser G.
AUTHOR ADDRESSES
(Schaper A., aschaper@giz-nord.de; Kaiser G.) GIZ-Nord Poisons Centre,
University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075 Göttingen,
Germany.
(Ceschi A.) STIZ (Swiss Toxicological Information Centre), Institute of the
University of Zürich, Freiestraße 16, 8032 Zürich, Switzerland.
(Deters M.) GGIZ Erfurt Poisons Control Centre, Helios Hospital, Nordhäuser
Straße 74, 99089 Erfurt, Germany.
CORRESPONDENCE ADDRESS
A. Schaper, GIZ-Nord Poisons Centre, University Medical Centre Göttingen,
Robert-Koch-Straße 40, 37075 Göttingen, Germany. Email: aschaper@giz-nord.de
SOURCE
European Journal of Internal Medicine (2013) 24:2 (104-109). Date of
Publication: March 2013
ISSN
0953-6205
1879-0828 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
The organization and work of a poisons center are demonstrated on the basis
of GIZ-Nord Poisons Center Annual Report for 2011. In a short summary the
basic principles of clinical toxicology are elucidated: the indications for
gastric lavage and the application of activated charcoal. Moreover the means
of enhanced elimination are presented: hemodialysis, hemoperfusion,
multi-dose activated charcoal and molecular absorbent recirculating system
(MARS). Gastric lavage is indicated within one hour after ingestion of a
life-threatening dose of a poison. In intoxications with CNS penetrating
substances gastric lavage should be performed only after endotracheal
intubation due to the risk of aspiration. The basic management of the
intoxicated patient by emergency medicine personnel out of hospital and on
the way into the hospital is presented. The "Bremen List", a compilation of
five antidotes (atropine, 4-DMAP, tolonium chloride, naloxone, activated
charcoal) for the out of hospital treatment by emergency doctors is
introduced. © 2012 European Federation of Internal Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
paraquat
poison
EMTREE DRUG INDEX TERMS
4 dimethylaminophenol
activated carbon
atropine
cyanide
methemoglobin
naloxone
opiate
organophosphate
tolonium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
pill
poison center
EMTREE MEDICAL INDEX TERMS
aspiration
detoxification
endotracheal intubation
hemodialysis
hemoperfusion
human
review
stomach lavage
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
cyanide (57-12-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
tolonium chloride (92-31-9)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013099321
MEDLINE PMID
23245927 (http://www.ncbi.nlm.nih.gov/pubmed/23245927)
PUI
L52347394
DOI
10.1016/j.ejim.2012.11.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ejim.2012.11.013
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 682
TITLE
Pilot study of human recombinant hyaluronidase-enhanced subcutaneous
hydration and opioid administration for sickle cell disease acute pain
episodes
AUTHOR NAMES
Sandoval M.
Coleman P.
Govani R.
Siddiqui S.
Todd K.H.
AUTHOR ADDRESSES
(Sandoval M., msandoval@mdsanderson.org) Department of Emergency Medicine,
MD Anderson Cancer Center, F1400 Pressler Street, Houston, TX, United
States.
(Coleman P.) Emergency Department, Beth Israel Medical Center, New York, NY,
United States.
(Govani R.) Department of Emergency Medicine, Kaiser Permanente Medical
Center, Downey, CA, United States.
(Siddiqui S.) Children's Hospital at Montefiore, Bronx, NY, United States.
(Todd K.H.) Department of Emergency Medicine, MD Anderson Cancer Center,
Houston, TX, United States.
CORRESPONDENCE ADDRESS
M. Sandoval, Department of Emergency Medicine, MD Anderson Cancer Center,
F1400 Pressler Street, Houston, TX, United States. Email:
msandoval@mdsanderson.org
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2013) 27:1 (10-18).
Date of Publication: March 2013
ISSN
1536-0288
1536-0539 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
ABSTRACT
The objective of this study was to determine the feasibility of
protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced
subcutaneous (SC) hydration and opioid administration in adults presenting
to the emergency department (ED) with sickle cell disease acute pain
episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal
saline subcutaneously. Opioids were administered SC every 15 minutes for 4
hours until numerical rating scale (NRS) pain intensity scores fell to <5,
or Ramsay Sedation Scores were >4. Pain intensity and pain relief were
recorded hourly. Total morphine equivalents and fluid volume, total pain
relief (TOTPAR), patient- and physician-perceived global efficacy,
patient-perceived global SC needle discomfort, physician-rated ease of
needle placement, and adverse effects were noted. Ten patients (6 males, 4
females), mean age 32.9 years (23-56 years) completed the trial. Mean pain
intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour
TOTPAR score was 4 (maximum: 16). A mean total of 119 mg (70-170 mg)
morphine equivalents and 846 mL (200-1650 mL) normal saline were
administered. Mean patient and physician global perceived efficacy ratings
were 3.4 and 4.2 (of 5). Patient global discomfort of SC needle presence was
2.7 (of 10), and ease of needle placement was physician rated at 4 (of 4;
easiest). Patients experienced mild swelling and stinging at the SC site,
and no infusion required discontinuation. The authors conclude that
rHuPH20-enhanced subcutaneous hydration and opioid administration appear
feasible from this pilot study. These results need confirmation in a
controlled clinical trial. © 2013 Informa Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (subcutaneous drug administration)
recombinant hyaluronidase (adverse drug reaction)
EMTREE DRUG INDEX TERMS
morphine
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hypodermoclysis
pain
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
adverse outcome
allergic reaction (complication)
analgesia
article
clinical article
clinical protocol
controlled study
drug efficacy
drug withdrawal
dyspnea (complication, side effect)
emergency ward
feasibility study
female
human
injection site stinging (complication, side effect)
male
pain assessment
pilot study
Ramsay Sedation Scale
swelling (complication)
urticaria (complication, side effect)
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
recombinant hyaluronidase (757971-58-7)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Human Genetics (22)
Hematology (25)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013208958
PUI
L368632050
DOI
10.3109/15360288.2012.758683
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2012.758683
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 683
TITLE
Quality of life in chronic low back pain patients treated with opioids
AUTHOR NAMES
Kiencke P.
Viehmann K.
Kresimon J.
Löwenstein O.
Rychlik R.
AUTHOR ADDRESSES
(Kiencke P., peter.kiencke@ifeg.de; Viehmann K.; Kresimon J.; Rychlik R.)
Institut für Empirische Gesundheitsökonomie, Am Ziegelfeld 28, 51399
Burscheid, Germany.
(Löwenstein O.) Gemeinschaftspraxis Löwenstein O./Dr.Hesselbarth, Mainz,
Germany.
CORRESPONDENCE ADDRESS
P. Kiencke, Institut für Empirische Gesundheitsökonomie, Am Ziegelfeld 28,
51399 Burscheid, Germany. Email: peter.kiencke@ifeg.de
SOURCE
Journal of Pain and Palliative Care Pharmacotherapy (2013) 27:1 (77-79).
Date of Publication: March 2013
ISSN
1536-0288
1536-0539 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
ABSTRACT
A noninterventional study under real-life conditions comparing patients
receiving prolonged-release oral oxycodone/naloxone with those receiving
other World Health Organization (WHO) Step III opioids found patients in the
oxycodone/naloxone group had greater quality of life and less low back pain
after 12 months. Oxycodone/naloxone was also found to be more cost-effective
in the study. © 2013 Informa Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone plus oxycodone (drug therapy, oral drug administration,
pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
low back pain (drug therapy, drug therapy)
quality of life
EMTREE MEDICAL INDEX TERMS
analgesia
article
cost effectiveness analysis
drug cost
emergency treatment
follow up
human
major clinical study
world health organization
DRUG MANUFACTURERS
tragin
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013208960
PUI
L368632052
DOI
10.3109/15360288.2012.760704
FULL TEXT LINK
http://dx.doi.org/10.3109/15360288.2012.760704
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 684
TITLE
Opioid overdose rates and implementation of overdose education and nasal
naloxone distribution in Massachusetts: Interrupted time series analysis
AUTHOR NAMES
Walley A.Y.
Xuan Z.
Hackman H.H.
Quinn E.
Doe-Simkins M.
Sorensen-Alawad A.
Ruiz S.
Ozonoff A.
AUTHOR ADDRESSES
(Walley A.Y., awalley@bu.edu; Xuan Z.; Hackman H.H.; Doe-Simkins M.;
Sorensen-Alawad A.) Clinical Addiction Research Education Unit, Section of
General Internal Medicine, School of Medicine, 801 Massachusetts Avenue,
Boston, MA, United States.
(Walley A.Y., awalley@bu.edu; Xuan Z.) Department of Community Health
Sciences, Boston University, School of Public Health, United States.
(Walley A.Y., awalley@bu.edu; Ruiz S.) Massachusetts Department of Public
Health, United States.
(Quinn E.) Data Coordinating Center, Boston University, School of Public
Health, United States.
(Ozonoff A.) Design and Analysis Core, Clinical Research Center, Children's
Hospital, Boston, MA, United States.
(Ozonoff A.) Department of Biostatistics, Boston University, School of
Public Health, United States.
CORRESPONDENCE ADDRESS
A.Y. Walley, Clinical Addiction Research Education Unit, Section of General
Internal Medicine, School of Medicine, 801 Massachusetts Avenue, Boston, MA,
United States. Email: awalley@bu.edu
SOURCE
BMJ (Online) (2013) 346:7894 Article Number: f174. Date of Publication: 9
Feb 2013
ISSN
1756-1833 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Objective To evaluate the impact of state supported overdose education and
nasal naloxone distribution (OEND) programs on rates of opioid related death
from overdose and acute care utilization in Massachusetts. Design
Interrupted time series analysis of opioid related overdose death and acute
care utilization rates from 2002 to 2009 comparing community-year strata
with high and low rates of OEND implementation to those with no
implementation. Setting 19 Massachusetts communities (geographically
distinct cities and towns) with at least five fatal opioid overdoses in each
of the years 2004 to 2006. Participants OEND was implemented among opioid
users at risk for overdose, social service agency staff, family, and friends
of opioid users. Intervention OEND programs equipped people at risk for
overdose and bystanders with nasal naloxone rescue kits and trained them how
to prevent, recognize, and respond to an overdose by engaging emergency
medical services, providing rescue breathing, and delivering naloxone. Main
outcome measures Adjusted rate ratios for annual deaths related to opioid
overdose and utilization of acute care hospitals. Results Among these
communities, OEND programs trained 2912 potential bystanders who reported
327 rescues. Both community-year strata with 1-100 enrollments per 100 000
population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91)
and community-year strata with greater than 100 enrollments per 100 000
population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate
ratios compared with communities with no implementation. Differences in
rates of acute care hospital utilization were not significant. Conclusions
Opioid overdose death rates were reduced in communities where OEND was
implemented. This study provides observational evidence that by training
potential bystanders to prevent, recognize, and respond to opioid overdoses,
OEND is an effective intervention. © BMJ Publishing Group Ltd 2013.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
health program
overdose education and nasal naloxone distribution program
EMTREE MEDICAL INDEX TERMS
adult
article
community
controlled study
drug administration route
drug overdose
drug use
emergency medical services education
epidemiology
family
female
first aid
friend
health care utilization
high risk population
human
male
mortality
priority journal
resuscitation
staff
time series analysis
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013103374
MEDLINE PMID
23372174 (http://www.ncbi.nlm.nih.gov/pubmed/23372174)
PUI
L368319711
DOI
10.1136/bmj.f174
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.f174
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 685
TITLE
Injection drug users trained by overdose prevention programs: responses to
witnessed overdoses.
AUTHOR NAMES
Lankenau S.E.
Wagner K.D.
Silva K.
Kecojevic A.
Iverson E.
McNeely M.
Kral A.H.
AUTHOR ADDRESSES
(Lankenau S.E.) Department of Community Health and Prevention, School of
Public Health, Drexel University, Philadelphia, PA 19102, USA.
(Wagner K.D.; Silva K.; Kecojevic A.; Iverson E.; McNeely M.; Kral A.H.)
CORRESPONDENCE ADDRESS
S.E. Lankenau, Department of Community Health and Prevention, School of
Public Health, Drexel University, Philadelphia, PA 19102, USA. Email:
sel59@drexel.edu
SOURCE
Journal of community health (2013) 38:1 (133-141). Date of Publication: Feb
2013
ISSN
1573-3610 (electronic)
ABSTRACT
In response to the growing public health problem of drug overdose,
community-based organizations have initiated overdose prevention programs
(OPPs), which distribute naloxone, an opioid antagonist, and teach overdose
response techniques. Injection drug users (IDUs) have been targeted for this
intervention due to their high risk for drug overdose. Limited research
attention has focused on factors that may inhibit or prevent IDUs who have
been trained by OPPs to undertake recommended response techniques when
responding to a drug overdose. IDUs (n = 30) trained by two OPPs in Los
Angeles were interviewed in 2010-2011 about responses to their most recently
witnessed drug overdose using an instrument containing both open and
closed-ended questions. Among the 30 witnessed overdose events, the victim
recovered in 29 cases while the outcome was unknown in one case.
Participants responded to overdoses using a variety of techniques taught by
OPPs. Injecting the victim with naloxone was the most commonly recommended
response while other recommended responses included stimulating the victim
with knuckles, calling 911, and giving rescue breathing. Barriers preventing
participants from employing recommended response techniques in certain
circumstances included prior successes using folk remedies to revive a
victim, concerns over attracting police to the scene, and issues surrounding
access to or use of naloxone. Practical solutions, such as developing
booster sessions to augment OPPs, are encouraged to increase the likelihood
that trained participants respond to a drug overdose with the full range of
recommended techniques.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (prevention, therapy)
patient education
substance abuse (prevention)
EMTREE MEDICAL INDEX TERMS
adult
article
education
emergency health service
female
human
interview
male
methodology
middle aged
psychological aspect
resuscitation
risk factor
utilization review
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
22847602 (http://www.ncbi.nlm.nih.gov/pubmed/22847602)
PUI
L369296699
DOI
10.1007/s10900-012-9591-7
FULL TEXT LINK
http://dx.doi.org/10.1007/s10900-012-9591-7
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 686
TITLE
Early antidote use associated with noninvasive ventilation in prehospital
treatment of methadone intoxication.
AUTHOR NAMES
Gonzva J.
Prunet B.
Deniel C.
Benner P.
Toppin F.
Brun P.M.
AUTHOR ADDRESSES
(Gonzva J.) Prehospital Emergency Medical Services of Marine Fire Battalion,
Marseille, France.
(Prunet B.; Deniel C.; Benner P.; Toppin F.; Brun P.M.)
CORRESPONDENCE ADDRESS
J. Gonzva, Prehospital Emergency Medical Services of Marine Fire Battalion,
Marseille, France. Email: jonathangonzva@hotmail.fr
SOURCE
The American journal of emergency medicine (2013) 31:2 (448.e5-6). Date of
Publication: Feb 2013
ISSN
1532-8171 (electronic)
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (etiology, therapy)
emergency health service
noninvasive ventilation
EMTREE MEDICAL INDEX TERMS
adult
article
case report
human
male
multimodality cancer therapy
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
22944554 (http://www.ncbi.nlm.nih.gov/pubmed/22944554)
PUI
L368678520
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 687
TITLE
Maternal use of oxycodone resulting in opioid intoxication in her breastfed
neonate
AUTHOR NAMES
Timm N.L.
AUTHOR ADDRESSES
(Timm N.L., Nathan.timm@cchmc.org) Department of Clinical Pediatrics,
Division of Emergency Medicine, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States.
CORRESPONDENCE ADDRESS
N.L. Timm, Cincinnati Children's Hospital Medical Center, MLC 2008, 3333
Burnet Ave, Cincinnati, OH 45229, United States. Email:
Nathan.timm@cchmc.org
SOURCE
Journal of Pediatrics (2013) 162:2 (421-422). Date of Publication: February
2013
ISSN
0022-3476
1097-6833 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
A 4-day-old breastfed infant presented with opioid intoxication resulting
from the maternal use of oxycodone after cesarean delivery. The infant was
hypothermic, lethargic, and had pinpoint pupils. A dose of naloxone reversed
the symptoms. This report highlights the importance of recognizing the
potential effects of maternal oxycodone on the breastfed neonate in the
emergency department setting. Copyright © 2013 Mosby Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug toxicity)
oxycodone
EMTREE DRUG INDEX TERMS
bilirubin
ibuprofen
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
breast feeding
drug use
EMTREE MEDICAL INDEX TERMS
article
bilirubin blood level
birth weight
case report
cesarean section
feeding disorder
follow up
general practitioner
hospital admission
human
hypothermia
infant
lethargy
male
priority journal
Streptococcus
CAS REGISTRY NUMBERS
bilirubin (18422-02-1, 635-65-4)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013037565
MEDLINE PMID
23063265 (http://www.ncbi.nlm.nih.gov/pubmed/23063265)
PUI
L52251449
DOI
10.1016/j.jpeds.2012.08.047
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpeds.2012.08.047
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 688
TITLE
Emergency department visits and hospitalizations for buprenorphine ingestion
by children--United States, 2010-2011.
AUTHOR NAMES
Centers for Disease Control and Prevention (CDC)
AUTHOR ADDRESSES
(Centers for Disease Control and Prevention (CDC))
SOURCE
MMWR. Morbidity and mortality weekly report (2013) 62:3 (56). Date of
Publication: 25 Jan 2013
ISSN
1545-861X (electronic)
ABSTRACT
Buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) received Food
and Drug Administration approval in 2002 for the treatment of opioid
dependence. Introduction of these drugs expanded the availability of
opioid-dependence treatment options to reduce the morbidity and mortality
associated with opioid abuse, and buprenorphine has become an increasingly
prescribed component of office-based treatment. However, unsupervised
ingestion of buprenorphine-containing products by children is a growing
concern.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug administration, drug toxicity)
narcotic analgesic agent (drug administration, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
eating
hospitalization
human
infant
preschool child
statistics
United States (epidemiology)
utilization review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23344700 (http://www.ncbi.nlm.nih.gov/pubmed/23344700)
PUI
L368466662
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 689
TITLE
Opioid dose and risk of road trauma in Canada: A population-based study
AUTHOR NAMES
Gomes T.
Redelmeier D.A.
Juurlink D.N.
Dhalla I.A.
Camacho X.
Mamdani M.M.
AUTHOR ADDRESSES
(Gomes T., gomest@smh.ca; Redelmeier D.A.; Juurlink D.N.; Camacho X.;
Mamdani M.M.) Institute for Clinical Evaluative Sciences, Canada.
(Redelmeier D.A.; Juurlink D.N.) Sunnybrook Research Institute, Canada.
(Dhalla I.A.; Mamdani M.M.) Department of Medicine, Canada.
(Gomes T., gomest@smh.ca; Dhalla I.A.; Mamdani M.M.) Keenan Research Centre
of the Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St,
Toronto, ON, Canada.
(Redelmeier D.A.; Juurlink D.N.; Dhalla I.A.; Mamdani M.M.) St Michael's
Hospital, Departments of Medicine, Canada.
(Redelmeier D.A.; Juurlink D.N.; Dhalla I.A.; Mamdani M.M.) Health Policy,
Management and Evaluation, Canada.
(Juurlink D.N.) Pediatrics, Canada.
(Gomes T., gomest@smh.ca; Mamdani M.M.) Leslie Dan, Faculty of Pharmacy,
Canada.
(Mamdani M.M.) University of Toronto, Toronto, ON, Canada.
CORRESPONDENCE ADDRESS
T. Gomes, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St
Michael's Hospital, 30 Bond St, Toronto, ON, Canada. Email: gomest@smh.ca
SOURCE
JAMA Internal Medicine (2013) 173:3 (196-201). Date of Publication: 11 Jan
2013
ISSN
2168-6106
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Background: Use of opioids may predispose drivers to road trauma, yet the
effect of opioid dose on this association is unknown. Methods:Weconducted a
population-based nested casecontrol study of patients aged 18 to 64 years
who received at least 1 publicly funded prescription for an opioid from
April 1, 2003, through March 31, 2011. Cases were defined as having an
emergency department visit related to road trauma. Patients without road
trauma served as a control group matched to cases by age, sex, index year,
prior road trauma, and a disease risk index. We compared the risk of road
trauma among patients treated with doses of opioids ranging from very low to
very high (20 to 200 morphine equivalents daily). In a subgroup analysis, we
stratified our analysis by driver status. Results: Among 549 878 eligible
adults, we identified 5300 cases with road trauma and matched an equal
number of controls. Multivariate adjustment yielded no significant
association between escalating opioid dose and odds of road trauma (adjusted
odds ratio ranged between 1.00 and 1.09). However, a significant association
between opioid dose and road trauma was observed among drivers. Compared
with very low opioid doses, drivers prescribed low doses had a 21% increased
odds of road trauma (adjusted odds ratio, 1.21 [95% CI, 1.02-1.42]); those
prescribed moderate doses, 29% increased odds (1.29 [1.06-1.57]); those
prescribed high doses, 42% increased odds (1.42 [1.15-1.76]); and those
prescribed very high doses, 23% increased odds (1.23 [1.02-1.49]).
Conclusions: Among drivers prescribed opioids, a significant relationship
exists between drug dose and risk of road trauma. This association is
distinct and does not appear with passengers, pedestrians, and others
injured in road trauma. © 2013 American Medical Association.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose)
EMTREE DRUG INDEX TERMS
codeine
fentanyl (transdermal drug administration)
hydromorphone
morphine sulfate
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
traffic accident
EMTREE MEDICAL INDEX TERMS
adult
article
Canada
case control study
controlled study
drug dose escalation
female
human
major clinical study
male
population research
prescription
priority journal
risk assessment
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013119771
MEDLINE PMID
23318919 (http://www.ncbi.nlm.nih.gov/pubmed/23318919)
PUI
L368365387
DOI
10.1001/2013.jamainternmed.733
FULL TEXT LINK
http://dx.doi.org/10.1001/2013.jamainternmed.733
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 690
TITLE
Cost-effectiveness of distributing naloxone to heroin users for lay overdose
reversal
AUTHOR NAMES
Coffin P.O.
Sullivan S.D.
AUTHOR ADDRESSES
(Coffin P.O., pcoffin@gmail.com) San Francisco Department of Public Health,
25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, United States.
(Sullivan S.D.) Pharmaceutical Outcomes Research and Policy Program,
University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA
98195-7630, United States.
CORRESPONDENCE ADDRESS
P. O. Coffin, San Francisco Department of Public Health, 25 Van Ness Avenue,
Suite 500, San Francisco, CA 94102, United States. Email: pcoffin@gmail.com
SOURCE
Annals of Internal Medicine (2013) 158:1 (1-9). Date of Publication: 1 Jan
2013
ISSN
0003-4819
1539-3704 (electronic)
BOOK PUBLISHER
American College of Physicians, 190 N. Indenpence Mall West, Philadelphia,
United States.
ABSTRACT
Background: Opioid overdose is a leading cause of accidental death in the
United States. Objective: To estimate the cost-effectiveness of distributing
naloxone, an opioid antagonist, to heroin users for use at witnessed
overdoses. Design: Integrated Markov and decision analytic model using
deterministic and probabilistic analyses and incorporating recurrent
overdoses and a secondary analysis assuming heroin users are a net cost to
society. Data Sources: Published literature calibrated to epidemiologic
data. Target Population: Hypothetical 21-year-old novice U.S. heroin user
and more experienced users with scenario analyses. Time Horizon: Lifetime.
Perspective: Societal. Intervention: Naloxone distribution for lay
administration. Outcome Measures: Overdose deaths prevented and incremental
cost-effectiveness ratio (ICER). Results of Base-Case Analysis: In the
probabilistic analysis, 6% of overdose deaths were prevented with naloxone
distribution; 1 death was prevented for every 227 naloxone kits distributed
(95% CI, 71 to 716). Naloxone distribution increased costs by $53 (CI, $3 to
$156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an
ICER of $438 (CI, $48 to $1706). Results of Sensitivity Analysis: Naloxone
distribution was costeffective in all deterministic and probabilistic
sensitivity and scenario analyses, and it was cost-saving if it resulted in
fewer overdoses or emergency medical service activations. In a "worst-case
scenario" where overdose was rarely witnessed and naloxone was rarely used,
minimally effective, and expensive, the ICER was $14 000. If national
drug-related expenditures were applied to heroin users, the ICER was $2429.
Limitation: Limited sources of controlled data resulted in wide CIs.
Conclusion: Naloxone distribution to heroin users is likely to reduce
overdose deaths and is cost-effective, even under markedly conservative
assumptions. Primary Funding Source: National Institute of Allergy and
Infectious Diseases. © 2013 American College of Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cost effectiveness analysis
drug use
resource allocation
EMTREE MEDICAL INDEX TERMS
accidental death
adult
article
cost control
drug cost
drug overdose
emergency health service
hidden Markov model
human
mortality
priority journal
quality adjusted life year
sensitivity analysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013015623
MEDLINE PMID
23277895 (http://www.ncbi.nlm.nih.gov/pubmed/23277895)
PUI
L368048025
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 691
TITLE
Take-home emergency naloxone to prevent heroin overdose deaths after prison
release: rationale and practicalities for the N-ALIVE randomized trial.
AUTHOR NAMES
Strang J.
Bird S.M.
Parmar M.K.
AUTHOR ADDRESSES
(Strang J., john.strang@kcl.ac.uk) King's College London, National Addiction
Centre (Institute of Psychiatry and The Maudsley), London, SE5 8AF, UK,
(Bird S.M.; Parmar M.K.)
CORRESPONDENCE ADDRESS
J. Strang, Email: john.strang@kcl.ac.uk
SOURCE
Journal of urban health : bulletin of the New York Academy of Medicine
(2013) 90:5 (983-996). Date of Publication: Oct 2013
ISSN
1468-2869 (electronic)
ABSTRACT
The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in
May 2012, with the preliminary phase involving 5,600 prisoners on release.
The trial is investigating whether heroin overdose deaths post-prison
release can be prevented by prior provision of a take-home emergency supply
of naloxone. Heroin contributes disproportionately to drug deaths through
opiate-induced respiratory depression. Take-home emergency naloxone is a
novel preventive measure for which there have been encouraging preliminary
reports from community schemes. Overdoses are usually witnessed, and drug
users themselves and also family members are a vast intervention workforce
who are willing to intervene, but whose responses are currently often
inefficient or wrong. Approximately 10% of provided emergency naloxone is
thought to be used in subsequent emergency resuscitation but, as yet, there
have been no definitive studies. The period following release from prison is
a time of extraordinarily high mortality, with heroin overdose deaths
increased more than sevenfold in the first fortnight after release. Of
prisoners with a previous history of heroin injecting who are released from
prison, 1 in 200 will die of a heroin overdose within the first 4 weeks.
There are major scientific and logistical challenges to assessing the impact
of take-home naloxone. Even in recently released prisoners, heroin overdose
death is a relatively rare event: hence, large numbers of prisoners need to
enter the trial to assess whether take-home naloxone significantly reduces
the overdose death rate. The commencement of pilot phase of the N-ALIVE
trial is a significant step forward, with prisoners being randomly assigned
either to treatment-as-usual or to treatment-as-usual plus a supply of
take-home emergency naloxone. The subsequent full N-ALIVE trial (contingent
on a successful pilot) will involve 56,000 prisoners on release, and will
give a definitive conclusion on lives saved in real-world application.
Advocates call for implementation, while naysayers raise concerns. The issue
does not need more public debate; it needs good science.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
narcotic antagonist (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
heroin dependence (drug therapy)
prison
EMTREE MEDICAL INDEX TERMS
article
controlled clinical trial
controlled study
emergency
human
mortality
patient attitude
randomized controlled trial
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23633090 (http://www.ncbi.nlm.nih.gov/pubmed/23633090)
PUI
L563063068
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 692
TITLE
Pediatric procedural sedation and analgesia
AUTHOR NAMES
Pacheco G.S.
Ferayorni A.
AUTHOR ADDRESSES
(Pacheco G.S.; Ferayorni A., aferayorni@gmail.com) Department of Pediatrics
and Emergency Medicine, University of Arizona, 1501 North Campbell Avenue,
Tucson, AZ 85724-5057, United States.
CORRESPONDENCE ADDRESS
A. Ferayorni, Department of Pediatrics and Emergency Medicine, University of
Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5057, United States.
Email: aferayorni@gmail.com
SOURCE
Emergency Medicine Clinics of North America (2013) 31:3 (831-852). Date of
Publication: August 2013
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Sedation and analgesia are vital components of pediatric emergency care.
When children present to the emergency department injured, it may be
difficult to administer care secondary to the child's anxiety, pain, lack of
cooperation, and pressure by the parents to alleviate the child's
discomfort. There is much in the emergency physician armamentarium to
address these circumstances and provide excellent care, safely. © 2013
Elsevier Inc.
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
barbituric acid derivative (adverse drug reaction)
epinephrine (adverse drug reaction, drug combination, drug therapy)
etomidate (adverse drug reaction, drug comparison, intravenous drug
administration)
fentanyl (drug combination, drug therapy, intramuscular drug administration,
intranasal drug administration, intravenous drug administration)
fentanyl citrate (drug therapy, intranasal drug administration)
flumazenil
glycopyrronium (drug therapy)
hydromorphone (drug therapy, intramuscular drug administration, intravenous
drug administration)
ibuprofen (drug therapy, oral drug administration, pharmacokinetics,
pharmacology)
ketamine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration)
ketorolac (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration, oral drug administration)
lidocaine (adverse drug reaction, drug combination, drug therapy)
lidocaine plus prilocaine (drug therapy, topical drug administration)
lorazepam (intravenous drug administration, oral drug administration)
methohexital (adverse drug reaction, intravenous drug administration, rectal
drug administration)
midazolam (adverse drug reaction, drug combination, drug comparison,
intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, rectal drug
administration)
morphine sulfate (drug therapy, intramuscular drug administration,
intravenous drug administration, subcutaneous drug administration)
naloxone (drug therapy)
nitrous oxide (adverse drug reaction, inhalational drug administration)
opiate (adverse drug reaction, drug therapy)
paracetamol (drug therapy, oral drug administration, rectal drug
administration)
pentobarbital (drug dose, intravenous drug administration, oral drug
administration, rectal drug administration)
propofol (adverse drug reaction, drug combination, drug comparison,
intravenous drug administration)
prostaglandin (endogenous compound)
remifentanil (drug therapy, intravenous drug administration,
pharmacokinetics)
sucrose
tetracaine (adverse drug reaction, drug combination, drug therapy)
thiopental (adverse drug reaction, intravenous drug administration)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
child health care
sedation
EMTREE MEDICAL INDEX TERMS
adrenal disease (side effect)
airway obstruction
analgesic activity
anxiety
apnea (side effect)
aspiration
assessment of humans
blood pressure monitoring
capnometry
cardiovascular disease (side effect)
child
child development
childhood injury
cognition
continuous infusion
cooperation
coughing (side effect)
disorientation (side effect)
drug dosage form comparison
drug excretion
drug half life
drug metabolism
drug safety
emergency medicine
Faces Pain Scale
hallucination (side effect)
health care delivery
health care quality
hiccup (side effect)
hospital discharge
human
hypersalivation (drug therapy, side effect)
hypotension (side effect)
hypoventilation (side effect)
imagery
injection site pain (drug therapy)
interpersonal communication
intracranial hypertension (side effect)
intraocular hypertension (side effect)
larynx spasm (side effect)
medical decision making
methemoglobinemia (side effect)
music
myoclonus (side effect)
nausea (side effect)
nausea and vomiting (side effect)
Neonatal Infant Pain Scale
Neonatal Pain Agitation and Sedation Scale
neurologic disease (side effect)
pain (drug therapy)
pain assessment
parental behavior
pathological crying (side effect)
patient monitoring
physical examination
physician attitude
play therapy
priority journal
prostaglandin synthesis inhibition
pruritus (side effect)
pulse oximetry
recommended drug dose
respiration depression (side effect)
restlessness (side effect)
review
risk assessment
side effect (side effect)
thorax disease (drug therapy, side effect)
thorax pain (side effect)
thorax wall rigidity (drug therapy, side effect)
thorax wall rigidity (drug therapy, side effect)
videorecording
violence
vomiting (side effect)
DRUG TRADE NAMES
lmx 4
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
EMLA (101362-25-8)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
glycopyrronium bromide (596-51-0)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pentobarbital (57-33-0, 76-74-4)
propofol (2078-54-8)
remifentanil (132539-07-2)
sucrose (122880-25-5, 57-50-1)
tetracaine (136-47-0, 94-24-6)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013490294
MEDLINE PMID
23915606 (http://www.ncbi.nlm.nih.gov/pubmed/23915606)
PUI
L52654338
DOI
10.1016/j.emc.2013.04.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2013.04.002
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 693
TITLE
Acute pain management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine
sulfate in limb traumatized patients: A randomized double-blinded
placebo-controlled trial
ORIGINAL (NON-ENGLISH) TITLE
Ekstremite yaralanmasi{dotless} olan hastalarda intravenöz 0.10 mg/kg veya
0.15 mg/kg morfin sülfat ile akut aǧri{dotless} tedavisi: Randomize çift
kontrollü plasebo kontrollü çali{dotless}şma
AUTHOR NAMES
Farsi D.
Movahedi M.
Hafezimoghadam P.
Abbasi S.
Shahlaee A.
Rahimi-Movaghar V.
AUTHOR ADDRESSES
(Farsi D.) Hazrat-e-rasool Akram Medical Complex, Tehran University of
Medical Sciences, Tehran, Iran.
(Movahedi M.) Shahid Mohammadi Hospital, Hormozgan University of Medical
Sciences, Bandar Abbas, Iran.
(Hafezimoghadam P.; Abbasi S.) Department of Emergency Medicine, Tehran
University of Medical Sciences, Tehran, Iran.
(Shahlaee A.; Rahimi-Movaghar V., v_rahimi@tums.ac.ir) Sina Trauma and
Surgery Research Center, Sina Hospital, Tehran University of Medical
Sciences, Tehran, Iran.
(Shahlaee A.) Students' Scientific Research Center, Tehran University of
Medical Sciences, Tehran, Iran.
CORRESPONDENCE ADDRESS
V. Rahimi-Movaghar, Sina Hospital, Tehran University of Medical Sciences,
Hassan-abad Square, Imam Khomeini Ave, 11365 Tehran, Iran. Email:
v_rahimi@tums.ac.ir
SOURCE
Ulusal Travma ve Acil Cerrahi Dergisi (2013) 19:5 (398-404). Date of
Publication: 2013
ISSN
1306-696X
BOOK PUBLISHER
Turkish Association of Trauma and Emergency Surgery, info@travma.org.tr
ABSTRACT
Background: We aimed to compare pain relief and safety of two doses of
morphine in adult emergency department (ED) patients with acute limb trauma
pain. Methods: A total of 200 adult ED patients over 20 years of age
requiring opioid analgesia were randomly allocated to two groups. Following
a first dose of intravenous morphine sulfate at 0.10 mg/kg, a randomized
double-blind placebo-controlled trial of intravenous morphine sulfate at
0.05 mg/kg versus the same amount of placebo was performed. Measurement of
visual analogue scale pain intensity and assessment of adverse effects were
performed at baseline (before morphine at 0.10 mg/kg), 30 minutes from
baseline (just before study drug administration), and at 60 minutes from
baseline (30 minutes after study drug). Results: No significant difference
was found between groups at 30 minutes from baseline. There was significant
reduction in final pain after 1 hour in the 0.15 mg/kg compared to 0.10
mg/kg group (p<0.05). In addition, there was a significant improvement in
the mean score of pain in the same group (p<0.05). The percent of pain
reduction in the intervention and control group relative to the basic
measures was 52.70% and 35.82%, respectively. Adverse effects were present
in both groups; however, there was no statistically significant difference
between groups. Conclusion: Using two doses of morphine instead of one is a
safe and effective method for pain reduction in isolated limb trauma. We
recommend performing a second injection of 0.05 mg/kg morphine 30 minutes
after the initial standard dose of 0.10 mg/ kg to decrease pain in these
patients. © 2013 TJTES.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (adverse drug reaction, clinical trial, drug therapy,
intravenous drug administration)
EMTREE DRUG INDEX TERMS
naloxone
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
limb injury
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
double blind procedure
drug dose comparison
drug safety
female
human
hypotension (side effect)
major clinical study
male
pain (drug therapy)
pain assessment
pulse rate
randomized controlled trial
respiration depression
tachycardia (side effect)
visual analog scale
vomiting (side effect)
CAS REGISTRY NUMBERS
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English, Turkish
LANGUAGE OF SUMMARY
English, Turkish
EMBASE ACCESSION NUMBER
2013577008
MEDLINE PMID
24214779 (http://www.ncbi.nlm.nih.gov/pubmed/24214779)
PUI
L369813192
DOI
10.5505/tjtes.2013.86383
FULL TEXT LINK
http://dx.doi.org/10.5505/tjtes.2013.86383
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 694
TITLE
Acute respiratory distress syndrome caused by methadone syrup
AUTHOR NAMES
Aghabiklooei A.
Shadnia S.
Hassanian-Moghaddam H.
Zamani N.
AUTHOR ADDRESSES
(Aghabiklooei A.) Iran University of Medical Sciences, Firoozgar Teaching
Hospital, Tehran, Iran.
(Shadnia S.; Hassanian-Moghaddam H.; Zamani N., nasim.zamani@gmail.com)
Department of Clinical Toxicology, Shahid Beheshti University of Medical
Sciences, Loghman Hakim Hospital, Karegar Street, Tehran, Iran.
CORRESPONDENCE ADDRESS
N. Zamani, Department of Clinical Toxicology, Shahid Beheshti University of
Medical Sciences, Loghman Hakim Hospital, Karegar Street, Tehran, Iran.
Email: nasim.zamani@gmail.com
SOURCE
Arhiv za Higijenu Rada i Toksikologiju (2013) 64:3 (439-443). Date of
Publication: 2013
ISSN
0004-1254
ABSTRACT
Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity
is a known but rather uncommon phenomenon. In most of the previously
reported cases of MTD-related ARDS, MTD was ingested orally in the form of
tablets in high or unknown amounts. Despite the fi ndings from the available
literature, this case report is aimed at demonstrating that even small
amounts of MTD syrup can cause ARDS earlier than it is usually expected. We
present a non-addicted MTD-overdosed patient who developed ARDS after
ingesting a very small amount of MTD syrup. We suggest close monitoring of
MTD-overdosed patients from at least 48 h to 72 h for possible respiratory
complications such as pulmonary oedema.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adult respiratory distress syndrome
EMTREE MEDICAL INDEX TERMS
adult
agitation
arterial gas
article
blood gas analysis
bolus injection
bradypnea
breathing rate
case report
coma
crackle
disease severity
drug overdose
drug urine level
emergency ward
extubation
female
human
hypoventilation (drug therapy, prevention)
hypoxia
intensive care unit
lung auscultation
lung infiltrate
maintenance drug dose
medication error
oxygen saturation
oxygen tension
oxygen therapy
oxygenation
pain
patient care
patient monitoring
patient referral
positive end expiratory pressure
pulse oximetry
recurrent disease (drug therapy, prevention)
respiratory acidosis
respiratory distress
stimulus response
sweating
syrup
thorax radiography
urinalysis
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Bosnian
EMBASE ACCESSION NUMBER
2013784488
MEDLINE PMID
24084353 (http://www.ncbi.nlm.nih.gov/pubmed/24084353)
PUI
L370451699
DOI
10.2478/10004-1254-64-2013-2347
FULL TEXT LINK
http://dx.doi.org/10.2478/10004-1254-64-2013-2347
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 695
TITLE
Is the flumazenil administration diagnosis or treatment? two case reports
AUTHOR NAMES
Yardan T.
Acar E.
Akdemir H.U.
Baydin A.
Duran L.
AUTHOR ADDRESSES
(Yardan T.; Akdemir H.U.; Baydin A.; Duran L.) Department of Emergency
Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
(Acar E., dr.ethemacar@hotmail.com) Department of Emergency, Training and
Research Hospital, Muǧla Sitki Kocman University, Muǧla, Turkey.
CORRESPONDENCE ADDRESS
T. Yardan, Service of Emergency, Muǧla Sitki Kocman University, Training and
Research Hospital, Mugla, Turkey.
SOURCE
Journal of Experimental and Clinical Medicine (Turkey) (2013) 30:4
(395-397). Date of Publication: December 2013
ISSN
1309-4483
BOOK PUBLISHER
Ondokuz Mayis Universitesi, Samsun, Turkey.
ABSTRACT
Benzodiazepine has the central nervous system (CNS), cardiac and respiratory
side effects when intaked more than therapeutic doses. Acute benzodiazepine
poisoning may be manifest taken in the form of dizziness, ataxia, nystagmus,
dysarthria, hypoxia, hypothermia, hypotension, bradycardia, apnea, pulmonary
aspiration, respiratory depression, coma, cardiopulmonary arrest and death.
Alprazolam is the most toxic form of benzodiazepines and unless combined
with the other CNS depressants such as barbiturates and alcohol, death is
rare. When benzodiazepine intoxication is suspected, the next step is
flumazenil administration to reverse the CNS and respiratory system
depression. In this case report, we aimed to point to the diagnosis and
treatment of benzodiazepine intoxications by representing two intoxicated
patients with coma. © 2013 OMU.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine (adverse drug reaction)
flumazenil (drug therapy)
EMTREE DRUG INDEX TERMS
activated carbon
alcohol
naloxone (drug therapy)
thiamine (drug therapy)
valproic acid (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
benzodiazepine poisoning (drug therapy, side effect, diagnosis, drug
therapy, side effect)
drug intoxication (drug therapy, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
coma (drug therapy)
comatose patient
depression (drug therapy)
dose response
drug dose increase
drug dose regimen
drug treatment failure
emergency ward
female
gastric suction
Glasgow coma scale
human
major depression (drug therapy)
male
middle aged
pupil reflex
treatment response
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014359054
PUI
L373160151
DOI
10.5835/jecm.omu.30.04.026
FULL TEXT LINK
http://dx.doi.org/10.5835/jecm.omu.30.04.026
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 696
TITLE
'Do you know where your cyanide kit is?': A study of perceived and actual
antidote availability to emergency departments in the South West of England
AUTHOR NAMES
Mitchell L.J.
Higginson I.
Smith J.E.
Swains L.
Farrant J.
Gagg J.
Lindenbaum C.
Mathieu N.
AUTHOR ADDRESSES
(Mitchell L.J.; Higginson I., ianhigginson@nhs.net; Smith J.E.; Swains L.)
Emergency Department, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
(Smith J.E.) Academic Department of Military Emergency Medicine, Royal
Centre for Defence Medicine, Birmingham, United Kingdom.
(Farrant J.) Emergency Department, Royal Cornwall Hospital, Truro, United
Kingdom.
(Gagg J.) Emergency Department, Musgrove Park Hospital, Taunton, United
Kingdom.
(Lindenbaum C.) Emergency Department, North Devon District Hospital,
Barnstaple, United Kingdom.
(Mathieu N.) Emergency Department, Torbay Hospital, Torquay, United Kingdom.
CORRESPONDENCE ADDRESS
I. Higginson, Emergency Department, Derriford Hospital, Plymouth PL6 8DH,
United Kingdom. Email: ianhigginson@nhs.net
SOURCE
Emergency Medicine Journal (2013) 30:1 (43-48). Date of Publication: January
2013
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Objective: The authors set out to investigate perceived and actual
availability of antidotes recommended for stocking in emergency departments
(EDs) by the College of Emergency Medicine in EDs in the South West of
England. Methods: Data collectors were asked to physically locate each
relevant antidote in the ED, and check whether the recommended quantity was
available. If the antidote was not available in the department, the data
collector located where in the hospital stocks were available. Senior
medical and nursing staff were asked to specify where they believed the
antidotes were stored or who they would ask if they did not know. It was
then ascertained whether their source of advice would have known the
location. Results: 5 out of 6 departments returned data with an overall
response rate from senior medical and nursing staff of 80%. Knowledge of
common antidote locations was variable, and stocking of antidotes did not
universally meet the College of Emergency Medicine recommendations.
Conclusion: Stocking of important antidotes should be rationalised and
simplified using central locations, preferably close to the ED. Clinically
important antidotes may not be available for patients when they need them.
Clear guidance should be available for staff detailing the location of
antidotes. There is a need for clarification around the treatment of cyanide
poisoning to facilitate rational antidote stocking for this potentially
lethal condition.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
activated carbon
alpha adrenergic receptor blocking agent
atropine
bicarbonate
calcium chloride
cobalt edetate
cyproheptadine
dantrolene
deferoxamine
diazepam
digoxin
flumazenil
folinate calcium
glucagon
gluconate calcium
glyceryl trinitrate
hydroxocobalamin
isosorbide dinitrate
lorazepam
methylene blue
naloxone
phenoxybenzamine
phentolamine
procyclidine
sodium nitrite
sodium thiosulfate
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cyanide poisoning
drug storage
emergency ward
EMTREE MEDICAL INDEX TERMS
article
human
medical staff
nursing staff
priority journal
questionnaire
United Kingdom
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
cobalt edetate (14931-83-0, 36499-65-7)
cyproheptadine (129-03-3, 969-33-5)
dantrolene (14663-23-1, 7261-97-4)
deferoxamine (70-51-9)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
flumazenil (78755-81-4)
folinate calcium (1492-18-8, 51057-63-7)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glyceryl trinitrate (55-63-0)
hydroxocobalamin (13422-51-0, 13422-52-1)
isosorbide dinitrate (87-33-2)
lorazepam (846-49-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
phenoxybenzamine (59-96-1, 63-92-3)
phentolamine (50-60-2, 73-05-2)
procyclidine (1508-76-5, 77-37-2)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013034794
MEDLINE PMID
22389349 (http://www.ncbi.nlm.nih.gov/pubmed/22389349)
PUI
L51895855
DOI
10.1136/emermed-2012-201106
FULL TEXT LINK
http://dx.doi.org/10.1136/emermed-2012-201106
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 697
TITLE
Associations between public health indicators and injecting prescription
opioids by prescription opioid abusers in substance abuse treatment
AUTHOR NAMES
Black R.A.
Trudeau K.J.
Cassidy T.A.
Budman S.H.
Butler S.F.
AUTHOR ADDRESSES
(Black R.A.) Nova Southeastern University, Ft. Lauderdale, FL, United
States.
(Trudeau K.J.; Cassidy T.A.; Budman S.H.; Butler S.F.) Inflexxion, Inc.,
Newton, MA, United States.
CORRESPONDENCE ADDRESS
R.A. Black, Nova Southeastern University, Ft. Lauderdale, FL, United States.
SOURCE
Journal of Opioid Management (2013) 9:1 (5-17). Date of Publication:
January-February 2013
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Objective: To determine what, if any, public health and societal impacts are
associated specifically with injection of prescription opioids. Design:
Cross-sectional observational study. Setting: Five hundred forty treatment
facilities in 35 states across the United States performing Addiction
Severity Index-Multimedia Version (ASI-MV) assessments. Participants: Adult
patients (29,459) who reported past 30-day abuse of any prescription opioid
on the ASI-MV assessment between January 2007 and January 2011. Main outcome
measures: The public health indicators selected for this study were liver
disease, HIV/AIDS status, recent visit to an emergency room, treatment for
pain, treatment for overdosing, homelessness, residence with
alcohol/substance abuser, and unemployment. Results: Prescription opioid
injection was significantly associated with health problems, psychosocial
problems, and utilization of medical services. Conclusions: This study
demonstrates an approach to measure the potential impact of injecting
prescription opioids on public health indicators. Findings indicate a
positive association between injection of prescription opioids and public
health indicators suggesting a need for prescription opioid formulations
that may inhibit injection of these medications. © 2013 Journal of Opioid
Management. All Rights Reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
substance abuse
EMTREE MEDICAL INDEX TERMS
acquired immune deficiency syndrome
adult
aged
alcohol abuse
article
cross-sectional study
drug overdose
female
health care utilization
homelessness
human
Human immunodeficiency virus infection
liver disease
major clinical study
male
medical service
observational study
prescription
public health
unemployment
United States
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013235816
MEDLINE PMID
23709299 (http://www.ncbi.nlm.nih.gov/pubmed/23709299)
PUI
L368719590
DOI
10.5055/jom.2013.0142
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2013.0142
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 698
TITLE
Triage in opioid replacement therapy: what's the wait?
AUTHOR NAMES
Harlow W.
Happell B.M.
Browne G.
Choudhury J.
Pinchin D.
AUTHOR ADDRESSES
(Harlow W., warren_harlow@health.qld.gov.au) School of Nursing and
Midwifery, Central Queensland University, Rockhampton, Australia.
(Happell B.M.; Browne G.; Choudhury J.; Pinchin D.)
CORRESPONDENCE ADDRESS
W. Harlow, School of Nursing and Midwifery, Central Queensland University,
Rockhampton, Australia. Email: warren_harlow@health.qld.gov.au
SOURCE
Substance use & misuse (2013) 48:1-2 (137-146). Date of Publication: Jan
2013
ISSN
1532-2491 (electronic)
ABSTRACT
In Australia, a wait for Opioid Replacement Therapy (ORT) has been reported
although the magnitude is unknown. This study examined data recorded by one
urban publicly funded ORT clinic (from 2009 to 2011) to identify if people
(n = 803) were waiting for ORT assessment appointments and to explore how
triage influences access to ORT. Data analysis incorporated descriptive
methods and the use of Kaplan-Meier estimator of the cumulative incidence
function. The implications and limitations of this study are included with
further research suggestions.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
hospital admission
opiate substitution treatment
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
Australia
female
health care delivery
health service
human
male
methodology
middle aged
statistics
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23127198 (http://www.ncbi.nlm.nih.gov/pubmed/23127198)
PUI
L563000462
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 699
TITLE
Acute pain control challenges with buprenorphine/naloxone therapy in a
patient with compartment syndrome secondary to McArdle's disease: A case
report and review
AUTHOR NAMES
Mccormick Z.
Chu S.K.
Chang-Chien G.C.
Joseph P.
AUTHOR ADDRESSES
(Mccormick Z., zmccormi@gmail.com; Chu S.K.; Chang-Chien G.C.; Joseph P.)
The Rehabilitation Institute of Chicago/Northwestern McGaw Medical Center,
Department of Physical Medicine and Rehabilitation, Chicago, IL, United
States.
CORRESPONDENCE ADDRESS
Z. Mccormick, not available, 780 S. Federal, Chicago, IL 60605, United
States. Email: zmccormi@gmail.com
SOURCE
Pain Medicine (United States) (2013) 14:8 (1187-1191). Date of Publication:
August 2013
ISSN
1526-4637 (electronic)
1526-2375
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Objective: We report the first case of non-iatrogentic exertional
rhabdomyolysis leading to acute compartment syndrome in a patient with
McArdle's disease. We describe considerations of concurrent
buprenorphine/naloxone therapy during episodes of severe acute pain. Design:
Case report. Case Presentation: A 50-year-old male with a history of
McArdle's disease, taking buprenorphine/naloxone for chronic pain and opioid
dependence, presented to the Emergency Department with severe bilateral
anterior thigh pain. Over the following 8 hours, he was given a total of
12mg of intravenous hydromorphone with minimal pain relief. The decision was
made to initiate patient-controlled analgesia (PCA) with hydromorphone
started at 0.5mg as needed with a 15-minute lockout. Subsequently, the
patient's anterior thighs were found to be extremely tense. His creatine
kinase level rose to 198,688 units/L and compartment pressures were greater
than 90mmHg bilaterally. The patient was taken for emergent bilateral
fasciotomies. The hydromorphone PCA was increased to 0.8mg as needed with a
15-minute lockout and a basal rate of 0.5mg/h. The patient's reported pain
plateaued at 3/10 intensity 2 days after surgery, and he was transitioned to
oxycodone and hydrocodone/acetaminophen. He followed up with his pain
management physician 2 months later who restarted suboxone and a
buphrenorphine transdermal patch. Discussion: Buprenorphine/naloxone is
being prescribed off-label with increasing frequency for pain management in
patients with or without a history of opioid abuse. Severe acute pain is
more difficult to control with opioid analgesics in patients taking
buprenorphine/naloxone, requiring higher than usual doses. If
buprenorphine/naloxone is discontinued to better treat acute pain with other
opioids, monitoring for overdose must take place for at least 72 hours. ©
2013 American Academy of Pain Medicine Wiley Periodicals, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
acetaminophen plus hydrocodone (drug therapy)
buprenorphine (drug therapy, transdermal drug administration)
creatine kinase (endogenous compound)
hydrocodone (drug therapy)
hydromorphone (drug therapy, intravenous drug administration)
oxycodone (drug therapy)
paracetamol (drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
compartment syndrome (complication)
glycogen storage disease type 5
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
patient controlled analgesia
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
creatine kinase (9001-15-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013527029
MEDLINE PMID
23647815 (http://www.ncbi.nlm.nih.gov/pubmed/23647815)
PUI
L52570681
DOI
10.1111/pme.12135
FULL TEXT LINK
http://dx.doi.org/10.1111/pme.12135
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 700
TITLE
Fatal heat stroke associated with topiramate therapy
AUTHOR NAMES
Borron S.W.
Woolard R.
Watts S.
AUTHOR ADDRESSES
(Borron S.W.) Division of Medical Toxicology, Texas Tech University Health
Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905,
United States.
(Woolard R.; Watts S.) Department of Emergency Medicine, Texas Tech
University Health Sciences Center, Paul L. Foster School of Medicine, El
Paso, TX 79905, United States.
SOURCE
American Journal of Emergency Medicine (2013) 31:12 (1720.e5-1720.e6). Date
of Publication: December 2013
ISSN
1532-8171 (electronic)
0735-6757
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
A 40-year-old man with diabetes and seizure disorder was found at home
unresponsive and "very hot to touch" by his father 40 minutes before
emergency medical services arrival. His usual medications included
topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics
administered oxygen, intravenous fluids, and naloxone. They did not witness
or report seizure activity. Upon emergency department arrival, the patient
was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and
tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute
and elevated rectal temperature peaking at 43.2°C. His skin was hot and dry,
without rash; physical examination was otherwise normal. Laboratory studies
revealed severe metabolic acidosis with acute renal failure and
rhabdomyolysis. In spite of sedation, intubation, and aggressive cooling
measures, the patient had cardiac arrest and died approximately 2 hours
after arrival. Serum topiramate and valproate concentrations were within
therapeutic ranges at 8.8 μg/mL (therapeutic 2-12) and 97 μg/mL (therapeutic
50-100), respectively. © 2013 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
topiramate (adverse drug reaction, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
amphetamine derivative (drug toxicity)
anticonvulsive agent (adverse drug reaction)
antidepressant agent (adverse drug reaction)
antihistaminic agent (adverse drug reaction)
atropine
butyrophenone derivative (adverse drug reaction)
carbonate dehydratase (endogenous compound)
cocaine (drug toxicity)
dopamine
epinephrine
etomidate (intravenous drug administration)
fosphenytoin sodium (intravenous drug administration)
heparin (adverse drug reaction)
inhalation anesthetic agent (adverse drug reaction)
lorazepam (intravenous drug administration)
metformin plus rosiglitazone (drug therapy)
monoamine oxidase inhibitor (adverse drug reaction)
naloxone (intravenous drug administration)
phenothiazine derivative (adverse drug reaction)
rocuronium (intravenous drug administration)
salicylic acid derivative
serotonin uptake inhibitor (adverse drug reaction)
valproate semisodium (drug therapy)
valproic acid (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heat stroke
EMTREE MEDICAL INDEX TERMS
adult
anhidrosis (side effect)
article
case report
clinical feature
diabetes mellitus (drug therapy)
DRESS syndrome (side effect)
drug blood level
drug withdrawal
enzyme inhibition
fever (side effect)
fluid resuscitation
general condition deterioration
human
hyperthermia (side effect)
hypotension
kidney failure
male
malignant hyperthermia (side effect)
metabolic acidosis
neuroleptic malignant syndrome (side effect)
oligohydrosis (side effect)
oligohydrosis (side effect)
priority journal
rhabdomyolysis
seizure (drug therapy)
serotonin syndrome (side effect)
tachypnea
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
carbonate dehydratase (9001-03-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dopamine (51-61-6, 62-31-7)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fosphenytoin sodium (92134-98-0)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
rocuronium (119302-91-9)
topiramate (97240-79-4)
valproate semisodium (76584-70-8)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013774666
MEDLINE PMID
23993866 (http://www.ncbi.nlm.nih.gov/pubmed/23993866)
PUI
L52752316
DOI
10.1016/j.ajem.2013.07.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2013.07.013
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 701
TITLE
EMS runs for suspected opioid overdose: implications for surveillance and
prevention
AUTHOR NAMES
Knowlton A.
Weir B.W.
Hazzard F.
Olsen Y.
McWilliams J.
Fields J.
Gaasch W.
AUTHOR ADDRESSES
(Knowlton A.; Weir B.W.; Hazzard F.; Olsen Y.; McWilliams J.; Fields J.;
Gaasch W.) Johns Hopkins University Bloomberg School of Public Health,
Baltimore, MD 21205 , USA. aknowlto@jhsph.edu
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2013)
17:3 (317-329). Date of Publication: 2013 Jul-Sep
ISSN
1545-0066 (electronic)
ABSTRACT
BACKGROUND: Opioid (including prescription opiate) abuse and overdose rates
in the United States have surged in the past decade. The dearth and
limitations of opioid abuse and overdose surveillance systems impede the
development of interventions to address this epidemic. Objective. We
explored evidence to support the validity of emergency medical services
(EMS) data on naloxone administration as a possible proxy for estimating
incidence of opioid overdose.METHODS: We reviewed data from Baltimore City
Fire Department EMS patient records matched with dispatch records over a
13-month time period (2008-2009) based on 2008 Census data. We calculated
incidence rates and patient demographic and temporal patterns of naloxone
administration, and examined patient evaluation data associated with
naloxone administration. Results were compared with the demographic
distributions of the EMS patient and city populations and with prior study
findings.RESULTS: Of 116,910 EMS incidents during the study period for
patients aged 15 years and older, EMS providers administered naloxone 1,297
times (1.1% of incidents), an average of 100 administrations per month. The
overall incidence was 1.87 administrations per 1,000 residents per year.
Findings indicated that naloxone administration peaked in the summer months
(31% of administrations), on weekends (32%), and in the late afternoon
(4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week
of the month. The incidence of suspected opioid overdose was highest among
male patients, white patients, and those in the 45-54-year age group.
Findings on temporal patterns were comparable with findings from prior
studies. Demographic patterns of suspected opioid overdose were similar to
medical examiner reports of demographic patterns of fatal drug- or
alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved
opioids). The findings on patient evaluation data suggest some
inconsistencies with previously recommended clinical indications of opioid
overdose.CONCLUSIONS: While our findings suggest limitations of EMS naloxone
administration data as a proxy indicator of opioid overdose, the results
provide partial support for using these data for estimating opioid overdose
incidence and suggest ways to improve such data. The study findings have
implications for an EMS role in conducting real-time surveillance and
treatment and prevention of opioid abuse and overdose.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
utilization
EMTREE MEDICAL INDEX TERMS
drug dependence (drug therapy, epidemiology)
drug overdose (drug therapy, epidemiology)
emergency health service
female
human
incidence
male
retrospective study
risk factor
treatment outcome
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
23734988 (http://www.ncbi.nlm.nih.gov/pubmed/23734988)
PUI
L603380646
DOI
10.3109/10903127.2013.792888
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2013.792888
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 702
TITLE
Triage in opioid replacement therapy: what's the wait?
AUTHOR NAMES
Harlow W.
Happell B.M.
Browne G.
Choudhury J.
Pinchin D.
AUTHOR ADDRESSES
(Harlow W., warren_harlow@health.qld.gov.au; Happell B.M.; Browne G.;
Choudhury J.; Pinchin D.) School of Nursing and Midwifery, Central
Queensland University, Rockhampton, Australia
SOURCE
Substance use & misuse (2013) 48:1-2 (137-146). Date of Publication: 1 Jan
2013
ISSN
1532-2491 (electronic)
ABSTRACT
In Australia, a wait for Opioid Replacement Therapy (ORT) has been reported
although the magnitude is unknown. This study examined data recorded by one
urban publicly funded ORT clinic (from 2009 to 2011) to identify if people
(n = 803) were waiting for ORT assessment appointments and to explore how
triage influences access to ORT. Data analysis incorporated descriptive
methods and the use of Kaplan-Meier estimator of the cumulative incidence
function. The implications and limitations of this study are included with
further research suggestions.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
hospital admission
statistics and numerical data
EMTREE MEDICAL INDEX TERMS
adolescent
adult
Australia
female
health care delivery
health service
human
male
middle aged
opiate substitution treatment
procedures
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
23127198 (http://www.ncbi.nlm.nih.gov/pubmed/23127198)
PUI
L603379506
DOI
10.3109/10826084.2012.736050
FULL TEXT LINK
http://dx.doi.org/10.3109/10826084.2012.736050
COPYRIGHT
Copyright 2015 Medline is the source for the citation and abstract of this
record.
RECORD 703
TITLE
Opioid analgesic-treated chronic pain patients at risk for problematic use
AUTHOR NAMES
Tkacz J.
Pesa J.
Vo L.
Kardel P.G.
Un H.
Volpicelli J.R.
Ruetsch C.
AUTHOR ADDRESSES
(Tkacz J., joseph.tkacz@healthanalytic.com; Kardel P.G.; Ruetsch C.) Health
Analytics, LLC, Columbia, MD, United States.
(Pesa J.; Vo L.) Janssen Scientific Affairs, LLC, Raritan, NJ, United
States.
(Un H.) Aetna Behavioral Health, Blue Bell, PA, United States.
(Volpicelli J.R.) Institute of Addiction Medicine, Plymouth Meeting, PA,
United States.
CORRESPONDENCE ADDRESS
J. Tkacz, not available, 9200 Rumsey Rd, Ste 215, Columbia, MD 21045, United
States. Email: joseph.tkacz@healthanalytic.com
SOURCE
American Journal of Managed Care (2013) 19:11 (871-880). Date of
Publication: November 2013
ISSN
1088-0224
BOOK PUBLISHER
Ascend Media, medentcirc@ascendmedia.com
ABSTRACT
Objectives: To characterize potentially problematic opioid use (PPOU) among
opioid analgesic-treated chronic pain (OAT-CP)patients and to compare their
healthcare service utilization and expenditures with those of a control
group of OAT-CP patients notexhibiting these behaviors.Study Design:
Cross-sectional, retrospective analysis of health claims data.Methods:
Members of a national health plan (n = 3891) with chronic pain and an opioid
prescription were categorized into 3 groups:PPOU group (n = 1499), those
displaying evidence of doctor shopping or rapid opioid dose escalation;
buprenorphine/naloxone group(n =199), those who filled a prescription for
buprenorphine/naloxone, which served as a proxy for opioid dependence; and
control group(n = 2193), those not meeting either of the above criteria.
Groups were compared on 1-year healthcare service utilization and
costs.Results: The PPOU group made up more than one-third of the study
sample. Compared with the control group, they incurredsignificantly greater
1-year adjusted mean pharmacy costs ($6573 vs $6160), office costs ($5705 vs
$4479), emergency department (ED) costs ($835 vs $388), inpatient costs
($15,646 vs $7445), and total healthcare costs ($39,048 vs $26,171) (all P
<.05). Thebuprenorphine/naloxone group incurred significantly greater 1-year
pharmacy costs ($6981 vs $6160) and ED costs ($1126 vs $388) (both P <.05)
than the control group.Conclusions: The PPOU group had the highest
healthcare service utilization and costs. Although drivers of elevated
service utilizationand cost among this population are not clear, health
plans may want to focus on PPOU case identification and development
ofinterventions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug comparison, drug dose, drug therapy,
pharmacoeconomics)
EMTREE DRUG INDEX TERMS
buprenorphine plus naloxone (drug comparison, drug therapy,
pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
billing and claims
Charlson Comorbidity Index
controlled study
cross-sectional study
diabetic neuropathy (disease management, drug therapy)
drug cost
drug dose escalation
drug use
emergency ward
female
health care cost
health care utilization
health service
hospital cost
human
low back pain (disease management, drug therapy)
major clinical study
male
middle aged
national health insurance
opiate addiction (drug therapy)
osteoarthritis (disease management, drug therapy)
pharmacy
prescription
priority journal
retrospective study
young adult
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2014002067
MEDLINE PMID
24511985 (http://www.ncbi.nlm.nih.gov/pubmed/24511985)
PUI
L372012775
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 704
TITLE
The Development of the Washington State Emergency Department Opioid
Prescribing Guidelines
AUTHOR NAMES
Neven D.E.
Sabel J.C.
Howell D.N.
Carlisle R.J.
AUTHOR ADDRESSES
(Neven D.E., darin.neven@wsu.edu; Howell D.N.) Program of Excellence in the
Addictions, Washington State University College of Nursing, PO Box 1495,
Spokane, WA, 99210-1495, United States.
(Neven D.E., darin.neven@wsu.edu) WWAMI Medical Education Program,
Washington State University, PO Box 1495, Spokane, WA, 99210-1495, United
States.
(Neven D.E., darin.neven@wsu.edu) Providence Sacred Heart Medical Center and
Children's Hospital, Consistent Care Program, PO Box 2555, Spokane, WA,
99220-2555, United States.
(Sabel J.C.) Washington State Department of Health, PO Box 47853, Olympia,
WA, 98504-7853, United States.
(Carlisle R.J.) Swedish Medical Center Cherry Hill, 500 17th Ave, Seattle,
WA, 98122, United States.
CORRESPONDENCE ADDRESS
D. E. Neven, Program of Excellence in the Addictions, Washington State
University College of Nursing, PO Box 1495, Spokane, WA, 99210-1495, United
States. Email: darin.neven@wsu.edu
SOURCE
Journal of Medical Toxicology (2012) 8:4 (353-359). Date of Publication:
2012
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
diamorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
practice guideline
prescription
EMTREE MEDICAL INDEX TERMS
article
consensus development
emergency health service
emergency ward
funding
information dissemination
medicaid
opiate addiction
patient care planning
patient education
teamwork
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012719035
MEDLINE PMID
23055125 (http://www.ncbi.nlm.nih.gov/pubmed/23055125)
PUI
L52239294
DOI
10.1007/s13181-012-0267-6
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-012-0267-6
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 705
TITLE
The Toxicology Investigators Consortium Case Registry-The 2011 Experience
AUTHOR NAMES
Wiegand T.J.
Wax P.M.
Schwartz T.
Finkelstein Y.
Gorodetsky R.
Brent J.
AUTHOR ADDRESSES
(Wiegand T.J., Timothy_Wiegand@URMC.Rochester.edu; Gorodetsky R.) University
of Rochester Medical Center and Strong Memorial Hospital, Rochester, NY,
United States.
(Wax P.M.) University of Texas, Southwestern Medical Center, Dallas, TX,
United States.
(Schwartz T.) Brown University, Alpert Medical School, Providence, RI,
United States.
(Finkelstein Y.) Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada.
(Brent J.) Toxicology Associates, University of Colorado, School of
Medicine, Denver, CO, United States.
(Gorodetsky R.) D'Youville College School of Pharmacy, Buffalo, NY, United
States.
CORRESPONDENCE ADDRESS
T. J. Wiegand, University of Rochester Medical Center and Strong Memorial
Hospital, Rochester, NY, United States. Email:
Timothy_Wiegand@URMC.Rochester.edu
SOURCE
Journal of Medical Toxicology (2012) 8:4 (360-377). Date of Publication:
2012
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Spring Street, New York, United States.
ABSTRACT
In 2010, the American College of Medical Toxicology established its Case
Registry, the Toxicology Investigators Consortium (ToxIC). ToxIC is a
prospective registry, which exclusively compiles suspected and confirmed
toxic exposure cases cared for at the bedside by medical toxicologists at
its participating sites. The Registry aims to fulfill two important gaps in
the field: a real-time toxicosurveillance system to identify current
poisoning trends and a powerful research tool in toxicology. ToxIC allows
extraction of information from medical records making it the most robust
multicenter database on chemical toxicities in existence. All cases seen by
medical toxicologists at participating institutions were entered in a
database. Information characterizing patients entered in 2011 was tabulated.
2010 data was also included so that cumulative total numbers could be
described as well. The current report is a summary of the data collected in
2011 in comparison to 2010 entries and also includes cumulative data through
December 31st, 2011. During 2011, 28 sites with 49 specific institutions
contributed a total of 6,456 cases to the Registry. The total number of
cases entered into the registry at the end of 2011 was 10,392. Emergency
departments remained the most common source of consultations in 2011,
accounting for 53 % of cases. The most common reason for consultation was
for pharmaceutical overdoses, which occurred in 48 % of patients, including
intentional (37 %) and unintentional (11 %) exposures. The most common
classes of agents were sedative-hypnotics (1,492 entries in 23 % of cases),
non-opioid analgesics (1,368 cases in 21 % of cases), opioids (17 %),
antidepressants (16 %), stimulants/sympathomimetics (12 %), and ethanol (8
%). N-acetylcysteine was the most commonly administered antidote during
2011, similar to 2010, followed by the opioid antagonist naloxone, sodium
bicarbonate, physostigmine and flumazenil. Anti-crotalid Fab fragments
(CroFab) were administered in 106 out of 131 cases in which an envenomation
occurred. There were 35 deaths recorded in the Registry during 2011. The
most common associated agents, including when reported as sole agent or in
combination with other agents, were opioids and analgesics (acetaminophen,
aspirin, NSAIDS) with ten and eight deaths, respectively. Oxycodone was
reported in six of the ten opioid-related deaths and heroin in three.
Acetaminophen was the most common single agent reported overall being
identified in all eight of the death cases attributed to analgesics. There
were significant trends identified during 2011. Cases involving designer
drugs including psychoactive bath salts and synthetic cannabinoids increased
substantially from 2010 to 2011. The psychoactive bath salts were
responsible for a large increase in stimulant/sympathomimetic-related cases
reported to the Registry in 2011 with overall numbers doubling from 6 % of
all Registry entries in 2010 to 12 % in 2011. Entries involving psychoactive
drugs of abuse also increased twofold from 2010 to 2011 jumping 3 to 6 %,
primarily due to increasing frequency of synthetic cannabinoid ("K2")
related intoxications as 2011 progressed. The 2011 Registry included over
600 ADR's (10 % of Registry Cases) with 115 agents causing at least 2 ADR's.
This is up from only 3 % of cases (116 total cases) in 2010. The ToxIC Case
Registry continues to grow. At the end of 2011, over 10,000 cases had been
entered into the Registry. As demonstrated by the trends identified in
psychoactive bath salt and synthetic cannabinoid reports, the Registry is a
valuable toxicosurveillance and research tool. The ToxIC Registry is a
unique tool for identifying and characterizing confirmed cases of
significant or potential toxicity or complexity to require bedside
consultation by a medical toxicologist. © 2012 American College of Medical
Toxicology.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
factual database
toxicology consortium case registry
EMTREE MEDICAL INDEX TERMS
article
data analysis
data extraction
data mining
drug classification
drug dependence
information service
information storage
patient information
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012719036
MEDLINE PMID
23055123 (http://www.ncbi.nlm.nih.gov/pubmed/23055123)
PUI
L52237547
DOI
10.1007/s13181-012-0264-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-012-0264-9
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 706
TITLE
The Prescription Opioid Epidemic: Repercussions on Pediatric Emergency
Medicine
AUTHOR NAMES
Gugelmann H.M.
Nelson L.S.
AUTHOR ADDRESSES
(Gugelmann H.M., hallamg@gmail.com) Department of Emergency Medicine,
Hospital of the University of Pennsylvania, Ground Silverstein,
Philadelphia, PA, United States.
(Nelson L.S.) Department of Emergency Medicine, New York University School
of Medicine, New York City Poison Control Center, New York, NY, United
States.
CORRESPONDENCE ADDRESS
H.M. Gugelmann, Department of Emergency Medicine, Hospital of the University
of Pennsylvania, 3400 Spruce St, Ground Silverstein, Philadelphia, PA 19104,
United States. Email: hallamg@gmail.com
SOURCE
Clinical Pediatric Emergency Medicine (2012) 13:4 (260-268). Date of
Publication: December 2012
ISSN
1522-8401
1558-2310 (electronic)
BOOK PUBLISHER
W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Among other developed and developing nations, the United States is
experiencing an unprecedented epidemic of prescription opioid misuse. The
prescription opioid epidemic clearly continues to have significant and
widespread adverse effects on pediatric and adult populations alike.
Prescription opioids have had the single greatest impact on pediatric
emergency department visits, with visits increasing by 101% from 2001 to
2008, and an 86% increase in rates of admission, with rates of injury
increasing by 92%. This article provides readers with an overview of the
epidemiology, history, basic science, and advocacy interventions associated
with this public health calamity. It discusses the increased susceptibility
of young children to the adverse effects of these drugs and the neonatal
abstinence syndrome, an opioid withdrawal syndrome. A multifaceted approach
will be needed to contain the problem including comprehensive prescriber and
patient education, expanded prescription drug monitoring programs, increased
protection against accidental ingestion, increased law enforcement efforts,
and stringent regulation and oversight of pharmaceutical companies. © 2012
Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug dose, drug therapy, drug toxicity, oral
drug administration, pharmacology)
prescription drug (drug toxicity)
EMTREE DRUG INDEX TERMS
benzodiazepine (drug toxicity)
buprenorphine (adverse drug reaction, drug therapy)
fentanyl
G protein coupled receptor (endogenous compound)
hydrocodone
hydromorphone
methadone (adverse drug reaction, drug therapy)
morphine (adverse drug reaction)
naloxone (drug therapy, inhalational drug administration, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration)
oxycodone (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, side effect, drug therapy, epidemiology,
side effect)
drug misuse (epidemiology)
emergency medicine
pediatrics
EMTREE MEDICAL INDEX TERMS
analgesia
article
cancer pain (drug therapy)
channel gating
child safety
demography
disease predisposition
disease severity
disease surveillance
drug absorption
drug dependence
drug dose increase
drug dose reduction
drug exposure
drug fatality (side effect)
drug metabolism
drug overdose
drug receptor binding
drug surveillance program
drug tolerance
drug traffic
epidemic
health education
health hazard
high risk population
hospital admission
human
hyperalgesia (side effect)
opiate addiction (drug therapy)
poison center
practice guideline
prenatal exposure
prescription
protein conformation
public health
respiration depression (side effect)
risk assessment
sustained release formulation
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013136482
PUI
L368440024
DOI
10.1016/j.cpem.2012.10.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2012.10.002
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 707
TITLE
Community-based naloxone: A Canadian pilot program
AUTHOR NAMES
Dong K.A.
Taylor M.
Wild C.T.
Villa-Roel C.
Rose M.
Salvalaggio G.
Rowe B.H.
AUTHOR ADDRESSES
(Dong K.A., kathryni@ualberta.ca; Villa-Roel C.; Rowe B.H.) Department of
Emergency Medicine, Faculty of Medicine and Dentistry, University of
Alberta, Edmonton, AB, Canada.
(Dong K.A., kathryni@ualberta.ca; Taylor M.; Wild C.T.; Rose M.; Salvalaggio
G.; Rowe B.H.) Edmonton Inner City Health Research and Education Network,
Edmonton, AB, Canada.
(Taylor M.; Wild C.T.) Streetworks Needle Exchange Program, Boyle Street
Community Services, Edmonton, AB, Canada.
(Wild C.T.; Villa-Roel C.; Rowe B.H.) School of Public Health, University of
Alberta, Edmonton, AB, Canada.
(Rose M.) Boyle McCauley Health Centre, Edmonton, AB, Canada.
(Rose M.; Salvalaggio G.) Department of Family Medicine, Faculty of Medicine
and Dentistry, University of Alberta, Edmonton, AB, Canada.
CORRESPONDENCE ADDRESS
K.A. Dong, Royal Alexandra Hospital, CSC, 10240 Kingsway Avenue, Edmonton,
AB, T5H 3V9, Canada. Email: kathryni@ualberta.ca
SOURCE
CJAM Canadian Journal of Addiction Medicine (2012) 3:2 (4-9). Date of
Publication: 2012
ISSN
1923-1210
BOOK PUBLISHER
Canadian Society of Addiction Medicine, 47 Tuscany Ridge Terrace NW, Calgary
Alberta, Canada.
ABSTRACT
Objectives: This study was designed to gather data on the implementation of
community-based naloxone delivery for opioid overdose in a Canadian setting.
Participants: A convenience sample of 50 clients accessing a needle exchange
program for harm reduction supplies. Setting: This program took place in an
urban Canadian city and was based out of a needle exchange program.
Intervention: After written, informed consent was obtained, all participants
were trained in overdose recognition, artificial respiration, naloxone
administration and emergency medical services (EMS) activation. Outcomes:
Most participants were male (30, 60%) and the average age was 45.1 years
(±8.6 years). The majority (40, 80%) used opioids either daily (36, 72%) or
weekly (4, 8%). Most (39, 78%) had experienced an overdose themselves and
the vast majority (46, 92%) had witnessed someone else overdose. Over the
20-month study period, naloxone use was reported nine times. It was most
often administered in a private residence (4, 44%). It was administered to
another individual in eight cases; one person self-administered naloxone.
Artificial respiration was provided in four cases, and a clean needle and
syringe were used in all cases; EMS was activated in only one case. No
adverse reactions and no deaths after naloxone use were reported.
Conclusions: Community-based naloxone programs can be implemented in a
Canadian setting and have the potential to reduce the morbidity and
mortality associated with opioid overdose. Significant barriers to
activating EMS still exist in this setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
community care
drug program
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
clinical article
controlled study
disease association
drug fatality (side effect)
drug overdose
drug safety
drug self administration
drug tolerability
drug use
emergency health service
female
follow up
health care access
health program
human
male
morbidity
mortality
outcome assessment
pilot study
risk reduction
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013060821
PUI
L368177130
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 708
TITLE
ST elevation in tricyclic antidepressants toxicity: A case report
AUTHOR NAMES
Taherinia A.
Heidarpour A.
AUTHOR ADDRESSES
(Taherinia A.) Karaj University of Medical Sciences, Kearaj, Iran.
(Heidarpour A., azadeh.heidarpour@yahoo.com) Kermanshah University of
Medical Sciences, Kermanshah, Iran.
CORRESPONDENCE ADDRESS
A. Heidarpour, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Email: azadeh.heidarpour@yahoo.com
SOURCE
Iranian Heart Journal (2012) 13:3 (43-45). Date of Publication: 2012
ISSN
1735-7306
BOOK PUBLISHER
Iranian Heart Association, P.O. Box 15745-1341, Tehran, Iran.
ABSTRACT
Of all antidepressants, tricyclic antidepressants (TCAs) are the most toxic
drugs and they are often used for suicide attempts. An 18-year-old female
was admitted to the emergency department after having taken 30 tablets of
Nortriptyline 50 mg in a suicide attempt. A twelve-lead electrocardiogram
revealed right bundle branch block in leads V(1), V(2), and V(3) as well as
deep S in leads İ, V(5), and V(6), and tall R in AVR, which meant extreme
right axis and ST elevation in leads V(2) and V(3): that raised the
suspicion of the Brugada syndrome. ST elevation after TCA toxicity is a rare
medical condition, and our literature review failed to find any relevant
reports.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nortriptyline (drug toxicity)
EMTREE DRUG INDEX TERMS
bicarbonate
glucose
naloxone
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ST segment elevation
EMTREE MEDICAL INDEX TERMS
adult
case report
electrocardiography
female
heart right bundle branch block
human
involuntary movement
lethargy
review
suicide attempt
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
nortriptyline (72-69-5, 894-71-3)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013000409
PUI
L368002627
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 709
TITLE
Commentary: If we shoot ourselves in the foot, will EMS be there to respond?
AUTHOR NAMES
Kahn C.
AUTHOR ADDRESSES
(Kahn C.) Department of Emergency Medicine, University of California, San
Diego, San Diego, CA, United States.
CORRESPONDENCE ADDRESS
C. Kahn, Department of Emergency Medicine, University of California, San
Diego, San Diego, CA, United States.
SOURCE
Annals of Emergency Medicine (2012) 60:6 (800-802). Date of Publication:
December 2012
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
diamorphine
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
emergency physician
heroin dependence (drug therapy)
human
medicare
note
priority journal
public health
reimbursement
resuscitation
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012697678
MEDLINE PMID
23178019 (http://www.ncbi.nlm.nih.gov/pubmed/23178019)
PUI
L366143106
DOI
10.1016/j.annemergmed.2012.10.016
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2012.10.016
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 710
TITLE
Prolonged Profound Hypoxia and Cardiac Failure in a Young Woman Presenting
to the Emergency Department: Unexpected Pulmonary Embolus, Catheter-Directed
Thrombolysis, and Subsequent Multi-Organ Failure
AUTHOR NAMES
Breyer K.E.W.
Ou J.
Durack J.C.
Prakash A.
AUTHOR ADDRESSES
(Breyer K.E.W.; Ou J.; Prakash A., prakasha@anesthesia.ucsf.edu) Department
of Anesthesia and Perioperative Care, United States.
(Durack J.C.) Department of Radiology and Biomedical Imaging, San Francisco
General Hospital University of California, San Francisco, CA, United States.
CORRESPONDENCE ADDRESS
A. Prakash, Department of Anesthesia and Perioperative Care - University of
California, San Francisco, 521 Parnassus Avenue, San Francisco; CA 94143,
United States. Email: prakasha@anesthesia.ucsf.edu
SOURCE
ICU Director (2012) 3:5 (215-219). Date of Publication: 2012
ISSN
1944-4516
1944-4524 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
Pulmonary emboli are rare occurrences in young patients, especially those
who present precipitously to the emergency department. In a young
unresponsive patient, recognition of thromboembolic etiology may be delayed
due to atypical presenting physiology or competing diagnoses. In this
report, the authors describe an initially confounding case of catastrophic
bilateral pulmonary emboli in a young woman who presented to the emergency
department having been found unconscious on the street. Despite severe and
prolonged hypoxia as well as multi-organ failure, the patient achieved a
near complete recovery. © 2012 The Author(s).
EMTREE DRUG INDEX TERMS
amiodarone
atropine (intravenous drug administration)
bicarbonate
epinephrine
heparin (intravenous drug administration)
milrinone
naloxone (intranasal drug administration)
noradrenalin
prostacyclin (drug therapy, inhalational drug administration)
tissue plasminogen activator (drug therapy)
vasopressin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart failure (diagnosis)
hypoxia (diagnosis, therapy)
lung embolism (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
akinesia
alcohol intoxication
article
assisted ventilation
blood clot lysis
blood clotting disorder
brain hypoxia (drug therapy, prevention)
case report
clinical feature
continuous hemofiltration
cyanide poisoning (diagnosis)
differential diagnosis
drug intoxication
extracorporeal oxygenation
female
heart arrhythmia
heart ventricle tachycardia
human
kidney failure (therapy)
lactic acidosis (diagnosis)
lung angiography
lung perfusion
methemoglobinemia (diagnosis)
priority journal
resuscitation
sinus tachycardia
ST segment elevation
tracheostomy
unconsciousness
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
milrinone (78415-72-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
prostacyclin (35121-78-9, 61849-14-7)
tissue plasminogen activator (105913-11-9)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013202663
PUI
L368610781
DOI
10.1177/1944451612455500
FULL TEXT LINK
http://dx.doi.org/10.1177/1944451612455500
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 711
TITLE
Retention on buprenorphine treatment reduces emergency department
utilization, but not hospitalization, among treatment-seeking patients with
opioid dependence
AUTHOR NAMES
Schwarz R.
Zelenev A.
Bruce R.D.
Altice F.L.
AUTHOR ADDRESSES
(Schwarz R.) Department of Medicine, Brigham and Women's Hospital, Boston,
MA, United States.
(Schwarz R.) Department of Medicine, Children's Hospital of Boston, Boston,
MA, United States.
(Schwarz R.; Zelenev A.; Bruce R.D.; Altice F.L., frederick.altice@yale.edu)
Yale University School of Medicine, New Haven, CT, United States.
(Bruce R.D.; Altice F.L., frederick.altice@yale.edu) Yale University School
of Public Health, New Haven, CT, United States.
CORRESPONDENCE ADDRESS
F.L. Altice, Department of Medicine, Section of Infectious Diseases, AIDS
Program, Yale University School of Medicine, 135 College Street, Suite 323,
New Haven, CT 06510, United States. Email: frederick.altice@yale.edu
SOURCE
Journal of Substance Abuse Treatment (2012) 43:4 (451-457). Date of
Publication: December 2012
ISSN
0740-5472
1873-6483 (electronic)
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
Drug users are marginalized from typical primary care, often resulting in
emergency department (ED) usage and hospitalization due to late-stage
disease. Though data suggest methadone decreases such fragmented healthcare
utilization (HCU), the impact of buprenorphine maintenance treatment (BMT)
on HCU is unknown. Chart review was conducted on opioid dependent patients
seeking BMT, comparing individuals (n= 59) who left BMT ≤ 7. days with those
retained on BMT (n= 150), for ED use and hospitalization. Using negative
binomial regressions, including comparison of time before BMT induction, ED
utilization and hospitalization were assessed. Overall, ED utilization was
0.93 events per person year and was significantly reduced by BMT, with
increasing time (retention) on BMT. BMT had no significant effect on
hospitalizations or average length of stay. © 2012 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health care utilization
help seeking behavior
hospitalization
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
binomial distribution
comparative study
controlled study
drug use
female
human
length of stay
maintenance therapy
major clinical study
male
priority journal
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012633561
MEDLINE PMID
22534003 (http://www.ncbi.nlm.nih.gov/pubmed/22534003)
PUI
L51972588
DOI
10.1016/j.jsat.2012.03.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jsat.2012.03.008
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 712
TITLE
The Grocery Store Blues: Recognizing a Toxic Syndrome When History Fails
AUTHOR NAMES
Burns R.A.
AUTHOR ADDRESSES
(Burns R.A., raburns@luriechildrens.org) Ann and Robert H. Lurie Children's
Hospital of Chicago, Feinberg School of Medicine, Chicago, IL, United
States.
CORRESPONDENCE ADDRESS
R.A. Burns, Division of Emergency Medicine, Ann and Robert H. Lurie
Children's Hospital of Chicago, 225 E Chicago Ave, Box 62, Chicago, IL,
60611, United States. Email: raburns@luriechildrens.org
SOURCE
Clinical Pediatric Emergency Medicine (2012) 13:4 (269-275). Date of
Publication: December 2012
ISSN
1522-8401
1558-2310 (electronic)
BOOK PUBLISHER
W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Altered mental status and decreased respiratory effort are potentially
life-threatening symptoms that encompass a wide variety of etiologies
including toxic ingestions. We report a case of methadone toxicity in a
34-month-old girl with Noonan syndrome who presented to the emergency
department with episodes of altered mental status, bradypnea/apnea, and
miosis. Initial history and comprehensive evaluation including urine drug
screen did not reveal a diagnosis; however, response to naloxone indicated
that her presentation was likely caused by opioid toxicity. This diagnosis
was later confirmed with toxicologic testing, which demonstrated an elevated
serum methadone concentration. This case illustrates the need for a high
index of suspicion for ingestions in children presenting with altered mental
status and respiratory depression without an obvious pulmonary or central
nervous system cause as well as the importance of recognizing a toxidrome,
despite a lack of history of a toxic exposure. © 2012 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
amphetamine
barbituric acid derivative
benzodiazepine
calcium (endogenous compound)
cocaine
diphenhydramine
glucose (endogenous compound)
growth hormone (drug therapy, subcutaneous drug administration)
hemoglobin (endogenous compound)
levothyroxine (drug therapy)
magnesium (endogenous compound)
naloxone (intravenous drug administration)
opiate
paracetamol
phencyclidine
salicylic acid
tetrahydrocannabinol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis)
EMTREE MEDICAL INDEX TERMS
abnormal respiratory sound
apnea
article
assisted ventilation
blood cell count
blood gas analysis
breathing rate
cardiologist
case report
child
cyanosis
developmental disorder (diagnosis)
differential diagnosis
disease severity
drug blood level
drug megadose
drug withdrawal
echocardiography
electrocardiogram
electroencephalogram
electrolyte blood level
emergency ward
fatty acid desaturation
female
glucose blood level
heart rate
heart right ventricle hypertrophy
hemoglobin blood level
human
Human respiratory syncytial virus
hypothyroidism (drug therapy)
intensive care unit
kidney function test
medical history
miosis
neuroimaging
Noonan syndrome (diagnosis)
nuclear magnetic resonance imaging
opiate addiction (drug therapy)
oxygen saturation
oxygen therapy
patient monitoring
patient transport
pediatrics
perioral cyanosis
physical examination
platelet count
point of care testing
polymerase chain reaction
pulmonary valve insufficiency
pulmonary valve stenosis (surgery)
QT interval
repeated drug dose
rhinorrhea
serology
short stature (drug therapy)
sinus tachycardia (diagnosis)
social work
somnolence
systolic heart murmur
thorax radiography
toxicology
treatment response
urinalysis
vital sign
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
benzodiazepine (12794-10-4)
calcium (14092-94-5, 7440-70-2)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diphenhydramine (147-24-0, 58-73-1)
glucose (50-99-7, 84778-64-3)
growth hormone (36992-73-1, 37267-05-3, 66419-50-9, 9002-72-6)
hemoglobin (9008-02-0)
levothyroxine (51-48-9)
magnesium (7439-95-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
phencyclidine (77-10-1, 956-90-1)
salicylic acid (63-36-5, 69-72-7)
tetrahydrocannabinol (1972-08-3)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013136483
PUI
L368440025
DOI
10.1016/j.cpem.2012.09.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2012.09.003
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 713
TITLE
Estimating the prevalence of illicit opioid use in New York City using
multiple data sources.
AUTHOR NAMES
McNeely J.
Gourevitch M.N.
Paone D.
Shah S.
Wright S.
Heller D.
AUTHOR ADDRESSES
(McNeely J.) Department of Population Health, NYU School of Medicine, New
York, NY 10016, USA.
(Gourevitch M.N.; Paone D.; Shah S.; Wright S.; Heller D.)
CORRESPONDENCE ADDRESS
J. McNeely, Department of Population Health, NYU School of Medicine, New
York, NY 10016, USA. Email: jennifer.mcneely@nyumc.org
SOURCE
BMC public health (2012) 12 (443). Date of Publication: 2012
ISSN
1471-2458 (electronic)
ABSTRACT
Despite concerns about its health and social consequences, little is known
about the prevalence of illicit opioid use in New York City. Individuals who
misuse heroin and prescription opioids are known to bear a disproportionate
burden of morbidity and mortality. Service providers and public health
authorities are challenged to provide appropriate interventions in the
absence of basic knowledge about the size and characteristics of this
population. While illicit drug users are underrepresented in
population-based surveys, they may be identified in multiple administrative
data sources. We analyzed large datasets tracking hospital inpatient and
emergency room admissions as well as drug treatment and detoxification
services utilization. These were applied in combination with findings from a
large general population survey and administrative records tracking
prescriptions, drug overdose deaths, and correctional health services, to
estimate the prevalence of heroin and non-medical prescription opioid use
among New York City residents in 2006. These data were further applied to a
descriptive analysis of opioid users entering drug treatment and
hospital-based medical care. These data sources identified 126,681 cases of
opioid use among New York City residents in 2006. After applying adjustment
scenarios to account for potential overlap between data sources, we
estimated over 92,000 individual opioid users. By contrast, just 21,600
opioid users initiated drug treatment in 2006. Opioid users represented 4 %
of all individuals hospitalized, and over 44,000 hospitalizations during the
calendar year. Our findings suggest that innovative approaches are needed to
provide adequate services to this sizeable population of opioid users. Given
the observed high rates of hospital services utilization, greater
integration of drug services into medical settings could be one component of
an effective approach to expanding both the scope and reach of health
interventions for this population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prescription drug
street drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
factual database
heroin dependence (epidemiology)
opiate addiction (epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
drug dependence treatment
emergency health service
female
hospitalization
human
male
middle aged
prevalence
statistics
United States (epidemiology)
utilization review
LANGUAGE OF ARTICLE
English
MEDLINE PMID
22713674 (http://www.ncbi.nlm.nih.gov/pubmed/22713674)
PUI
L366359422
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 714
TITLE
Case for mandatory reporting of 'body packers'
AUTHOR NAMES
Mitra B.
Smit D.V.
O'Shea W.P.
AUTHOR ADDRESSES
(Mitra B., b.mitra@alfred.org.au; Smit D.V.) Emergency and Trauma Centre,
The Alfred Hospital, Melbourne, VIC, Australia.
(Mitra B., b.mitra@alfred.org.au; Smit D.V.) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia.
(O'Shea W.P.) Alfred Health, Melbourne, VIC, Australia.
CORRESPONDENCE ADDRESS
B. Mitra, Emergency and Trauma Centre, The Alfred Hospital, Commercial Road,
Melbourne, VIC 3004, Australia. Email: b.mitra@alfred.org.au
SOURCE
EMA - Emergency Medicine Australasia (2012) 24:6 (670-672). Date of
Publication: December 2012
ISSN
1742-6731
1742-6723 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
Body packing is the term used to describe the ingestion of illicit
substances for transport across control lines. Where the diagnosis of body
packing is made independently in the ED, the issue of reporting the case to
law enforcement officials poses a difficult scenario given the legal
obligations of patient confidentiality. We describe a case of a body packer
brought into the ED and subsequently reported to the police. The conflicts
between patient confidentiality versus statutory exceptions to
confidentiality along with case law regarding this scenario are discussed. ©
2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and
Australasian Society for Emergency Medicine.
EMTREE DRUG INDEX TERMS
naloxone (oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
body packing
drug traffic
EMTREE MEDICAL INDEX TERMS
adult
article
Australia
case report
computer assisted tomography
confidentiality
emergency ward
endotracheal intubation
human
male
nasogastric tube
police
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012720621
MEDLINE PMID
23216730 (http://www.ncbi.nlm.nih.gov/pubmed/23216730)
PUI
L366218131
DOI
10.1111/1742-6723.12012
FULL TEXT LINK
http://dx.doi.org/10.1111/1742-6723.12012
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 715
TITLE
Life-threatening complications of ibogaine: Three case reports
AUTHOR NAMES
Paling F.P.
Andrews L.M.
Valk G.D.
Blom H.J.
AUTHOR ADDRESSES
(Paling F.P., paling.f@gmail.com; Andrews L.M.; Blom H.J.) Zuwe Hofpoort
Hospital, Woerden, Netherlands.
(Paling F.P., paling.f@gmail.com) Diakonessenhuis, Utrecht, Netherlands.
(Andrews L.M.) Erasmus Medical Centre, Rotterdam, Netherlands.
(Valk G.D.) University Medical Centre, Utrecht, Netherlands.
CORRESPONDENCE ADDRESS
F. P. Paling, Zuwe Hofpoort Hospital, Woerden, Netherlands. Email:
paling.f@gmail.com
SOURCE
Netherlands Journal of Medicine (2012) 70:9 (422-424). Date of Publication:
2012
ISSN
0300-2977
BOOK PUBLISHER
Van Zuiden Communications BV, Postbus 2122, Alphen aan de Rijn, Netherlands.
ABSTRACT
Ibogaine is a naturally occurring psychoactive alkaloid extracted from the
roots of the Tabernanthe iboga plant, which in alternative medicine is used
to treat drug dependency. However, this upcoming, online advocated therapy
can be dangerous due to its potentially lethal adverse effects. We present
three cases in which toxic side effects were noted. We used the Naranjo
scale to estimate the probability of a causal relationship between these
effects and ibogaine. Findings in these three cases are suggestive of a
causal relationship between the use of ibogaine and serious respiratory and
cardiac problems (including lengthening of the QT interval). In our opinion
it is of great importance that clinicians are aware of these potentially
serious side effects and realise that widespread online marketing practices
will give many more people access to ibogaine. © Van Zuiden Communications
B.V. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ibogaine (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
flumazenil (adverse drug reaction)
naloxone (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adult
alcoholism (drug therapy)
article
case report
collapse
defibrillation
drug effect
electrocardiogram
emergency ward
erythrocyte sedimentation rate
female
heart disease (side effect)
heroin dependence (drug therapy)
human
hypokalemia (side effect)
hypophosphatemia (side effect)
intensive care unit
leukocytosis (side effect)
male
nausea (side effect)
probability
QT prolongation (side effect)
rating scale
respiratory failure (side effect)
respiratory tract disease (side effect)
seizure (side effect)
side effect (side effect)
tachycardia (side effect, therapy)
torsade des pointes (side effect)
urinalysis
withdrawal syndrome (side effect)
DRUG TRADE NAMES
anexate
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
ibogaine (83-74-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012665690
MEDLINE PMID
23123541 (http://www.ncbi.nlm.nih.gov/pubmed/23123541)
PUI
L366042770
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 716
TITLE
Neurological emergencies
AUTHOR NAMES
Shiber J.R.
MacIndoe C.
Flower O.
Knight IV W.A.
Bösel J.
AUTHOR ADDRESSES
(Shiber J.R., shiberj@bellsouth.net) Department of Emergency Medicine and
Critical Care, College of Medicine, University of Florida, Jacksonville, FL
32209, United States.
(MacIndoe C., chamisa.macindoe@gmail.com) Department of Emergency Medicine
and Surgery, University of New Mexico, Albuquerque, NM 87131, United States.
(Flower O., oliver.flower@gmail.com) Department of Intensive Care Medicine,
E25-Royal North Shore Hospital, University of Sydney, Sydney, NSW 2006,
Australia.
(Knight IV W.A., knightwa@ucmail.uc.edu) Department of Emergency Medicine
and Neurosurgery, University of Cincinnati, Cincinnati, OH 45267-0769,
United States.
(Bösel J., julian.boesel@med.uni-heidelberg.de) Neurological Clinic,
University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg,
Germany.
CORRESPONDENCE ADDRESS
J.R. Shiber, Department of Emergency Medicine and Critical Care, College of
Medicine, University of Florida, Jacksonville, FL 32209, United States.
Email: shiberj@bellsouth.net
SOURCE
Emergency Medicine International (2012) 2012 Article Number: 208193. Date of
Publication: 2012
ISSN
2090-2840
2090-2859 (electronic)
BOOK PUBLISHER
Hindawi Publishing Corporation, 410 Park Avenue, 15th Floor, 287 pmb, New
York, United States.
EMTREE DRUG INDEX TERMS
naloxone (intranasal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
neurologic disease
EMTREE MEDICAL INDEX TERMS
bacterial meningitis
drug efficacy
drug safety
editorial
emergency physician
headache
human
intensive care unit
operating room
patient care
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012663209
PUI
L366038209
DOI
10.1155/2012/208193
FULL TEXT LINK
http://dx.doi.org/10.1155/2012/208193
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 717
TITLE
Seizurogenic effects of low-dose naloxone in tramadol overdose
AUTHOR NAMES
Farzaneh E.
Mostafazadeh B.
Mehrpour O.
AUTHOR ADDRESSES
(Farzaneh E.) Department of Forensic Medicine and Toxicology, Ardabil
University of Medical Sciences, Ardabil, Iran.
(Mostafazadeh B., mstzbmd@sbmu.ac.ir) Department of Forensic Medicine and
Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
(Mehrpour O.) Department of Forensic Medicine and Toxicology, Birjand
University of Medical Sciences, Birjand, Iran.
CORRESPONDENCE ADDRESS
B. Mostafazadeh, Department of Forensic Medicine and Toxicology, Shahid
Beheshti University of Medical Sciences, Tehran, Iran. Email:
mstzbmd@sbmu.ac.ir
SOURCE
Iranian Journal of Pharmacology and Therapeutics (2012) 11:1 (6-9). Date of
Publication: 2012
ISSN
1735-2657
BOOK PUBLISHER
IranUniversity ofMedicalSciencesand HealthServices, Cross Roads of Shahid
Hemmat, Shahid Chamran Express Ways, Tehran, Iran.
ABSTRACT
Tramadol is used in treatment of moderate to severe pain. Nowadays tramadol
overdose is one of the common emergencies. Naloxone is an antagonist which
is used as a first step of treatment in these patients. This study was
designed to evaluate the seizurogenic effects of naloxone in tramadol
overdose. A number of 124 patients with the diagnosis of tramadol overdose
were divided to receive low-doses of intravenous naloxone (0.8 mg, case
group) or just supportive cares (control group). All patients in case and
control groups were observed by a single emergency resident and fallowed for
1.5 hours to document the happening of seizures. In the naloxone group,
incidence of seizure was higher than in control group. The possibility of
seizure occurrence was significantly higher in naloxone group than the
control group (p<0.05). In conclusion, naloxone induced a seizurogenic
effect in patients with tramadol overdose. This finding could be considered
in the management of patients with tramadol overdose. © 2012 by Tehran
University of Medical Sciences (TUMS).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacology)
tramadol (adverse drug reaction, drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
seizure (side effect, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
agitation
apnea
article
coma (side effect)
controlled study
demography
disease severity
drug mechanism
emergency ward
female
human
hypertension (side effect)
incidence
Iran
lethargy (side effect)
low drug dose
major clinical study
male
nausea (side effect)
pain (drug therapy)
prognosis
respiration depression (side effect)
risk factor
side effect (side effect)
single drug dose
tachycardia (side effect)
tramadol overdose (drug therapy)
tramadol overdose (drug therapy)
urinalysis
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012627973
PUI
L365923068
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 718
TITLE
Buprenorphine and buprenorphine/naloxone soluble-film for treatment of
opioid dependence
AUTHOR NAMES
Soyka M.
AUTHOR ADDRESSES
(Soyka M., Michael.Soyka@privatklinik-meiringen.ch) University of Munich,
Psychiatric Hospital, Nussbaumstr. 7, Munich, Germany.
(Soyka M., Michael.Soyka@privatklinik-meiringen.ch) Private Hospital
Meiringen, Willigen, CH 3860 Meiringen, Switzerland.
CORRESPONDENCE ADDRESS
M. Soyka, University of Munich, Psychiatric Hospital, Nussbaumstr. 7,
Munich, Germany. Email: Michael.Soyka@privatklinik-meiringen.ch
SOURCE
Expert Opinion on Drug Delivery (2012) 9:11 (1409-1417). Date of
Publication: November 2012
ISSN
1742-5247
1744-7593 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
Introduction: Opioid dependence is a chronic relapsing disorder that shows
excess mortality and comorbidity with somatic and psychiatric disorders.
Methadone and buprenorphine/naloxone are widely accepted and are used as
first-line maintenance treatments for opioid dependence. Fatal intoxications
with these agents, risk of diversion, and accidental intoxications,
especially in children, are apparent risks and are of increasing public
concern. Buprenorphine/naloxone sublingual tablet is an established
treatment for opioid dependence. A novel buprenorphine/naloxone film has
been developed with improved pharmacokinetics and a hopefully lower risk of
diversion and accidental intoxications. Areas covered: This review evaluates
the available preclinical and clinical data on the novel
buprenorphine/naloxone film for the treatment of opioid dependence.
Literature was identified though a comprehensive PubMed search and data
sources included official FDA information. Expert opinion: This is an
interesting new formulation of a well-established medication in opioid
dependence. However, few data have been published on its safety and
efficacy. In an experimental study, the new formulation suppressed symptoms
of opioid withdrawal as expected. Results of an unpublished study made
public by the FDA suggest a spectrum of adverse events similar to that of
the conventional sublingual tablet. Some data show patients may prefer the
novel film over the sublingual tablet. The estimated lower risk for
diversion and especially for accidental poisoning in children cannot be
assessed in clinical studies but requires data from emergency room visits. ©
Informa UK, Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (adverse drug reaction, clinical trial, drug comparison, drug
concentration, drug dose, drug therapy, drug toxicity, pharmaceutics,
pharmacoeconomics, pharmacokinetics, sublingual drug administration)
buprenorphine plus naloxone (adverse drug reaction, clinical trial, drug
concentration, drug dose, drug therapy, intramuscular drug administration,
oral drug administration, pharmaceutics, pharmacoeconomics,
pharmacokinetics, sublingual drug administration)
EMTREE DRUG INDEX TERMS
cytochrome P450 2D6 (endogenous compound)
cytochrome P450 3A4 (endogenous compound)
methadone (drug comparison)
opiate receptor (endogenous compound)
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
film
opiate addiction (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
accident
allergic reaction (side effect)
article
attention disturbance (side effect)
blurred vision (side effect)
central nervous system depression
constipation (side effect)
drug absorption
drug bioavailability
drug dosage form comparison
drug efficacy
drug formulation
drug marketing
drug metabolism
drug overdose
drug safety
drug solubility
drug tolerability
erythema (side effect)
food and drug administration
glossodynia (side effect)
heart palpitation (side effect)
human
hyperhidrosis (side effect)
hypesthesia (side effect)
insomnia (side effect)
intoxication (side effect)
liver toxicity (side effect)
maximum plasma concentration
Medline
mouth hypesthesia (side effect)
mouth hypesthesia (side effect)
mouth mucosa erythema (side effect)
mouth mucosa erythema (side effect)
randomized controlled trial (topic)
respiration depression (side effect)
side effect (side effect)
tablet formulation
vomiting (side effect)
withdrawal syndrome (side effect)
DRUG TRADE NAMES
suboxone
DRUG MANUFACTURERS
(United States)Reckitt Benckiser
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
cytochrome P450 3A4 (329736-03-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012627267
MEDLINE PMID
23013384 (http://www.ncbi.nlm.nih.gov/pubmed/23013384)
PUI
L365920748
DOI
10.1517/17425247.2012.729574
FULL TEXT LINK
http://dx.doi.org/10.1517/17425247.2012.729574
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 719
TITLE
Why do emergency providers choose one opioid over another? A prospective
cohort analysis
AUTHOR NAMES
O'Connor A.B.
Rao A.
AUTHOR ADDRESSES
(O'Connor A.B.) Department of Medicine, Hospital Medicine Division,
University of Rochester School of Medicine and Dentistry, Rochester, NY,
United States.
(Rao A.) Mount Sinai School of Medicine, New York, NY, United States.
CORRESPONDENCE ADDRESS
A.B. O'Connor, Department of Medicine, Hospital Medicine Division,
University of Rochester School of Medicine and Dentistry, Rochester, NY,
United States.
SOURCE
Journal of Opioid Management (2012) 8:6 (403-413). Date of Publication:
November-December 2012
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Objective: The reasons providers choose one parenteral opioid over another
are not well understood. The authors sought to determine why emergency
department (ED) providers choose one parenteral opioid over another.
Methods: In a cohort of ED patients who received intravenous morphine or
hydromorphone, the authors prospectively assessed patient and provider
factors associated with choice of opioid, which were included in regression
analyses to identify independent predictors of hydromorphone prescription.
Providers were also asked in real time why they chose one opioid over
another for a specific patient. Narrative responses were coded and analyzed.
Results: Opioid choice was tightly linked with equianalgesic dose, with the
median hydromorphone dosage more than 50 percent higher than the dosage of
morphine. Besides dose, choice of hydromorphone was most strongly associated
with home opioid use and a diagnosis of kidney stone. Provider preference or
habit was the most commonly cited reason for choosing the prescribed opioid,
with the majority of those responses given by providers who prescribed
morphine. One-fourth of morphine prescribers stated that the patient
required a lower dosage or less potent option; one-fourth of hydromorphone
prescribers stated that either the patient required a higher dosage or more
potent option or hydromorphone is more effective. In total, 46 percent of
providers gave a reason that does not seem to have pharmacologic validity.
Conclusions: ED providers seem to prescribe "usual" dosages of morphine and
relatively higher usual dosages of hydromorphone. The reasons for choosing
one opioid over the other for a specific patient vary from simple preference
to common misconceptions about opioid pharmacology. Improved understanding
of opioid pharmacology may improve analgesic outcomes for some patients. ©
2012 Journal of Opioid Management, All Rights Reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, drug combination, intravenous drug
administration)
morphine (adverse drug reaction, drug combination, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
antiemetic agent (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug choice
health care personnel
EMTREE MEDICAL INDEX TERMS
adult
analgesic activity
article
backache
cohort analysis
drug efficacy
drug megadose
drug potency
drug seeking behavior
drug sensitivity
drug use
emergency patient
emergency ward
female
human
low drug dose
major clinical study
male
medical history
nephrolithiasis
observational study
pain assessment
patient preference
prescription
prospective study
side effect (side effect)
therapeutic misconception
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013151952
MEDLINE PMID
23264318 (http://www.ncbi.nlm.nih.gov/pubmed/23264318)
PUI
L368487336
DOI
10.5055/jom.2012.0140
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2012.0140
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 720
TITLE
Response to: Who receives opioids for acute pain in emergency departments?
Considering evidence, patient and provider preferences
AUTHOR NAMES
McLean S.A.
Platts-Mills T.F.
Hunold K.M.
AUTHOR ADDRESSES
(McLean S.A.; Platts-Mills T.F., tplattsm@med.unc.edu; Hunold K.M.)
Department of Anesthesiology, University of North Carolina, 170 Manning
Drive CB#7594, Chapel Hill, NC 27599-7010, United States.
CORRESPONDENCE ADDRESS
T.F. Platts-Mills, Department of Anesthesiology, University of North
Carolina, 170 Manning Drive CB#7594, Chapel Hill, NC 27599-7010, United
States. Email: tplattsm@med.unc.edu
SOURCE
Pain (2012) 153:11 (2300-2301). Date of Publication: November 2012
ISSN
0304-3959
1872-6623 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
alcohol consumption
drug use
educational status
health care personnel
human
letter
patient preference
priority journal
smoking
toxicology
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012606188
MEDLINE PMID
22947223 (http://www.ncbi.nlm.nih.gov/pubmed/22947223)
PUI
L52188660
DOI
10.1016/j.pain.2012.07.036
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pain.2012.07.036
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 721
TITLE
Utilization of a pediatric observation unit for toxicologic ingestions
AUTHOR NAMES
Plumb J.
Dudley N.C.
Herman B.E.
Kadish H.A.
AUTHOR ADDRESSES
(Plumb J., jenplumb@yahoo.com; Dudley N.C.; Herman B.E.; Kadish H.A.)
Division of Pediatric Emergency Medicine, Department of Pediatrics,
University of Utah School of Medicine, PO Box 581289, Salt Lake City, UT
84158, United States.
CORRESPONDENCE ADDRESS
J. Plumb, Division of Pediatric Emergency Medicine, Department of
Pediatrics, University of Utah School of Medicine, PO Box 581289, Salt Lake
City, UT 84158, United States. Email: jenplumb@yahoo.com
SOURCE
Pediatric Emergency Care (2012) 28:11 (1169-1172). Date of Publication:
November 2012
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
OBJECTIVES: The objectives of this study were to evaluate the efficacy and
utilization of an observation unit (OU) for admission of pediatric patients
after a toxicologic ingestion; compare the characteristics and outcomes of
patients admitted to the pediatric OU, inpatient (IP) service, and intensive
care unit (ICU) after ingestions using retrospective chart review; and
attempt to identify factors associated with unplanned IP admission after an
OU admission. METHODS: This was a retrospective chart review of children
seen in the emergency department (ED) after potentially toxic suspected
ingestions and then admitted to the OU, IP service, or ICU from June 2003 to
September 2007. RESULTS: One thousand twenty-three children were seen in the
ED for ingestions: 18% were admitted to the OU, 15% to the IP service
service, and 6% to the ICU. Observation unit patients had less mental status
changes reported and were less frequently given medications while in the ED.
Eighty-one percent of OU patients were admitted with poison center
recommendation. Ninety-four percent of OU patients were discharged within 24
hours, and less than half of IP service/ICU patients were discharged that
quickly. No significant associations were found between specific historical
and physical examination or laboratory characteristics in the ED and the
need for unplanned IP admission. CONCLUSIONS: Observation unit patients
admitted after ingestions were young, typically ingested substances found in
the home, and required observation according to poison center
recommendations. Ninety-four percent were able to be discharged home within
24 hours even after ingesting some of the most concerning substances such as
central nervous system depressants, cardiac/antihypertension medications,
hypoglycemics, and opiates. All OU patients did well without any adverse
events reported. Many patients requiring prolonged observation after an
ingestion, and who do not require ICU care, may be appropriate for OU
management. This study suggests a potential underutilization of observation
units in this setting. Copyright © 2012 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS
lorazepam
naloxone
paracetamol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood injury (disease management)
hospital utilization
intoxication (disease management)
observation unit
EMTREE MEDICAL INDEX TERMS
adolescent
agitation
ataxia
bradycardia
child
child hospitalization
child neglect
clinical effectiveness
emergency ward
heart arrhythmia
hospital patient
hospital service
human
hypoglycemia
hypoxia
infant
intensive care unit
length of stay
major clinical study
mental health
nurse patient ratio
physical examination
preschool child
psychiatric treatment
respiratory distress
respiratory failure
retrospective study
review
school child
telemetry
vital sign
CAS REGISTRY NUMBERS
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012679599
MEDLINE PMID
23114240 (http://www.ncbi.nlm.nih.gov/pubmed/23114240)
PUI
L52284368
DOI
10.1097/PEC.0b013e3182717329
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e3182717329
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 722
TITLE
It took a Redbull to unmask Brugada syndrome
AUTHOR NAMES
Rutledge M.
Witthed A.
Khouzam R.N.
AUTHOR ADDRESSES
(Rutledge M.; Witthed A.; Khouzam R.N., khouzamrami@yahoo.com) Department of
Medicine, Division of Cardiovascular Diseases, University of Tennessee
Health Science Center, United States.
CORRESPONDENCE ADDRESS
R.N. Khouzam, University of Tennessee Health Science Center, 6283 Common
Oaks Crt # 106, Memphis, TN 38120, United States. Email:
khouzamrami@yahoo.com
SOURCE
International Journal of Cardiology (2012) 161:1 (e14-e15). Date of
Publication: 1 Nov 2012
ISSN
0167-5273
1874-1754 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
EMTREE DRUG INDEX TERMS
amiodarone (drug combination, drug therapy)
caffeine
epinephrine (drug combination, drug therapy)
naloxone (drug combination, drug therapy)
taurine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Brugada syndrome (drug therapy, diagnosis, drug therapy, therapy)
energy drink
EMTREE MEDICAL INDEX TERMS
adult
case report
collapse
defibrillation
electrocardiogram
emergency health service
faintness (complication, therapy)
heart palpitation
heart ventricle arrhythmia
heart ventricle fibrillation (drug therapy, therapy)
human
implantable cardioverter defibrillator
intensive care unit
letter
lung edema
male
physical activity
physical examination
priority journal
QRS complex
resuscitation
sinus rhythm
ST segment elevation
thorax radiography
vodka
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
caffeine (58-08-2)
naloxone (357-08-4, 465-65-6)
taurine (107-35-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012600186
MEDLINE PMID
22465350 (http://www.ncbi.nlm.nih.gov/pubmed/22465350)
PUI
L51938704
DOI
10.1016/j.ijcard.2012.03.095
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijcard.2012.03.095
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 723
TITLE
One drop can be beneficial, one swig can be deadly: Tetrahydrozoline
intoxication
AUTHOR NAMES
Paksu S.M.
Paksu S.
Akkuş T.
Baysal K.
AUTHOR ADDRESSES
(Paksu S.M., sukrupaksu@yahoo.com; Paksu S., sukrupaksu@yahoo.com; Akkuş T.,
sukrupaksu@yahoo.com; Baysal K., sukrupaksu@yahoo.com) Department of
Pediatrics, Ondokuz Mayis University, Samsun, Turkey.
CORRESPONDENCE ADDRESS
S. M. Paksu, Department of Pediatrics, Ondokuz Mayis University, Samsun,
Turkey. Email: sukrupaksu@yahoo.com
SOURCE
Turkish Journal of Pediatrics (2012) 54:6 (658-660). Date of Publication:
November - December 2012
ISSN
0041-4301
BOOK PUBLISHER
Turkish Journal of Pediatrics, Samanpazan, P.O. Box 66, Ankara, Turkey.
ABSTRACT
Tetrahydrozoline is a commonly used imidazoline derivative with serious side
effects and toxicity, particularly in small children. A one-year-old boy was
admitted to the emergency department (ED) after he accidentally ingested
about half a bottle of nasal decongestant solution containing
tetrahydrozoline. He was unconscious, hypothermic and bradycardic on
presentation. His respiration was irregular and superficial, and blood
pressure was borderline hypotensive. His skin was pale and cold. Atropine
was administered twice for symptomatic bradycardia, and the child was
transferred to the pediatric intensive care unit (PICU). During the 12th
hour of observation, vital signs returned to normal and there was no need
for mechanical ventilation. Although suitable room temperature with passive
warming was applied, hypothermia continued for approximately 24 hours. The
patient was discharged on the second day of admission. There were no
complaints one week later, and the physical examination was normal. We
report a case of accidental tetrahydrozoline intoxication with
life-threatening events accompanying hypothermia in a small infant.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
tetryzoline (drug toxicity)
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
decongestive agent
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
blood pressure monitoring
body temperature
bradycardia (drug therapy)
case report
child
general condition deterioration
Glasgow coma scale
human
hypotension
hypothermia
intensive care unit
male
oxygen saturation
patient monitoring
physical examination
pulse rate
tactile stimulation
treatment outcome
unconsciousness
warming
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
naloxone (357-08-4, 465-65-6)
tetryzoline (522-48-5, 84-22-0)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013236120
MEDLINE PMID
23692795 (http://www.ncbi.nlm.nih.gov/pubmed/23692795)
PUI
L368721023
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 724
TITLE
Correlates of higher-dose opioid medication use for low back pain in primary
care
AUTHOR NAMES
Kobus A.M.
Smith D.H.
Morasco B.J.
Johnson E.S.
Yang X.
Petrik A.F.
Deyo R.A.
AUTHOR ADDRESSES
(Kobus A.M., kobusa@ohsu.edu; Morasco B.J.; Deyo R.A.) Department of
Psychiatry, Oregon Health and Science University, Mail Code: OP 02, 3181 SW
Sam Jackson Park Road, Portland, OR 97239, United States.
(Smith D.H.; Johnson E.S.; Yang X.; Petrik A.F.; Deyo R.A.) Kaiser
Permanente Center for Health Research, Portland, OR, United States.
(Morasco B.J.) Portland VA Medical Center, Portland, OR, United States.
CORRESPONDENCE ADDRESS
A.M. Kobus, Department of Psychiatry, Oregon Health and Science University,
Mail Code: OP 02, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United
States. Email: kobusa@ohsu.edu
SOURCE
Journal of Pain (2012) 13:11 (1131-1138). Date of Publication: November 2012
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
Factors associated with high-dose opioid therapy for noncancer pain are
poorly understood. We documented the prevalence of high-dose opioid use as
well as associated demographic, clinical, and health service utilization
correlates among low back pain patients. Patients prescribed higher doses of
opioids (≥100 mg/day morphine equivalent at last dispensing; n = 453) and
receiving opioids for 90+ consecutive days were compared to 2 groups:
lower-dose opioid group (1-99 mg/day; n = 4,815) or no-opioid group (n =
10,184). Higher-dose opioid use occurred in 2.9% of patients who received
any opioids and in 8.6% of patients who received opioids long-term. The
median dose in the higher-dose group was 180.0 mg/day. Compared to the
no-opioid group, higher-dose users reported poorer health. Compared to
either comparison group, patients in the higher-dose group had higher rates
of mental health and substance use disorders, concurrent sedative-hypnotic
use (60.5%; n = 274), and health service utilization. After adjusting for
select covariates, male gender (odds ratio [OR] = 1.68, 95% confidence
interval [CI] = 1.37-2.06), higher comorbidity, Medicare coverage (OR =
1.65, 95% CI = 1.22-2.23), any mental health or substance use diagnosis (OR
= 1.58, 95% CI = 1.28-1.95), co-prescriptions of sedative-hypnotics (OR =
1.75, 95% CI = 1.42-2.16), and more emergency department and specialty pain
clinic visits were associated with higher likelihood of high-dose
prescriptions. Perspective: Higher-dose opioid therapy is being prescribed
to 8.6% of back pain patients who receive long-term opioids. These patients
had higher mental health and medical comorbidities and co-prescriptions of
sedative-hypnotics, raising potential safety concerns. © 2012 by the
American Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
hypnotic sedative agent (drug therapy)
morphine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
low back pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
comorbidity
controlled study
dose response
drug megadose
emergency ward
female
health care utilization
human
major clinical study
male
medicare
mental health
prescription
primary medical care
substance abuse
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012636543
MEDLINE PMID
23117108 (http://www.ncbi.nlm.nih.gov/pubmed/23117108)
PUI
L365948368
DOI
10.1016/j.jpain.2012.09.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2012.09.003
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 725
TITLE
Prescription drug monitoring programs and other interventions to combat
prescription opioid abuse
AUTHOR NAMES
Chakravarthy B.
Shah S.
Lotfipour S.
AUTHOR ADDRESSES
(Chakravarthy B., bchakrav@uci.edu; Shah S.; Lotfipour S.) University of
California Irvine, School of Medicine, Department of Emergency Medicine,
Irvine, CA, United States.
CORRESPONDENCE ADDRESS
B. Chakravarthy, University of California Irvine, School of Medicine,
Department of Emergency Medicine, Irvine, CA, United States. Email:
bchakrav@uci.edu
SOURCE
Western Journal of Emergency Medicine (2012) 13:5 (422-425). Date of
Publication: November 2012
ISSN
1936-900X
1936-9018 (electronic)
BOOK PUBLISHER
University of California Irvine, 101 The City Dr,Rte 128-01, Orange,, United
States.
ABSTRACT
The Center for Disease Control and Prevention (CDC) has published
significant data and trends related to opioid prescription pain relievers
(OPR). In 2008, 20,044 deaths were attributed to prescription drug overdose
of which 14,800 (73.8%) were due to OPR, an amount greater than the number
of overdose deaths from heroin and cocaine combined. The majority of these
deaths were unintentional. Between 1999-2008, overdose deaths from OPR
increased almost four-fold. Correspondingly, sales of OPR were four times
greater in 2010 than in 1999. Most significant to emergency physicians is
the estimate that 39% of all opioids prescribed, administered or continued
come from the emergency department (ED). We present findings from the CDC's
Morbidity and Mortality Weekly Report (MMWR) with commentary on current
recommendations and policies for curtailing the OPR epidemic.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine
buprenorphine plus naloxone (drug therapy)
cocaine (drug dose, drug toxicity)
diamorphine (drug dose, drug toxicity)
illicit drug
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug monitoring
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
death
drug intoxication (drug therapy)
drug overdose
emergency care
emergency physician
ethnicity
human
practice guideline
prescription
race
reimbursement
substance abuse
DRUG TRADE NAMES
suboxone
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2013047659
PUI
L368138825
DOI
10.5811/westjem.2012.7.12936
FULL TEXT LINK
http://dx.doi.org/10.5811/westjem.2012.7.12936
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 726
TITLE
Clinical policy: Critical issues in the prescribing of opioids for adult
patients in the emergency department
AUTHOR NAMES
Cantrill S.V.
Brown M.D.
Carlisle R.J.
Delaney K.A.
Hays D.P.
Nelson L.S.
O'Connor R.E.
Papa A.
Sporer K.A.
Todd K.H.
Whitson R.R.
AUTHOR ADDRESSES
(Cantrill S.V.; Brown M.D.; Carlisle R.J.; Delaney K.A.; Hays D.P.; Nelson
L.S.; O'Connor R.E.; Papa A.; Sporer K.A.; Todd K.H.; Whitson R.R.) American
College of Emergency Physicians Opioid Guideline Writing Panel, United
States.
CORRESPONDENCE ADDRESS
S.V. Cantrill, American College of Emergency Physicians Opioid Guideline
Writing Panel, United States.
SOURCE
Annals of Emergency Medicine (2012) 60:4 (499-525). Date of Publication:
October 2012
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
This clinical policy deals with critical issues in prescribing of opioids
for adult patients treated in the emergency department (ED). This guideline
is the result of the efforts of the American College of Emergency
Physicians, in consultation with the Centers for Disease Control and
Prevention, and the Food and Drug Administration. The critical questions
addressed in this clinical policy are: (1) In the adult ED patient with
noncancer pain for whom opioid prescriptions are considered, what is the
utility of state prescription drug monitoring programs in identifying
patients who are at high risk for opioid abuse? (2) In the adult ED patient
with acute low back pain, are prescriptions for opioids more effective
during the acute phase than other medications? (3) In the adult ED patient
for whom opioid prescription is considered appropriate for treatment of
new-onset acute pain, are short-acting schedule II opioids more effective
than short-acting schedule III opioids? (4) In the adult ED patient with an
acute exacerbation of noncancer chronic pain, do the benefits of prescribing
opioids on discharge from the ED outweigh the potential harms?
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (oral drug administration)
codeine (drug combination, drug therapy, oral drug administration)
codeine plus acetaminophen (oral drug administration)
fentanyl (adverse drug reaction, clinical trial, drug comparison, drug
therapy, transdermal drug administration)
hydrocodone (drug combination, drug therapy, oral drug administration)
hydrocodone plus acetaminophen (oral drug administration)
hydromorphone (clinical trial, drug comparison, drug therapy, oral drug
administration)
ibuprofen (clinical trial, drug comparison, drug therapy)
morphine (adverse drug reaction, clinical trial, drug comparison, drug
therapy, oral drug administration)
muscle relaxant agent
oxycodone (drug comparison, oral drug administration)
oxycodone plus paracetamol (clinical trial, drug comparison, drug therapy,
oral drug administration)
oxymorphone (drug comparison, oral drug administration)
paracetamol (clinical trial, drug combination, drug comparison, drug
therapy, oral drug administration)
paracetamol plus tramadol (adverse drug reaction, drug therapy)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
EMTREE MEDICAL INDEX TERMS
analgesia
article
chronic pain (drug therapy)
clinical effectiveness
constipation (side effect)
dizziness (side effect)
drug withdrawal
emergency physician
emergency ward
follow up
health care policy
human
low back pain (drug therapy)
musculoskeletal pain (drug therapy)
nausea (side effect)
opiate addiction
outcome assessment
prescription
priority journal
public health service
somnolence (side effect)
therapy effect
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
morphine (52-26-6, 57-27-2)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012569639
MEDLINE PMID
23010181 (http://www.ncbi.nlm.nih.gov/pubmed/23010181)
PUI
L365717158
DOI
10.1016/j.annemergmed.2012.06.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2012.06.013
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 727
TITLE
Buprenorphine/naloxone inhibition of remifentanil procedural sedation
AUTHOR NAMES
Gilmore T.
Saccheti A.
Cortese T.
AUTHOR ADDRESSES
(Gilmore T., thomas_gilmore@hotmail.com) Department of Emergency Medicine,
Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States.
(Saccheti A.) Department of Emergency Medicine, Our Lady of Lourdes Medical
Center, Camden, NJ 08103, United States.
(Cortese T.) Department of Pharmacy, Our Lady of Lourdes Medical Center,
Camden, NJ 08103, United States.
CORRESPONDENCE ADDRESS
T. Gilmore, Department of Emergency Medicine, Thomas Jefferson University
Hospital, Philadelphia, PA 19107, United States. Email:
thomas_gilmore@hotmail.com
SOURCE
American Journal of Emergency Medicine (2012) 30:8 (1655.e3-1655.e4). Date
of Publication: October 2012
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Opioid analgesics are the mainstay of treatment of moderate and severe pain.
Remifentanil is an ultrashort acting opioid analgesic used in emergency
department (ED) procedural sedation, whereas buprenorphine/naloxone
(Suboxone) is an opioid agonist-antagonist combination used in the treatment
of addiction-prone individuals. We report here a case of
buprenorphine/naloxone inhibition of remifentanil analgesia in a patient
undergoing ED procedural sedation. © 2012 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug interaction, drug therapy, pharmacology)
remifentanil (drug interaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug inhibition
sedation
EMTREE MEDICAL INDEX TERMS
adult
analgesia
arm injury
article
backache (drug therapy)
case report
diaphoresis
human
male
priority journal
wrist radiography
DRUG TRADE NAMES
suboxone
ultiva
CAS REGISTRY NUMBERS
remifentanil (132539-07-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012677478
MEDLINE PMID
22030204 (http://www.ncbi.nlm.nih.gov/pubmed/22030204)
PUI
L366082268
DOI
10.1016/j.ajem.2011.07.024
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2011.07.024
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 728
TITLE
Nonmedical use of prescription drugs
AUTHOR ADDRESSES
SOURCE
Obstetrics and Gynecology (2012) 120:4 (977-982). Date of Publication:
October 2012
ISSN
0029-7844
BOOK PUBLISHER
Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom.
ABSTRACT
The nonmedical use of prescription drugs, particularly opioids, sedatives,
and stimulants, has been cited as epidemic in the United States, accounting
for increasing numbers of emergency department visits and deaths from
reactions and overdoses. The prevalence of prescription drug abuse is
similar among men and women. Those who abuse prescription drugs most often
obtain them from friends and family either through sharing or theft.
Physicians should screen all patients annually and early in prenatal care
with a validated questionnaire for the nonmedical use of prescription drugs.
They should provide preventive education for all patients and referral for
treatment, when psychologic or physical drug dependence is identified.
Physicians should also educate patients in the proper use, storage, and
disposal of prescription drugs. © 2012 by The American College of
Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prescription drug
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, pharmaceutics, pharmacology)
alcohol
amphetamine derivative (adverse drug reaction, drug therapy)
anesthetic agent
barbituric acid derivative (drug therapy, pharmacology)
benzodiazepine derivative (drug therapy, pharmacology)
buprenorphine (drug dose, drug therapy)
central stimulant agent (adverse drug reaction)
codeine (drug dose)
dextropropoxyphene (drug dose)
fentanyl (drug dose)
hydrocodone (drug dose)
hydromorphone (drug dose)
ibuprofen (adverse drug reaction, pharmaceutics, pharmacology)
ketamine (adverse drug reaction, intramuscular drug administration,
pharmacology)
methadone (adverse drug reaction, drug dose, drug therapy)
methamphetamine (adverse drug reaction, drug therapy)
methylphenidate (adverse drug reaction, drug therapy)
morphine (drug dose)
naloxone (drug therapy)
opiate (drug combination, drug dose, drug therapy, pharmaceutics,
pharmacokinetics, pharmacology)
oxycodone (drug dose)
paracetamol (adverse drug reaction, pharmaceutics, pharmacology)
sedative agent (drug combination, pharmacology)
tramadol (drug dose)
tranquilizer (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism (prevention)
drug abuse
drug dependence (prevention)
methamphetamine dependence
morphine addiction (prevention)
opiate addiction (drug therapy, drug therapy, prevention, therapy)
patient education
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
agitation
alcohol consumption
analgesia
anxiety disorder
assisted ventilation
attention deficit disorder (drug therapy)
blood brain barrier
central nervous system depression
cognitive defect (side effect)
drug binding
drug fatality (side effect)
drug formulation
drug overdose
drug screening
drug storage
drug transport
drug use
euphoria
gastrointestinal hemorrhage (side effect)
heart arrhythmia (side effect)
human
hypertension (side effect)
laboratory test
liver failure (side effect)
liver injury (side effect)
mental disease (drug therapy, side effect)
narcolepsy (drug therapy)
neurologic disease (drug therapy, side effect)
pain (drug therapy)
patient referral
physical examination
physician
pregnant woman
prenatal care
preventive health service
priority journal
psychomotor disorder (side effect)
psychosis (side effect)
questionnaire
respiration depression (side effect)
review
rhabdomyolysis (side effect)
risk factor
sedation
side effect (side effect)
tachycardia (side effect)
urinary tract disease (side effect)
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alcohol (64-17-5)
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
methylphenidate (113-45-1, 298-59-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012577043
MEDLINE PMID
22996128 (http://www.ncbi.nlm.nih.gov/pubmed/22996128)
PUI
L365749829
DOI
10.1097/AOG.0b013e3182723b5a
FULL TEXT LINK
http://dx.doi.org/10.1097/AOG.0b013e3182723b5a
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 729
TITLE
Drug overdoses
ORIGINAL (NON-ENGLISH) TITLE
Drogenintoxikationen
AUTHOR NAMES
Eyer F.
Zilker T.
AUTHOR ADDRESSES
(Eyer F., Florian.Eyer@mac.com; Zilker T.) Toxikologische Abteilung-II,
Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität,
München, Germany.
(Eyer F., Florian.Eyer@mac.com) Toxikologische Abteilung-II, Medizinische
Klinik, Klinikum rechts der Isar der Technischen Universität München,
Ismaningerstr. 22, 81675 München, Germany.
CORRESPONDENCE ADDRESS
F. Eyer, Toxikologische Abteilung-II, Medizinische Klinik, Klinikum rechts
der Isar der Technischen Universität München, Ismaningerstr. 22, 81675
München, Germany. Email: Florian.Eyer@mac.com
SOURCE
Notfall und Rettungsmedizin (2012) 15:7 (569-576). Date of Publication:
October 2012
ISSN
1434-6222
1436-0578 (electronic)
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
Background. Toxicity resulting from the abuse of drugs or alcohol is a
frequent indication for primary care by emergency physicians in Germany.
Alcohol intoxication . Excessive consumption of alcoholic beverages and
caffeinated alcoholic drinks is increasingly observed among adolescents and
accounts for a significant number of visits to emergency departments. While
treatment of alcohol intoxication remains symptomatic, overdoses with
methanol or ethylene glycol often require specific administration of alcohol
dehydrogenase inhibitors or haemodialysis. Opiate and opioid intoxication .
Treatment of opiate-And opioid-related toxicity is mainly symptomatic, while
the use of specific antidote treatment with naloxone should be reserved for
a specific patient population. Cocaine . Cocaine consumption may result in
central nervous, sympathomimetic and cardiovascular toxicity with the risk
of hypertensive crisis, malignant hyperthermia or arrhythmia as well as
acute coronary syndrome. Treatment consists of aggressive administration of
benzodiazepines for agitation, alpha-blockers for hypertension and, in
selected cases, hypertonic sodium bicarbonate or lidocaine for ventricular
arrhythmia. Designer drugs. The use of designer drugs known as "legal highs"
as well as the consumption of "spice", acting as cannabinoid receptor
agonists, is increasingly observed; the mainstay of treatment consists of
benzodiazepine administration. Herbal drugs. Misuse of hallucinogenic plants
such as jimson weed or deadly nightshade can cause acute anticholinergic
syndrome requiring careful administration of physostigmine in some cases.
Gamma hydroxybutyrate intoxication . Users of gamma hydroxybutyrate (liquid
ecstasy) and its derivates can present to emergency departments with signs
of overdose, withdrawal and associated trauma as well as delirium. This
patient group demonstrates reduced consciousness to deep coma requiring
thorough cardiovascular monitoring and airway protection with intubation
and, in some cases, mechanical ventilation. © Springer-Verlag Berlin
Heidelberg 2012.
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
alcohol dehydrogenase
alpha adrenergic receptor blocking agent (drug therapy)
antidote
benzodiazepine derivative
bicarbonate (drug therapy)
cocaine (drug toxicity)
designer drug (drug toxicity)
ethylene glycol (drug toxicity)
herbaceous agent (drug toxicity)
lidocaine (drug therapy)
methanol (drug toxicity)
naloxone
opiate (drug toxicity)
physostigmine
stramonium (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
EMTREE MEDICAL INDEX TERMS
acute coronary syndrome
agitation
alcohol intoxication
anticholinergic syndrome
article
artificial ventilation
cardiotoxicity
cardiovascular system examination
coma
consciousness disorder
delirium
drug intoxication
emergency ward
heart arrhythmia
heart ventricle arrhythmia (drug therapy)
hemodialysis
human
hypertension (drug therapy)
hypertensive crisis
intubation
malignant hyperthermia
neurotoxicity
opiate intoxication
patient monitoring
symptom
withdrawal syndrome
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
alcohol dehydrogenase (9031-72-5)
bicarbonate (144-55-8, 71-52-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
ethylene glycol (107-21-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
physostigmine (57-47-6, 64-47-1)
stramonium (8063-18-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2012673563
PUI
L366062632
DOI
10.1007/s10049-012-1577-6
FULL TEXT LINK
http://dx.doi.org/10.1007/s10049-012-1577-6
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 730
TITLE
ESC Guidelines for the management of acute myocardial infarction in patients
presenting with ST-segment elevation
AUTHOR NAMES
Steg P.G.
James S.K.
Atar D.
Badano L.P.
Lundqvist C.B.
Borger M.A.
Di Mario C.
Dickstein K.
Ducrocq G.
Fernandez-Aviles F.
Gershlick A.H.
Giannuzzi P.
Halvorsen S.
Huber K.
Juni P.
Kastrati A.
Knuuti J.
Lenzen M.J.
Mahaffey K.W.
Valgimigli M.
Van'T Hof A.
Widimsky P.
Zahger D.
Bax J.J.
Baumgartner H.
Ceconi C.
Dean V.
Deaton C.
Fagard R.
Funck-Brentano C.
Hasdai D.
Hoes A.
Kirchhof P.
Kolh P.
McDonagh T.
Moulin C.
Popescu B.A.
Reiner Ž.
Sechtem U.
Sirnes P.A.
Tendera M.
Torbicki A.
Vahanian A.
Windecker S.
Astin F.
Åström-Olsson K.
Budaj A.
Clemmensen P.
Collet J.-P.
Fox K.A.
Fuat A.
Gustiene O.
Hamm C.W.
Kala P.
Lancellotti P.
Maggioni A.P.
Merkely B.
Neumann F.-J.
Piepoli M.F.
Van De Werf F.
Verheugt F.
Wallentin L.
AUTHOR ADDRESSES
(Steg P.G., gabriel.steg@bch.aphp.fr; Ducrocq G.; Dean V.; Funck-Brentano
C.; Moulin C.; Torbicki A.; Clemmensen P.) AP-HP, Hôpital Bichat, Univ Paris
Diderot, Sorbonne Paris-Cité, Paris, France.
(James S.K., gabriel.steg@bch.aphp.fr; Lundqvist C.B.; Astin F.; Verheugt
F.; Wallentin L.)
(Atar D.; Dickstein K.; Halvorsen S.; Sirnes P.A.)
(Badano L.P.; Giannuzzi P.; Valgimigli M.; Ceconi C.; Lancellotti P.;
Maggioni A.P.; Neumann F.-J.)
(Borger M.A.; Kastrati A.; Baumgartner H.; Sechtem U.; Gustiene O.)
(Di Mario C.; Gershlick A.H.; Deaton C.; Hasdai D.; Kirchhof P.; McDonagh
T.; Collet J.-P.; Fox K.A.)
(Fernandez-Aviles F.)
(Huber K.)
(Juni P.; Vahanian A.)
(Knuuti J.)
(Lenzen M.J.; Van'T Hof A.; Bax J.J.; Hoes A.; Van De Werf F.)
(Mahaffey K.W.)
(Widimsky P.; Hamm C.W.)
(Zahger D.; Hasdai D.; Windecker S.)
(Fagard R.; Kolh P.; Kala P.; Piepoli M.F.)
(Popescu B.A.)
(Reiner Ž.)
(Tendera M.; Åström-Olsson K.)
(Budaj A.)
(Fuat A.)
(Merkely B.)
CORRESPONDENCE ADDRESS
P.G. Steg, AP-HP, Hôpital Bichat, Univ Paris Diderot, Sorbonne Paris-Cité,
Paris, France. Email: gabriel.steg@bch.aphp.fr
SOURCE
European Heart Journal (2012) 33:20 (2569-2619). Date of Publication:
October 2012
ISSN
0195-668X
1522-9645 (electronic)
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS
abciximab (drug therapy, intravenous drug administration)
acetylsalicylic acid (drug therapy, intravenous drug administration, oral
drug administration)
alteplase (drug therapy, intravenous drug administration)
atorvastatin (drug therapy)
atropine (drug therapy)
bivalirudin (drug therapy, intravenous drug administration)
captopril (drug therapy)
clopidogrel (drug therapy, oral drug administration)
enoxaparin (drug therapy, intrathecal drug administration, intravenous drug
administration, subcutaneous drug administration)
eptifibatide (drug therapy, intravenous drug administration)
fondaparinux (drug therapy, intravenous drug administration, subcutaneous
drug administration)
heparin (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
prasugrel (drug therapy, oral drug administration)
reteplase (drug therapy, intravenous drug administration)
rivaroxaban (drug therapy)
streptokinase (drug therapy)
tenecteplase (drug therapy)
ticagrelor (drug therapy, oral drug administration)
tirofiban (drug therapy, intravenous drug administration)
valsartan (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart infarction (drug therapy, drug therapy, epidemiology, therapy)
practice guideline
ST segment elevation
EMTREE MEDICAL INDEX TERMS
acute heart infarction
algorithm
anticoagulant therapy
anxiety
automated external defibrillator
blood pressure regulation
body weight control
bradycardia (drug therapy)
brain hemorrhage
cardiogenic shock (complication)
cardiovascular mortality
cognitive therapy
computer assisted tomography
coronary artery blood flow
coronary artery bypass surgery
coronary care unit
creatinine clearance
diet therapy
dyspnea
electrocardiography monitoring
emergency care
emergency health service
fibrinolysis
fibrinolytic therapy
first degree atrioventricular block (complication)
follow up
general practitioner
health care quality
health care system
heart arrest
heart failure
heart left ventricle aneurysm (complication)
heart muscle conduction disturbance (complication)
heart muscle ischemia
heart muscle reperfusion
heart muscle revascularization
heart rehabilitation
heart rupture (complication)
heart supraventricular arrhythmia (complication)
heart ventricle extrasystole (complication)
heart ventricle fibrillation (complication)
heart ventricle septum rupture (complication)
heart ventricle tachycardia (complication)
heart work
hospital admission
hospitalization
human
hyperglycemia
hypotension (complication, drug therapy)
incidence
intracardiac thrombosis (complication)
kidney dysfunction
kinesiotherapy
length of stay
lifestyle modification
loading drug dose
long term care
lung congestion (complication)
lung embolism
meta analysis (topic)
mitral valve regurgitation (complication)
mobilization
myocardial perfusion imaging
out of hospital cardiac arrest
pain
patient compliance
patient monitoring
patient transport
percutaneous coronary intervention
pericardial effusion
pericarditis (complication)
phase 3 clinical trial (topic)
posterior myocardial infarction
priority journal
randomized controlled trial (topic)
respiration depression (drug therapy)
resuscitation
review
risk assessment
risk factor
second degree atrioventricular block (complication)
sinus bradycardia (complication)
smoking cessation
social psychology
ST segment depression
ST segment elevation myocardial infarction (drug therapy, epidemiology)
stent thrombosis
stress management
teleconsultation
therapy delay
thrombocyte aggregation
treatment duration
CAS REGISTRY NUMBERS
abciximab (143653-53-6)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alteplase (105857-23-6)
atorvastatin (134523-00-5, 134523-03-8)
atropine (51-55-8, 55-48-1)
captopril (62571-86-2)
clopidogrel (113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8)
enoxaparin (679809-58-6)
eptifibatide (148031-34-9)
fondaparinux (104993-28-4, 114870-03-0)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hirulog (128270-60-0)
naloxone (357-08-4, 465-65-6)
prasugrel (150322-43-3, 389574-19-0)
reteplase (133652-38-7)
rivaroxaban (366789-02-8)
streptokinase (9002-01-1)
tenecteplase (191588-94-0)
ticagrelor (274693-27-5)
tirofiban (142373-60-2, 144494-65-5, 150915-40-5)
valsartan (137862-53-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012616713
MEDLINE PMID
22922416 (http://www.ncbi.nlm.nih.gov/pubmed/22922416)
PUI
L365889890
DOI
10.1093/eurheartj/ehs215
FULL TEXT LINK
http://dx.doi.org/10.1093/eurheartj/ehs215
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 731
TITLE
The Joint Commission and the FDA take steps to curb adverse events related
to the use and misuse of opioid drugs.
AUTHOR ADDRESSES
SOURCE
ED management : the monthly update on emergency department management (2012)
24:10 (112-116). Date of Publication: Oct 2012
ISSN
1044-9167
ABSTRACT
Alarmed by adverse events involving opioid drugs, the Joint Commission has
issued a Sentinel Alert urging hospitals to take steps to improve safety in
the prescribing of these powerful drugs. In addition, the Food and Drug
Administration (FDA) has launched an initiative that will soon require the
manufacturers of long-acting and extended-release opioids to offer education
and training to physicians and others who prescribe these pharmaceuticals.
The Joint Commission reports that of the opioid-related adverse events
reported to the agency between 2004 and 2011, 47% involved wrong-dosage
medication errors, 29% pertained to improper patient monitoring, and 11%
were attributed to other factors such as excessive dosing, drug-drug
interactions, and adverse reactions. The FDA reports that nearly 16,000
Americans died from overdoses involving opioids in 2009, and in 2011, there
were nearly 23 million prescriptions written for extended-release and
long-acting opioids. Some new guidelines on opioid prescribing in the ED
urge providers to avoid prescribing extended-release or long-acting opioids
altogether, and to consider measures that will limit opportunities for drug
diversion.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
accreditation
food and drug administration
opiate addiction (prevention)
EMTREE MEDICAL INDEX TERMS
article
drug interaction
emergency health service
human
United States (epidemiology)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
23045763 (http://www.ncbi.nlm.nih.gov/pubmed/23045763)
PUI
L366351020
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 732
TITLE
Treatment of guanfacine toxicity with naloxone
AUTHOR NAMES
Tsze D.S.
Dayan P.S.
AUTHOR ADDRESSES
(Tsze D.S., dst2141@columbia.edu; Dayan P.S.) Division of Pediatric
Emergency Medicine, Department of Pediatrics, Columbia University College of
Physicians and Surgeons, New York, NY, United States.
CORRESPONDENCE ADDRESS
D.S. Tsze, New York Presbyterian Morgan Stanley, Children's Hospital of New
York, 622West 168th St, PH 137, New York, NY 10032, United States. Email:
dst2141@columbia.edu
SOURCE
Pediatric Emergency Care (2012) 28:10 (1060-1061). Date of Publication:
October 2012
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
ABSTRACT: We describe a 4-year-old boy who presents to the emergency
department with lethargy, bradycardia, and initial hypertension followed by
hypotension due to guanfacine toxicity after ingestion of standard doses of
the extended release formulation. This is the first case report to describe
the use of naloxone to treat these symptoms and document improvements in
level of consciousness, blood pressure, and heart rate associated with this
therapy. Copyright © 2012 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
guanfacine (adverse drug reaction, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
attention deficit disorder (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
blood pressure
bradycardia (drug therapy, side effect)
case report
child
consciousness
continuous infusion
drug dose increase
emergency care
evening dosage
heart rate
human
hypertension (drug therapy, side effect)
hypotension (drug therapy, side effect)
lethargy (drug therapy, side effect)
male
preschool child
somnolence (side effect)
sustained release formulation
DRUG TRADE NAMES
intuniv
tenex
CAS REGISTRY NUMBERS
guanfacine (29110-47-2, 29110-48-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012598343
MEDLINE PMID
23034493 (http://www.ncbi.nlm.nih.gov/pubmed/23034493)
PUI
L365827570
DOI
10.1097/PEC.0b013e31826ce9f1
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e31826ce9f1
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 733
TITLE
Correlations between population levels of prescription opioid use and
prescription-opioid-related substance use treatment admissions in the USA
and Canada since 2001
AUTHOR NAMES
Fischer B.
Nakamura N.
Urbanoski K.
Rush B.
Rehm J.
AUTHOR ADDRESSES
(Fischer B., bfischer@sfu.ca; Nakamura N.) Centre for Applied Research in
Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser
University, Vancouver, Canada.
(Fischer B., bfischer@sfu.ca; Urbanoski K.; Rush B.; Rehm J.) Centre for
Addiction and Mental Health, Toronto, Canada.
(Rush B.; Rehm J.) University of Toronto, Toronto, Canada.
CORRESPONDENCE ADDRESS
B. Fischer, Centre for Applied Research in Mental Health and Addictions,
Harbour Centre 2400, Simon Fraser University, 515 West Hastings Street,
Vancouver, BC V6B 5K3, Canada. Email: bfischer@sfu.ca
SOURCE
Public Health (2012) 126:9 (749-751). Date of Publication: September 2012
ISSN
0033-3506
1476-5616 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction, drug toxicity)
hydrocodone (adverse drug reaction, drug toxicity)
methadone (adverse drug reaction, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
prescription
EMTREE MEDICAL INDEX TERMS
article
Canada
chronic pain (drug therapy)
correlation analysis
disease severity
drug intoxication
drug monitoring
emergency ward
health care
hospital admission
human
liver cirrhosis
morbidity
mortality
population research
sensitivity analysis
United States
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012532716
MEDLINE PMID
22770736 (http://www.ncbi.nlm.nih.gov/pubmed/22770736)
PUI
L52098484
DOI
10.1016/j.puhe.2012.04.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.puhe.2012.04.010
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 734
TITLE
Dosing and titration of intravenous opioid analgesics administered to ED
patients in acute severe pain
AUTHOR NAMES
Bijur P.E.
Esses D.
Chang A.K.
Gallagher E.J.
AUTHOR ADDRESSES
(Bijur P.E., polly.bijur@einstein.yu.edu; Esses D.; Chang A.K.; Gallagher
E.J.) Department of Emergency Medicine, Albert Einstein College of Medicine,
Bronx, NY 10461, United States.
CORRESPONDENCE ADDRESS
P.E. Bijur, Department of Emergency Medicine, Albert Einstein College of
Medicine, Bronx, NY 10461, United States. Email: polly.bijur@einstein.yu.edu
SOURCE
American Journal of Emergency Medicine (2012) 30:7 (1241-1244). Date of
Publication: September 2012
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Objectives: The objectives were to describe the dose of opioids and
incidence of titration for management of acute pain in emergency department
patients and, secondarily, to assess the association between change in pain
and dose. Methods: Data from control groups of 2 randomized clinical trials
were analyzed. Patients 21 to 64 years with acute pain judged to warrant
intravenous (IV) opioids were eligible. We calculated the mean weight-based
dose of IV opioids, distribution of dose, proportion of patients receiving
additional IV opioids, and 95% confidence intervals. We compared these
statistics to 3 recommendations: 0.1 mg/kg morphine, 10 mg morphine, and
titration to analgesic effect. We used multiple linear regression to assess
the association between change in pain measured on a numerical rating scale
and dose. Results: There were 281 patients with an initial median pain score
of 10 (interquartile range: 8, 10). Mean weight-based dose of IV opioids was
0.08 mg/kg (0.07, 0.08 mg/kg). A total of 268 patients (95.4% [92.2%,
97.5%]) received less than 10 mg IV morphine equivalents; 7 patients (2.5%
[1.0%, 5.0%]) received additional opioids. There was a weak association
between change in pain in the 15, 30, and 60 minutes after the initial bolus
and dose: b = 0.22 (0.07, 0.37), b = 0.17 (0.02, 0.32), and b = 0.12 (-0.03,
0.28), respectively, after adjustment for baseline pain. Conclusion:
Analgesic practice did not conform to recommended doses or regimens. There
was only a weak association between change of pain and dose in the range of
doses given. These findings suggest that oligoanalgesia continues to be a
problem despite improvements over the past 20 years. © 2012 Elsevier Inc.
All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (clinical trial, drug dose, drug therapy, intravenous drug
administration)
morphine (clinical trial, drug dose, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
controlled study
dose calculation
drug dose titration
human
major clinical study
pain assessment
priority journal
rating scale
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012505786
MEDLINE PMID
21908134 (http://www.ncbi.nlm.nih.gov/pubmed/21908134)
PUI
L365523708
DOI
10.1016/j.ajem.2011.06.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2011.06.015
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 735
TITLE
Trauma and substance abuse: Deadly consequences of intravenous percocet
tablets
AUTHOR NAMES
Galante J.M.
Ahmad S.
Albers E.A.
Sena M.J.
AUTHOR ADDRESSES
(Galante J.M.; Sena M.J.) Department of Surgery, University of California
Davis Medical Center, Sacramento, CA, United States.
(Ahmad S.) Department of Surgery, Jacobi Medical Center, Bronx, NY, United
States.
(Albers E.A.) Sacramento County Coroner's Office, Sacramento, CA, United
States.
CORRESPONDENCE ADDRESS
J.M. Galante, Division of Trauma/Critical Care, UC Davis Medical Center,
2315 Stockton Blvd., Sacramento, CA 95817, United States.
SOURCE
Journal of Emergency Medicine (2012) 43:3 (e167-e169). Date of Publication:
September 2012
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: The prevalence of drug or alcohol addiction among trauma
patients approaches 40%, yet many require narcotics during admission for
adequate pain control. Provider awareness is the most reasonable option to
avoid the devastating consequence of narcotic tablet injection. Objective:
To illustrate the misuse of oral narcotics and to heighten provider
awareness of a potential cause for acute respiratory failure in recently
discharged patients. Case Report: A 20-year-old man was admitted to the
hospital after an assault to the head and face. He was discharged from the
hospital with 30 oral Percocet® (Endo Pharmaceuticals, Newark, DE) tablets
after 24 h of observation. The day after discharge, emergency medical
services were called to his residence for a decreased level of
consciousness. During transport to the Emergency Department, he went into
cardiac arrest with pulseless electrical activity. He could not be
resuscitated. Postmortem biochemical and anatomical evidence suggested that
the patient had attempted to inject crushed Percocet® tablets, which
resulted in acute foreign body pulmonary microembolism and death.
Conclusion: Patients with a history of substance abuse may be inclined to
crush and inject oral narcotics. Narcotic injection should be considered in
recently discharged patients who present with pulmonary failure. Patients
with suspected narcotic addiction should be counseled before discharge on
the risks of misusing oral medications in this fashion. © 2012 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
oxycodone plus paracetamol (adverse drug reaction, drug therapy, oral drug
administration)
EMTREE DRUG INDEX TERMS
fibrin (endogenous compound)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
injury
intravenous drug abuse
substance abuse
EMTREE MEDICAL INDEX TERMS
acute respiratory failure
adult
anterior maxillary sinus fracture
article
assault
autopsy
case report
clinical observation
computer assisted tomography
consciousness level
drug misuse
emergency care
emergency health service
face injury
follow up
foreign body
head injury
headache (drug therapy)
heart arrest
heart electrophysiology
histopathology
hospital discharge
human
human tissue
inflammatory cell
lung congestion
lung embolism (side effect)
male
maxilla fracture
orbit fracture
priority journal
respiratory tract intubation
tablet
tissue necrosis
DRUG TRADE NAMES
percocet , United StatesEndo
DRUG MANUFACTURERS
(United States)Endo
CAS REGISTRY NUMBERS
fibrin (9001-31-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012535390
MEDLINE PMID
20079996 (http://www.ncbi.nlm.nih.gov/pubmed/20079996)
PUI
L50764690
DOI
10.1016/j.jemermed.2009.11.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2009.11.004
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 736
TITLE
Emergency neurological life support: Approach to the patient with coma
AUTHOR NAMES
Huff J.S.
Stevens R.D.
Weingart S.D.
Smith W.S.
AUTHOR ADDRESSES
(Huff J.S., jshuff505@me.com) Departments of Emergency Medicine and
Neurology, University of Virginia School of Medicine, Charlottesville, VA,
United States.
(Stevens R.D.) Departments of Anesthesiology and Critical Care Medicine,
Neurology Neurosurgery and Radiology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States.
(Weingart S.D.) Division of ED Critical Care, Mount Sinai School of
Medicine, New York, NY, United States.
(Smith W.S., spambin55@gmail.com) Department of Neurology, University of
California, San Francisco, CA, United States.
CORRESPONDENCE ADDRESS
J.S. Huff, Departments of Emergency Medicine and Neurology, University of
Virginia School of Medicine, Charlottesville, VA, United States. Email:
jshuff505@me.com
SOURCE
Neurocritical Care (2012) 17:SUPPL. 1 (S54-S59). Date of Publication:
September 2012
ISSN
1541-6933
1556-0961 (electronic)
BOOK PUBLISHER
Humana Press, 999 Riverview Drive, Suite 208, Totowa, United States.
ABSTRACT
Coma is an acute failure of neuronal systems governing arousal and awareness
and represents a neurological emergency. When encountering a comatose
patient, the clinician must have an organized approach to detect easily
remedial causes, prevent ongoing neurologic injury, and determine a
hierarchy of diagnostic tests, treatments, and neuromonitoring. Coma was
chosen as an Emergency Neurological Life Support (ENLS) protocol because
timely medical and surgical interventions can be life-saving, and the
initial work-up of such patients is critical to establishing a correct
diagnosis. © Neurocritical Care Society 2012.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
antibiotic agent (drug therapy)
dexamethasone (drug therapy)
glucose (endogenous compound)
naloxone (drug therapy, intravenous drug administration)
physostigmine (drug therapy)
thiamine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
emergency neurological life support
emergency treatment
patient care
EMTREE MEDICAL INDEX TERMS
acetominophen intoxication (drug therapy)
acetominophen intoxication (drug therapy)
airway
anamnesis
anticholinergic syndrome (drug therapy)
bacterial meningitis (drug therapy)
body position
brain ischemia (diagnosis)
breathing
breathing pattern
caloric vestibular test
cerebellum hemorrhage (diagnosis)
cervical spine injury (therapy)
circulation
computer assisted tomography
cranial nerve reflex
critically ill patient
decebrate position
decorticate position
doctor patient relation
drug intoxication (drug therapy)
emergency care
Glasgow coma scale
glucose blood level
human
immobilization
interpersonal communication
intoxication (drug therapy)
laboratory test
long term care
motor performance
neuroimaging
neurologic examination
nuclear magnetic resonance imaging
opioid intoxication (drug therapy)
opioid intoxication (drug therapy)
oxygenation
patient referral
priority journal
reflex
resuscitation
review
subarachnoid hemorrhage (diagnosis)
thiamine deficiency (drug therapy)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
dexamethasone (50-02-2)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Radiology (14)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012673621
MEDLINE PMID
22932989 (http://www.ncbi.nlm.nih.gov/pubmed/22932989)
PUI
L52184675
DOI
10.1007/s12028-012-9755-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s12028-012-9755-4
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 737
TITLE
My mistake
AUTHOR NAMES
Veysman B.D.
AUTHOR ADDRESSES
(Veysman B.D., veysmabo@umdnj.edu) Department of Emergency Medicine,
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson
Medical School, New Brunswick, NJ, United States.
CORRESPONDENCE ADDRESS
B.D. Veysman, Department of Emergency Medicine, University of Medicine and
Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick,
NJ, United States. Email: veysmabo@umdnj.edu
SOURCE
Annals of Emergency Medicine (2012) 60:2 (235). Date of Publication: August
2012
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medical education
medical student
student attitude
EMTREE MEDICAL INDEX TERMS
anger
diarrhea
differential diagnosis
electrocardiogram
emergency ward
heart arrest
human
intravenous drug administration
irritability
medical record
mental disease (drug therapy)
note
patient attitude
pharmacy
physician
physician attitude
priority journal
radiography
tachycardia
teacher
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012437669
MEDLINE PMID
22818372 (http://www.ncbi.nlm.nih.gov/pubmed/22818372)
PUI
L365313721
DOI
10.1016/j.annemergmed.2011.11.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2011.11.006
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 738
TITLE
American Society of Interventional Pain Physicians (ASIPP) guidelines for
responsible opioid prescribing in chronic non-cancer pain: Part I--evidence
assessment.
AUTHOR NAMES
Manchikanti L.
Abdi S.
Atluri S.
Balog C.C.
Benyamin R.M.
Boswell M.V.
Brown K.R.
Bruel B.M.
Bryce D.A.
Burks P.A.
Burton A.W.
Calodney A.K.
Caraway D.L.
Cash K.A.
Christo P.J.
Damron K.S.
Datta S.
Deer T.R.
Diwan S.
Eriator I.
Falco F.J.
Fellows B.
Geffert S.
Gharibo C.G.
Glaser S.E.
Grider J.S.
Hameed H.
Hameed M.
Hansen H.
Harned M.E.
Hayek S.M.
Helm 2nd. S.
Hirsch J.A.
Janata J.W.
Kaye A.D.
Kaye A.M.
Kloth D.S.
Koyyalagunta D.
Lee M.
Malla Y.
Manchikanti K.N.
McManus C.D.
Pampati V.
Parr A.T.
Pasupuleti R.
Patel V.B.
Sehgal N.
Silverman S.M.
Singh V.
Smith H.S.
Snook L.T.
Solanki D.R.
Tracy D.H.
Vallejo R.
Wargo B.W.
American Society of Interventional Pain Physicians
AUTHOR ADDRESSES
(Manchikanti L.) American Society of Interventional Pain Physicians, USA.
(Abdi S.; Atluri S.; Balog C.C.; Benyamin R.M.; Boswell M.V.; Brown K.R.;
Bruel B.M.; Bryce D.A.; Burks P.A.; Burton A.W.; Calodney A.K.; Caraway
D.L.; Cash K.A.; Christo P.J.; Damron K.S.; Datta S.; Deer T.R.; Diwan S.;
Eriator I.; Falco F.J.; Fellows B.; Geffert S.; Gharibo C.G.; Glaser S.E.;
Grider J.S.; Hameed H.; Hameed M.; Hansen H.; Harned M.E.; Hayek S.M.; Helm
2nd. S.; Hirsch J.A.; Janata J.W.; Kaye A.D.; Kaye A.M.; Kloth D.S.;
Koyyalagunta D.; Lee M.; Malla Y.; Manchikanti K.N.; McManus C.D.; Pampati
V.; Parr A.T.; Pasupuleti R.; Patel V.B.; Sehgal N.; Silverman S.M.; Singh
V.; Smith H.S.; Snook L.T.; Solanki D.R.; Tracy D.H.; Vallejo R.; Wargo
B.W.; American Society of Interventional Pain Physicians)
CORRESPONDENCE ADDRESS
L. Manchikanti, American Society of Interventional Pain Physicians, USA.
SOURCE
Pain physician (2012) 15:3 Suppl (S1-65). Date of Publication: Jul 2012
ISSN
2150-1149 (electronic)
ABSTRACT
Opioid abuse has continued to increase at an alarming rate since the 1990 s.
As documented by different medical specialties, medical boards, advocacy
groups, and the Drug Enforcement Administration, available evidence suggests
a wide variance in chronic opioid therapy of 90 days or longer in chronic
non-cancer pain. Part 1 describes evidence assessment. The objectives of
opioid guidelines as issued by the American Society of Interventional Pain
Physicians (ASIPP) are to provide guidance for the use of opioids for the
treatment of chronic non-cancer pain, to produce consistency in the
application of an opioid philosophy among the many diverse groups involved,
to improve the treatment of chronic non-cancer pain, and to reduce the
incidence of abuse and drug diversion. The focus of these guidelines is to
curtail the abuse of opioids without jeopardizing non-cancer pain management
with opioids. 1) There is good evidence that non-medical use of opioids is
extensive; one-third of chronic pain patients may not use prescribed opioids
as prescribed or may abuse them, and illicit drug use is significantly
higher in these patients. 2) There is good evidence that opioid
prescriptions are increasing rapidly, as the majority of prescriptions are
from non-pain physicians, many patients are on long-acting opioids, and many
patients are provided with combinations of long-acting and short-acting
opioids. 3) There is good evidence that the increased supply of opioids, use
of high dose opioids, doctor shoppers, and patients with multiple comorbid
factors contribute to the majority of the fatalities. 4) There is fair
evidence that long-acting opioids and a combination of long-acting and
short-acting opioids contribute to increasing fatalities and that even
low-doses of 40 mg or 50 mg of daily morphine equivalent doses may be
responsible for emergency room admissions with overdoses and deaths. 5)
There is good evidence that approximately 60% of fatalities originate from
opioids prescribed within the guidelines, with approximately 40% of
fatalities occurring in 10% of drug abusers. 6) The short-term effectiveness
of opioids is fair, whereas the long-term effectiveness of opioids is
limited due to a lack of long-term (> 3 months) high quality studies, with
fair evidence with no significant difference between long-acting and
short-acting opioids. 7) Among the individual drugs, most opioids have fair
evidence for short-term and limited evidence for long-term due to a lack of
quality studies. 8) The evidence for the effectiveness and safety of chronic
opioid therapy in the elderly for chronic non-cancer pain is fair for
short-term and limited for long-term due to lack of high quality studies;
limited in children and adolescents and patients with comorbid psychological
disorders due to lack of quality studies; and the evidence is poor in
pregnant women. 9) There is limited evidence for reliability and accuracy of
screening tests for opioid abuse due to lack of high quality studies. 10)
There is fair evidence to support the identification of patients who are
non-compliant or abusing prescription drugs or illicit drugs through urine
drug testing and prescription drug monitoring programs, both of which can
reduce prescription drug abuse or doctor shopping. DISCLAIMER: The
guidelines are based on the best available evidence and do not constitute
inflexible treatment recommendations. Due to the changing body of evidence,
this document is not intended to be a "standard of care."
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy)
opiate addiction (prevention)
EMTREE MEDICAL INDEX TERMS
adolescent
aged
article
child
female
human
infant
male
practice guideline
pregnancy
LANGUAGE OF ARTICLE
English
MEDLINE PMID
22786448 (http://www.ncbi.nlm.nih.gov/pubmed/22786448)
PUI
L366347411
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 739
TITLE
The Bremen antidote list
ORIGINAL (NON-ENGLISH) TITLE
Vorhaltung von Antidota im Notarztdienst
AUTHOR NAMES
Schaper A.
Bandemer G.
Callies A.
Brau C.
Braun J.
Dörges V.
Knacke P.
V. Knobelsdorff G.
Marung H.
Piscol-Haritz C.
Roessler M.
Ruppert M.
Schimansky J.
Wenzel V.
Wirtz S.
Desel H.
Tonner P.H.
AUTHOR ADDRESSES
(Schaper A.; Desel H.) Giftinformationszentrum-Nord der Länder Bremen,
Niedersachsen und Schleswig-Holstein, Universitätsmedizin Göttingen,
Hamburg, United States.
(Bandemer G., Gerald.Bandemer@klinikum-bremen-ldw.de; Callies A.; Tonner
P.H.) Gesundheit Nord, Klinikum Links der Weser, Klinik für Anästhesie,
Bremen, Germany.
(Bandemer G., Gerald.Bandemer@klinikum-bremen-ldw.de; Callies A.; Brau C.;
Dörges V.; Knacke P.; V. Knobelsdorff G.; Marung H.; Piscol-Haritz C.;
Roessler M.; Schimansky J.; Wirtz S.; Tonner P.H.) Arbeitsgemeinschaft der
in Norddeutschland Tätigen Notärzte (AGNN), Germany.
(Bandemer G., Gerald.Bandemer@klinikum-bremen-ldw.de; Callies A.; Braun J.;
Tonner P.H.) DRF Stiftung Luftrettung Gemeinnützige AG, Filderstadt,
Germany.
(Bandemer G., Gerald.Bandemer@klinikum-bremen-ldw.de; Callies A.; Ruppert
M.; Tonner P.H.) ADAC Luftrettung GmbH, München, Germany.
(Wenzel V.) Universitätsklinik für Anaesthesie und Allgemeine
Intensivmedizin, Innsbruck, Austria.
CORRESPONDENCE ADDRESS
G. Bandemer, Rettungshubschrauber Christoph 6, Bremen, Klinik für
Anästhesie, Operative und Allgemeine Intensivmedizin, Klinikum Links der
Weser, Senator-Weßling-Straße 1, 28277 Bremen, Germany. Email:
Gerald.Bandemer@klinikum-bremen-ldw.de
SOURCE
Notarzt (2012) 28:3 (114-118). Date of Publication: 2012
ISSN
0177-2309
1438-8693 (electronic)
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
ABSTRACT
For poison related emergencies German ambulances are equipped with a big
number of antidotes. However most intoxications are not treated specifically
out of hospital by ambulance physicians. Ambulances are requested, when
vital functions of a patient are jeopardised. In most cases symptomatic
treatment is sufficient; including mechanical ventilation, whereas need for
administration of a specific antidote is extremely rare. On behalf of the
Working Group of Northern German Emergency Physicians (AGNN) the authors,
all of them emergency physicians and toxicologists, developed a list of
antidotes necessary in the out-of-hospital emergency setting. The results
are based on the experience of thousands of treated emergencies and on the
calls to the GIZ-Nord Poisons Centre Göttingen from 1996 to 2010. The list
was discussed by the Board of Continuing Education of the AGNN as well as at
a meeting of Medical Directors of Emergency Services. Both boards supported
the list of antidotes. Without reduction of quality of care antidotes held
available in an ambulance car can be reduced to 5 substances: atropine,
4-DMAP, naloxone, tolonium chloride, activated charcoal. This general
recommendation has to be adjusted to local conditions. A list of antidotes
that need to be carried by an ambulance car is proposed. Due to a lack of
studies the list has a low evidence level (expert judgement). It is based on
the experience of emergency physicians and toxicologists. The list is
thought to provoke a discussion among experts and to prompt further studies
on the use and usefulness of antidotes. © Georg Thieme Verlag KG Stuttgart ·
New York.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulance
emergency care
intoxication
EMTREE MEDICAL INDEX TERMS
article
artificial ventilation
health care quality
human
physician
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2012349449
PUI
L365043057
DOI
10.1055/s-0032-1304841
FULL TEXT LINK
http://dx.doi.org/10.1055/s-0032-1304841
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 740
TITLE
More educated emergency department patients are less likely to receive
opioids for acute pain
AUTHOR NAMES
Platts-Mills T.F.
Hunold K.M.
Bortsov A.V.
Soward A.C.
Peak D.A.
Jones J.S.
Swor R.A.
Lee D.C.
Domeier R.M.
Hendry P.L.
Rathlev N.K.
McLean S.A.
AUTHOR ADDRESSES
(Platts-Mills T.F., tplattsm@med.unc.edu; Hunold K.M.; Bortsov A.V.; Soward
A.C.; McLean S.A.) Department of Anesthesiology, University of North
Carolina, Chapel Hill, NC 27599-7010, United States.
(Platts-Mills T.F., tplattsm@med.unc.edu; McLean S.A.) Department of
Emergency Medicine, University of North Carolina, Chapel Hill, NC, United
States.
(Peak D.A.) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, MA, United States.
(Jones J.S.) Department of Emergency Medicine, Spectrum Health - Butterworth
Campus, Grand Rapids, MI, United States.
(Swor R.A.) Department of Emergency Medicine, William Beaumont Hospital,
Royal Oak, MI, United States.
(Lee D.C.) Department of Emergency Medicine, North Shore University
Hospital, Manhasset, NY, United States.
(Domeier R.M.) Department of Emergency Medicine, St. Joseph Mercy Hospital,
Ann Arbor, MI, United States.
(Hendry P.L.) Department of Emergency Medicine and Pediatrics, University of
Florida, Jacksonville, FL, United States.
(Rathlev N.K.) Department of Emergency Medicine, Baystate Medical Center,
Springfield, MA, United States.
CORRESPONDENCE ADDRESS
T.F. Platts-Mills, Department of Anesthesiology, University of North
Carolina, Chapel Hill, NC 27599-7010, United States. Email:
tplattsm@med.unc.edu
SOURCE
Pain (2012) 153:5 (967-973). Date of Publication: May 2012
ISSN
0304-3959
1872-6623 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Inadequate treatment of pain in United States emergency departments (EDs) is
common, in part because of the limited and idiosyncratic use of opioids by
emergency providers. This study sought to determine the relationship between
patient socioeconomic characteristics and the likelihood that they would
receive opioids during a pain-related ED visit. We conducted a
cross-sectional analysis of ED data obtained as part of a multicenter study
of outcomes after minor motor vehicle collision (MVC). Study patients were
non-Hispanic white patients between the ages of 18 and 65 years who were
evaluated and discharged home from 1 of 8 EDs in 4 states. Socioeconomic
characteristics include educational attainment and income. Of 690 enrolled
patients, the majority had moderate or severe pain (80%). Patients with
higher education attainment had lower levels of pain, pain catastrophizing,
perceived life threat, and distress. More educated patients were also less
likely to receive opioids during their ED visit. Opioids were given to 54%
of patients who did not complete high school vs 10% of patients with
post-college education (χ(2) test P <.001). Differences in the frequency of
opioid administration between patients with the lowest educational
attainment (39%, 95% confidence interval 22% to 60%) and highest educational
attainment (13%, 95% confidence interval 7% to 23%) remained after
adjustment for age, sex, income, and pain severity (P =.01). In this sample
of post-MVC ED patients, more educated patients were less likely to receive
opioids. Further study is needed to assess the generalizability of these
findings and to determine the reason for the difference. © 2012
International Association for the Study of Pain. Published by Elsevier B.V.
All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
educational status
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
catastrophizing
cross-sectional study
disease severity
distress syndrome
emergency ward
female
high school
human
income
major clinical study
male
pain assessment
postgraduate education
priority journal
social status
threat
traffic accident
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012224960
MEDLINE PMID
22386895 (http://www.ncbi.nlm.nih.gov/pubmed/22386895)
PUI
L51891614
DOI
10.1016/j.pain.2012.01.013
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pain.2012.01.013
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 741
TITLE
How Do Emergency Department Patients Store and Dispose of Opioids After
Discharge? A Pilot Study
AUTHOR NAMES
Tanabe P.
Paice J.A.
Stancati J.
Fleming M.
AUTHOR ADDRESSES
(Tanabe P., Paula.tanabe@duke.edu) Duke University Schools of Nursing and
Medicine, Durham, NC, United States.
(Paice J.A.) Division of Hematology-Oncology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States.
(Stancati J.) Northwestern University, Chicago, IL, United States.
(Fleming M.) Feinberg School of Medicine, Northwestern University, Chicago,
IL, United States.
CORRESPONDENCE ADDRESS
P. Tanabe, Duke University, DUMC 3322, 307 Trent Dr, Durham NC 27710, United
States. Email: Paula.tanabe@duke.edu
SOURCE
Journal of Emergency Nursing (2012) 38:3 (273-279). Date of Publication: May
2012
ISSN
0099-1767
1527-2966 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Introduction: Opioid abuse and overdose have increased drastically in recent
years. Diversion of opioids used to treat pain, either through theft or
sharing, is increasing and may contribute to this misuse. Based on these
trends, we designed a study to investigate opioid storage and disposal
practices of patients who were prescribed these agents in the emergency
department. Methods: A prospective cohort pilot study was conducted. All
adults (aged ≥18 years) with a chief complaint of either minor
musculoskeletal trauma, renal colic, or acute back pain who were discharged
home with an opioid prescription were eligible for inclusion; persons with
chronic pain were excluded. Patients were asked to participate in two home
interviews in which the research assistant viewed the storage location of
the opioid prescription. Safe storage was defined as being stored in a
locked container or cabinet. Safe disposal was defined as returning the
drugs to a designated location or mixing unused pills with an undesirable
substance, placing in a sealable container, and then in the trash. Patients
self-reported disposal methods. Feasibility of study methods evaluated the
ability to conduct home interviews after the ED visit. Descriptive
statistics were used to analyze the data. Results: Twenty-five subjects
consented to participate; 20 patients completed both home interviews. None
of the medications were safely stored. Only 1 patient disposed of the
medication, yet did so improperly. Conclusion: This pilot study revealed
widespread improper storage and disposal of opioids. The study has major
implications for education for ED physicians, nurses, and residents. © 2012
Emergency Nurses Association.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug storage
emergency health service
waste disposal
EMTREE MEDICAL INDEX TERMS
adult
aged
article
female
hospital discharge
human
interview
male
methodology
middle aged
pilot study
prospective study
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
22204885 (http://www.ncbi.nlm.nih.gov/pubmed/22204885)
PUI
L51784519
DOI
10.1016/j.jen.2011.09.023
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2011.09.023
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 742
TITLE
Guide to Emergency Interception During Parturition in the Dog and Cat
AUTHOR NAMES
Smith F.O.
AUTHOR ADDRESSES
(Smith F.O., zacrescendo@comcast.net) Orthopedic Foundation for Animals,
Inc, 2300 East Nifong Boulevard, Columbia, MO 65201, United States.
(Smith F.O., zacrescendo@comcast.net) Smith Veterinary Hospital, 1110
Highway 13 East, Burnsville, MN 55337, United States.
CORRESPONDENCE ADDRESS
F.O. Smith, Smith Veterinary Hospital, 1110 Highway 13 East, Burnsville, MN
55337, United States. Email: zacrescendo@comcast.net
SOURCE
Veterinary Clinics of North America - Small Animal Practice (2012) 42:3
(489-499). Date of Publication: May 2012
ISSN
0195-5616
1878-1306 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS
bicarbonate (intravenous drug administration)
calcium (drug therapy, pharmacology)
cholinergic receptor blocking agent (pharmacology)
doxapram (intravenous drug administration)
epinephrine
gluconate calcium (drug combination, drug therapy, subcutaneous drug
administration)
glucose (drug combination, drug therapy)
halothane
isoflurane
naloxone (intravenous drug administration)
opiate (pharmacology)
oxytocin (drug combination, drug therapy, intramuscular drug administration)
propofol (intravenous drug administration)
sevoflurane
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
birth
cat
dog
dystocia (drug therapy, diagnosis, drug therapy, etiology, surgery)
emergency treatment
EMTREE MEDICAL INDEX TERMS
add on therapy
bitch
cesarean section
convalescence
episiotomy
female
female animal
litter size
neonatal outcome
newborn mortality
nonhuman
outcome assessment
parameters concerning the fetus, newborn and pregnancy
pregnancy outcome
queen
recommended drug dose
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
calcium (14092-94-5, 7440-70-2)
doxapram (113-07-5, 309-29-5, 7081-53-0)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
halothane (151-67-7, 66524-48-9)
isoflurane (26675-46-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxytocin (50-56-6, 54577-94-5)
propofol (2078-54-8)
sevoflurane (28523-86-6)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012193819
MEDLINE PMID
22482814 (http://www.ncbi.nlm.nih.gov/pubmed/22482814)
PUI
L364560468
DOI
10.1016/j.cvsm.2012.02.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cvsm.2012.02.001
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 743
TITLE
Who receives opioids for acute pain in emergency departments? Considering
evidence, patient and provider preferences
AUTHOR NAMES
Fanciullo G.J.
AUTHOR ADDRESSES
(Fanciullo G.J., gilbert.j.fanciullo@hitchcock.org) Department of
Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Medical
School, One Medical Center Drive, Lebanon, NH 03756, United States.
CORRESPONDENCE ADDRESS
G.J. Fanciullo, Department of Anesthesiology, Dartmouth Hitchcock Medical
Center, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH
03756, United States. Email: gilbert.j.fanciullo@hitchcock.org
SOURCE
Pain (2012) 153:5 (941-942). Date of Publication: May 2012
ISSN
0304-3959
1872-6623 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
health care utilization
pain
EMTREE MEDICAL INDEX TERMS
educational status
human
medical decision making
multicenter study (topic)
note
opiate addiction
patient care
patient decision making
patient information
patient preference
patient selection
prescription
priority journal
risk reduction
traffic accident
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012224983
MEDLINE PMID
22445292 (http://www.ncbi.nlm.nih.gov/pubmed/22445292)
PUI
L51925602
DOI
10.1016/j.pain.2012.02.038
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pain.2012.02.038
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 744
TITLE
Can nebulized naloxone be used safely and effectively by emergency medical
services for suspected opioid overdose?
AUTHOR NAMES
Weber J.M.
Tataris K.L.
Hoffman J.D.
Aks S.E.
Mycyk M.B.
AUTHOR ADDRESSES
(Weber J.M.) Department of Emergency Medicine, Cook County Hospital,
Chicago, IL 60612, USA.
(Tataris K.L.; Hoffman J.D.; Aks S.E.; Mycyk M.B.)
CORRESPONDENCE ADDRESS
J.M. Weber, Department of Emergency Medicine, Cook County Hospital, Chicago,
IL 60612, USA. Email: josephmweber@yahoo.com
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2012)
16:2 (289-292). Date of Publication: 2012 Apr-Jun
ISSN
1545-0066 (electronic)
ABSTRACT
Emergency medical services (EMS) traditionally administer naloxone using a
needle. Needleless naloxone may be easier when intravenous (IV) access is
difficult and may decrease occupational blood-borne exposure in this
high-risk population. Several studies have examined intranasal naloxone, but
nebulized naloxone as an alternative needleless route has not been examined
in the prehospital setting. We sought to determine whether nebulized
naloxone can be used safely and effectively by prehospital providers for
patients with suspected opioid overdose. We performed a retrospective
analysis of all consecutive cases administered nebulized naloxone from
January 1 to June 30, 2010, by the Chicago Fire Department. All clinical
data were entered in real time into a structured EMS database and data
abstraction was performed in a systematic manner. Included were cases of
suspected opioid overdose, altered mental status, and respiratory
depression; excluded were cases where nebulized naloxone was given for
opioid-triggered asthma and cases with incomplete outcome data. The primary
outcome was patient response to nebulized naloxone. Secondary outcomes
included need for rescue naloxone (IV or intramuscular), need for assisted
ventilation, and adverse antidote events. Kappa interrater reliability was
calculated and study data were analyzed using descriptive statistics. Out of
129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete
response, 62 (59%) had partial response, and 20 (19%) had no response.
Eleven cases (10%) received rescue naloxone, no case required assisted
ventilation, and no adverse events occurred. The kappa score was 0.993.
Nebulized naloxone is a safe and effective needleless alternative for
prehospital treatment of suspected opioid overdose in patients with
spontaneous respirations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
cohort analysis
female
follow up
human
inhalational drug administration
intoxication (drug therapy)
male
methodology
middle aged
nebulizer
opiate addiction (drug therapy)
retrospective study
risk assessment
safety
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
22191727 (http://www.ncbi.nlm.nih.gov/pubmed/22191727)
PUI
L365134085
DOI
10.3109/10903127.2011.640763
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2011.640763
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 745
TITLE
Medication errors during medical emergencies in a large, tertiary care,
academic medical center
AUTHOR NAMES
Gokhman R.
Seybert A.L.
Phrampus P.
Darby J.
Kane-Gill S.L.
AUTHOR ADDRESSES
(Gokhman R.; Seybert A.L., seyberta@upmc.edu; Kane-Gill S.L.) Department of
Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy,
Pittsburgh, PA, 15213, United States.
(Gokhman R.; Seybert A.L., seyberta@upmc.edu; Kane-Gill S.L.) Department of
Pharmacy, UPMC, Pittsburgh, PA, 15213, United States.
(Gokhman R.) Medical/Trauma Intensive Care Unit, The Reading Hospital and
Medical Center, West Reading, PA 19611, United States.
(Seybert A.L., seyberta@upmc.edu; Phrampus P.) Peter M. Winter Institute for
Simulation, Education and Research (WISER), University of Pittsburgh,
Pittsburgh, PA, 15213, United States.
(Phrampus P.) Departments of Emergency Medicine and Anesthesiology,
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United
States.
(Darby J.) Departments of Critical Care Medicine and Surgery, University of
Pittsburgh Physicians UPMC Presbyterian, Pittsburgh, PA, 15213, United
States.
CORRESPONDENCE ADDRESS
A.L. Seybert, Lothrop Street PFG01-01-01, Pittsburgh, PA 15213, United
States. Email: seyberta@upmc.edu
SOURCE
Resuscitation (2012) 83:4 (482-487). Date of Publication: April 2012
ISSN
0300-9572
1873-1570 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Purpose: Evaluate the rate, type and severity of medication errors occurring
during Medical Emergency Team (MET) care at a large, tertiary-care, academic
medical center. Methods: A prospective, observational evaluation of 50
patients that required MET care was conducted. Data on medication use were
collected using a direct-observation method whereby an observer documented
drug information such as drug, dose, frequency, rate of administration and
administration technique. Subsequently, a team of three clinicians assessed
rate, type and severity of medication errors using definitions consistent
with United States Pharmacopeia MEDMARX system. Severity was assessed on a
scale of minor, moderate and severe. Results: One hundred eighty six doses
were observed for 36 different medications. A total of 296 errors were
identified; of these 196 errors (66%) were inappropriate aseptic technique.
Of the remaining 100 errors, 46% were prescribing errors, 28% administration
technique errors, 14% mislabeling errors, 10% drug preparation errors and 2%
improper dose prescribing. Examples included: (1) prescribing errors, (2)
administering wrong doses, (3) mislabeling, and (4) wrong administration
technique such as not flushing intravenous medication through intravenous
access. The rate of medication administration errors was 1.6 errors/dose
including aseptic technique and 0.5 errors/dose excluding aseptic technique.
A notable portion (14%) of errors was considered at least moderate in
severity. Conclusions: One out of 2 doses was administered in error after
errors of using inappropriate aseptic technique were excluded. There is a
need for education and systematic changes to prevent medication errors
during medical emergencies as an effort to avoid harm. © 2011 Elsevier
Ireland Ltd.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
amiodarone
atropine
calcium chloride
diltiazem
diphenhydramine
dopamine
epinephrine
etomidate
fentanyl
flumazenil
furosemide
glucose
glyceryl trinitrate
heparin
hetastarch
lidocaine
lorazepam
magnesium sulfate
methylprednisolone
metoprolol
midazolam
morphine
naloxone
noradrenalin
paracetamol
phenylephrine
phenytoin
propofol
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
medication error
rapid response team
EMTREE MEDICAL INDEX TERMS
adult
article
asepsis
clinical article
disease severity
drug information
drug labeling
female
human
inappropriate prescribing
male
medical literature
observational study
priority journal
prospective study
tertiary health care
university hospital
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
calcium chloride (10043-52-4)
diltiazem (33286-22-5, 42399-41-7)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hetastarch (9005-27-0)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
magnesium sulfate (7487-88-9)
methylprednisolone (6923-42-8, 83-43-2)
metoprolol (37350-58-6)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
paracetamol (103-90-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
phenytoin (57-41-0, 630-93-3)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012146037
MEDLINE PMID
22001000 (http://www.ncbi.nlm.nih.gov/pubmed/22001000)
PUI
L51706027
DOI
10.1016/j.resuscitation.2011.10.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2011.10.001
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 746
TITLE
Efficacy of patient-controlled analgesia for patients with acute abdominal
pain in the emergency department: A randomized trial
AUTHOR NAMES
Birnbaum A.
Schechter C.
Tufaro V.
Touger R.
Gallagher E.J.
Bijur P.
AUTHOR ADDRESSES
(Birnbaum A., adrienne.birnbaum@nbhn.net; Touger R.; Gallagher E.J.; Bijur
P.) Department of Emergency Medicine, Population Health, Albert Einstein
College of Medicine, Bronx, NY, United States.
(Schechter C.) Department of Family and Social Medicine and Epidemiology,
Population Health, Albert Einstein College of Medicine, Bronx, NY, United
States.
(Tufaro V.) Jacobi Medical Center, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
A. Birnbaum, Department of Emergency Medicine, Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States. Email:
adrienne.birnbaum@nbhn.net
SOURCE
Academic Emergency Medicine (2012) 19:4 (370-377). Date of Publication:
April 2012
ISSN
1069-6563
1553-2712 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: The objective was to assess the efficacy of patient-controlled
analgesia (PCA) in the emergency department (ED) and to compare two PCA
dosing regimens. Methods: A randomized controlled trial with three treatment
arms was performed in an urban ED. A convenience sample of ED patients ages
18 to 65 years with abdominal pain of 7 days or less duration requiring
intravenous (IV) opioid analgesia was enrolled between April 2009 and June
2010. All patients received an initial dose of 0.1 mg/kg IV morphine
followed by physician-managed analgesia as needed. Patients in the PCA arms
also received IV morphine with on-demand doses of 1 or 1.5 mg, with a
6-minute lockout between doses. Pain intensity was rated by patients on an
11-point numeric rating scale (NRS). Satisfaction with pain treatment,
desire for the same treatment in the future, and need for additional
analgesia were assessed at study end. Adverse events (O(2) sat < 92%,
respiratory rate [RR] < 10/min, systolic blood pressure [sBP] < 90 mm Hg,
and naloxone use) were counted. One-way analysis of variance was used to
test the difference among groups in short-term pain relief, as assessed by
mean change in NRS pain intensity from baseline to 30 minutes and pain over
the entire 2-hour study period measured by area under the curve (AUC) of NRS
pain ratings. A post hoc hierarchical linear model was used to test the
observed difference in NRS between the groups between 30 and 120 minutes.
Results: A total of 211 patients were enrolled. A sharp, nearly identical
decline in mean NRS scores occurred from baseline to 30 minutes in the three
groups (p = 0.82). Between 30 and 120 minutes, there was little further
decline in the non-PCA NRS scores, while both PCA groups continued to
decline (p = 0.004). The net treatment effect over the entire 2 hours was
smallest in the non-PCA group and largest in the group receiving 1.5 mg of
morphine (p = 0.06). The mean decline in pain from baseline to 120 minutes
postbaseline in both PCA groups was 1.4 NRS units (95% confidence interval
[CI] = 0.3 to 2.4) greater than the decline in patients treated without PCA.
More patients in the PCA arms reported satisfaction, wanting the same pain
management in the future, and not wanting further analgesics at 120 minutes
than patients who did not receive PCA. There were no clinically or
statistically significant differences in any outcomes between the two PCA
groups. One PCA patient had a transient oxygen saturation of 88% after the
initial bolus only, and one non-PCA patient had a brief drop in sBP to 87 mm
Hg. Conclusions: This study provides support for efficacy of PCA when
applied to the ED setting. Future studies designed to assess implementation
of this modality in the context of conditions of actual ED staffing and
competing patient demands are warranted. © 2012 by the Society for Academic
Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, clinical trial, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
lorazepam
naloxone
opiate (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (drug therapy, drug therapy)
patient controlled analgesia
EMTREE MEDICAL INDEX TERMS
adult
article
breathing rate
controlled study
disease duration
drug efficacy
emergency ward
female
human
major clinical study
male
pain assessment
patient satisfaction
priority journal
randomized controlled trial
systolic blood pressure
treatment outcome
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
lorazepam (846-49-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT00910208)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012224719
MEDLINE PMID
22506940 (http://www.ncbi.nlm.nih.gov/pubmed/22506940)
PUI
L364646870
DOI
10.1111/j.1553-2712.2012.01322.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1553-2712.2012.01322.x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 747
TITLE
"Bath salt" ingestion leading to severe intoxication delirium: Two cases and
a brief review of the emergence of mephedrone use
AUTHOR NAMES
Kasick D.P.
McKnight C.A.
Klisovic E.
AUTHOR ADDRESSES
(Kasick D.P., david.kasick@osumc.edu; McKnight C.A.; Klisovic E.) Department
of Psychiatry, Ohio State University College of Medicine, 1670 Upham Drive,
Columbus, OH 43210, United States.
CORRESPONDENCE ADDRESS
D.P. Kasick, Department of Psychiatry, Ohio State University College of
Medicine, 1670 Upham Drive, Columbus, OH 43210, United States. Email:
david.kasick@osumc.edu
SOURCE
American Journal of Drug and Alcohol Abuse (2012) 38:2 (176-180). Date of
Publication: March 2012
ISSN
0095-2990
1097-9891 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
Background: Recreational use of designer substances containing synthetic
cathinones such as mephedrone, commonly sold as "bath salts," has recently
been increasing in the United States (National Institute on Drug Abuse.
Available at:
http://www.nida.nih.gov/about/welcome/MessageBathSalts211.html. Accessed
March 25, 2011; The Washington Post. Available at: http://www.
washingtonpost.com/national/officials-fear-bath-salts-becoming-the-next-big-
drug-menace/2011/01/22/ABybyRJ-story.html. Accessed March 25, 2011). "Bath
salt" ingestion can generate an intense stimulant toxidrome and has been
associated with significant morbidity. Objectives: The authors seek to alert
clinicians to the potential for profound delirium, psychosis, and other
medical and behavioral sequelae of "bath salt" use. Methods: Case series.
Results: We describe our recent experience with two highly agitated and
delirious patients following "bath salt" ingestion and offer a brief review
of the emergence of this phenomenon. Conclusions: Challenges and strategies
surrounding diagnosis and treatment are described, which may be useful as
"bath salt" use becomes more widespread. Scientific Significance: As an
emerging trend, bath salt intoxication delirium appears to cause intense
psychosis that can be managed with antipsychotic medications. Clinicians
should be aware of this phenomenon until more precise detection methods are
available. Copyright © Informa Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4' methylmethcathinone
bath salt
EMTREE DRUG INDEX TERMS
haloperidol (drug therapy, intramuscular drug administration)
lorazepam (drug therapy, intravenous drug administration)
naloxone (drug therapy)
phencyclidine
risperidone (drug therapy, oral drug administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
delirium (drug therapy, drug therapy)
intoxication
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
case report
clinical feature
drug dose increase
human
laboratory test
male
review
treatment outcome
CAS REGISTRY NUMBERS
haloperidol (52-86-8)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
phencyclidine (77-10-1, 956-90-1)
risperidone (106266-06-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012120826
MEDLINE PMID
22221190 (http://www.ncbi.nlm.nih.gov/pubmed/22221190)
PUI
L364342346
DOI
10.3109/00952990.2011.643999
FULL TEXT LINK
http://dx.doi.org/10.3109/00952990.2011.643999
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 748
TITLE
Opipramol overdose presented with wide-complex tachycardia to the emergency
department
AUTHOR NAMES
Sogut O.
Yalcin S.
Kaya H.
Gokdemir M.T.
Sezen Y.
AUTHOR ADDRESSES
(Sogut O., drosogut@harran.edu.tr) Harran University, Medical Faculty,
Department of Emergency Medicine, Sanliurfa, Turkey.
(Kaya H.; Gokdemir M.T.) Harran University, Medical Faculty, Department of
Anesthesiology and Reanimation, Sanliurfa, Turkey.
(Yalcin S.) Harran University, Medical Faculty, Department of Cardiology,
Sanliurfa, Turkey.
(Sezen Y.)
CORRESPONDENCE ADDRESS
O. Sogut, Harran University, Medical Faculty, Department of Emergency
Medicine, Sanliurfa, Turkey. Email: drosogut@harran.edu.tr
SOURCE
Hong Kong Journal of Emergency Medicine (2012) 19:2 (121-125). Date of
Publication: March 2012
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, 18 Cheung Lee Street, Chaiwan, Hong Kong.
ABSTRACT
Opipramol is an antidepressant and anxiolytic drug similar in structure to
tricyclic antidepressants (TCAs) but it is primarily used for the treatment
of generalized anxiety disorders. Unlike many TCAs, opipramol has no
reuptake-inhibiting properties. Opipramol acts as a high affinity sigma
receptor agonist. Opipramol acts as a low to moderate affinity antagonist
for the dopamine-2 (D2), 5-hydroxtryptamine (5-HT2), histamine 1 (H1),
histamine 2 (H2), and muscarinic acetylcholine receptors accounting for its
antihistamine effects, and muscarinic anticholinergic properties. Here, we
report a rare case of opipramol overdose case involving a 18-year-old woman,
presenting to our emergency department (ED) with loss of consciousness and
widecomplex tachycardia. A firm diagnosis of opipramol overdose was made on
the basis of clinical, laboratory and electrocardiogram findings.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opipramol (drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
bicarbonate (drug therapy)
diazepam (drug therapy, intravenous drug administration)
dopamine (intravenous drug administration)
glucose
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
tachycardia
EMTREE MEDICAL INDEX TERMS
adult
anticonvulsant therapy
anxiety disorder (drug therapy)
article
blood gas analysis
case report
consciousness disorder
convulsion
drug dose titration
dry skin
ECG abnormality
electrocardiogram
emergency ward
female
fluid resuscitation
hemodynamic monitoring
human
intensive care
mass fragmentography
metabolic acidosis
oxygenation
physical examination
seizure (drug therapy)
stomach lavage
suicidal ideation
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
opipramol (315-72-0, 909-39-7)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2012423181
PUI
L365273365
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 749
TITLE
Cardiopulmonary arrest following cervical epidural injection
AUTHOR NAMES
Stauber B.
Ma L.
Nazari R.
AUTHOR ADDRESSES
(Stauber B.; Ma L.; Nazari R., Reza.Nazari@emanuelmed.org) Emanuel Medical
Center, 825 Delbon Ave, Turlock, CA 95382, United States.
(Stauber B.; Nazari R., Reza.Nazari@emanuelmed.org) Touro University,
California College of Osteopathic Medicine, Vallejo, CA, United States.
CORRESPONDENCE ADDRESS
R. Nazari, Emanuel Medical Center, 825 Delbon Ave, Turlock, CA 95382, United
States. Email: Reza.Nazari@emanuelmed.org
SOURCE
Pain Physician (2012) 15:2 (147-152). Date of Publication: March/April 2012
ISSN
1533-3159
BOOK PUBLISHER
American Society of Interventional Pain Physicians, Pain Physicians, 81
Lakeview Drive, Paducah, United States.
ABSTRACT
Epidural steroid injection is a common treatment for the management of pain
in a wide variety of patients. It is generally well tolerated and perceived
to have few side effects, with a low risk of serious complications. Only a
handful of reports exist that describe life-threatening complications such
as subdural hematoma, respiratory depression, vasovagal response, and
pneumocephalus. This is a case report of a 67-year-old woman with a
relatively unremarkable past medical history, other than rheumatoid
arthritis, osteoarthritis, and hypertension, who suffered from chronic neck
pain treated with cervical epidural steroid injection at the C6-C7 level.
She went into immediate cardiopulmonary arrest following the injection. She
was brought to the emergency department by ambulance and resuscitated, and
was found to have pneumocephalus. Ultimately, she made a relatively full
recovery over the following weeks. Cardiopulmonary arrest is a rare but
potentially deadly side effect of epidural steroid injection. To the best of
our knowledge, this is the first report of such an arrest following a
steroid injection in the cervical spinal region. There are several possible
mechanisms for the immediate arrest, including cardioacceleratory center
blockade, severe vasovagal response, iatrogenic pneumocephalus, and
involvement of the phrenic nerve followed by apnea. Our conclusion in this
case is that the most likely scenario was injection of the C6-C7 level led
to a blockade of the cardiac accelerator fibers located just below in the
T1-T4 spinal level, causing a sympathetic blockade and profound bradycardia,
leading to cardiopulmonary arrest.
EMTREE DRUG INDEX TERMS
betamethasone (drug combination, drug therapy, epidural drug administration)
epinephrine (drug therapy, intravenous drug administration)
etanercept (drug therapy)
flumazenil (drug therapy)
hydrocodone (drug combination, drug therapy)
lidocaine (drug combination, drug therapy, epidural drug administration)
methotrexate (drug therapy)
metoprolol (drug therapy)
naloxone (drug therapy)
paracetamol (drug combination, drug therapy)
prednisone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary arrest (drug therapy, complication, drug therapy, therapy)
epidural anesthesia
EMTREE MEDICAL INDEX TERMS
aged
anemia
article
bradycardia
brain infarction
case report
chronic pain (drug therapy)
computer assisted tomography
drowsiness
electroencephalogram
female
human
hypertension (drug therapy)
hyperthermia
hypoxia
induced hypothermia
neck pain (drug therapy)
nuclear magnetic resonance imaging
pneumocephalus (complication, diagnosis)
respiratory alkalosis
resuscitation
rheumatoid arthritis (drug therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
betamethasone (378-44-9)
etanercept (185243-69-0, 200013-86-1)
flumazenil (78755-81-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methotrexate (15475-56-6, 59-05-2, 7413-34-5)
metoprolol (37350-58-6)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
prednisone (53-03-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012187850
MEDLINE PMID
22430652 (http://www.ncbi.nlm.nih.gov/pubmed/22430652)
PUI
L364537234
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 750
TITLE
Rescue therapy for acute migraine, part 3: Opioids, NSAIDs, steroids, and
post-discharge medications
AUTHOR NAMES
Kelley N.E.
Tepper D.E.
AUTHOR ADDRESSES
(Kelley N.E.; Tepper D.E., debtepper@gmail.com) Center for Headache and
Pain, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue,
Cleveland, OH 44195, United States.
CORRESPONDENCE ADDRESS
D.E. Tepper, Center for Headache and Pain, Neurological Institute, Cleveland
Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States. Email:
debtepper@gmail.com
SOURCE
Headache (2012) 52:3 (467-482). Date of Publication: March 2012
ISSN
0017-8748
1526-4610 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Objective. The final section of this 3-part review analyzes published
reports involving the acute treatment of migraine with opioids,
non-steroidal anti-inflammatory drugs (NSAIDs), and steroids in the
emergency department (ED), urgent care, and headache clinic settings, as
well as post-discharge medications. In the Conclusion, there is a general
discussion of all the therapies presented in the 3 sections. Method. Using
the terms ("migraine" AND "emergency") AND ("therapy" OR "treatment"), the
author searched MEDLINE for reports from ED and urgent care settings that
involved all routes of medication delivery. Reports from headache clinic
settings were included only if medications were delivered by a parenteral
route. Results. Seventy-five reports were identified that compared the
efficacy and safety of multiple acute migraine medications for rescue. Of
the medications reviewed in Part 3, opioids, NSAIDs, and steroids all
demonstrated some effectiveness. When used alone, nalbuphine and metamizole
were superior to placebo. NSAIDs were inferior to the combination of
metoclopramide and diphenhydramine. Meperidine was arguably equivalent when
compared with ketorolac and dihydroergotamine (DHE) but was inferior to
chlorpromazine and equivalent to the other dopamine antagonists. Steroids
afford some protection against headache recurrence after the patient leaves
the treatment center. Conclusions. All 3 opioids most frequently studied -
meperidine, tramadol, and nalbuphine - were superior to placebo in relieving
migraine pain, although meperidine combined with promethazine was not.
Opioid side effects included dizziness, sedation, and nausea. With ketorolac
being the most frequently studied drug in the class, NSAIDs were generally
well tolerated, and they may provide benefit even when given late in the
migraine attack. The rate of headache recurrence within 24-72 hours after
discharge from the ED can be greater than 50%. Corticosteroids can be useful
in reducing headache recurrence after discharge. As discussed in Parts 1, 2,
and 3, there are effective medications for provider-administered "rescue" in
all the classes discussed. Prochlorperazine and metoclopramide are the most
frequently studied of the anti-migraine medications in the emergent setting,
and their effectiveness is superior to placebo. Prochlorperazine is superior
or equivalent to all other classes of medications in migraine pain relief.
Although there are fewer studies involving sumatriptan and DHE, relatively
"migraine- specific" medications, they appear to be equivalent to the
dopamine antagonists for migraine pain relief. Lack of comparisons with
placebo and the frequent use of combinations of medications in treatment
arms complicate the comparison of single agents to one another. When used
alone, prochlorperazine, promethazine, metoclopramide, nalbuphine, and
metamizole were superior to placebo. Droperidol and prochlorperazine were
superior or equal in efficacy to all other treatments, although they also
are more likely to produce side effects that are difficult for a patient to
tolerate (especially akathisia). Metoclopramide was equivalent to
prochlorperazine, and, when combined with diphenhydramine, was superior in
efficacy to triptans and NSAIDs. Meperidine was arguably equivalent when
compared with ketorolac and DHE but was inferior to chlorpromazine and
equivalent to the other neuroleptics. Sumatriptan was inferior or equivalent
to the neuroleptics and equivalent to DHE when only paired comparisons were
considered. The overall percentage of patients with pain relief after taking
sumatriptan was equivalent to that observed with droperidol or
prochlorperazine. © 2012 American Headache Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nonsteroid antiinflammatory agent (drug therapy)
opiate (adverse drug reaction, drug therapy)
steroid (drug therapy)
EMTREE DRUG INDEX TERMS
butorphanol (adverse drug reaction, drug comparison, drug therapy,
intramuscular drug administration)
chlorpromazine (drug comparison, drug therapy, intravenous drug
administration)
clonixin lysine (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration)
dexamethasone (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration)
diclofenac (drug comparison, drug therapy, intramuscular drug
administration)
dihydroergotamine (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration)
dimenhydrinate (drug combination, drug comparison, drug therapy,
intramuscular drug administration, intravenous drug administration)
diphenhydramine (drug combination, drug therapy, intravenous drug
administration)
dipyrone (adverse drug reaction, drug comparison, drug therapy, intravenous
drug administration)
dopamine receptor blocking agent (adverse drug reaction, drug therapy,
parenteral drug administration)
droperidol (drug comparison, drug therapy)
hydroxyzine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intramuscular drug administration)
ibuprofen (drug comparison, drug therapy, oral drug administration)
ketorolac (adverse drug reaction, drug comparison, drug therapy,
intramuscular drug administration, intravenous drug administration)
levomepromazine (drug comparison, drug therapy, intramuscular drug
administration)
metoclopramide (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration)
nalbuphine (drug combination, drug comparison, drug therapy)
naproxen (clinical trial, drug comparison, drug therapy, oral drug
administration)
pethidine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intramuscular drug administration)
placebo
prednisone (drug comparison, drug therapy, oral drug administration)
prochlorperazine (drug comparison, drug therapy, intravenous drug
administration)
promethazine (drug combination, drug comparison, drug therapy, intramuscular
drug administration)
secobarbital (adverse drug reaction, clinical trial, drug therapy, oral drug
administration)
sumatriptan (clinical trial, drug comparison, drug therapy, oral drug
administration, subcutaneous drug administration)
tramadol (adverse drug reaction, drug comparison, drug therapy,
intramuscular drug administration, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
migraine (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
akathisia (side effect)
allodynia
analgesia
comparative effectiveness
dizziness (side effect)
drowsiness (side effect)
drug efficacy
drug safety
dysphoria (side effect)
emergency ward
gastrointestinal symptom (side effect)
hospital discharge
hot flush (side effect)
human
injection site burning (side effect)
injection site pain (side effect)
Medline
migraine without aura
nausea (side effect)
nausea and vomiting (side effect)
nociception
pain assessment
paresthesia (side effect)
priority journal
randomized controlled trial (topic)
recurrent disease (prevention)
restlessness (side effect)
review
sedation
side effect (side effect)
single drug dose
steroid therapy
swelling (side effect)
treatment response
visual analog scale
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
chlorpromazine (50-53-3, 69-09-0)
clonixin lysine (55837-30-4)
dexamethasone (50-02-2)
diclofenac (15307-79-6, 15307-86-5)
dihydroergotamine (511-12-6)
dimenhydrinate (523-87-5)
diphenhydramine (147-24-0, 58-73-1)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
droperidol (548-73-2)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
ketorolac (74103-06-3)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
nalbuphine (20594-83-6, 23277-43-2)
naproxen (22204-53-1, 26159-34-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
prednisone (53-03-2)
prochlorperazine (58-38-8)
promethazine (58-33-3, 60-87-7)
secobarbital (309-43-3, 76-73-3)
sumatriptan (103628-46-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012157049
MEDLINE PMID
22404708 (http://www.ncbi.nlm.nih.gov/pubmed/22404708)
PUI
L364443494
DOI
10.1111/j.1526-4610.2012.02097.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1526-4610.2012.02097.x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 751
TITLE
HIV infection and risk of overdose: A systematic review and meta-analysis
AUTHOR NAMES
Green T.C.
McGowan S.K.
Yokell M.A.
Pouget E.R.
Rich J.D.
AUTHOR ADDRESSES
(Green T.C., traci.c.green@brown.edu; Yokell M.A.; Rich J.D.)
Lifespan/Tufts/Brown Center for AIDS Research, Brown University, Rhode
Island Hospital, Providence, RI 02903, United States.
(Green T.C., traci.c.green@brown.edu; Rich J.D.) Warren Alpert Medical
School, Brown University, Rhode Island Hospital, Providence, RI 02903,
United States.
(Green T.C., traci.c.green@brown.edu) Rhode Island Hospital, Miriam
Hospital, Providence, RI, United States.
(McGowan S.K.; Yokell M.A.; Rich J.D.) Division of Infectious Diseases,
Miriam Hospital, Providence, RI, United States.
(Yokell M.A.) Stanford University School of Medicine, Stanford, CA, United
States.
(Pouget E.R.) National Development and Research Institutes, New York, NY,
United States.
CORRESPONDENCE ADDRESS
T.C. Green, Warren Alpert Medical School, Brown University, Rhode Island
Hospital, Providence, RI 02903, United States. Email:
traci.c.green@brown.edu
SOURCE
AIDS (2012) 26:4 (403-417). Date of Publication: 20 Feb 2012
ISSN
0269-9370
1473-5571 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom.
ABSTRACT
Drug overdose is a common cause of non-AIDS death among people with HIV and
the leading cause of death for people who inject drugs. People with HIV are
often exposed to opioid medications during their HIV care experience; others
may continue to use illicit opioids despite their disease status. In either
situation, there may be a heightened risk for nonfatal or fatal overdose.
The potential mechanisms for this elevated risk remain controversial. We
systematically reviewed the literature on the HIV-overdose association,
meta-analyzed results, and investigated sources of heterogeneity, including
study characteristics related to hypothesize biological, behavioral, and
structural mechanisms of the association. Forty-six studies were reviewed,
24 of which measured HIV status serologically and provided data quantifying
an association. Meta-analysis results showed that HIV seropositivity was
associated with an increased risk of overdose mortality (pooled risk ratio
1.74, 95% confidence interval 1.45, 2.09), although the effect was
heterogeneous (Q=80.3, P<0.01, I(2)=71%). The wide variability in study
designs and aims limited our ability to detect potentially important sources
of heterogeneity. Causal mechanisms considered in the literature focused
primarily on biological and behavioral factors, although evidence suggests
structural or environmental factors may help explain the greater risk of
overdose among HIV-infected drug users. Gaps in the literature for future
research and prevention efforts as well as recommendations that follow from
these findings are discussed. © 2012 Wolters Kluwer Health | Lippincott
Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antiretrovirus agent (drug therapy)
EMTREE DRUG INDEX TERMS
naloxone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
Human immunodeficiency virus infection (drug therapy, drug therapy)
infection risk
EMTREE MEDICAL INDEX TERMS
cause of death
cohort analysis
drug fatality
drug mechanism
emergency ward
follow up
hepatitis B
hepatitis C
highly active antiretroviral therapy
human
intravenous drug abuse
meta analysis
patient compliance
priority journal
prospective study
retrospective study
review
substance abuse
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Immunology, Serology and Transplantation (26)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012090874
MEDLINE PMID
22112599 (http://www.ncbi.nlm.nih.gov/pubmed/22112599)
PUI
L51728404
DOI
10.1097/QAD.0b013e32834f19b6
FULL TEXT LINK
http://dx.doi.org/10.1097/QAD.0b013e32834f19b6
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 752
TITLE
Preemptive treatment of constipation when opioids are initiated
AUTHOR NAMES
Zagaria M.A.E.
AUTHOR ADDRESSES
(Zagaria M.A.E.) Senior Care Consultant Pharmacist, President of MZ
Associates, Inc, Norwich, NY, United States.
CORRESPONDENCE ADDRESS
M. A. E. Zagaria, Senior Care Consultant Pharmacist, President of MZ
Associates, Inc, Norwich, NY, United States.
SOURCE
U.S. Pharmacist (2012) 37:1 (21-24). Date of Publication: 2012
ISSN
0148-4818
BOOK PUBLISHER
Jobson Publishing Corporation, 100 Avenue of the Americas, New York, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, oral drug administration,
parenteral drug administration)
EMTREE DRUG INDEX TERMS
beta endorphin (endogenous compound)
docusate sodium plus Senna extract (drug therapy)
lactulose (adverse drug reaction, drug dose, drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation (drug therapy, side effect, drug therapy, prevention, side
effect)
EMTREE MEDICAL INDEX TERMS
article
autonomic neuropathy
chronic pain (drug therapy)
delirium (side effect)
diabetes mellitus
diabetic neuropathy
diarrhea (side effect)
diet
drug megadose
drug safety
dyspepsia
emergency treatment
exercise
feces impaction (complication)
flatulence (side effect)
fluid intake
functional disease
high fiber diet
hospital admission
human
intestine transit time
lifestyle modification
musculoskeletal pain (drug therapy)
myenteric plexus
paradoxical drug reaction (side effect)
Parkinson disease
patient education
patient guidance
pharmacist
polypharmacy
prescription
quality of life
receptor binding
sedation
self medication
side effect (side effect)
stroke patient
CAS REGISTRY NUMBERS
beta endorphin (59887-17-1)
lactulose (4618-18-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012081238
PUI
L364217457
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 753
TITLE
Clinical reasoning: A 41-year-old comatose man with absent brainstem
reflexes
AUTHOR NAMES
Beh S.C.
Vernino S.
Warnack W.R.
AUTHOR ADDRESSES
(Beh S.C., scjbeh@gmail.com; Vernino S.; Warnack W.R.) Departments of
Neurology and Neurotherapeutics, University of Texas Southwestern Medical
Center at Dallas, Dallas, TX, United States.
CORRESPONDENCE ADDRESS
S.C. Beh, Departments of Neurology and Neurotherapeutics, University of
Texas Southwestern Medical Center at Dallas, Dallas, TX, United States.
Email: scjbeh@gmail.com
SOURCE
Neurology (2012) 78:7 (e42-e45). Date of Publication: 14 Feb 2012
ISSN
0028-3878
1526-632X (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
EMTREE DRUG INDEX TERMS
aciclovir
antibiotic agent
baclofen (drug dose)
cyproheptadine
desvenlafaxine
duloxetine
naloxone
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain stem response
comatose patient
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
case report
computed tomographic angiography
drug overdose
electroencephalogram
emergency ward
Glasgow coma scale
heart rate
human
intravenous drug administration
male
priority journal
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
baclofen (1134-47-0)
cyproheptadine (129-03-3, 969-33-5)
desvenlafaxine (386750-22-7)
duloxetine (116539-59-4, 136434-34-9)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012146331
MEDLINE PMID
22330418 (http://www.ncbi.nlm.nih.gov/pubmed/22330418)
PUI
L364415647
DOI
10.1212/WNL.0b013e318246d690
FULL TEXT LINK
http://dx.doi.org/10.1212/WNL.0b013e318246d690
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 754
TITLE
Baclofen overdose mimicking brain death
AUTHOR NAMES
Sullivan R.
Hodgman M.J.
Kao L.
Tormoehlen L.M.
AUTHOR ADDRESSES
(Sullivan R., sullivar@upstate.edu; Hodgman M.J.) SUNY Upstate Medical
University, Department of Emergency Medicine, Syracuse, United States.
(Kao L.; Tormoehlen L.M.) Indiana University School of Medicine,
Indianapolis, United States.
CORRESPONDENCE ADDRESS
R. Sullivan, SUNY Upstate Medical University, Department of Emergency
Medicine, Syracuse, United States. Email: sullivar@upstate.edu
SOURCE
Clinical Toxicology (2012) 50:2 (141-144). Date of Publication: February
2012
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
ABSTRACT
Context. Brain death guidelines should be used with caution in patients with
drug intoxication. It is often suggested that physicians use five half-lives
of a drug when observing a patient with an overdose. We report two cases of
baclofen intoxication where brain death was entertained as an explanation
for prolonged coma, with arousal seen days later, suggesting that routine
use of a 5-half-life observation period is insufficient with baclofen
intoxication. Case presentation. A 40-year-old woman was found unresponsive
by her family. Baclofen was found to be the responsible overdose. The
patient had absent brain stem reflexes and was intubated and in the ICU for
several days. Although EEG and Apnea test were inconclusive, the patient was
thought to be brain dead and organ procurement was arranged. On hospital day
5, the patient started having purposeful movements. The patient had
progressive arousal and was eventually transferred without neurologic
sequelae to psychiatry. The second patient also had a massive baclofen
overdose, had absence of almost all brain stem reflexes and was also
intubated and in the ICU. Brain death was felt to be imminent, but the
patient began to awake on hospital day 7. Discussion. Our two cases suggest
that baclofen intoxication may result in very prolonged and profound coma
and may, in fact, mimic brain death. Conclusion. The determination of brain
death in the comatose overdose patient must proceed with caution. An
adequate period of time to allow drug clearance must be allowed. © 2012
Informa Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
baclofen (drug toxicity, pharmacokinetics)
EMTREE DRUG INDEX TERMS
alprazolam
benzodiazepine
clorazepate
digoxin
diphenhydramine
dopamine
hydroxyzine
hypertensive factor
naloxone
opiate
paroxetine
phenobarbital
phenytoin
propofol (drug therapy)
sodium chloride
warfarin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain death
EMTREE MEDICAL INDEX TERMS
adult
apnea
arousal
article
body movement
brain injury
brain stem response
case report
coma
comatose patient
consultation
delirium
drug blood level
drug clearance
drug intoxication
drug overdose
electrocardiogram
electroencephalogram
emergency ward
family
female
Glasgow coma scale
hospital discharge
human
hypotension
inspiratory capacity
intensive care unit
international normalized ratio
intubation
mydriasis
neurologist
organ donor
organ transplantation
seizure (drug therapy)
sinus rhythm
wakefulness
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
baclofen (1134-47-0)
benzodiazepine (12794-10-4)
clorazepate (20432-69-3, 23887-31-2)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paroxetine (61869-08-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
propofol (2078-54-8)
sodium chloride (7647-14-5)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012093227
MEDLINE PMID
22292975 (http://www.ncbi.nlm.nih.gov/pubmed/22292975)
PUI
L364254814
DOI
10.3109/15563650.2011.654209
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2011.654209
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 755
TITLE
Emergence of functional spinal delta opioid receptors after chronic ethanol
exposure
AUTHOR NAMES
Van Rijn R.M.
Brissett D.I.
Whistler J.L.
AUTHOR ADDRESSES
(Van Rijn R.M.; Brissett D.I.; Whistler J.L., jwhistler@gallo.ucsf.edu)
Ernest Gallo Clinic and Research Center, Department of Neurology, University
of California San Francisco, Emeryville, CA, United States.
CORRESPONDENCE ADDRESS
J.L. Whistler, Department of Neurology, Research Center, University of
California, 5858 Horton Street, Emeryville, CA 94608, United States. Email:
jwhistler@gallo.ucsf.edu
SOURCE
Biological Psychiatry (2012) 71:3 (232-238). Date of Publication: 1 Feb 2012
ISSN
0006-3223
1873-2402 (electronic)
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
The delta opioid receptor (DOR) is a promising target to treat multiple
indications, including alcoholism, anxiety, and nonmalignant pain. The
potential of the DORs has been underappreciated, in part, due to relatively
low functional expression of these receptors in nave states. However,
chronic exposure to stress, opioids, and inflammation can induce a
redistribution of DORs to the cell surface where they can be activated.
Previously, DORs were shown to be selectively/exclusively present in spinal
cord circuits mediating mechanical sensitivity but not those mediating
thermal nociception under nave conditions. We spinally administered DOR and
mu opioid receptor (MOR) selective agonists ([D-Pen2,D-Pen5]-Enkephalin,
deltorphin II, SNC80, and DAMGO) and antagonists (naltriben and CTAP) and
determined thermal antinociception and mechanical sensitivity in wild-type
mice or mice with a genetic disruption of DOR or MOR. Thermal
antinociception was measured using a radiant heat tail-flick assay;
mechanical sensitivity was measured using von Frey filaments. Dose response
curves were generated in nave mice and mice exposed to ethanol in a model of
voluntary consumption. We show that prolonged exposure to ethanol can
promote an upregulation of functional DORs in the spinal cord in thermal
pain-mediating circuits but not in those mediating mechanical sensitivity.
The upregulated DORs either modulate MOR-mediated analgesia through
convergence of circuits or signal transduction pathways and/or interact
directly with MORs to form a new functional (heteromeric) unit. Our findings
suggest that DORs could be a novel target in conditions in which DORs are
redistributed. © 2012 Society of Biological Psychiatry.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
delta opiate receptor (endogenous compound)
EMTREE DRUG INDEX TERMS
4 [alpha (4 allyl 2,5 dimethyl 1 piperazinyl) 3 methoxybenzyl] n,n
diethylbenzamide
deltorphin
dextro phenylalanylcysteinyltyrosyl dextro
tryptophylarginylthreonylpenicillaminylthreoninamide 2,7 disulfide
enkephalin
enkephalin[2 dextro alanine 4 methylphenylalanine 5 glycine]
mu opiate receptor (endogenous compound)
naltriben
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism
EMTREE MEDICAL INDEX TERMS
alcohol consumption
animal experiment
animal model
antinociception
article
controlled study
gene disruption
heat sensitivity
mouse
nociception
nonhuman
priority journal
signal transduction
spinal cord
tail flick test
upregulation
CAS REGISTRY NUMBERS
4 [alpha (4 allyl 2,5 dimethyl 1 piperazinyl) 3 methoxybenzyl] n,n
diethylbenzamide (156727-74-1)
alcohol (64-17-5)
deltorphin (119975-64-3)
dextro phenylalanylcysteinyltyrosyl dextro
tryptophylarginylthreonylpenicillaminylthreoninamide 2,7 disulfide
(103429-32-9)
enkephalin[2 dextro alanine 4 methylphenylalanine 5 glycine] (78123-71-4)
naltriben (111555-58-9)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012017463
MEDLINE PMID
21889123 (http://www.ncbi.nlm.nih.gov/pubmed/21889123)
PUI
L51601544
DOI
10.1016/j.biopsych.2011.07.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.biopsych.2011.07.015
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 756
TITLE
Emergency drug doses? PBS *doctor's bag items
AUTHOR ADDRESSES
SOURCE
Australian Prescriber (2012) 35:1 (25-27). Date of Publication: February
2012
ISSN
0312-8008
BOOK PUBLISHER
National Prescribing Service, 3/2 Phipps Close, Deakin, Australia.
EMTREE DRUG INDEX TERMS
atropine (drug therapy, intravenous drug administration)
benzatropine (drug therapy, intramuscular drug administration, intravenous
drug administration)
chlorpromazine (adverse drug reaction, drug therapy, intramuscular drug
administration)
dexamethasone sodium phosphate (drug therapy, intravenous drug
administration, oral drug administration)
diazepam (drug therapy, intravenous drug administration, rectal drug
administration)
dihydroergotamine (drug therapy, intramuscular drug administration,
subcutaneous drug administration)
diphtheria tetanus vaccine (drug therapy, intramuscular drug administration)
epinephrine (drug therapy, intramuscular drug administration)
furosemide (drug therapy, intramuscular drug administration, intravenous
drug administration)
glucagon (drug therapy, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
glyceryl trinitrate (drug therapy)
haloperidol (drug therapy, intramuscular drug administration)
hydrocortisone sodium succinate (drug therapy, intramuscular drug
administration, intravenous drug administration)
lidocaine (drug therapy, intravenous drug administration)
methoxyflurane (drug therapy)
metoclopramide (drug therapy, intramuscular drug administration, intravenous
drug administration)
morphine sulfate (drug dose, drug therapy, intramuscular drug
administration, subcutaneous drug administration)
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
penicillin G (drug therapy, intramuscular drug administration, intravenous
drug administration)
procaine penicillin (drug therapy, intramuscular drug administration)
prochlorperazine (drug therapy, intramuscular drug administration,
intravenous drug administration)
promethazine (drug therapy, intramuscular drug administration)
salbutamol (drug therapy, inhalational drug administration)
terbutaline (drug therapy, subcutaneous drug administration)
tramadol (drug therapy, intramuscular drug administration, intravenous drug
administration)
verapamil (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
EMTREE MEDICAL INDEX TERMS
acute psychosis (drug therapy)
adrenal insufficiency (drug therapy)
allergic reaction (drug therapy)
anaphylaxis (drug therapy)
angina pectoris (drug therapy)
asthma (drug therapy)
bacterial meningitis (drug therapy)
behavior disorder (drug therapy)
bradycardia (drug therapy)
bronchospasm (drug therapy)
dose response
drug dose increase
drug dose titration
drug safety
drug tolerability
dystonia (drug therapy)
heart arrest (drug therapy)
heart arrest (drug therapy)
heart left ventricle failure (drug therapy)
heart ventricle tachycardia (drug therapy)
human
hypoglycemia (drug therapy)
infection (drug therapy)
intoxication (drug therapy)
lung edema (drug therapy)
meningococcosis (drug therapy)
mental disease (drug therapy)
migraine (drug therapy)
nausea and vomiting (drug therapy)
note
pain (drug therapy, side effect)
paroxysmal supraventricular tachycardia (drug therapy)
pharmaceutical care
seizure (drug therapy)
skin irritation (side effect)
tetanus (drug therapy)
vertigo (drug therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzatropine (86-13-5)
chlorpromazine (50-53-3, 69-09-0)
dexamethasone sodium phosphate (2392-39-4, 312-93-6)
diazepam (439-14-5)
dihydroergotamine (511-12-6)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methoxyflurane (56274-14-7, 76-38-0)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
procaine penicillin (54-35-3, 6130-64-9)
prochlorperazine (58-38-8)
promethazine (58-33-3, 60-87-7)
salbutamol (18559-94-9, 35763-26-9)
terbutaline (23031-25-6)
tramadol (27203-92-5, 36282-47-0)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012148074
PUI
L364420063
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 757
TITLE
Scientists, officials eye tools aimed at combating abuse of painkillers
AUTHOR NAMES
Kuehn B.M.
AUTHOR ADDRESSES
(Kuehn B.M.)
CORRESPONDENCE ADDRESS
B.M. Kuehn,
SOURCE
JAMA - Journal of the American Medical Association (2012) 307:1 (19-21).
Date of Publication: 4 Jan 2012
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
buprenorphine
cocaine
diamorphine
illicit drug
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug misuse
EMTREE MEDICAL INDEX TERMS
analgesia
chronic pain (drug therapy)
drug monitoring
emergency ward
food and drug administration
health care personnel
heroin dependence
human
mood disorder
prescription
priority journal
public health
scientist
short survey
substance abuse
treatment outcome
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012014542
MEDLINE PMID
22215154 (http://www.ncbi.nlm.nih.gov/pubmed/22215154)
PUI
L364036588
DOI
10.1001/jama.2011.1900
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2011.1900
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 758
TITLE
Medication dosing errors in pediatric patients treated by emergency medical
services.
AUTHOR NAMES
Hoyle J.D.
Davis A.T.
Putman K.K.
Trytko J.A.
Fales W.D.
AUTHOR ADDRESSES
(Hoyle J.D.) Emergency Department, Helen DeVos Children's Hospital/Michigan
State University College of Human Medicine, Grand Rapids, Michigan 49503,
USA.
(Davis A.T.; Putman K.K.; Trytko J.A.; Fales W.D.)
CORRESPONDENCE ADDRESS
J.D. Hoyle, Emergency Department, Helen DeVos Children's Hospital/Michigan
State University College of Human Medicine, Grand Rapids, Michigan 49503,
USA. Email: jdhoyle@hotmail.com
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2012)
16:1 (59-66). Date of Publication: Jan 2012
ISSN
1545-0066 (electronic)
ABSTRACT
BAKGROUND: Medication dosing errors occur in up to 17.8% of hospitalized
children. There are limited data to describe pediatric medication errors by
emergency medical services (EMS) paramedics. It has been shown that
paramedics have infrequent encounters with pediatric patients. To
characterize medication dosing errors in children treated by EMS. We studied
patients aged ≤11 years who were treated by paramedics from eight Michigan
EMS agencies from January 2004 through March 2006. We defined a medication
dosing error as ≥20% deviation from the weight-appropriate dose, as
determined by the patient's reported weight in the prehospital medical
record or by use of the Broselow-Luten tape (BLT). We studied errors in
administering six EMS medications commonly given to children: albuterol,
atropine, dextrose, diphenhydramine, epinephrine, and naloxone. There were
5,547 children aged ≤11 years who were treated during the study period, of
whom 230 (4.1%) received drugs and had a documented weight. These patients
received a total of 360 medication administrations. Multiple drug
administrations occurred in 73 cases. Medication dosing errors occurred in
125 of the 360 drug administrations (34.7%; 95% confidence interval [CI]
30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows:
albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine
53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (±
standard deviation) for intravenous/intraosseous 1:1000 epinephrine
overdoses was 808% ± 428%. The mean error (± standard deviation) for
intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% ± 27.4%.
Medications delivered in the prehospital care of children were frequently
administered outside of the proper dose range when compared with patient
weights recorded in the prehospital medical record. EMS systems should
develop strategies to reduce pediatric medication dosing errors.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
medication error
patient care
pediatrics
safety
EMTREE MEDICAL INDEX TERMS
age
article
child
confidence interval
female
health care survey
human
male
preschool child
retrospective study
statistics
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
21999707 (http://www.ncbi.nlm.nih.gov/pubmed/21999707)
PUI
L560061127
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 759
TITLE
Opioid use and dependence among persons with migraine: Results of the ampp
study
AUTHOR NAMES
Buse D.C.
Pearlman S.H.
Reed M.L.
Serrano D.
Ng-Mak D.S.
Lipton R.B.
AUTHOR ADDRESSES
(Buse D.C., dbuse@montefiore.org; Lipton R.B.) Albert Einstein College of
Medicine, Bronx, NY, United States.
(Buse D.C., dbuse@montefiore.org; Lipton R.B.) Montefiore Headache Center,
Montefiore Medical Center, 1575 Blondell Avenue, Bronx, NY 10461, United
States.
(Pearlman S.H.) Armstrong Atlantic State University, Savannah, GA, United
States.
(Reed M.L.; Serrano D.) Vedanta Research, Chapel Hill, NC, United States.
(Ng-Mak D.S.) Merck Sharp and Dohme Corp., West Point, PA, United States.
(Lipton R.B.) Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
D.C. Buse, Montefiore Headache Center, Montefiore Medical Center, 1575
Blondell Avenue, Bronx, NY 10461, United States. Email: dbuse@montefiore.org
SOURCE
Headache (2012) 52:1 (18-36). Date of Publication: January 2012
ISSN
0017-8748
1526-4610 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Objective.To assess the frequency of opioid use for acute migraine treatment
and characterize use groups by sociodemographics, health-care resource
utilization (HRU), comorbidities and probable dependence within a large, US
population-based sample of persons with migraine. Background.Opioids are
used in the acute treatment of migraine. However, their use is
controversial. Methods.Data from the 2009 American Migraine Prevalence and
Prevention (AMPP) study were used to categorize persons with migraine into 4
groups based on reported opioid use: nonusers (between 2005 and 2009),
previous users (history of use between 2005 and 2008 but no-use in 2009),
and current opioid users (those reporting use of opioids in the 3 months
preceding the 2009 American Migraine Prevalence and Prevention survey).
Current opioid users were divided into nondependent and probable dependence
users according to criteria for dependence adapted for inclusion in the
survey from the Diagnostic and Statistical Manual of Mental Disorders-4th
edition. All opioid-use groups were contrasted by sociodemographics,
headache characteristics, medical and psychiatric comorbidities (depression
[measured by the Patient Health Questionnaire-9], anxiety [measured by the
Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and
cardiovascular events and risk factors), and headache-related HRU.
Results.In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers,
798 (13.8%) were previous users, and 922 (15.9%) were current opioid users.
Among current opioid users, 153 (16.6%) met criteria for probable dependence
and 769 (83.4%) did not. Headache-related disability (Migraine Disability
Assessment sum scores) increased across groups as follows: nonusers: 7.8,
previous users: 13.3, current nondependent users: 19.1, and current probable
dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2
days/month, previous users: 4.3 days/month, current nondependent users: 5.6
days/month, and current probable dependence users: 8.6 days/month. The
prevalence of depression and anxiety was highest among current users with
probable dependence. Rates of headache-related HRU were higher for all
opioid-use groups for emergency department/urgent care, primary care, and
specialty care visits compared to nonusers. Conclusions.Opioid use for
migraine is associated with more severe headache-related disability,
symptomology, comorbidities (depression, anxiety, and cardiovascular disease
and events), and greater HRU for headache. Longitudinal studies are needed
to further assess the directionality and causality between opioid use and
the outcomes we examined. © 2011 American Headache Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug combination, drug therapy)
caffeine (drug combination, drug therapy)
codeine (drug combination, drug therapy)
dextropropoxyphene (drug combination, drug therapy)
hydrocodone (drug therapy)
oxycodone (drug therapy)
paracetamol (drug combination, drug therapy)
pethidine (drug therapy)
tramadol (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
migraine (drug therapy, drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
anxiety disorder
article
cardiovascular risk
clinical article
depression
Diagnostic and Statistical Manual of Mental Disorders
disease severity
drug use
emergency ward
female
headache (drug therapy)
health care utilization
health survey
human
male
prevalence
primary medical care
priority journal
risk factor
treatment duration
United States
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
caffeine (58-08-2)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012057822
MEDLINE PMID
22268775 (http://www.ncbi.nlm.nih.gov/pubmed/22268775)
PUI
L364151434
DOI
10.1111/j.1526-4610.2011.02050.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1526-4610.2011.02050.x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 760
TITLE
Rethinking out-of-hospital intravenous access
AUTHOR NAMES
Stratton S.J.
AUTHOR ADDRESSES
(Stratton S.J., strattos@ucla.edu) Harbor-UCLA Medical Center, Department of
Emergency Medicine, David Geffen School of Medicine at UCLA, Torrance, CA,
United States.
(Stratton S.J., strattos@ucla.edu) Department of Community Health Sciences,
UCLA School of Public Health, Los Angeles, CA, United States.
CORRESPONDENCE ADDRESS
S.J. Stratton, Harbor-UCLA Medical Center, Department of Emergency Medicine,
David Geffen School of Medicine at UCLA, Torrance, CA, United States. Email:
strattos@ucla.edu
SOURCE
Annals of Emergency Medicine (2012) 59:4 (304-306). Date of Publication:
April 2012
ISSN
1097-6760 (electronic)
0196-0644
BOOK PUBLISHER
Mosby Inc., customerservice@mosby.com
EMTREE DRUG INDEX TERMS
adenosine (drug therapy)
antiarrhythmic agent (drug therapy, intravenous drug administration)
epinephrine (drug therapy, intramuscular drug administration)
fentanyl
glucose (drug therapy)
infusion fluid
midazolam
naloxone
ondansetron (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
intravenous drug administration
EMTREE MEDICAL INDEX TERMS
aerosol
anaphylaxis (drug therapy)
emergency health service
heart arrest (drug therapy)
hematoma (complication)
human
hypoglycemia (drug therapy)
infection (complication)
intravenous catheter
mortality
nausea (drug therapy)
needlestick injury
note
orthostatic hypotension (therapy)
phlebitis (complication)
priority journal
sclerosis (complication)
sepsis (complication)
supraventricular tachycardia (drug therapy)
survival rate
venous sclerosis (complication)
vomiting (drug therapy)
CAS REGISTRY NUMBERS
adenosine (58-61-7)
fentanyl (437-38-7)
glucose (50-99-7, 84778-64-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012181398
PUI
L51696712
DOI
10.1016/j.annemergmed.2011.09.019
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2011.09.019
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 761
TITLE
Economic Impact of Potential CYP450 Pharmacokinetic Drug-Drug Interactions
Among Chronic Low Back Pain Patients Taking Opioids
AUTHOR NAMES
Pergolizzi J.V.
Labhsetwar S.A.
Amy Puenpatom R.
Ben-Joseph R.
Ohsfeldt R.
Summers K.H.
AUTHOR ADDRESSES
(Pergolizzi J.V., jpjmd@msn.comc) Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States.
(Pergolizzi J.V., jpjmd@msn.comc) Department of Anesthesiology, Georgetown
University School of Medicine, Washington, DC, United States.
(Pergolizzi J.V., jpjmd@msn.comc; Labhsetwar S.A.) NEMA Research, Naples,
FL, United States.
(Amy Puenpatom R.; Ben-Joseph R.; Summers K.H.) Department of Health
Outcomes and Pharmacoeconomics (HOPE), Endo Pharmaceuticals, Chadds Ford,
PA, United States.
(Ohsfeldt R.) Department of Health Policy and Management, School of Rural
Public Health, Texas A and M Health Science Center, College Station, TX,
United States.
CORRESPONDENCE ADDRESS
J.V. Pergolizzi, 840 111th Avenue North, Suite #7, Naples, FL 34108-1877,
United States. Email: jpjmd@msn.comc
SOURCE
Pain Practice (2012) 12:1 (45-56). Date of Publication: January 2012
ISSN
1533-2500 (electronic)
1530-7085
BOOK PUBLISHER
Blackwell Publishing Inc., subscrip@blackwellpub.com
ABSTRACT
Chronic low back pain (cLBP) patients who take at least 1 CYP450-metabolized
opioid analgesic agent concurrent with at least 1 other CYP450-metabolized
medication experience a drug-drug exposure (DDE), which puts them at risk
for a pharmacokinetic drug-drug interaction (PK DDI). This study compared
utilization of healthcare resources and associated payments in cLBP patients
with and without incident DDEs with the potential to cause PK DDIs. A
retrospective database analysis examined the associated clinical events,
healthcare utilization (measured in terms of claims for office visits,
outpatient visits, emergency department visits, and hospitalization), and
cost to the health plan, as defined as the sum of health plan payments for
resources used. Patients were grouped into 2 cohorts by age (those under 65
and those 65years and over). In the 6months after exposure, total healthcare
payments were significantly higher for DDE patients than those without DDEs
(no-DDE), in both in the younger ($7,086, SD=$8,370) and $6,353, SD=$8,352,
respectively, P<0.001) and the older cohorts ($7,806 vs. $7,043,
respectively, P=0.013). Younger and older patients with DDE had
significantly higher prescription payments than those without DDE ($2,041,
SD=$2,706 vs. $1,565, SD=$2,349, respectively, P<0.001 for younger and
$2,482, SD=$2,481 vs. $2,286, SD=$2,521, respectively, P=0.044 for older
patients). Both older and younger patients with DDE had significantly more
claims for office visits and higher associated payments than similar
patients without DDE. Patients in the study who experienced DDEs that placed
them at risk for PK DDIs had significantly greater utilization rates of
healthcare resources and higher associated payments in the 6-month
observation period following exposure. © 2011 The Authors. Pain Practice ©
2011 World Institute of Pain.
EMTREE DRUG INDEX TERMS
codeine
cytochrome P450
fentanyl
hydrocodone
methadone
narcotic analgesic agent
oxycodone
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
low back pain
EMTREE MEDICAL INDEX TERMS
adult
aged
article
economic aspect
female
health care cost
health care utilization
human
major clinical study
male
prescription
CAS REGISTRY NUMBERS
codeine (76-57-3)
cytochrome P450 (9035-51-2)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
oxycodone (124-90-3, 76-42-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012028591
PUI
L51653809
DOI
10.1111/j.1533-2500.2011.00503.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1533-2500.2011.00503.x
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 762
TITLE
Disparities in opioid prescribing for patients with psychiatric diagnoses
presenting with pain to the emergency department
AUTHOR NAMES
Simon L.J.
Bizamcer A.N.
Lidz C.W.
Stefan S.
Pletcher M.J.
AUTHOR ADDRESSES
(Simon L.J., lorna.simon@umassmed.edu; Lidz C.W.; Stefan S.) Center for
Mental Health Services Research, University of Massachusetts Medical School,
55 Lake Avenue North, Worcester, MA 01655, United States.
(Bizamcer A.N.) Temple University School of Medicine, Philadelphia, PA,
United States.
(Stefan S.) University of Miami School of Law, Miami, United States.
(Pletcher M.J.) Department of Epidemiology and Biostatistics, and Medicine,
University of California, San Francisco, CA, United States.
CORRESPONDENCE ADDRESS
L.J. Simon, Center for Mental Health Services Research, University of
Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655,
United States. Email: lorna.simon@umassmed.edu
SOURCE
Emergency Medicine Journal (2012) 29:3 (201-204). Date of Publication: March
2012
ISSN
1472-0213 (electronic)
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, subscriptions@bmjgroup.com
ABSTRACT
Background: The goal of this investigation is to discover whether or not
patients with psychiatric diagnoses are less likely to be prescribed opioids
for pain in emergency departments compared with other patients. Methods:
Pain-related visits to US emergency departments were identified using
reason-for-visit and physician diagnosis codes for 13 years (1993-2005) of
the National Hospital Ambulatory Medical Care Survey. The outcome measure
was the prescription or administration of an opioid analgesic. Results:
Roughly 10 million pain-related visits were made by persons with psychiatric
diagnoses in the USA between 1993 and 2005. Across all years, only 18% (95%
CI 16 to 20) of pain-related visits by patients with psychiatric diagnoses
resulted in an opioid prescription, whereas 33% (95% CI 32 to 34) of visits
by other patients did. Lower prescription rates for patients with
psychiatric diagnoses were seen for every year of the survey and this
difference occurred at every level of pain severity. Controlling for
confounding factors did not attenuate this difference. In a multivariate
model, patients with psychiatric diagnoses were about half as likely as
other patients to be prescribed opiates (adjusted OR 0.49; 95% CI 0.44 to
0.56). Major limitations of the study include the uncertain precision of
psychiatric and drug/alcohol diagnoses and the lack of detail about each
patient visit. Conclusion: Having a psychiatric diagnosis was associated
with a lower likelihood of receiving an opioid among persons presenting with
pain to the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
mental patient
pain (drug therapy, drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
alcohol intoxication
alcoholism
article
drug dependence
drug intoxication
female
health care quality
human
major clinical study
male
mental disease
priority journal
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012108318
PUI
L51289046
DOI
10.1136/emj.2010.097949
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2010.097949
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 763
TITLE
Clinical presentation of the main poisonings and toxidrome-based approach
ORIGINAL (NON-ENGLISH) TITLE
Présentation clinique des principales intoxications et approche par les
toxidromes
AUTHOR NAMES
Mégarbane B.
AUTHOR ADDRESSES
(Mégarbane B., bruno.megarbane@lrb.aphp.fr) Réanimation Médicale et
Toxicologique, Hôpital Lariboisière, Université Paris-Diderot, Paris,
France.
CORRESPONDENCE ADDRESS
B. Mégarbane, Réanimation Médicale et Toxicologique, Hôpital Lariboisière,
Université Paris-Diderot, Paris, France. Email: bruno.megarbane@lrb.aphp.fr
SOURCE
Reanimation (2012) 21:SUPPL.2 (S482-S493). Date of Publication: January 2012
ISSN
1624-0693
1951-6959 (electronic)
BOOK PUBLISHER
Springer Paris, 1 rue Paul Cezanne, Paris, France.
ABSTRACT
Acute poisonings represent a frequent cause of patient admission in the
emergency department and intensive care unit. Diagnosis in clinical
toxicology is based on medical history and clinical examination focused on
the identification of toxidromes. Clinical examination is mandatory and
should be evaluated several times and documented. Electrocardiogram as well
as sampling for routine laboratory tests should be performed in any severely
poisoned patient admitted to the intensive care unit. Despite no definitive
predictive value, the clinical approach allows obtaining not only a positive
diagnosis but also eliminating differential hypotheses. Administration of
supportive treatments as well as emergency antidotes is based on clinical
examination. Pharmacodynamic tests using specific antidotes including
naloxone for opioids and flumazenil for benzodiazepines or analogs may
complete the patient's examination. Therefore, toxicological analysis allows
only a retrospective confirmation of the initially suspected toxic etiology
based on the clinical approach. © SRLF et Springer-Verlag 2011.
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
benzodiazepine derivative (drug toxicity)
flumazenil (drug therapy)
naloxone (drug therapy)
opiate derivative (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical examination
electrocardiogram
emergency ward
hospital admission
human
intensive care unit
laboratory test
review
syndrome
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2012171642
PUI
L364488767
DOI
10.1007/s13546-011-0433-x
FULL TEXT LINK
http://dx.doi.org/10.1007/s13546-011-0433-x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 764
TITLE
Clinical implications of pharmacokinetics and pharmacodynamics of procedural
sedation agents in children
AUTHOR NAMES
Sahyoun C.
Krauss B.
AUTHOR ADDRESSES
(Sahyoun C., cyril.sahyoun@childrens.harvard.edu; Krauss B.) Division of
Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston,
MA 02115, United States.
CORRESPONDENCE ADDRESS
C. Sahyoun, Division of Emergency Medicine, Children's Hospital Boston, 300
Longwood Avenue, Boston, MA 02115, United States. Email:
cyril.sahyoun@childrens.harvard.edu
SOURCE
Current Opinion in Pediatrics (2012) 24:2 (225-232+283). Date of
Publication: April 2012
ISSN
1531-698X (electronic)
1040-8703
BOOK PUBLISHER
Lippincott Williams and Wilkins, kathiest.clai@apta.org
ABSTRACT
PURPOSE OF REVIEW: Procedural sedation has become the standard of care for
managing pain and anxiety in children in the emergency department. RECENT
FINDINGS: Numerous articles have been published on pediatric procedural
sedation with, however, little in-depth discussion of the pharmacodynamics
and pharmacokinetics of the sedation agents utilized. SUMMARY: We review the
pharmacokinetics and pharmacodynamics of the pediatric procedural sedation
pharmacopeia from a clinical perspective with emphasis on the practical
implications for drug titration and dosing. © 2012 Lippincott Williams &
Wilkins, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
sedative agent
EMTREE DRUG INDEX TERMS
alfentanil (drug therapy)
benzodiazepine derivative (adverse drug reaction, drug combination, drug
therapy)
chloral hydrate (adverse drug reaction, drug therapy, oral drug
administration, pharmacokinetics, pharmacology, rectal drug administration)
fentanyl (adverse drug reaction, drug combination, drug therapy, intranasal
drug administration, intravenous drug administration, pharmacokinetics,
pharmacology)
flumazenil (drug comparison, pharmacokinetics, pharmacology)
hydromorphone (drug therapy, pharmacokinetics, pharmacology)
ketamine (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration, pharmacokinetics,
pharmacology)
lidocaine (drug therapy, intranasal drug administration)
midazolam (adverse drug reaction, drug combination, drug comparison, drug
therapy, intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, pharmacokinetics,
pharmacology)
morphine (drug therapy, pharmacokinetics, pharmacology)
naloxone (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacokinetics, pharmacology)
nitrous oxide (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacokinetics, pharmacology)
ondansetron (drug therapy)
opiate (adverse drug reaction, drug combination, drug therapy)
pentobarbital (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration, oral drug administration,
pharmacokinetics, pharmacology, rectal drug administration)
pethidine (drug therapy)
propofol (adverse drug reaction, drug therapy, pharmacokinetics,
pharmacology)
remifentanil (drug therapy)
sufentanil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pharmacodynamics
sedation
EMTREE MEDICAL INDEX TERMS
analgesia
anxiety
apnea (side effect)
blood pressure
bradycardia (side effect)
cardiovascular depression (side effect)
cardiovascular depression (side effect)
cardiovascular disease (side effect)
child
continuous infusion
delirium (side effect)
diffusional hypoxia (side effect)
diffusional hypoxia (side effect)
drug clearance
drug effect
drug efficacy
drug half life
drug mechanism
drug safety
drug tolerability
egg allergy
emergency ward
heart rate
hepatomegaly (side effect)
human
hyperlipidemia (side effect)
hypersalivation (side effect)
hypertension (side effect)
hypotension (side effect)
hypoxia (side effect)
injection site pain (drug therapy, side effect)
intracranial hypertension (side effect)
larynx spasm (side effect)
lipophilicity
mean arterial pressure
medical literature
metabolic acidosis (side effect)
mucosa inflammation (drug therapy, side effect)
nasal mucosa irritation (drug therapy, side effect)
nasal mucosa irritation (drug therapy, side effect)
nausea (side effect)
nystagmus (side effect)
pain (drug therapy)
priority journal
pruritus (side effect)
psychosis
pulse oximetry
respiration depression (side effect)
review
rhabdomyolysis (side effect)
rigid chest syndrome (side effect)
rigid chest syndrome (side effect)
side effect (side effect)
sleep disordered breathing (side effect)
thorax disease (side effect)
treatment contraindication
unpleasant dream (side effect)
unpleasant sensation
upper respiratory tract obstruction (side effect)
vomiting (drug therapy, side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
chloral hydrate (302-17-0)
fentanyl (437-38-7)
flumazenil (78755-81-4)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
remifentanil (132539-07-2)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012182462
PUI
L51814505
DOI
10.1097/MOP.0b013e3283504f88
FULL TEXT LINK
http://dx.doi.org/10.1097/MOP.0b013e3283504f88
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 765
TITLE
Perinatal asphyxia and treatment with hypothermia
AUTHOR NAMES
Cerar L.K.
Babnik J.
AUTHOR ADDRESSES
(Cerar L.K., lilijana.kornhauser-cerar@guest.arnes.si; Babnik J.)
Univerzitetni Klinični Center Ljubljana, Ginekološka Klinika, Klinični
Oddelek za Perinatologijo, Zaloška 11, SI-1525 Ljubljana, Slovenia.
CORRESPONDENCE ADDRESS
L.K. Cerar, Univerzitetni Klinični Center Ljubljana, Ginekološka Klinika,
Klinični Oddelek za Perinatologijo, Zaloška 11, SI-1525 Ljubljana, Slovenia.
Email: lilijana.kornhauser-cerar@guest.arnes.si
SOURCE
Paediatria Croatica, Supplement (2011) 55:SUPPL. 1 (140-145). Date of
Publication: 2011
ISSN
1330-724X
BOOK PUBLISHER
Children's Hospital Zagreb, Klaiceva 16, Zagreb, Croatia.
ABSTRACT
Hypoxia-ischaemia in the perinatal period is a major cause of neonatal death
and long-term disability. There are advances in research of cellular
processes and molecular mechanisms underlying hypoxic-ischaemic
encephalopathy (HIE) over the last decades. In recent multicenter clinical
trials, hypothermia initiated within the first 6 postnatal hours has emerged
as the only effective treatment in reducing the risk of death and
impairment. As hypothermia is a time-critical emergency treatment after
perinatal asphyxia, optimal collaboration among local hospitals, transport
team, and cooling centers is essential. National cooling protocols are
needed in order to ensure safe cooling, appropriate monitoring, imaging, and
follow-up assessment. A national registry is important to collect data on
diagnosis, treatment, adverse events, and outcome.
EMTREE DRUG INDEX TERMS
allopurinol (drug therapy)
anticonvulsive agent (drug therapy)
brain derived neurotrophic factor (drug therapy)
calcium channel blocking agent (drug therapy)
corticosteroid (drug therapy)
deferoxamine (drug therapy)
dopamine (drug therapy)
magnesium sulfate (drug therapy)
mannitol (drug therapy)
naloxone (drug therapy)
recombinant erythropoietin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hypothermia (drug therapy, disease management, drug therapy)
perinatal asphyxia
EMTREE MEDICAL INDEX TERMS
clinical feature
emergency treatment
follow up
human
hyperventilation
hypoxic ischemic encephalopathy
imaging
incidence
induced hypothermia
mortality
oxygen therapy
pathophysiology
patient monitoring
perinatal period
review
risk assessment
CAS REGISTRY NUMBERS
allopurinol (315-30-0)
brain derived neurotrophic factor (218441-99-7)
deferoxamine (70-51-9)
dopamine (51-61-6, 62-31-7)
magnesium sulfate (7487-88-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
recombinant erythropoietin (113427-24-0, 122312-54-3, 130455-76-4,
148363-16-0, 154725-65-2, 879555-13-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Obstetrics and Gynecology (10)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, unknown
EMBASE ACCESSION NUMBER
2011655566
PUI
L363010361
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 766
TITLE
Procedural sedation and analgesia in a large UK Emergency Department:
Factors associated with complications
AUTHOR NAMES
Jacques K.G.
Dewar A.
Gray A.
Kerslake D.
Leal A.
Lees F.
AUTHOR ADDRESSES
(Jacques K.G., keith.jacques@nhs.net) Department Emergency Medicine,
Stirling Royal Infirmary, Livilands, Stirling, FK8 2AU, United Kingdom.
(Dewar A.; Gray A.; Kerslake D.; Leal A.) Emergency Department, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom.
(Lees F.) NHS National Services Scotland, Paisley, United Kingdom.
CORRESPONDENCE ADDRESS
K.G. Jacques, Department Emergency Medicine, Stirling Royal Infirmary,
Livilands, Stirling, FK8 2AU, United Kingdom. Email: keith.jacques@nhs.net
SOURCE
Emergency Medicine Journal (2011) 28:12 (1036-1040). Date of Publication:
December 2011
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Background: The aim of this study was to investigate the delivery of
procedural sedation and analgesia (PSA) in an urban teaching hospital
Emergency Department (ED) over a 2-year period, and identify factors
associated with complications. Methods: Consecutive ED patients requiring
PSA were prospectively enrolled onto the Registry of Emergency Procedural
Sedation. Data collected included: patient and procedural characteristics;
process times; physiological parameters; agents; sedation depth; and
composition of staff team and complications. Multivariable binary logistic
regression was used to identify factors associated with an increased risk of
complications. Results: 1402 patents required PSA during the study period.
1345 (95.9%) underwent orthopaedic manipulations. 597 (42.6%) received
moderate sedation. 401 (28.6%) were sedated to deeper levels. Complications
occurred in 49 (3.5%) cases. Deeper levels of sedation and the procedure
occurring overnight were identified as risk factors for complications.
Procedure type, patient age, grade of doctor and choice of drug were not
found to be associated with an increased risk of complications. Conclusions:
Procedural sedation and analgesia by Emergency Physicians is safe and
effective; however, complications do happen. Complications are more likely
at deeper levels of sedation and at night. Emergency Physicians must have
the necessary skills and equipment to deal with such complications when they
arise. EDs must be adequately staffed with trained clinicians 24 h a day to
provide PSA.
EMTREE DRUG INDEX TERMS
cyclizine (adverse drug reaction)
etomidate
fentanyl
flumazenil
ketamine (adverse drug reaction)
midazolam
morphine
naloxone
propofol (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
complication
emergency ward
procedural sedation and analgesia
sedation
EMTREE MEDICAL INDEX TERMS
adult
age distribution
aged
agitation
anesthesia level
apnea (complication)
arterial oxygen saturation
article
aspiration
atrial fibrillation (complication)
bradycardia (complication)
bronchospasm (complication, side effect)
controlled study
disease association
drug choice
emergency care
emergency health service
emergency physician
female
general anesthesia
heart arrhythmia (complication)
hip surgery
human
hypotension
larynx spasm (complication, side effect)
major clinical study
male
medical staff
orthopedic manipulation
oversedation
oxygen desaturation
physician
priority journal
prospective study
risk factor
supraventricular tachycardia (complication, side effect)
teaching hospital
United Kingdom
urban area
vomiting
CAS REGISTRY NUMBERS
cyclizine (303-25-3, 5897-18-7, 82-92-8)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011644620
MEDLINE PMID
21109703 (http://www.ncbi.nlm.nih.gov/pubmed/21109703)
PUI
L51173260
DOI
10.1136/emj.2010.102475
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2010.102475
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 767
TITLE
Addressing obstructive sleep apnea in the emergency department
AUTHOR NAMES
Vearrier D.
Phillips B.
Greenberg M.I.
AUTHOR ADDRESSES
(Vearrier D.; Greenberg M.I.) Department of Emergency Medicine, Division of
Medical Toxicology, Drexel University College of Medicine, 245 N 15th St,
Philadelphia, PA 19102, United States.
(Phillips B.) Department of Internal Medicine, Division of Pulmonary,
Critical Care and Sleep Medicine, University of Kentucky College of
Medicine, Lexington, KY, United States.
CORRESPONDENCE ADDRESS
D. Vearrier, Department of Emergency Medicine, Division of Medical
Toxicology, Drexel University College of Medicine, 245 N 15th St,
Philadelphia, PA 19102, United States.
SOURCE
Journal of Emergency Medicine (2011) 41:6 (728-740). Date of Publication:
December 2011
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: Obstructive sleep apnea (OSA) is a prevalent, serious disease
that is under-recognized and under-treated. It results from a combination of
increased pharyngeal collapsibility and impaired compensatory pharyngeal
muscle dilator activity. OSA causes serious morbidity and mortality. OSA is
also a public health problem in that it is an independent cause of car
crashes, at great cost to society in dollars and lives. OSA is
conservatively estimated to affect 24% of Americans; however, recent
estimates are much higher. Objectives: To educate emergency physicians on
the pathophysiology, epidemiology, diagnosis, and management of OSA and
discuss diagnostic approaches and recommendations that can be made from the
emergency department (ED). Discussion: Emergency physicians can play an
important role in the recognition and referral of patients at risk for OSA.
A focused history and physical examination or the use of a structured
evaluation can identify patients at risk for OSA. In addition to referring
patients at risk for OSA for further diagnostic work-up, emergency
physicians can offer recommendations such as weight loss, moderation of
alcohol use and certain medications, and smoking cessation. Conclusion: OSA
is a common disease in the United States that is under-recognized and
under-treated. ED patients who do not regularly see a primary care provider
or have no primary care provider are particularly at risk for undiagnosed
OSA. Emergency physicians can play an important role in recognizing patients
at risk for OSA, referring them for further diagnostic work-up, and offering
recommendations from the ED. Copyright © 2011 Elsevier Inc. Printed in the
USA. All rights reserved.
EMTREE DRUG INDEX TERMS
acetazolamide (drug therapy)
antihypertensive agent (drug therapy)
fluticasone (drug therapy)
medroxyprogesterone (drug therapy)
mirtazapine (drug therapy)
modafinil (drug therapy)
naloxone (drug therapy)
nicotine (drug therapy)
physostigmine (drug therapy)
protriptyline (drug therapy)
serotonin uptake inhibitor (drug therapy)
theophylline (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency physician
sleep disordered breathing (drug therapy, diagnosis, drug therapy,
epidemiology, surgery)
EMTREE MEDICAL INDEX TERMS
age
alcohol consumption
anamnesis
bariatric surgery
body weight
body weight loss
cephalometry
cerebrovascular disease
cognitive defect
coronary artery disease
diabetes mellitus
emergency ward
endoscopy
Epworth sleepiness scale
ethnicity
family history
genetics
heart arrhythmia
human
hypertension
hypothyroidism
lifestyle
mandible reconstruction
metabolic syndrome X
occupation
pathophysiology
physical examination
polysomnography
positive end expiratory pressure
priority journal
public health
review
risk factor
sex
smoking
somnolence (drug therapy)
sudden death
tracheostomy
CAS REGISTRY NUMBERS
acetazolamide (1424-27-7, 59-66-5)
fluticasone (90566-53-3)
medroxyprogesterone (520-85-4)
mirtazapine (61337-67-5)
modafinil (68693-11-8)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
physostigmine (57-47-6, 64-47-1)
protriptyline (1225-55-4, 438-60-8)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011694194
MEDLINE PMID
20227230 (http://www.ncbi.nlm.nih.gov/pubmed/20227230)
PUI
L50829099
DOI
10.1016/j.jemermed.2010.01.018
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2010.01.018
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 768
TITLE
Opioid replacement therapy: A wait unmanaged
AUTHOR NAMES
Harlow W.
Happell B.
Browne G.
AUTHOR ADDRESSES
(Harlow W.; Happell B., b.happell@cqu.edu.au) Institute for Health, Social
Science Research, Australia.
(Harlow W.; Happell B., b.happell@cqu.edu.au) School of Nursing and
Midwifery, CQUniversity Australia, Rockhampton, Australia.
(Harlow W.) Southside Clinic, Alcohol Tobacco and Other Drugs Service,
Queensland Health, Gold Coast, QLD, Australia.
(Browne G.) School of Health and Human Sciences, Southern Cross University,
Lismore, NSW, Australia.
CORRESPONDENCE ADDRESS
B. Happell, School of Nursing and Midwifery, CQUniversity Australia, Bruce
Highway, Rockhampton, Queensland 4702, Australia. Email:
b.happell@cqu.edu.au
SOURCE
International Journal of Mental Health Nursing (2011) 20:6 (418-427). Date
of Publication: December 2011
ISSN
1445-8330
1447-0349 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
There has been a rapid increase in members of the Australian population
using opioids in recent years. The flow-on effect has been an increase in
demand for treatments, particularly opioid replacement therapy (ORT), but
the availability of treatments has not increased. This has frequently
resulted in delays before treatment can be commenced. Outcomes could improve
if health-care professionals had clearer guidelines on how to prioritize
access to ORT. This review investigates the triage of consumers in ORT
within Australia. Information on triage in ORT was not available, and an
understanding of how consumer needs are managed when they present for ORT
triage was not identified. In the absence of research to guide this
practice, the body of evidence regarding ORT treatment access is weighted on
government policies. Triage, as applied in general health and mental
health-care service delivery, was reviewed to consider the components of
triage and how these might pertain to triage in ORT. Failure to facilitate
the needs of consumers accessing ORT can result in further harm to consumers
and increased social and financial costs for society. Research is required
to investigate how this issue is currently being managed and to lead the way
for needed improvements in service delivery. © 2011 The Authors.
International Journal of Mental Health Nursing © 2011 Australian College of
Mental Health Nurses Inc.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital admission
opiate substitution treatment
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
Australia (epidemiology)
child
emergency health service
female
health service
human
male
mental health service
middle aged
opiate addiction (drug therapy, epidemiology)
practice guideline
statistics
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
21592273 (http://www.ncbi.nlm.nih.gov/pubmed/21592273)
PUI
L362858208
DOI
10.1111/j.1447-0349.2011.00748.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1447-0349.2011.00748.x
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 769
TITLE
Anaphylaxis with Latrodectus Antivenin Resulting in Cardiac Arrest
AUTHOR NAMES
Murphy C.M.
Hong J.J.
Beuhler M.C.
AUTHOR ADDRESSES
(Murphy C.M., christine.murphy@carolinas.org) Department of Emergency
Medicine, Carolinas Medical Center, PO Box 32861, MEB 3rd Floor, Charlotte,
NC 28232, United States.
(Hong J.J.) School of Pharmacy, University of North Carolina, Chapel Hill,
NC, United States.
(Beuhler M.C.) Carolinas Poison Center, Charlotte, NC, United States.
CORRESPONDENCE ADDRESS
C. M. Murphy, Department of Emergency Medicine, Carolinas Medical Center, PO
Box 32861, MEB 3rd Floor, Charlotte, NC 28232, United States. Email:
christine.murphy@carolinas.org
SOURCE
Journal of Medical Toxicology (2011) 7:4 (317-321). Date of Publication:
December 2011
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Springer Street, New York, United States.
ABSTRACT
Latrodectus mactans antivenin is a safe and effective therapy for severe
black widow spider envenomations when given to most patients. We report a
case of a 37-year-old male with a history of asthma that was given L.
mactans antivenin for symptoms related to a black widow envenomation and
developed a severe anaphylactic reaction resulting in cardiac arrest. When
traditional therapies failed, the patient was given methylene blue for
anaphylactic shock resulting in a 30-h period of hemodynamic stability.
Despite initial resuscitation, the patient ultimately died 40 h after
presentation. Under the right circumstances, L. mactans antivenin remains a
safe and effective therapy for severe black widow envenomations. However,
anaphylaxis is a risk for those receiving this therapy, even when the
antivenin is diluted and given as an infusion. We report the first death
related to diluted L. mactans antivenin given as an infusion. © 2011
American College of Medical Toxicology.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
spider venom antiserum (drug toxicity)
EMTREE DRUG INDEX TERMS
bicarbonate
calcium chloride
diphenhydramine
dopamine
epinephrine
fluticasone propionate plus salmeterol (drug therapy, inhalational drug
administration)
hydromorphone (intravenous drug administration)
immunoglobulin G (endogenous compound)
ketorolac (intravenous drug administration)
lorazepam (intravenous drug administration)
methylene blue
methylprednisolone
naloxone
noradrenalin
phenylephrine
salbutamol (drug therapy, inhalational drug administration)
vasopressin
vecuronium
venom antiserum
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anaphylaxis
anaphylaxis
heart arrest
EMTREE MEDICAL INDEX TERMS
adult
article
asthma (drug therapy)
case report
diaphoresis
drug efficacy
drug safety
emergency ward
envenomation
hemodynamics
human
male
medical history
metered dose inhaler
nausea
neck
physical examination
resuscitation
risk
shoulder
spider
DRUG TRADE NAMES
antivenin , United StatesMerck and Co
DRUG MANUFACTURERS
(United States)Merck and Co
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
hydromorphone (466-99-9, 71-68-1)
immunoglobulin G (97794-27-9)
ketorolac (74103-06-3)
lorazepam (846-49-1)
methylene blue (61-73-4)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
salbutamol (18559-94-9, 35763-26-9)
vasopressin (11000-17-2)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011661997
MEDLINE PMID
22052335 (http://www.ncbi.nlm.nih.gov/pubmed/22052335)
PUI
L51699770
DOI
10.1007/s13181-011-0183-1
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-011-0183-1
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 770
TITLE
Methadone, another cause of opioid-associated hearing loss: A case report
AUTHOR NAMES
Shaw K.A.
Babu K.M.
Hack J.B.
AUTHOR ADDRESSES
(Shaw K.A.; Babu K.M.; Hack J.B.) Department of Emergency Medicine, Brown
University Alpert Medical School, Providence, RI, United States.
(Babu K.M.; Hack J.B.) Division of Medical Toxicology, UEMF, Brown
University Alpert Medical School, Providence, RI, United States.
CORRESPONDENCE ADDRESS
K.A. Shaw, Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy
Street, Claverick 274, Providence, RI 02903, United States.
SOURCE
Journal of Emergency Medicine (2011) 41:6 (635-639). Date of Publication:
December 2011
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Methadone has been used for many years in the clinical setting and has many
well-described side effects. In recent years, the use of methadone and other
opioids have been increasing throughout the United States (US), and
presentations to US Emergency Departments (EDs) due to opioid use and abuse
are increasing as well. As methadone and opioid use increases, ED physicians
should be aware of infrequently seen side effects and toxicities associated
with the use of these drugs. We report the case of a previously healthy
20-year-old man who presented with acute onset of bilateral hearing loss
secondary to an unintentional methadone overdose. At follow-up, the
patient's hearing had returned to normal, with the only intervention being
abstinence from methadone. Although bilateral hearing loss is a rare toxic
finding of opioid ingestion, given the prevalence of opioid use, this
etiology should be considered in any patient presenting with this chief
complaint. Copyright © 2011 Elsevier Inc. Printed in the USA. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hearing impairment
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
clinical article
clinical feature
drug overdose
follow up
human
male
physical examination
priority journal
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011694203
MEDLINE PMID
21145191 (http://www.ncbi.nlm.nih.gov/pubmed/21145191)
PUI
L51185173
DOI
10.1016/j.jemermed.2010.11.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2010.11.014
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 771
TITLE
Prehospital treatment of opioid overdose in Copenhagen-Is it safe to
discharge on-scene?
AUTHOR NAMES
Rudolph S.S.
Jehu G.
Nielsen S.L.
Nielsen K.
Siersma V.
Rasmussen L.S.
AUTHOR ADDRESSES
(Rudolph S.S., rudolph@dadlnet.dk; Nielsen S.L.; Nielsen K.; Rasmussen L.S.)
The Mobile Emergency Care Unit (MECU), Dept. of Anaesthesia, Centre of Head
and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark.
(Jehu G.) The Department of Forensic Medicine, University of Copenhagen,
Denmark.
(Siersma V.) The Research Unit for General Practice and Section of General
Practice, Dept. of Public Health, University of Copenhagen, Denmark.
CORRESPONDENCE ADDRESS
S.S. Rudolph, Azaleavej 38, 2000 Frederiksberg, Denmark. Email:
rudolph@dadlnet.dk
SOURCE
Resuscitation (2011) 82:11 (1414-1418). Date of Publication: November 2011
ISSN
0300-9572
1873-1570 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Introduction: In the prehospital setting opioid overdose is often treated
with naloxone. In our physician-based medical emergency care unit (MECU) we
have adopted a discharge-on-scene policy, where patients are released on
scene if no residual signs of opioid intoxication are found after treatment.
The aim of this study was to describe our experience with the
discharge-on-scene policy used during a 10-year-period with focus on the
frequency of rebound opioid toxicity. Methods: Data were prospectively
recorded in our MECU database and we reviewed all cases of opioid overdose
between 1994 and 2003. The MECU database was cross-referenced with the
Central Personal Registry. For patients who died within 48. h of MECU
contact we reviewed the forensic autopsy reports to establish whether
rebound opioid toxicity was likely. Results: We found 4762 cases of acute
opioid overdose. In 3245 cases positive identification was obtained. Over
this ten year period fourteen patients who were released on-scene after
having been treated with naloxone died within 48. h, but only in 3 of these
we found a rebound opioid toxicity to be the likely cause of death,
corresponding to 0.13% of those 2241 released on scene who were identified.
Conclusion: Prehospital discharge-on-scene after naloxone treatment is
associated with a low risk of death due to rebound toxicity. © 2011 Elsevier
Ireland Ltd.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
discharge on scene policy
drug overdose (drug therapy, drug therapy)
emergency care
health care policy
EMTREE MEDICAL INDEX TERMS
article
cause of death
Denmark
human
major clinical study
outcomes research
patient safety
priority journal
prospective study
rebound
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011570598
MEDLINE PMID
21745532 (http://www.ncbi.nlm.nih.gov/pubmed/21745532)
PUI
L51529104
DOI
10.1016/j.resuscitation.2011.06.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2011.06.027
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 772
TITLE
Treatment of opioid overdose in a physician-based prehospital EMS: Frequency
and long-term prognosis
AUTHOR NAMES
Nielsen K.
Nielsen S.L.
Siersma V.
Rasmussen L.S.
AUTHOR ADDRESSES
(Nielsen K., karinanielsen_1@msn.com; Nielsen S.L.; Rasmussen L.S.)
Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Copenhagen
University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
(Nielsen K., karinanielsen_1@msn.com; Nielsen S.L.; Rasmussen L.S.) Mobile
Emergency Care Unit, Copenhagen Hospital Corporation, Copenhagen, Denmark.
(Siersma V.) The Research Unit for General Practice and Section of General
Practice, Department of Public Health, University of Copenhagen, Copenhagen,
Denmark.
CORRESPONDENCE ADDRESS
K. Nielsen, Department of Anaesthesia Centre of Head and Orthopaedics, 4231
Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
Email: karinanielsen_1@msn.com
SOURCE
Resuscitation (2011) 82:11 (1410-1413). Date of Publication: November 2011
ISSN
0300-9572
1873-1570 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: Prehospital treatment of opioid overdose accounts for a
significant proportion of the workload of the emergency system in most major
cities. Treatment consists of basic life support and administering naloxone.
In our physician-manned mobile emergency care unit (MECU), most patients are
released and not admitted to hospital. In this study, we aimed to assess the
pattern in the number of episodes with opioid overdose treated by MECU in
Copenhagen during a 10-year period and to investigate risk factors for
mortality of these patients beyond the initial contact. Methods: Data were
collected prospectively in the MECU database covering all cases of opioid
overdose in a 10-year period between 1994 and 2003. The pattern in the
number of opioid overdose was analysed in Poisson regression models, and
mortality was analysed in Kaplan-Meier plots and in Cox regression models.
Results: A total of 4762 episodes of opioid overdose were recorded. Patients
were identified in 3245 of these episodes. The annual number of episodes
decreased significantly over the data-collection period: from 639 overdoses
out of 4520 (14.1%) patients treated in 1994 to 311 out of 7263 patients
treated (4.3%) in 2003. A total of 352 patients had cardiac arrest at the
scene. The MECU released 2246 patients (69.3%) after treatment, while 675
(20.8%) were admitted to hospital and 322 (9.9%) died. Long-term prognosis
was poor with 14% mortality at 1 year. Long-term mortality was significantly
related to increasing age, time of the year and if the patient had previous
episodes of opioid overdose. Conclusions: There has been a significant
decrease in the number of opioid overdoses during this 10-year-period.
Long-term mortality is high in these patients and highest in those with
advanced age and numerous episodes of opioid overdose. © 2011 Elsevier
Ireland Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency care
mobile emergency care unit
patient transport
EMTREE MEDICAL INDEX TERMS
adult
aged
article
data base
female
heart arrest
hospital admission
human
Kaplan Meier method
major clinical study
male
mortality
multivariate analysis
priority journal
prognosis
proportional hazards model
prospective study
risk factor
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011570597
MEDLINE PMID
21756968 (http://www.ncbi.nlm.nih.gov/pubmed/21756968)
PUI
L51565371
DOI
10.1016/j.resuscitation.2011.05.027
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2011.05.027
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 773
TITLE
Parenteral opioids in emergency medicine - A systematic review of efficacy
and safety
AUTHOR NAMES
Niemi-Murola L.
Unkuri J.
Hamunen K.
AUTHOR ADDRESSES
(Niemi-Murola L., leila.niemi-murola@hus.fi; Unkuri J.) Dept. of
Anaesthesiology and Intensive Care Medicine, University of Helsinki, P.O.
Box 20, 00014 Helsinki, Finland.
(Niemi-Murola L., leila.niemi-murola@hus.fi; Hamunen K.) Meilahti Hospital,
Dept. of Anaesthesiology and Intensive Care Medicine, Helsinki University
Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
CORRESPONDENCE ADDRESS
L. Niemi-Murola, Meilahti Hospital, Dept. of Anaesthesiology and Intensive
Care Medicine, P.O. Box 340, FIN-00029 HUS, Finland. Email:
leila.niemi-murola@hus.fi
SOURCE
Scandinavian Journal of Pain (2011) 2:4 (187-194). Date of Publication:
October 2011
ISSN
1877-8860
1877-8879 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Introduction and aim: Pain is a frequent symptom in emergency patients and
opioids are commonly used to treat it at emergency departments and at
pre-hospital settings. The aim of this systematic review is to examine the
efficacy and safety of parenteral opioids used for acute pain in emergency
medicine. Method: Qualitative review of randomized controlled trials (RCTs)
on parenteral opioids for acute pain in adult emergency patients. Main
outcome measures were: type and dose of the opioid, analgesic efficacy as
compared to either placebo or another opioid and adverse effects. Results:
Twenty double-blind RCTs with results on 2322 patients were included. Seven
studies were placebo controlled. Majority of studies were performed in the
emergency department. Only five studies were in prehospital setting.
Prehospital studies: Four studies were on mainly trauma-related pain, one
ischemic chest pain. One study compared two different doses of morphine in
mainly trauma pain showing faster analgesia with the larger dose but no
difference at 30. min postdrug. Three other studies on the same pain model
showed equal analgesic effects with morphine and other opioids. Alfentanil
was more effective than morphine in ischemic chest pain. Emergency
department studies: Pain models used were acute abdominal pain seven, renal
colic four, mixed (mainly abdominal pain) three and trauma pain one study.
Five studies compared morphine to placebo in acute abdominal pain and in all
studies morphine was more effective than placebo. In four out of five
studies on acute abdominal pain morphine did not change diagnostic accuracy,
clinical or radiological findings. Most commonly used morphine dose in the
emergency department was 0.1. mg/kg (five studies). Other opioids showed
analgesic effect comparable to morphine. Adverse effects: Recording and
reporting of adverse effects was very variable. Vital signs were recorded in
15 of the 20 studies (including all prehospital studies). Incidence of
adverse effects in the opioid groups was 5-38% of the patients in the
prehospital setting and 4-46% of the patients in the emergency department.
Nausea or vomiting was reported in 11-25% of the patients given opioids.
Study drug was discontinued because of adverse effects five patients (one
placebo, two sufentanil, two morphine). Eight studies commented on
administration of naloxone for reversal of opioid effects. One patient out
of 1266 was given naloxone for drowsiness. Ventilatory depression defined by
variable criteria occurred in occurred in 7 out of 756 emergency department
patients. Conclusion: Evidence for selection of optimal opioid and dose is
scarce. Opioids, especially morphine, are effective in relieving acute pain
also in emergency medicine patients. Studies so far are small and reporting
of adverse effects is very variable. Therefore the safety of different
opioids and doses remains to be studied. Also the optimal titration regimens
need to be evaluated in future studies. The prevention and treatment of
opioid-induced nausea and vomiting is an important clinical consideration
that requires further clinical and scientific attention in this patient
group. © 2011 Scandinavian Association for the Study of Pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, clinical trial, drug comparison, drug
therapy, intramuscular drug administration, parenteral drug administration)
EMTREE DRUG INDEX TERMS
alfentanil (clinical trial, drug comparison, drug therapy, intravenous drug
administration)
butorphanol (clinical trial, drug comparison, drug therapy, intravenous drug
administration)
fentanyl (clinical trial, drug comparison, drug therapy, inhalational drug
administration, intravenous drug administration)
hydromorphone (adverse drug reaction, clinical trial, drug comparison, drug
therapy, intravenous drug administration)
morphine (adverse drug reaction, clinical trial, drug comparison, drug dose,
drug therapy, intravenous drug administration)
naloxone (drug therapy)
paracetamol (clinical trial, drug therapy, intravenous drug administration)
pethidine (clinical trial, drug comparison, drug therapy, intravenous drug
administration)
placebo
sufentanil (clinical trial, drug comparison, drug therapy, intravenous drug
administration)
tramadol (clinical trial, drug comparison, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
acute abdomen (drug therapy)
analgesia
diagnostic accuracy
drowsiness (drug therapy, side effect)
drug dose titration
drug efficacy
drug safety
drug withdrawal
emergency care
emergency medicine
emergency ward
human
ischemic chest pain (drug therapy)
ischemic chest pain (drug therapy)
kidney colic (drug therapy)
musculoskeletal pain (drug therapy)
nausea (side effect)
numeric rating scale
pain assessment
patient satisfaction
pelvis pain syndrome (drug therapy)
priority journal
pruritus (side effect)
randomized controlled trial (topic)
rating scale
review
sedation
side effect (side effect)
systematic review
thorax pain (drug therapy)
visual analog scale
vital sign
vomiting (side effect)
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
butorphanol (42408-82-2)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
sufentanil (56030-54-7)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011535019
PUI
L362628093
DOI
10.1016/j.sjpain.2011.05.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.sjpain.2011.05.008
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 774
TITLE
A novel use of Naloxone as a treatment for Eucalyptus oil induced central
nervous system depression
AUTHOR NAMES
Doshi D.
Close B.R.
Reid P.F.W.
AUTHOR ADDRESSES
(Doshi D., drdeepdoshi@yahoo.com; Close B.R.; Reid P.F.W.) Townsville
Hospital, Emergency Department, 100, Angus Smith Drive, Douglas 4814,
Australia.
CORRESPONDENCE ADDRESS
D. Doshi, Townsville Hospital, Emergency Department, 100, Angus Smith Drive,
Douglas 4814, Australia. Email: drdeepdoshi@yahoo.com
SOURCE
Clinical Toxicology (2011) 49:8 (768). Date of Publication: October 2011
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, 52 Vanderbilt Ave., New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
eucalyptus oil (drug toxicity)
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
central nervous system depression
EMTREE MEDICAL INDEX TERMS
aged
case report
drug use
emergency ward
female
Glasgow coma scale
human
letter
tertiary health care
toxicity testing
urinalysis
CAS REGISTRY NUMBERS
eucalyptus oil (8000-48-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011558091
MEDLINE PMID
21970776 (http://www.ncbi.nlm.nih.gov/pubmed/21970776)
PUI
L362710410
DOI
10.3109/15563650.2011.609823
FULL TEXT LINK
http://dx.doi.org/10.3109/15563650.2011.609823
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 775
TITLE
Droperidol analgesia for opioid-tolerant patients
AUTHOR NAMES
Richards J.R.
Richards I.N.
Ozery G.
Derlet R.W.
AUTHOR ADDRESSES
(Richards J.R.; Ozery G.; Derlet R.W.) Department of Emergency Medicine, UC
Davis Medical Center, PSSB 2100, 2315 Stockton Boulevard, Sacramento, CA
95817, United States.
(Richards I.N.) Department of Internal Medicine, UC Davis Medical Center,
Sacramento, CA, United States.
CORRESPONDENCE ADDRESS
J.R. Richards, Department of Emergency Medicine, UC Davis Medical Center,
PSSB 2100, 2315 Stockton Boulevard, Sacramento, CA 95817, United States.
SOURCE
Journal of Emergency Medicine (2011) 41:4 (389-396). Date of Publication:
October 2011
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: Patients with acute and chronic pain syndromes such as migraine
headache, fibromyalgia, and sickle cell disease represent a significant
portion of emergency department (ED) visits. Certain patients may have
tolerance to opioid analgesics and often require large doses and prolonged
time in the ED to achieve satisfactory pain mitigation. Droperidol is a
unique drug that has been successfully used not only as an analgesic
adjuvant for the past 30 years, but also for treatment of nausea/vomiting,
psychosis, agitation, sedation, and vertigo. Objectives: In this review, we
examine the evidence supporting the use of droperidol for analgesia, adverse
side effects, and controversial United States (US) Food and Drug
Administration (FDA) black box warning. Discussion: Droperidol has myriad
pharmacologic properties that may explain its efficacy as an analgesic,
including: dopamine D2 antagonist, dose-dependent GABA agonist/antagonist,
α2 adrenoreceptor agonist, serotonin antagonist, histamine antagonist,
muscarinic and nicotinic cholinergic antagonist, anticholinesterase
activity, sodium channel blockade similar to lidocaine, and μ opiate
receptor potentiation. Conclusion: Droperidol is an important adjuvant for
patients who are tolerant to opioid analgesics. The FDA black box warning
does not apply to doses below 2.5 mg. © 2011 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
droperidol (adverse drug reaction, drug administration, drug analysis, drug
combination, drug comparison, drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration, pharmacokinetics,
pharmacology)
EMTREE DRUG INDEX TERMS
benzatropine (drug therapy)
benzodiazepine (drug therapy)
beta adrenergic receptor blocking agent (drug therapy)
butorphanol (drug combination, drug comparison, drug therapy)
cholinergic receptor blocking agent (drug therapy)
diphenhydramine (drug therapy)
droperidol plus fentanyl
fentanyl (drug combination, drug comparison, drug therapy, epidural drug
administration)
lidocaine (drug analysis, drug therapy)
morphine (drug combination, drug comparison, drug therapy)
nalbuphine (drug combination, drug comparison, drug therapy)
narcotic analgesic agent (drug therapy)
ondansetron (drug combination, drug comparison)
opiate (drug therapy)
sufentanil (adverse drug reaction, drug combination, drug therapy, epidural
drug administration)
tramadol (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
chronic pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
add on therapy
adjuvant therapy
akathisia (complication, drug therapy, etiology, side effect)
article
central nervous system
drowsiness (side effect)
drug approval
drug efficacy
drug labeling
drug tolerance
dystonia (complication, drug therapy, etiology, side effect)
emergency ward
epidural anesthesia
fibromyalgia
food and drug administration
headache (drug therapy)
human
migraine (drug therapy)
nausea (side effect)
neuropharmacology
nociception
nonhuman
pain (drug therapy)
pathophysiology
patient controlled analgesia
postoperative analgesia
postoperative nausea and vomiting (complication, drug therapy, prevention)
postoperative pain (complication, drug therapy, prevention)
priority journal
pruritus (side effect)
QT prolongation (side effect)
sedation
sickle cell anemia
treatment outcome
vomiting (side effect)
DRUG TRADE NAMES
innovar , United StatesJanssen
DRUG MANUFACTURERS
(United States)Janssen
CAS REGISTRY NUMBERS
benzatropine (86-13-5)
benzodiazepine (12794-10-4)
butorphanol (42408-82-2)
diphenhydramine (147-24-0, 58-73-1)
droperidol (548-73-2)
droperidol plus fentanyl (8004-27-1, 8067-59-2)
fentanyl (437-38-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
sufentanil (56030-54-7)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011574665
MEDLINE PMID
20832967 (http://www.ncbi.nlm.nih.gov/pubmed/20832967)
PUI
L51066165
DOI
10.1016/j.jemermed.2010.07.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2010.07.005
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 776
TITLE
Opioids in emergency medicine - Are we treating pain adequately?
AUTHOR NAMES
Kuusniemi K.S.
Olkkola K.T.
AUTHOR ADDRESSES
(Kuusniemi K.S., kristiina.kuusniemi@tyks.fi; Olkkola K.T.,
klaus.olkkola@utu.fi) Dept. of Anaesthesiology, Intensive Care, Emergency
Care and Pain Medicine, Turku University Hospital, University of Turku, P.O.
Box 52 (Kiinamyllynkatu 4-8), FI-20521 Turku, Finland.
CORRESPONDENCE ADDRESS
K.S. Kuusniemi, Department of Anaesthesiology, Intensive Care, Emergency
Care and Pain Medicine, Turku University Hospital, University of Turku, P.O.
Box 52 (Kiinamyllynkatu 4-8), FI-20521 Turku, Finland. Email:
kristiina.kuusniemi@tyks.fi
SOURCE
Scandinavian Journal of Pain (2011) 2:4 (185-186). Date of Publication:
October 2011
ISSN
1877-8860
1877-8879 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, clinical trial, drug therapy, parenteral drug
administration)
EMTREE DRUG INDEX TERMS
morphine
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
EMTREE MEDICAL INDEX TERMS
acute abdomen (diagnosis, drug therapy)
chronic pain (drug therapy)
disease severity
drowsiness (drug therapy, side effect)
drug efficacy
drug safety
human
medical documentation
nausea and vomiting (side effect)
note
numeric rating scale
pain (drug therapy)
pain assessment
priority journal
randomized controlled trial (topic)
rating scale
Red Wedge Scale
respiration depression (side effect)
risk factor
systematic review (topic)
treatment outcome
verbal rating scale
visual analog scale
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011535018
PUI
L362628092
DOI
10.1016/j.sjpain.2011.08.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.sjpain.2011.08.004
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 777
TITLE
Randomized clinical trial comparing the safety and efficacy of a
hydromorphone titration protocol to usual care in the management of adult
emergency department patients with acute severe pain
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K., achang@montefiore.org; Bijur P.E.; Gallagher E.J.) Department
of Emergency Medicine, Albert Einstein College of Medicine, Montefiore
Medical Center, 111 East 210th St, Bronx, NY 10467, United States.
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467,
United States. Email: achang@montefiore.org
SOURCE
Annals of Emergency Medicine (2011) 58:4 (352-359). Date of Publication:
October 2011
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: We test the efficacy and safety of the "1+1" (1 mg plus 1
mg 15 minutes later if needed) hydromorphone protocol against usual care of
emergency department (ED) patients with acute severe pain. Methods: This was
a prospective, randomized clinical trial of ED patients with acute severe
pain. The 1+1 protocol specifies administration of 1 mg intravenous
hydromorphone, followed by a second dose of 1 mg intravenous hydromorphone
15 minutes after the first bolus if the patient answers yes to the question,
"Do you want more pain medication?" Usual care is the administration of any
intravenous opioid, with type and dose chosen by the ED attending physician.
Usual care patients who wanted more medication at 15 minutes were treated at
the physician's discretion. At 60 minutes, all patients were asked again
whether they wanted more pain medication. The primary outcome was successful
treatment defined a priori as not wanting additional analgesia at either 15
or 60 minutes after the initial bolus. The primary endpoint was the
difference in the proportion of patients with successful treatment who
received the complete 1+1 protocol versus usual care with a per-protocol
analysis. An intention-to-treat analysis was also performed. A 10%
difference in rate of successful treatment was chosen a priori as a
clinically meaningful difference. Results: Of 167 patients in the 1+1 group,
156 received the full 1+1 protocol, whereas 171 received usual care. Of
patients who received the 1+1 protocol, 92.3% (144/156) had successful
treatment versus 76.6% (131/171) of usual care patients (difference=15.7%;
95% confidence interval 7.9% to 23.3%). In the intention-to-treat analysis,
86.8% (145/167) of patients randomized to the 1+1 group received successful
treatment versus 76.6% (131/171) of usual care patients (difference=10.2%;
95% confidence interval 2.0% to 18.3%). No patient required naloxone. One
patient in the 1+1 group and 2 patients in the usual care group had
transient oxygen saturation less than 95%. The incidence of all adverse
effects was similar in both groups. Conclusion: When analyzed per protocol
or with the more conservative intention-to-treat analysis, the 1+1
hydromorphone protocol is statistically and clinically more efficacious than
usual care. Safety profiles were similar in both groups. © 2010 American
College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, clinical trial, drug dose, drug
therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
ibuprofen (drug therapy)
ketorolac (drug therapy)
morphine (drug therapy)
naloxone (drug therapy)
naproxen (drug therapy)
opiate (adverse drug reaction, drug therapy, intravenous drug
administration)
oxycodone plus paracetamol (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
bolus injection
breathing rate
clinical protocol
disease severity
drug dose titration
drug efficacy
drug safety
emergency care
emergency ward
female
human
intention to treat analysis
major clinical study
male
nausea (side effect)
oxygen saturation
pain assessment
priority journal
prospective study
pruritus (side effect)
randomized controlled trial
side effect (side effect)
systolic blood pressure
treatment outcome
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 31121-93-4, 527688-20-6, 79261-49-7)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011539678
MEDLINE PMID
21507527 (http://www.ncbi.nlm.nih.gov/pubmed/21507527)
PUI
L362646659
DOI
10.1016/j.annemergmed.2011.03.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2011.03.003
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 778
TITLE
Opioid management and dependency among adult patients with sickle cell
disease
AUTHOR NAMES
Feliu M.H.
Wellington C.
Crawford R.D.
Wood M.
Edwards L.
Byrd G.
Edwards C.L.
AUTHOR ADDRESSES
(Feliu M.H., feliu001@mc.duke.edu; Wood M.; Edwards C.L.) Department of
Psychiatry, Duke University, Medical Center, 932 Morreene Rd., Durham, NC
27705, United States.
(Feliu M.H., feliu001@mc.duke.edu; Wood M.; Edwards C.L.) Pain and
Palliative Care Clinic, Duke University, Durham, NC, United States.
(Wellington C.) Department of Psychology, Shaw University, Raleigh, NC,
United States.
(Crawford R.D.; Edwards C.L.) Department of Hematology, Duke University,
Durham, NC, United States.
(Edwards L.) Department of Anesthesiology, University of North Carolina,
Chapel Hill, NC, United States.
(Byrd G.) Department of Biology, North Carolina A and T University,
Winston-Salem, NC, United States.
(Edwards C.L.) Center for Biobehavioral and Social Aspects of Health
Disparities, Duke University, Durham, NC, United States.
CORRESPONDENCE ADDRESS
M.H. Feliu, Department of Psychiatry, Duke University, Medical Center, 932
Morreene Rd., Durham, NC 27705, United States. Email: feliu001@mc.duke.edu
SOURCE
Hemoglobin (2011) 35:5-6 (485-494). Date of Publication: October 2011
The International Conference on Hemoglobin Disorders, Kuwait, February
5-7th, 2011 T.H.J. Huisman Memoriam, Book Series Title:
ISSN
0363-0269
1532-432X (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
While pain is one of the most debilitating symptoms of sickle cell disease,
narcotics remain an effective although controversial widely practiced
intervention. Vaso-occlusive crises are the most common cause for seeking
pharmacological treatment. The influence of stigmatization and pseudo
addiction in emergency departments and outpatient clinics was reviewed. We
analyzed patterns of narcotic utilization in a sample of 63 adult patients
with sickle cell disease to determine if their psychological functioning and
reports of pain differed as a function of the primary narcotics they were
taking for oral pain management. Fifty-one percent of patients reported
treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine.
Patients who were treated with Oxycodone reported greater sensory reactions
to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged
weekly pain intensity ratings than patients who did not use this medication.
There were no differences in pain or affective response in patients treated
with OxyContin, methadone or morphine. We suggest there are clear
differences between the reports of pain in patients with sickle cell disease
taking short-acting narcotics for pain management as compared to those who
are not, a pattern that does not distinguish patients who are managed with
long-acting preparations. We discuss the relevance of addressing narcotic
management in the context of the perception of health care providers and
patients with sickle cell disease. © 2011 Informa Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
methadone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
short acting drug (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy, drug therapy)
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
aged
controlled study
female
human
major clinical study
male
pain assessment
psychologic assessment
review
sensory dysfunction
treatment response
visual analog scale
DRUG TRADE NAMES
oxycontin
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Hematology (25)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011625376
MEDLINE PMID
21910605 (http://www.ncbi.nlm.nih.gov/pubmed/21910605)
PUI
L362917559
DOI
10.3109/03630269.2011.610914
FULL TEXT LINK
http://dx.doi.org/10.3109/03630269.2011.610914
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 779
TITLE
Altered mental status
AUTHOR NAMES
Douglas V.C.
Josephson S.A.
AUTHOR ADDRESSES
(Douglas V.C., vanja.douglas@ucsf.edu; Josephson S.A.)
CORRESPONDENCE ADDRESS
V.C. Douglas, UCSF Department of Neurology, Box 0114, 505 Parnassus Avenue
M798, San Francisco, CA 94143, United States. Email: vanja.douglas@ucsf.edu
SOURCE
CONTINUUM Lifelong Learning in Neurology (2011) 17:5 (967-983). Date of
Publication: October 2011
ISSN
1080-2371
1538-6899 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Purpose of Review: Altered mental status is a common reason for neurologic
consultation. Although it is often due to a systemic infection or metabolic
derangement, a host of other etiologies can lead to irreversible brain
injury if they are not promptly identified and treated. A systematic
approach to the patient is important, with an understanding of when to
initiate a more advanced and potentially more resource-intense diagnostic
workup. Recent Findings: The last decade has seen advances in both the
diagnosis and treatment of altered mental status. A significant step forward
in the diagnosis of patients with otherwise unexplained encephalitis has
been the identification of numerous antibodies associated with
paraneoplastic and nonparaneoplastic autoimmune encephalitis. The use of
continuous electroencephalography has shown that a significant proportion of
otherwise unexplained altered mental status may be caused by nonconvulsive
seizures. Several studies have demonstrated that proactive, multicomponent
interventions may be effective in preventing hospital-acquired delirium. The
recent introduction of dexmedetomidine may lead to decreased rates of
delirium in the intensive care unit if the results of clinical trials are
borne out in practice. Summary: This article discusses causes of altered
mental status, an initial approach to evaluating the patient, and elements
of the advanced diagnostic workup. The article concludes with a general
discussion of prevention and treatment. Copyright © 2011, American Academy
of Neurology. All rights reserved.
EMTREE DRUG INDEX TERMS
aciclovir (drug therapy)
anticonvulsive agent
benzodiazepine
calcineurin inhibitor
carbamazepine
cefazolin (drug therapy)
cephalosporin
cimetidine
creatinine (endogenous compound)
dexmedetomidine (drug therapy)
dopamine receptor stimulating agent
etiracetam
famotidine
glucose (drug combination)
levodopa
lorazepam (drug therapy)
memantine
metronidazole (drug therapy)
monoamine oxidase inhibitor
naloxone (drug therapy)
neuroleptic agent
opiate
quetiapine
quinoline derived antiinfective agent
tamsulosin
thiamine (drug combination, drug therapy, intravenous drug administration)
unindexed drug
valproate semisodium
valproic acid (adverse drug reaction)
venlafaxine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mental disease (etiology)
EMTREE MEDICAL INDEX TERMS
adult
aged
airway
arousal
attention disturbance
bicarbonate blood level
brain disease (side effect)
brain injury
case report
CD4 lymphocyte count
circulation
Clostridium difficile infection (drug therapy)
complex partial seizure
computer assisted tomography
confusion
consciousness
consultation
creatinine blood level
Cytomegalovirus retinitis
delirium (drug therapy)
disorientation
drug blood level
drug overdose (drug therapy)
drug substitution
drug withdrawal
dysarthria
electroencephalography
emergency ward
encephalitis
epilepsy (surgery)
female
follow up
gait disorder
herpes simplex encephalitis (drug therapy)
human
Human immunodeficiency virus infected patient
intensive care psychosis (drug therapy)
intensive care unit
intubation
kidney failure
laboratory test
lumbar puncture
male
medical history
neuroimaging
neurologic examination
neurology
paraneoplastic syndrome
paresthesia
parkinsonism
physical examination
pleocytosis (drug therapy)
respiratory acidosis
review
risk factor
temporal lobectomy
tonic clonic seizure (drug therapy)
unsteadiness
urea nitrogen blood level
urinalysis
urinary tract infection (drug therapy)
vertigo
weakness
Wernicke encephalopathy (drug therapy)
DRUG TRADE NAMES
divalproex
levetiracetam
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
benzodiazepine (12794-10-4)
carbamazepine (298-46-4, 8047-84-5)
cefazolin (25953-19-9, 27164-46-1)
cephalosporin (11111-12-9)
cimetidine (51481-61-9, 70059-30-2)
creatinine (19230-81-0, 60-27-5)
dexmedetomidine (113775-47-6)
etiracetam (102767-28-2, 33996-58-6)
famotidine (76824-35-6)
glucose (50-99-7, 84778-64-3)
levodopa (59-92-7)
lorazepam (846-49-1)
memantine (19982-08-2, 41100-52-1)
metronidazole (39322-38-8, 443-48-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
quetiapine (111974-72-2)
tamsulosin (106133-20-4, 106138-88-9, 106463-17-6, 80223-99-0, 94666-07-6)
thiamine (59-43-8, 67-03-8)
valproate semisodium (76584-70-8)
valproic acid (1069-66-5, 99-66-1)
venlafaxine (93413-69-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011555374
PUI
L362702825
DOI
10.1212/01.CON.0000407055.17661.33
FULL TEXT LINK
http://dx.doi.org/10.1212/01.CON.0000407055.17661.33
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 780
TITLE
Prolonged coma in a child due to hashish ingestion with quantitation of THC
metabolites in urine
AUTHOR NAMES
Carstairs S.D.
Fujinaka M.K.
Keeney G.E.
Ly B.T.
AUTHOR ADDRESSES
(Carstairs S.D.; Ly B.T.) Department of Emergency Medicine, Division of
Medical Toxicology, University of California San Diego, 11645 Thistle Hill
Place, San Diego, CA 92130-8678, United States.
(Carstairs S.D.) Department of Emergency Medicine, Naval Medical Center, San
Diego, CA, United States.
(Fujinaka M.K.) School of Medicine, University of California San Diego, San
Diego, CA, United States.
(Keeney G.E.) Department of Pediatrics, University of California San Diego,
San Diego, CA, United States.
CORRESPONDENCE ADDRESS
S.D. Carstairs, Department of Emergency Medicine, Division of Medical
Toxicology, University of California San Diego, 11645 Thistle Hill Place,
San Diego, CA 92130-8678, United States.
SOURCE
Journal of Emergency Medicine (2011) 41:3 (e69-e71). Date of Publication:
September 2011
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: Cannabinoid-containing substances are commonly abused worldwide.
Significant toxicity from these substances is uncommon in adults but can
result in significant symptoms in children; these symptoms are usually
short-lived. Objectives: To report a case of prolonged mental status
alteration of more than 2 days in a child who ingested hashish. Case Report:
A 14-month-old child presented comatose to a pediatric emergency department
after ingestion of hashish; she did not regain consciousness for more than
48 h. Quantitative testing of the child's urine for a tetrahydrocannabinol
metabolite revealed a markedly elevated level, the decline of which
coincided with the child's clinical improvement. Conclusions: Significant
ingestion of cannabinoid- containing substances is capable of causing
prolonged symptoms (including coma) in children. © 2011 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cannabis
EMTREE DRUG INDEX TERMS
flumazenil (intravenous drug administration)
naloxone (intravenous drug administration)
tetrahydrocannabinol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
EMTREE MEDICAL INDEX TERMS
article
case report
child
child welfare
female
human
lethargy
mental health
muscle hypotonia
nystagmus
oxygen therapy
preschool child
priority journal
respiratory acidosis
urine
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
tetrahydrocannabinol (1972-08-3)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011512385
MEDLINE PMID
20634020 (http://www.ncbi.nlm.nih.gov/pubmed/20634020)
PUI
L50992541
DOI
10.1016/j.jemermed.2010.05.032
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2010.05.032
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 781
TITLE
Toxic leukoencephalopathy due to transdermal fentanyl overdose
AUTHOR NAMES
Foy L.
Seeyave D.M.
Bradin S.A.
AUTHOR ADDRESSES
(Foy L.) Department of Pediatrics and Communicable Diseases, Department of
Emergency Medicine, University of Michigan, Ann Arbor, MI, United States.
(Seeyave D.M., desirees@med.umich.edu; Bradin S.A.) Children's Emergency
Services, Department of Emergency Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109-5303, United States.
CORRESPONDENCE ADDRESS
D.M. Seeyave, Children's Emergency Services, Department of Emergency
Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109-5303, United States. Email: desirees@med.umich.edu
SOURCE
Pediatric Emergency Care (2011) 27:9 (854-856). Date of Publication:
September 2011
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Children with altered mental status who present to the emergency department
have a broad differential diagnosis. We report a case of a 19-month-old girl
who presented in coma and who was later found to have a fentanyl patch
adhered to her back. She was found to have changes on brain magnetic
resonance imaging consistent with a toxic spongiform leukoencephalopathy but
had a good neurologic outcome. This case report illustrates the importance
of a thorough physical examination in children in coma and a rarely reported
magnetic resonance imaging finding that has been seen in opioid intoxication
and is usually associated with severe morbidity and mortality. Copyright ©
2011 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, drug combination, intradermal drug
administration, transdermal drug administration)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
vecuronium (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
leukoencephalopathy (side effect, side effect)
toxic leukoencephalopathy (side effect, side effect)
EMTREE MEDICAL INDEX TERMS
apnea (drug therapy)
article
breathing rate
case report
cerebrospinal fluid analysis
child
drug overdose
female
human
lumbar puncture
muscle relaxation
nuclear magnetic resonance imaging
preschool child
sedation
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011527633
MEDLINE PMID
21926884 (http://www.ncbi.nlm.nih.gov/pubmed/21926884)
PUI
L362597762
DOI
10.1097/PEC.0b013e31822c281f
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e31822c281f
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 782
TITLE
Ask the Experts: What do we know (and not know) about prescription opioid
misuse in the context of chronic pain management?
AUTHOR NAMES
Zacny J.
AUTHOR ADDRESSES
(Zacny J., jzacny@dacc.uchicago.edu) Department of Anesthesia and Critical
Care, University of Chicago, MC 4028, 5841 S Maryland Avenue, Chicago, IL
60637, United States.
CORRESPONDENCE ADDRESS
J. Zacny, Department of Anesthesia and Critical Care, University of Chicago,
MC 4028, 5841 S Maryland Avenue, Chicago, IL 60637, United States. Email:
jzacny@dacc.uchicago.edu
SOURCE
Pain Management (2011) 1:5 (395-398). Date of Publication: September 2011
ISSN
1758-1869
1758-1877 (electronic)
BOOK PUBLISHER
Future Medicine Ltd., 2nd Albert Place, Finchley Central, London, United
Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration)
EMTREE DRUG INDEX TERMS
barbituric acid derivative
benzodiazepine
hydrocodone
morphine (adverse drug reaction, subcutaneous drug administration)
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
analgesia
behavior disorder
drug misuse
drug research
dysphoria (side effect)
emergency ward
human
nausea (side effect)
note
nuclear magnetic resonance imaging
physician
prescription
priority journal
substance abuse
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012159702
PUI
L364450645
DOI
10.2217/pmt.11.40
FULL TEXT LINK
http://dx.doi.org/10.2217/pmt.11.40
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 783
TITLE
New Trends in Resuscitation
AUTHOR NAMES
Alam H.B.
Velmahos G.C.
AUTHOR ADDRESSES
(Alam H.B.) Harvard Medical School, Division of Trauma, Massachusetts,
United States.
(Alam H.B.; Velmahos G.C.) Emergency Surgery and Surgical Critical Care,
General Hospital, Boston, MA, United States.
(Velmahos G.C.) John F. Burke Professor of Surgery, Harvard Medical School,
Division of Trauma, Massachusetts, United States.
CORRESPONDENCE ADDRESS
H.B. Alam, Harvard Medical School, Division of Trauma, Massachusetts, United
States.
SOURCE
Current Problems in Surgery (2011) 48:8 (531-564). Date of Publication:
August 2011
ISSN
0011-3840
1535-6337 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
diaspirin crosslinked hemoglobin
dopamine (adverse drug reaction, drug therapy)
epinephrine (adverse drug reaction, drug therapy)
fresh frozen plasma
histone deacetylase inhibitor (drug therapy)
hypertensive agent (drug therapy)
hypertensive factor
naloxone (drug therapy)
noradrenalin (adverse drug reaction, clinical trial, drug comparison, drug
therapy)
phenylephrine (adverse drug reaction, drug therapy)
polymerized hemoglobin
recombinant blood clotting factor 7a (drug therapy)
thrombocyte concentrate
vasopressin (adverse drug reaction, clinical trial, drug comparison, drug
therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hemorrhagic shock (drug therapy, drug therapy, therapy)
resuscitation
EMTREE MEDICAL INDEX TERMS
adult respiratory distress syndrome (complication)
anemia (complication)
article
blood transfusion
bloodstream infection (complication)
brain hemorrhage (drug therapy)
cell damage
compartment syndrome (complication)
crystalloid
electrolyte disturbance (complication)
emergency treatment
erythrocyte concentrate
fluid resuscitation
heart rate
heart stroke volume
hemophilia (drug therapy)
human
hyperlactatemia (side effect)
hypotension (drug therapy)
hypovolemic shock (therapy)
intermethod comparison
lung edema (complication)
multiple organ failure (complication)
nonhuman
oxygen consumption
patient selection
pneumonia (complication)
sepsis (complication)
septic shock (drug therapy)
side effect (side effect)
splanchnic blood flow
substitution therapy
systemic inflammatory response syndrome (complication)
tachycardia (side effect)
thrombocytopenia (complication)
traumatic brain injury (drug therapy)
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
dopamine (51-61-6, 62-31-7)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
polymerized hemoglobin (197252-65-6)
recombinant blood clotting factor 7a (897936-89-9, 944130-77-2)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011353325
MEDLINE PMID
21718901 (http://www.ncbi.nlm.nih.gov/pubmed/21718901)
PUI
L362032045
DOI
10.1067/j.cpsurg.2011.04.002
FULL TEXT LINK
http://dx.doi.org/10.1067/j.cpsurg.2011.04.002
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 784
TITLE
Pulmonary hemorrhage: A rare complication of opioid overdose
AUTHOR NAMES
Porter R.
O'Reilly H.
AUTHOR ADDRESSES
(Porter R., rporter@mun.ca; O'Reilly H.) Discipline of Pediatrics, Faculty
of Medicine, Memorial University of Newfoundland, Labrador, NL, Canada.
CORRESPONDENCE ADDRESS
R. Porter, Department, Janeway Children's Health and Rehabilitation Centre,
Health Sciences Centre, 300 Prince Philip Dr, St John's, NL, A1B 3V6,
Canada. Email: rporter@mun.ca
SOURCE
Pediatric Emergency Care (2011) 27:8 (742-744). Date of Publication: August
2011
ISSN
0749-5161
1535-1815 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Children and adolescents with pulmonary hemorrhage are infrequently
encountered in the emergency department (ED). We describe a case of a 16
year-old boy who presented to a pediatric ED with pulmonary hemorrhage and
respiratory distress. The patient's unusual initial presentation resulted in
the consideration of a broad differential diagnosis for his symptoms,
including traumatic, neurological, respiratory, and toxicological causes.
After resuscitation in the ED, a prolonged admission, and extensive testing,
no cause could be found other than severe opioid toxicity. This case
illustrates a rare, life-threatening presentation of opiod toxicity in a
healthy adolescent and underlines the potentially serious nature of such
exposures. © 2011 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity, intravenous drug administration)
EMTREE DRUG INDEX TERMS
cannabinoid (drug toxicity)
clonidine (drug therapy)
ipratropium bromide (drug therapy)
morphine (drug therapy, oral drug administration)
morphine sulfate (drug toxicity)
naloxone (intravenous drug administration)
phenylephrine (drug therapy, intravenous drug administration)
salbutamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, diagnosis, drug therapy)
drug overdose
lung hemorrhage (complication, diagnosis)
opioid intoxication (drug therapy, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
article
asthmatic state (drug therapy)
bronchoscopy
case report
differential diagnosis
disease severity
drug blood level
drug dose reduction
endotracheal intubation
epistaxis
human
hypotension (drug therapy)
intensive care
male
pneumomediastinum
pneumothorax
respiratory distress
resuscitation
sedation
thorax radiography
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
ipratropium bromide (22254-24-6)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011455660
MEDLINE PMID
21822085 (http://www.ncbi.nlm.nih.gov/pubmed/21822085)
PUI
L362355996
DOI
10.1097/PEC.0b013e318226df00
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e318226df00
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 785
TITLE
No deaths associated with patient refusal of transport after
naloxone-reversed opioid overdose.
AUTHOR NAMES
Wampler D.A.
Molina D.K.
McManus J.
Laws P.
Manifold C.A.
AUTHOR ADDRESSES
(Wampler D.A.) Department of Emergency Health Sciences, University of Texas
Health Science Center San Antonio, San Antonio, Texas 78229, USA.
(Molina D.K.; McManus J.; Laws P.; Manifold C.A.)
CORRESPONDENCE ADDRESS
D.A. Wampler, Department of Emergency Health Sciences, University of Texas
Health Science Center San Antonio, San Antonio, Texas 78229, USA. Email:
wamplerd@uthscsa.edu
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2011)
15:3 (320-324). Date of Publication: 2011 Jul-Sep
ISSN
1545-0066 (electronic)
ABSTRACT
Naloxone is widely used in the treatment and reversal of opioid overdose.
Most emergency medical services (EMS) systems administer naloxone by
standing order, and titrate only to reverse respiratory depression without
fully reversing sedation. Some EMS systems routinely administer sufficient
naloxone to fully reverse the effects of opioid overdose. Frequently
patients refuse further medical evaluation or intervention, including
transport. The purpose of this study was to evaluate the safety of this
practice and determine whether increased mortality is associated with full
reversal of opioids. As a component of a comprehensive quality assurance
initiative, we assessed mortality during the 48 hours after patients
received naloxone to reverse opioid overdose followed by patient-initiated
refusal of transportation. The setting was a large urban fire-based EMS
system. Investigators provided the Bexar County Medical Examiner's Office
(MEO) with a list of patients who were treated by the San Antonio Fire
Department with naloxone, and not transported. Inclusion criteria were
administration of naloxone and patient-initiated refusal. Patient
dispositions also included aid only, referral to the MEO, or referral to law
enforcement. The list was then compared with the MEO database. A chart
review was completed on all patients treated and subsequently presented to
the MEO within two days. A secondary time period of 30 days was also
assessed. The list identified 592 patients treated with naloxone and not
transported to the emergency department. Five-hundred fifty-two patients
received naloxone and refused transport or were not transported. The
remaining 40 patients all presented to EMS in cardiac arrest, naloxone was
administered during the course of resuscitation, and subsequent efforts were
terminated in the field. None of the patients receiving naloxone with a
subsequent patient-initiated refusal were examined at the MEO within the
two-day end point. The 30-day assessment revealed that nine individuals were
treated with naloxone and subsequently died, but the shortest time interval
between date of service and date of death was four days. The primary outcome
was that no patients who were treated with naloxone for opioid overdose and
then refused care were examined by the MEO within a 48-hour time frame.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
patient transport
treatment refusal
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
emergency health service
factual database
female
human
intoxication (drug therapy)
male
middle aged
psychological aspect
retrospective study
risk
risk assessment
statistics
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
21612385 (http://www.ncbi.nlm.nih.gov/pubmed/21612385)
PUI
L362650311
DOI
10.3109/10903127.2011.569854
FULL TEXT LINK
http://dx.doi.org/10.3109/10903127.2011.569854
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 786
TITLE
Nausea, fever, and weight loss
AUTHOR NAMES
Ferrara M.
Bernheisel C.
AUTHOR ADDRESSES
(Ferrara M.; Bernheisel C., bernheiseljfp@me.com) Family Medicine Inpatient
Service, Christ Hospital, University of Cincinnati Family Medicine
Residency, United States.
CORRESPONDENCE ADDRESS
M. Ferrara, Family Medicine Inpatient Service, Christ Hospital, University
of Cincinnati Family Medicine Residency, United States.
SOURCE
Journal of Family Practice (2011) 60:7 (E1-E3). Date of Publication: July
2011
ISSN
0094-3509
1533-7294 (electronic)
BOOK PUBLISHER
Dowden Health Media,Inc, 110 Summit Avenue, Montvale, United States.
EMTREE DRUG INDEX TERMS
buprenorphine (intravenous drug administration)
buprenorphine plus naloxone
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
body weight loss
fever
mononucleosis (diagnosis)
nausea
EMTREE MEDICAL INDEX TERMS
adult
anorexia
article
bacterial endocarditis
case report
echocardiography
emergency ward
fatigue
heart surgery
human
male
valvuloplasty
DRUG TRADE NAMES
suboxone
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Hematology (25)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2012088465
PUI
L364239530
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 787
TITLE
Respiratory arrest due to airway obstruction following endoscopic removal of
trichobezoar
AUTHOR NAMES
Esmaili M.R.H.
Abbasi H.R.
Baradaranfar M.H.
AUTHOR ADDRESSES
(Esmaili M.R.H.) Anesthesiology Department, Yazd, Iran.
(Abbasi H.R.) Otolaryngology Department, Yazd, Iran.
(Baradaranfar M.H.) Shahid Sadoughi University of Medical Science and Health
Services, Yazd, Iran.
CORRESPONDENCE ADDRESS
M. R. H. Esmaili, Anesthesiology Department, Yazd, Iran.
SOURCE
Journal of the Pakistan Medical Association (2011) 61:7 (700-701). Date of
Publication: July 2011
ISSN
0030-9982
BOOK PUBLISHER
Pakistan Medical Association, Garden Road, Karachi - 3, Pakistan.
ABSTRACT
A trichobezoar is a ball of swallowed hair that collects in the stomach and
fails to pass through the intestines. Upper gastrointestinal endoscopy is
usually useful for diagnosis and retrieval of a portion of the gastric
Trichobezoars but can have complications. Upper airway obstruction may occur
during removal of bezoar. This complication may be life threatening. We
report the case of a 17-year-old girl who presented with severe anaemia and
hypoproteinaemia. During diagnostic upper GI endoscopy, a large piece of
hairball compressed the upper airway, leading to cyanosis, respiratory
arrest and cardiovascular collapse. The patient was immediately intubated
and transferred to the operation room for emergency esophagoscopy. In the
operation room, after haemodynamic stabilization the otolaryngologist
removed the large piece by esophagoscope. Then the patient was transferred
to ICU ward with spontaneous ventilCase reportation. The day after, she
became stable and conscious.
EMTREE DRUG INDEX TERMS
anesthetic agent
atracorium
atropine
flumazenil (drug combination, intravenous drug administration)
hemoglobin (endogenous compound)
midazolam (intravenous drug administration)
naloxone (drug combination, intravenous drug administration)
neostigmine
opiate antagonist
oxygen
pethidine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
airway obstruction (complication, therapy)
endoscopic surgery
respiratory arrest (complication, therapy)
trichobezoar (diagnosis, surgery)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adolescent
anemia
anesthesiological procedure
article
artificial ventilation
blood pressure
case report
compression therapy
cyanosis (complication)
emergency care
esophagoscopy
female
gastroscopy
hemodynamics
human
hyperventilation (therapy)
hypoproteinemia
intensive care unit
multiple cycle treatment
oxygen saturation
postoperative period
pulse oximetry
pulse rate
respiratory tract intubation
surgical technique
vomiting
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
flumazenil (78755-81-4)
hemoglobin (9008-02-0)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
oxygen (7782-44-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011357093
MEDLINE PMID
22204251 (http://www.ncbi.nlm.nih.gov/pubmed/22204251)
PUI
L362040882
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 788
TITLE
Poison exposure in the emergency department: A Singaporean experience
AUTHOR NAMES
Chiu L.Q.
Lim B.L.
Vasu A.
Phua D.H.
Goh H.K.
AUTHOR ADDRESSES
(Chiu L.Q., chiuliqi@gmail.com) National University Hospital, Department of
Emergency Medicine, 5 Lower Kent Ridge Road, Singapore.
(Lim B.L.; Vasu A.; Phua D.H.; Goh H.K.) Tan Tock Seng Hospital, Department
of Emergency Medicine, 11 Jalan Tan Tock Seng, Singapore.
CORRESPONDENCE ADDRESS
L. Chiu, National University Hospital, Department of Emergency Medicine, 5
Lower Kent Ridge Road, Singapore. Email: chiuliqi@gmail.com
SOURCE
Hong Kong Journal of Emergency Medicine (2011) 18:4 (197-203). Date of
Publication: July, 2011
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, 18 Cheung Lee Street, Chaiwan, Hong Kong.
ABSTRACT
Introduction: Poison exposure is a significant problem in emergency
departments (EDs) with high admission rates. Our study aims were to describe
the demographics, exposure patterns and clinical outcomes of our ED patients
as well as to explore predictors of Intensive Care Unit (ICU) / High
Dependency (HD) admission. Methods: In this retrospective study, we
recruited patients aged over 16 years who presented with poison exposure to
our ED over one year. We collected demographical and clinical data using our
hospital databases. Primary outcomes were mortality rate and disposition
status. Secondary outcomes were predictors for ICU/HD admission. Logistic
regression was applied to identify these predictors. Results: We recruited
615 patients from an ED attendance of 162,159. Four hundred and nineteen
(68%) patients were females; the majority [410 (66.7%)] was Chinese. The
median age was 33 years [interquartile range (IQR): 24-44]. Four hundred
fifty-six (74.1%) and 159 (25.9%) exposures were intentional or accidental
respectively. There were no mortalities. The majority [466 (75.8%)] was
admitted to the general ward and only 24 (3.9%) cases were ICU/HD
admissions. We identified four factors associated with ICU/HD admission.
Odds ratios (95% confidence intervals) for hypotension (systolic blood
pressure <90 mmHg), pupillary changes, previous psychiatric history and
tricyclic antidepressant overdose were 19.7 (5.57-69.65), 31.9
(7.01-145.76), 3.1 (1.08-9.07) and 30.1 (9.40-96.52) respectively.
Conclusions: Poison exposure is an infrequent ED occurrence with high
admission rates but low mortality. Our study identified risk factors for
ICU/HD admission that could be used in future studies to triage at-risk
patients for treatment escalation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
poison
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy, intravenous drug administration)
activated carbon (drug therapy)
bicarbonate (drug therapy, intravenous drug administration)
biodiesel (drug toxicity)
flumazenil (drug therapy, intravenous drug administration)
insecticide (drug toxicity)
naloxone (drug therapy, intravenous drug administration)
organophosphate insecticide (drug toxicity)
pralidoxime (drug therapy, intravenous drug administration)
serotonin uptake inhibitor (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adolescent
adult
agitation
article
Chinese
clinical feature
demography
diesel engine
disorientation
drowsiness
emergency health service
emergency ward
environmental exposure
female
Glasgow coma scale
hospital admission
human
hyperventilation
hypoglycemia
hypotension
major clinical study
male
medical history
mortality
nausea and vomiting
nerve block
outcome assessment
retrospective study
risk assessment
risk factor
Singapore
sinus bradycardia
sinus tachycardia
stomach lavage
systolic blood pressure
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
pralidoxime (6735-59-7)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2011422369
PUI
L362255022
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 789
TITLE
A qualitative evaluation of a peer-implemented overdose response pilot
project in Gejiu, China
AUTHOR NAMES
Bartlett N.
Xin D.
Zhang H.
Huang B.
AUTHOR ADDRESSES
(Bartlett N., Nicholas.bartlett@ucsf.edu) University of California,
Department of Anthropology, History and Social Medicine, San Francisco,
United States.
(Xin D.; Zhang H.) Huyangshu (Poplar Tree) Self-Help Group, China.
(Huang B.) Gejiu City Infectious Disease Hospital, China.
CORRESPONDENCE ADDRESS
N. Bartlett, University of California, Department of Anthropology, History
and Social Medicine, San Francisco, United States. Email:
Nicholas.bartlett@ucsf.edu
SOURCE
International Journal of Drug Policy (2011) 22:4 (301-305). Date of
Publication: July 2011
ISSN
0955-3959
1873-4758 (electronic)
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Background: A harm reduction NGO in southern Yunnan operating an emergency
overdose response hotline service successfully reversed 76 overdoses through
the administration of naloxone in one of the first interventions of its kind
in China. Method: To explore local understandings of risk factors related to
overdose, assess ongoing barriers to overdose response, and solicit client
input on how to further reduce opiate overdose mortality in Gejiu, the
authors conducted qualitative interviews with 30 clients, including 15
individuals who received naloxone injections to reverse an overdose and 15
individuals who called the hotline in response to the overdose of a peer.
Results: Participants pointed to a number of local structural shifts in
heroin use including the ageing of the opiate using population and drug
mixing practises that contribute to the city's overdose toll. Concerns over
medical professionals' willingness to treat drug users, protection of
confidentiality, and financial costs associated with treatment frequently
cause drug users to avoid contact with the city's emergency service
providers. Participants suggest directly distributing naloxone to clients as
one strategy to further reduce overdose mortality. Conclusion: The authors
explore possible strategies, including targeted trainings and new
partnerships with local hospitals, to further reduce opiate overdose
mortality in this resource-poor setting. © 2011 Elsevier B.V.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
harm reduction
health program
heroin dependence (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
China
clinical article
clinical evaluation
controlled study
drug misuse
drug overdose
female
human
male
mortality
peer group
priority journal
professional secrecy
qualitative analysis
risk factor
risk reduction
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011381623
MEDLINE PMID
21658931 (http://www.ncbi.nlm.nih.gov/pubmed/21658931)
PUI
L51463888
DOI
10.1016/j.drugpo.2011.04.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2011.04.005
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 790
TITLE
Diabetes in the emergency department: Acute care of diabetes patients
AUTHOR NAMES
McNaughton C.D.
Self W.H.
Slovis C.
AUTHOR ADDRESSES
(McNaughton C.D.; Self W.H.) A clinical instructor in Emergency Medicine,
United States.
(Slovis C.) Department of Emergency Medicine at Vanderbilt University in
Nashville, Tenn, United States.
CORRESPONDENCE ADDRESS
C. D. McNaughton, A clinical instructor in Emergency Medicine, United
States.
SOURCE
Clinical Diabetes (2011) 29:2 (51-59). Date of Publication: 2011
ISSN
0891-8929
BOOK PUBLISHER
American Diabetes Association Inc., 1701 North Beauregard St., Alexandria,
United States.
EMTREE DRUG INDEX TERMS
alpha glucosidase inhibitor (pharmacokinetics)
benzodiazepine (drug therapy)
biguanide (pharmacokinetics)
etiracetam (drug therapy)
glucagon (drug therapy, intramuscular drug administration)
glucose (drug therapy, intravenous drug administration)
insulin (drug therapy)
meglitinide (adverse drug reaction, pharmacokinetics)
metformin (adverse drug reaction, drug therapy)
naloxone (drug therapy)
phenobarbital (drug therapy)
phosphate (endogenous compound)
potassium (endogenous compound)
sodium chloride
sulfonylurea (adverse drug reaction, pharmacokinetics)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diabetes mellitus (drug therapy, drug therapy, therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
article
continuous infusion
dehydration
diabetic ketoacidosis (complication, etiology)
diabetic patient
diarrhea (side effect)
drug dose increase
drug megadose
drug overdose (drug therapy)
electrocardiogram
electrolyte intake
emergency health service
fluid therapy
glucose blood level
hemodynamic monitoring
hospital discharge
human
hyperglycemia
hyperkalemia (complication)
hypoglycemia (drug therapy, side effect)
hypokalemia (complication)
hypophosphatemia (complication)
insulin treatment
ketonuria
lactic acidosis (side effect)
loading drug dose
mental health
metabolic acidosis
nausea (side effect)
nonketotic diabetic coma (complication, etiology)
oxygen supply
phosphate blood level
polydipsia
polyuria
potassium blood level
recommended drug dose
seizure (complication, drug therapy)
vomiting (side effect)
Wernicke encephalopathy (drug therapy)
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
biguanide (56-03-1)
etiracetam (102767-28-2, 33996-58-6)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
meglitinide (54870-28-9)
metformin (1115-70-4, 657-24-9)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phosphate (14066-19-4, 14265-44-2)
potassium (7440-09-7)
sodium chloride (7647-14-5)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011322155
PUI
L361932045
DOI
10.2337/diaclin.29.2.51
FULL TEXT LINK
http://dx.doi.org/10.2337/diaclin.29.2.51
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 791
TITLE
Reversal of hepatic and renal failure from sickle cell intrahepatic
cholestasis
AUTHOR NAMES
Khan M.A.
Kerner J.A.
AUTHOR ADDRESSES
(Khan M.A., makhan7@stanford.edu; Kerner J.A.) Division of Pediatric
Gastroenterology, Hepatology, and Nutrition, Stanford University Medical
Center, Stanford, CA, United States.
CORRESPONDENCE ADDRESS
M. A. Khan, Division of Pediatric Gastroenterology, Hepatology, and
Nutrition, Stanford University Medical Center, Stanford, CA, United States.
Email: makhan7@stanford.edu
SOURCE
Digestive Diseases and Sciences (2011) 56:6 (1634-1636). Date of
Publication: June 2011
ISSN
0163-2116
1573-2568 (electronic)
BOOK PUBLISHER
Springer New York, 233 Springer Street, New York, United States.
EMTREE DRUG INDEX TERMS
aminotransferase (endogenous compound)
creatinine (endogenous compound)
fentanyl
folic acid
hemoglobin S (endogenous compound)
hydrocodone
hydroxyurea
naloxone
oral contraceptive agent
paracetamol
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intrahepatic cholestasis
kidney failure (therapy)
liver failure
sickle cell anemia (therapy)
EMTREE MEDICAL INDEX TERMS
acute brain disease
acute chest syndrome
adult
African American
aminotransferase blood level
analgesia
anemia
anuria
article
artificial ventilation
blood clotting disorder
blood transfusion
case report
cholelithiasis
common bile duct
continuous hemodialysis
creatinine blood level
echography
emergency ward
exchange blood transfusion
female
gallstone
hemodialysis
hepatic portal vein
human
hyperammonemia
hyperbilirubinemia
hyperkalemia (therapy)
intensive care unit
kidney function
leg pain
lethargy
leukocytosis
liver blood vessel
liver function
low back pain
priority journal
respiratory tract intubation
slurred speech
thrombocytopenia
upper abdominal pain
uremia
CAS REGISTRY NUMBERS
aminotransferase (9031-66-7)
creatinine (19230-81-0, 60-27-5)
fentanyl (437-38-7)
folic acid (59-30-3, 6484-89-5)
hemoglobin S (9035-22-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydroxyurea (127-07-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Hematology (25)
Urology and Nephrology (28)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011354910
MEDLINE PMID
21267779 (http://www.ncbi.nlm.nih.gov/pubmed/21267779)
PUI
L51248139
DOI
10.1007/s10620-011-1574-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s10620-011-1574-5
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 792
TITLE
Predictors of pain relief and adverse events in patients receiving opioids
in a prehospital setting
AUTHOR NAMES
Bounes V.
Barniol C.
Minville V.
Houze-Cerfon C.-H.
Ducassé J.L.
AUTHOR ADDRESSES
(Bounes V., bounes.v@chu-toulouse.fr; Houze-Cerfon C.-H.; Ducassé J.L.) SAMU
31, Pôle de Médecine d'Urgences, Hôpitaux Universitaires, 31059 Toulouse
Cedex 9, France.
(Barniol C.) Emergency Department, Pôle de Médecine d'Urgences, Hôpitaux
Universitaires, 31059 Toulouse Cedex 9, France.
(Minville V.) Department of Anesthesiology and Intensive Care, Hôpitaux
Universitaires, 31059 Toulouse Cedex 9, France.
CORRESPONDENCE ADDRESS
V. Bounes, SAMU 31, Pôle de Médecine d'Urgences, Hôpitaux Universitaires,
31059 Toulouse Cedex 9, France. Email: bounes.v@chu-toulouse.fr
SOURCE
American Journal of Emergency Medicine (2011) 29:5 (512-517). Date of
Publication: June 2011
ISSN
0735-6757
1532-8171 (electronic)
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Objective: The aim of the study was to analyze factors predicting pain
relief and adverse events in patients receiving opioids for acute pain in a
prehospital setting. Methods: In this prospective, observational clinical
study, adult patients with a numerical rating scale (NRS) score of 5 of 10
or higher who required treatment with intravenous opioids for pain control
were included. The primary outcome variable was final analgesia defined by
an NRS score of 3 of 10 or lower upon arrival to the emergency department.
Univariable and multivariable analyses were performed to identify predictive
factors of pain relief and adverse effects. Results: In total, 277 patients
(age, 49 ± 22 years), 205 (74%) of whom were male and 154 (56%) with a
traumatic pain were included in the analysis. Median (interquartile range)
NRS scores at baseline and at discharge were 8 of 10 (7-10) and 3 of 10
(2-5), respectively. The final model had 3 independent variables reaching
significance. Physician-staffed ambulance transportation (odds ratio [OR],
2.42; 95% confidence interval [CI], 1.07-5.49) was the only independent
predictor of patients' final pain relief. High initial pain scores and
acetaminophen use were predictive factors for failure of analgesia (OR,
0.79; 95% CI, 0.68-0.93 for one unit/10; P < .01; and OR, 0.40; 95% CI,
0.21-0.77; P < .01, respectively). In the entire sample, 25 (9.0%) presented
one adverse effect, all mild to moderate in severity, with no significant
predictive factors. Conclusion: Despite advancement in prehospital pain
management, pain relief at discharge is still inadequate in some patients.
Finally, one important message of our study is that patients in pain have to
be transported by well-equipped and staffed ambulances to reevaluate and
alleviate pain. © 2011 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
ketoprofen
morphine (drug comparison, drug therapy)
paracetamol
sufentanil (drug comparison, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
article
controlled study
dizziness (side effect)
drowsiness (side effect)
emergency care
emergency ward
female
health care facility
human
major clinical study
male
multivariate analysis
nausea (side effect)
nausea and vomiting (side effect)
observational study
prediction
priority journal
prospective study
pruritus (side effect)
rating scale
univariate analysis
vomiting (side effect)
CAS REGISTRY NUMBERS
ketoprofen (22071-15-4, 57495-14-4)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011309478
MEDLINE PMID
20825821 (http://www.ncbi.nlm.nih.gov/pubmed/20825821)
PUI
L361892638
DOI
10.1016/j.ajem.2009.12.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2009.12.005
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 793
TITLE
Studying adverse events related to prescription opioids: The Utah experience
AUTHOR NAMES
Porucznik C.A.
Johnson E.M.
Sauer B.
Crook J.
Rolfs R.T.
AUTHOR ADDRESSES
(Porucznik C.A., christy.porucznik@utah.edu) Division of Public Health,
Department of Family and Preventive Medicine, University of Utah, Salt Lake
City, UT, United States.
(Johnson E.M.; Crook J.; Rolfs R.T.) Prescription Pain Medication Program,
Utah Department of Health, Salt Lake City, UT, United States.
(Sauer B.) IDEAS Center, George E. Wahlen Department of Veterans Affairs
Medical Center, Salt Lake City, UT, United States.
CORRESPONDENCE ADDRESS
C.A. Porucznik, Division of Public Health, Department of Family and
Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake
City UT 84108, United States. Email: christy.porucznik@utah.edu
SOURCE
Pain Medicine (2011) 12:SUPPL. 2 (S16-S25). Date of Publication: June 2011
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Background. Epidemiologists at the Utah Department of Health (UDOH) began to
study prescription drug-related harm in 2004. We have analyzed several types
of data including vital statistics, medical examiner records, emergency
department diagnoses, and the state prescription registry to estimate the
scope and correlates of prescription drug-related harm. Objectives. To
describe data sets analyzed in Utah related to the problem of prescription
drug-related harm with the goal of designing interventions to reduce the
burden of adverse events and death. Results. Prescription drug-related harm
in Utah primarily involved opioids and can be examined with secondary
analysis of administrative databases, although each database has
limitations. Conclusions. More analyses, likely from cohort studies, are
needed to identify risky prescribing patterns and individual-level risk
factors for opioid-related harm. Combining data sets via linkage procedures
can generate individual-level drug exposure and outcome histories, which may
be useful to simulate a prospective cohort. Wiley Periodicals, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate derivative (drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
dextropropoxyphene (drug therapy)
hydrocodone (drug therapy)
hydromorphone (drug therapy)
methadone (drug therapy)
morphine (drug therapy)
oxycodone (drug therapy)
pethidine (drug therapy)
prescription drug
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug fatality (epidemiology)
drug overdose (epidemiology)
EMTREE MEDICAL INDEX TERMS
article
chronic pain (drug therapy)
data analysis
death certificate
emergency ward
human
pain (drug therapy)
prescription
United States
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011329892
MEDLINE PMID
21668753 (http://www.ncbi.nlm.nih.gov/pubmed/21668753)
PUI
L361954516
DOI
10.1111/j.1526-4637.2011.01133.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1526-4637.2011.01133.x
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 794
TITLE
Provision of opioid substitution therapy services in Australian pharmacies
AUTHOR NAMES
Chaar B.B.
Hanrahan Jr.
Day C.
AUTHOR ADDRESSES
(Chaar B.B., betty.chaar@sydney.edu.au; Hanrahan Jr.; Day C.) The University
of Sydney, Faculty of Pharmacy, Australia.
(Day C.) Drug Health Service, Discipline of Addiction Medicine, Central
Clinical School, Royal Prince Alfred Hospital, Sydney, Australia.
CORRESPONDENCE ADDRESS
B. B. Chaar, Bldg A15-Faculty of Pharmacy, The University of Sydney-NSW,
Australia. Email: betty.chaar@sydney.edu.au
SOURCE
Australasian Medical Journal (2011) 4:4 (210-216). Date of Publication: 2011
ISSN
1836-1935 (electronic)
BOOK PUBLISHER
Australasian Medical Journal, P.O. Box 99, Floreat, Perth, Australia.
ABSTRACT
Opioid dependence, despite being the subject of significant public funding,
remains a costly burden to Australian society in human and economic terms.
The most cost-effective public health strategy for managing opioid
dependence is opioid substitution therapy (OST), primarily through the use
of methadone or buprenorphine. Supervised dispensing of OST from specialist
clinics and community pharmacies plays a crucial role in enhancing
compliance, monitoring treatment and reducing diversion. Australia, compared
with other countries in the world, ranks very high in illicit opioid use;
hence there is a great demand for OST. The utilisation of community
pharmacies for stable patients has many advantages. For public clinics,
patient transfer to community pharmacies relieves workload and costs, and
increases capacity for new OST patients. From a patient's perspective,
dosing at a pharmacy is more flexible and generally more preferable.
Pharmacists stand to gain clientele, profit and receive small incentives
from state governments in Australia, for their services. Yet, many "unmet
needs" exist and there is a high demand for more involvement in OST service
provision in community pharmacy in Australia. In the UK there has been a
steady increase in community pharmacy provision of OST, and pharmacists
appear ready to provide further healthcare services to these patients. The
role of pharmacy in some countries in Europe, such as Germany, is less
prominent due to their approach to harm minimisation and the complex,
variable nature of OST provision across the European Union (EU). The
provision of OST by pharmacists in the USA on the other hand is of lesser
frequency as the healthcare system in the USA encourages detoxification
clinics to handle cases of illicit drug addiction. At a time when harm
minimisation strategies constitute a topic of considerable political and
public interest, it is important to understand the scope and variability of
pharmacy involvement in drug policy in Australia. Hence, this review
highlights the role of pharmacists in OST and explores the scope for
expanding this role in the future.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy, pharmacoeconomics)
methadone (drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
diamorphine
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence treatment
opiate addiction (drug therapy, disease management, drug therapy)
opiate substitution treatment
substitution therapy
EMTREE MEDICAL INDEX TERMS
accreditation
Australia
cost effectiveness analysis
drug cost
drug detoxification
drug misuse
emergency health service
European Union
government
health care access
health care policy
health care system
health care utilization
health program
heroin dependence
high risk population
human
patient monitoring
pharmacist
pharmacy
prevalence
review
United States
workload
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011249102
PUI
L361710875
DOI
10.4066/AMJ.2011.706
FULL TEXT LINK
http://dx.doi.org/10.4066/AMJ.2011.706
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 795
TITLE
Opioid prescribing - A matter of ethics
AUTHOR NAMES
Pakes B.N.
AUTHOR ADDRESSES
(Pakes B.N.)
CORRESPONDENCE ADDRESS
B. N. Pakes, North York, ON, Canada.
SOURCE
Canadian Family Physician (2011) 57:5 (531-532). Date of Publication: May
2011
ISSN
0008-350X
BOOK PUBLISHER
College of Family Physicians of Canada, 2630 Skymark Avenue, Mississauga
Ont., Canada.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
adverse outcome
emergency ward
emotion
family medicine
health care cost
human
letter
medical ethics
physician
wellbeing
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011275100
MEDLINE PMID
21571712 (http://www.ncbi.nlm.nih.gov/pubmed/21571712)
PUI
L361778847
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 796
TITLE
Gender rather than choice of intermediate duration opioids affects emergence
after craniotomy for large intracranial tumors
AUTHOR NAMES
Deogaonkar A.
Khin M.
Samuel S.
Ebrahim Z.Y.
Mascha E.J.
Schubert A.
AUTHOR ADDRESSES
(Deogaonkar A.; Khin M.; Samuel S.) Department of Regional Practice
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States.
(Ebrahim Z.Y.) Institute of Anesthesiology, Cleveland Clinic, Cleveland, OH,
United States.
(Mascha E.J.) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States.
(Schubert A., aschubert@ochsner.org) Cleveland Clinic Lerner College of
Medicine of Case Western Reserve University, Cleveland, OH, United States.
(Schubert A., aschubert@ochsner.org) Department of Anesthesiology, Ochsner
Clinic Foundation, New Orleans, LA, United States.
CORRESPONDENCE ADDRESS
A. Schubert, Department of Anesthesiology, Ochsner Clinic Foundation, 1514
Jefferson Highway, New Orleans, LA 70121, United States. Email:
aschubert@ochsner.org
SOURCE
Ochsner Journal (2011) 11:1 (22-28). Date of Publication: 2011
ISSN
1524-5012
BOOK PUBLISHER
Ochsner Clinic, 1514 Jefferson Highway, New Orleans, United States.
ABSTRACT
Background: Opioid-based anesthetic techniques are commonly used during
neurosurgical procedures. In the present randomized prospective study, we
studied emergence after 4 anesthetic regimens combining intermediate
duration opioids with isoflurane and nitrous oxide (N(2)O), in patients
undergoing craniotomy for large (> 30 mm diameter with intracranial mass
effect) intracranial tumors. Methods: One hundred seven patients were
randomized into 4 groups: Group A: fentanyl (≤ 5 μg/kg) + isoflurane (≤ 1
minimum alveolar concentration [MAC]), Group B: sufentanil (1-2 μg/kg plus
infusion) + isoflurane (≤ 0.5 MAC), Group C: sufentanil (2 mg/kg bolus only)
+ isoflurane (≤ 1 MAC), and Group D: alfentanil (100 μg/kg plus infusion) +
isoflurane (≤ 0.5 MAC). Boluses were administered as divided doses during
induction, laryngoscopy, head pinning, and incision. Blood pressure was
controlled at ±25% of baseline levels. All infusions were discontinued at
the start of dural closure. Emergence was assessed using a mini-neurologic
examination consisting of 7 questions. Groups were compared on time to
emergence using survival analysis methods. Results: The groups did not
differ regarding extubation time, which occurred at a median of 4 to 6
minutes across groups after discontinuing N(2)O. The median emergence time
ranged from 15 to 22.5 minutes and did not differ among groups. However,
across all groups more women had emerged by 30 minutes compared with men
(83% vs 57%, P =.002). The median emergence time in women was found to be
significantly shorter (0-15 minutes) than in men (15-30 minutes) (P =.012).
Conclusions: No between-group differences in emergence time were observed;
the study was stopped early because of evidence that no differences were
likely to be found if the study were continued. However, in a post hoc
analysis, female gender was associated with faster emergence. © Academic
Division of Ochsner Clinic Foundation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug combination)
EMTREE DRUG INDEX TERMS
alfentanil (clinical trial, drug combination)
fentanyl (clinical trial, drug combination)
isoflurane (drug combination)
nitrous oxide (drug combination)
sufentanil (clinical trial, drug combination)
thiopental (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia emergence
anesthetic recovery
intracranial tumor (surgery)
EMTREE MEDICAL INDEX TERMS
adult
anesthesia induction
arousal
article
bolus injection
continuous infusion
controlled study
craniotomy
female
human
major clinical study
male
minimum lung alveolus concentration
outcome assessment
prospective study
randomized controlled trial
sex difference
treatment duration
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
fentanyl (437-38-7)
isoflurane (26675-46-7)
nitrous oxide (10024-97-2)
sufentanil (56030-54-7)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011181411
PUI
L361537973
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 797
TITLE
Randomized Clinical Trial Comparing the Safety and Efficacy of a
Hydromorphone Titration Protocol to Usual Care in the Management of Adult
Emergency Department Patients With Acute Severe Pain
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K., achang@montefiore.org; Bijur P.E.; Gallagher E.J.) Department
of Emergency Medicine, Albert Einstein College of Medicine, Montefiore
Medical Center, Bronx, NY
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Br, . Email: achang@montefiore.org
SOURCE
Annals of Emergency Medicine (2011)
ISSN
0196-0644
1097-6760 (electronic)
ABSTRACT
Study objective: We test the efficacy and safety of the "1+1" (1 mg plus 1
mg 15 minutes later if needed) hydromorphone protocol against usual care of
emergency department (ED) patients with acute severe pain. Methods: This was
a prospective, randomized clinical trial of ED patients with acute severe
pain. The 1+1 protocol specifies administration of 1 mg intravenous
hydromorphone, followed by a second dose of 1 mg intravenous hydromorphone
15 minutes after the first bolus if the patient answers yes to the question,
"Do you want more pain medication?" Usual care is the administration of any
intravenous opioid, with type and dose chosen by the ED attending physician.
Usual care patients who wanted more medication at 15 minutes were treated at
the physician's discretion. At 60 minutes, all patients were asked again
whether they wanted more pain medication. The primary outcome was successful
treatment defined a priori as not wanting additional analgesia at either 15
or 60 minutes after the initial bolus. The primary endpoint was the
difference in the proportion of patients with successful treatment who
received the complete 1+1 protocol versus usual care with a per-protocol
analysis. An intention-to-treat analysis was also performed. A 10%
difference in rate of successful treatment was chosen a priori as a
clinically meaningful difference. Results: Of 167 patients in the 1+1 group,
156 received the full 1+1 protocol, whereas 171 received usual care. Of
patients who received the 1+1 protocol, 92.3% (144/156) had successful
treatment versus 76.6% (131/171) of usual care patients (difference=15.7%;
95% confidence interval 7.9% to 23.3%). In the intention-to-treat analysis,
86.8% (145/167) of patients randomized to the 1+1 group received successful
treatment versus 76.6% (131/171) of usual care patients (difference=10.2%;
95% confidence interval 2.0% to 18.3%). No patient required naloxone. One
patient in the 1+1 group and 2 patients in the usual care group had
transient oxygen saturation less than 95%. The incidence of all adverse
effects was similar in both groups. Conclusion: When analyzed per protocol
or with the more conservative intention-to-treat analysis, the 1+1
hydromorphone protocol is statistically and clinically more efficacious than
usual care. Safety profiles were similar in both groups. © 2010 American
College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone
EMTREE DRUG INDEX TERMS
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adult
clinical trial
emergency ward
pain
patient
safety
titrimetry
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
analgesia
college
confidence interval
drug therapy
emergency physician
intention to treat analysis
oxygen saturation
physician
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
PUI
L51390232
DOI
10.1016/j.annemergmed.2011.03.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2011.03.003
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 798
TITLE
Procedural sedation and analgesia in the emergency department
AUTHOR NAMES
Baker S.N.
Weant K.A.
AUTHOR ADDRESSES
(Baker S.N., stephnbaker@uky.edu; Weant K.A.) University of Kentucky
HealthCare, Lexington, KY, United States.
(Baker S.N., stephnbaker@uky.edu) Department of Pharmacy, University of
Kentucky HealthCare, 800 Rose Street, H109A, Lexington, KY 40536, United
States.
CORRESPONDENCE ADDRESS
S. N. Baker, Department of Pharmacy, University of Kentucky HealthCare, 800
Rose Street, H109A, Lexington, KY 40536, United States. Email:
stephnbaker@uky.edu
SOURCE
Journal of Pharmacy Practice (2011) 24:2 (189-195). Date of Publication:
April 2011
ISSN
0897-1900
1531-1937 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
Patients present to the emergency department (ED) for a variety of reasons
and some require diagnostic and therapeutic procedures for their conditions.
In order for some of these procedures to be carried out successfully, the
patient must be at a suppressed level of consciousness in order to tolerate
the associated pain and anxiety. Medications administered to achieve these
goals include analgesics and sedatives as they decrease the patient's
discomfort and awareness while allowing the patient to maintain their
airway. However, medication selection and dosing is critical and should be
tailored to each patient and procedure. Pharmacists have an opportunity to
reduce medication errors during procedural sedation and analgesia (PSAA) as
the majority of medication errors leading to adverse events occur during the
ordering and administration steps of the medication use process. Common
errors include drug-dosing, potential drug interactions, and administration
of the wrong pharmacologic agent. Pharmacists in the ED can provide drug
information and assist with drug selection and dosing; medication
preparation; and monitoring of the patient and of the time intervals since
medication administration relative to the duration of the procedure. Having
a pharmacist present provides an extra layer of protection and reduces the
likelihood for potential medication errors. © The Author(s) 2011.
EMTREE DRUG INDEX TERMS
atropine
benzodiazepine (drug combination)
diazepam
etomidate (adverse drug reaction, drug dose, pharmacology)
fentanyl (adverse drug reaction, drug combination, drug comparison, drug
dose, intravenous drug administration, pharmacokinetics, pharmacology)
flumazenil (adverse drug reaction, drug dose, intravenous drug
administration)
glycopyrronium
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison, intramuscular drug administration, intravenous drug
administration, pharmacology)
lorazepam
methohexital (adverse drug reaction, drug comparison, pharmacology)
midazolam (adverse drug reaction, drug combination, drug dose, intramuscular
drug administration, intranasal drug administration, intravenous drug
administration, oral drug administration, pharmacology)
morphine (adverse drug reaction, drug comparison, drug dose, intravenous
drug administration)
naloxone (adverse drug reaction)
propofol (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug dose, intravenous drug administration, pharmacology)
thiopental (adverse drug reaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesiological procedure
emergency ward
procedural sedation and analgesia
EMTREE MEDICAL INDEX TERMS
adrenal suppression
agitation
analgesic activity
anesthesia induction
anxiety
apnea (side effect)
article
blood gas parameters
blood pressure
bradycardia (side effect)
central nervous system depression
chest wall rigidity (side effect)
chest wall rigidity (side effect)
clinical assessment
coronary artery disease
delirium (side effect)
diaphoresis
drug dose titration
drug efficacy
drug hypersensitivity (side effect)
drug information
drug mechanism
drug overdose
drug potency
drug potentiation
drug safety
drug tolerability
drug underdose
drug withdrawal
dysarrhythmia (side effect)
dysarrhythmia (side effect)
egg
flushing
food allergy
geriatric patient
gold standard
heart function
hemodynamics
histamine release
hot flush (side effect)
human
hypotension (side effect)
hypoventilation (side effect)
hypoxemia (side effect)
injection site pain (side effect)
intracranial pressure
intraocular pressure
intubation
larynx spasm (side effect)
liver metabolism
lung edema (side effect)
medication error
myocardial depression (side effect)
myocardial depression (side effect)
myoclonus (side effect)
nausea (side effect)
oxygen desaturation (side effect)
oxygen desaturation (side effect)
pain (side effect)
paradoxical agitation (side effect)
paradoxical agitation (side effect)
patient monitoring
patient satisfaction
pediatrics
pharmacist
phlebitis (side effect)
randomized controlled trial (topic)
rapid sequence intubation
respiration depression (side effect)
risk assessment
risk reduction
salivation
seizure (side effect)
side effect (side effect)
soybean
sweating
tachycardia (side effect)
tranquilizing activity
treatment contraindication
tremor (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
glycopyrronium bromide (596-51-0)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011240434
MEDLINE PMID
21712213 (http://www.ncbi.nlm.nih.gov/pubmed/21712213)
PUI
L361690445
DOI
10.1177/0897190011400554
FULL TEXT LINK
http://dx.doi.org/10.1177/0897190011400554
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 799
TITLE
Clinical emergencies and outcomes in patients admitted to a surgical versus
medical service
AUTHOR NAMES
Sarani B.
Palilonis E.
Sonnad S.
Bergey M.
Sims C.
Pascual J.L.
Schweickert W.
AUTHOR ADDRESSES
(Sarani B., saranib@uphs.upenn.edu; Palilonis E.; Sonnad S.; Bergey M.; Sims
C.; Pascual J.L.) Department of Surgery, Division of Traumatology and
Surgical Critical Care, University of Pennsylvania, United States.
(Schweickert W.) Department of Medicine, Division of Pulmonary, Allergy and
Critical Care, University of Pennsylvania, United States.
CORRESPONDENCE ADDRESS
B. Sarani, 3400 Spruce Street, 5 Maloney, Philadelphia, PA 19104, United
States. Email: saranib@uphs.upenn.edu
SOURCE
Resuscitation (2011) 82:4 (415-418). Date of Publication: April 2011
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: The merit of rapid response systems (RRSs) remains
controversial. A tailored approach to specific groups may increase the
efficacy of these teams. The purpose of this study was to compare
differences in triggers for RRS activation, interventions, and outcomes in
patients on medical and surgical services. Methods: A retrospective review
RRS events was performed. The incidence of out of ICU cardiac arrests and
hospital mortality were compared 2 years prior to and following RRS
implementation. Call trigger, interventions, and disposition between medical
and surgical patients were compared over a 15 month period. Results: Out of
ICU cardiac arrest was significantly more prevalent in the medical group
both before and after implementation of RRS. The out of ICU cardiac arrest
rate decreased 32% in the surgical group (p= 0.05) but hospital mortality
did not change. Out of ICU cardiac arrest decreased 40% in the medical group
(p< 0.001) and hospital mortality decreased 25% (p< 0.001) following RRS
implementation. There were 1082 RRS activations, 286 surgical and 796
medical. Surgical patients were more likely to have received sedation within
24. h of evaluation (14% vs. 4%, p< 0.001). The majority of patients in both
cohorts were discharged alive. Conclusion: Implementation of a RRS had
greater impact on reduction of out of ICU cardiac arrest and mortality in
medical inpatients. Triggers for activation and interventions were similar
between groups; however, surgical patients demonstrated substantial risk for
decompensation within the first 24. h following operation. More research is
needed to evaluate the disproportionate benefit observed between cohorts. ©
2010 Elsevier Ireland Ltd.
EMTREE DRUG INDEX TERMS
antiarrhythmic agent
antibiotic agent
flumazenil
naloxone
vasoactive agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital patient
mortality
out of hospital cardiac arrest
rapid response team
surgical patient
EMTREE MEDICAL INDEX TERMS
article
assisted ventilation
clinical evaluation
controlled study
emergency care
hospital admission
hospital discharge
human
intensive care unit
intubation
priority journal
rescue personnel
resuscitation
retrospective study
sedation
treatment outcome
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011146973
MEDLINE PMID
21242020 (http://www.ncbi.nlm.nih.gov/pubmed/21242020)
PUI
L51232266
DOI
10.1016/j.resuscitation.2010.12.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2010.12.005
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 800
TITLE
The obesity-hypoventilation syndrome and respiratory failure in the acute
trauma patient
AUTHOR NAMES
Nelson J.A.
Loredo J.S.
Acosta J.A.
AUTHOR ADDRESSES
(Nelson J.A.) Mail Code 8676, Department of Emergency Medicine, University
of California San Diego Medical Center, San Diego, CA 92103, United States.
(Loredo J.S.) Department of Medicine, University of California San Diego,
San Diego, CA, United States.
(Acosta J.A.) Medical Corps, United States Navy, Naval Medical Center San
Diego, San Diego, CA, United States.
CORRESPONDENCE ADDRESS
J. A. Nelson, Mail Code 8676, Department of Emergency Medicine, University
of California San Diego Medical Center, San Diego, CA 92103, United States.
SOURCE
Journal of Emergency Medicine (2011) 40:4 (e67-e69). Date of Publication:
April 2011
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: The Emergency Department experience, for many patients, involves
procedures and therapies that can compromise ventilation. In the acute
trauma patient, these include spinal immobilization, supine positioning, and
the administration of sedative and analgesic medications. Patients with the
obesity-hypoventilation syndrome have a syndrome distinct from mere obesity,
and are more sensitive to these insults. Objective: To describe a case of
respiratory failure in a patient with the obesity-hypoventilation syndrome
resulting from injuries and therapies that in any other patient would not be
expected to cause respiratory failure. Case Report: A 59-year-old woman
suffered a mechanical fall, fractured her T6 vertebral body and right
proximal humerus, and, after spinal immobilization and the administration of
routine doses of opioid analgesics, suffered significant hypoxemia and
respiratory acidosis. Reversal agents were ineffective, but non-invasive
mechanical ventilation restored adequate respiration. Conclusion: Although
obesity-hypoventilation syndrome occurs in only a minority of morbidly obese
patients, it is important because the consequences of respiratory failure
can be severe if not recognized and anticipated. Such patients will not be
able to adequately increase ventilation in response to mounting hypercapnia.
The condition is easily addressed through non-invasive ventilation. © 2011
Elsevier Inc.
EMTREE DRUG INDEX TERMS
hydromorphone (intramuscular drug administration)
naloxone (intravenous drug administration)
oxyhemoglobin
pethidine
promethazine (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
injury
obesity hypoventilation syndrome (therapy)
respiratory failure
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
atelectasis
backache
blood pressure
breathing
breathing rate
case report
electrocardiogram
falling
female
human
humerus fracture
hypercapnia
hypoxemia
immobilization
metabolic alkalosis
oxygen therapy
positive end expiratory pressure
priority journal
respiratory acidosis
sinus tachycardia
somnolence
spine fracture
thorax radiography
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
oxyhemoglobin (9061-63-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011210645
MEDLINE PMID
18757156 (http://www.ncbi.nlm.nih.gov/pubmed/18757156)
PUI
L50255827
DOI
10.1016/j.jemermed.2007.12.022
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2007.12.022
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 801
TITLE
Homicides using muscle relaxants, opioids, and anesthetic drugs:
Anesthesiologist assistance in their investigation and prosecution
AUTHOR NAMES
Johnstone R.E.
Katz R.L.
Stanley T.H.
AUTHOR ADDRESSES
(Johnstone R.E., johnstoner@rcbhsc.wvu.edu) Department of Anesthesiology,
West Virginia University, P.O. Box 9134, Morgantown, WV 26506, United
States.
(Katz R.L.) University of California, Los Angeles, Los Angeles, CA, United
States.
(Katz R.L.) University of Southern California, Los Angeles, CA, United
States.
(Stanley T.H.) Department of Anesthesiology, University of Utah, Salt Lake
City, UT, United States.
CORRESPONDENCE ADDRESS
R. E. Johnstone, Department of Anesthesiology, West Virginia University,
P.O. Box 9134, Morgantown, WV 26506, United States. Email:
johnstoner@rcbhsc.wvu.edu
SOURCE
Anesthesiology (2011) 114:3 (713-716). Date of Publication: March 2011
ISSN
0003-3022
1528-1175 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
midazolam (drug toxicity)
rocuronium (drug toxicity)
suxamethonium (drug toxicity)
EMTREE DRUG INDEX TERMS
carbon monoxide
choline
methamphetamine
neostigmine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
homicide
EMTREE MEDICAL INDEX TERMS
adult
anesthesist
apnea
article
autopsy
blood
blood analysis
breathing
burn
death
dose response
drug blood level
emergency ward
female
general practitioner
heart
human
hyoid bone
liver
male
nurse practitioner
paralysis
postanesthesia care
priority journal
respiratory arrest
resuscitation
stomach juice
strangulation
CAS REGISTRY NUMBERS
carbon monoxide (630-08-0)
choline (123-41-1, 13232-47-8, 1927-06-6, 4858-96-2, 62-49-7, 67-48-1)
fentanyl (437-38-7)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
midazolam (59467-70-8)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
rocuronium (119302-91-9)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011114448
MEDLINE PMID
21343726 (http://www.ncbi.nlm.nih.gov/pubmed/21343726)
PUI
L361331764
DOI
10.1097/ALN.0b013e31820b8d19
FULL TEXT LINK
http://dx.doi.org/10.1097/ALN.0b013e31820b8d19
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 802
TITLE
Validation of a 6-hour observation period for cocaine body stuffers
AUTHOR NAMES
Moreira M.
Buchanan J.
Heard K.
AUTHOR ADDRESSES
(Moreira M.; Buchanan J., jennie.buchanan3@dhha.org; Heard K.) Denver Health
Hospital and Authority, Emergency Department, 777 Bannock Street, Denver, CO
80204, United States.
(Buchanan J., jennie.buchanan3@dhha.org; Heard K.) Rocky Mountain Poison and
Drug Center, Denver, CO 80204, United States.
(Moreira M.; Buchanan J., jennie.buchanan3@dhha.org; Heard K.) University of
Colorado, Department of Emergency Medicine, Colorado Emergency Medicine
Research Center, Aurora, CO 80004, United States.
CORRESPONDENCE ADDRESS
J. Buchanan, Denver Health Hospital and Authority, Emergency Department, 777
Bannock Street, Denver, CO 80204, United States. Email:
jennie.buchanan3@dhha.org
SOURCE
American Journal of Emergency Medicine (2011) 29:3 (299-303). Date of
Publication: March 2011
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Often, patients are brought in to the emergency department after ingesting
large amounts of cocaine in an attempt to conceal it. This act is known as
body stuffing. The observation period required to recognize potential toxic
adverse effects in these patients is not well described in the literature.
We sought to validate a treatment algorithm for asymptomatic cocaine body
stuffers using a 6-hour observation period by observing the clinical course
of cocaine body stuffers over a 24-hour period. A retrospective chart review
was performed on all patients evaluated for witnessed or suspected stuffing
over 2 years using a standardized protocol. One hundred six patients met
final inclusion criteria as adult cocaine stuffers. No patients developed
life-threatening symptoms, and no patients died during observation. In our
medical setting, stuffers could be discharged after a 6-hour observation
period if there was either complete resolution or absence of clinical
symptoms. © 2011 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
EMTREE DRUG INDEX TERMS
activated carbon
antihistaminic agent
glyceryl trinitrate
macrogol
naloxone
neuroleptic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug traffic
illicit drug body stuffing
observation
EMTREE MEDICAL INDEX TERMS
adult
algorithm
angiography
article
colon lavage
disease course
emergency care
female
hospital discharge
human
hypertension
major clinical study
male
medical record review
priority journal
retrospective study
seizure
stomach lavage
symptom
tachycardia
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
glyceryl trinitrate (55-63-0)
macrogol (25322-68-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011107353
MEDLINE PMID
20825819 (http://www.ncbi.nlm.nih.gov/pubmed/20825819)
PUI
L361309444
DOI
10.1016/j.ajem.2009.11.022
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2009.11.022
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 803
TITLE
Accidental and non-accidental ingestion of methadone and buprenorphine in
childhood: A single center experience, 1999-2009
AUTHOR NAMES
Martin T.C.
Rocque M.
AUTHOR ADDRESSES
(Martin T.C., tcmartin@emh.org) Department of Pediatrics, Eastern Maine
Medical Center, 21 Greystone Bldg, 489 State Street, PO Box 404, Bangor, ME
04402, United States.
(Martin T.C., tcmartin@emh.org) Tufts University School of Medicine, Boston,
MA, United States.
(Martin T.C., tcmartin@emh.org) Crossroads Centre Antigua, Willoughby Bay,
St. John's, Antigua and Barbuda.
(Rocque M.) Clinical Research Center, Eastern Maine Medical Center, Bangor,
ME, United States.
(Rocque M.) Northeastern University, School of Criminology and Criminal
Justice, Boston, MA, United States.
CORRESPONDENCE ADDRESS
T. C. Martin, Department of Pediatrics, Eastern Maine Medical Center, 21
Greystone Bldg, 489 State Street, PO Box 404, Bangor, ME 04402, United
States. Email: tcmartin@emh.org
SOURCE
Current Drug Safety (2011) 6:1 (12-16). Date of Publication: 2011
ISSN
1574-8863
BOOK PUBLISHER
Bentham Science Publishers B.V., P.O. Box 294, Bussum, Netherlands.
ABSTRACT
Objective: To assess the effect of recent availability (due to more home
use) of methadone and buprenophine has had on the accidental and
non-accidental misuse by children. Methods: A retrospective review of all
pediatric (< 18 years old) admissions for methadone or buprenorphine
ingestion at Eastern Maine Medical Center (EMMC) from September 1, 1999 to
August 31, 2009 was performed. Data recorded included age, sex, accidental
or non-accidental ingestion, source of drug, ward or pediatric intensive
care unit (PICU) admission, treatment given and length of hospital stay.
Relation to pediatric emergency department (ED) visits, general pediatric
ward admissions and patients on opioid maintenance treatment in the area was
also assessed. Results: There were 22 children (12 female) admitted for
methadone (10, 46%) or buprenorphine (12, 54%) ingestion, with ingestions
tripling in the later five year period compared with the earlier five years.
The trend was statistically significant, unrelated to pediatric ED visits or
ward admissions but statistically related to number of patients on opioid
maintenance treatment in the region. Of the 22 children with ingestion, six
(27%) were adolescents (mean age 15.2 years) and ingestion was intentional
(three suicide, three recreational) and 16 were infants or toddlers (mean
age 21.6 months) whose ingestions were accidental. The drug source was
family and friend (18, 82%) or unknown (four, 18%). There were six patients
admitted to the ward and 16 patients (74%) admitted to the PICU. Two
patients had observation only, seven had anticipatory intravenous (IV) line
placement, nine patients were given IV line and naloxone (bolus + IV
infusion), and four patients required endotracheal intubation, IV placement
and naloxone. There were no fatalities and mean hospital stay was one to
seven days, mean 2.3 days. All families were referred to family services.
Conclusions: Accidental and non-accidental ingestion of methadone and
buprenorphine by children is increasing in proportion to increased clinical
use and availability. Health providers should be aware of this increased
risk and be able to provide appropriate treatment and family support. © 2011
Bentham Science Publishers Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine
methadone
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
article
child
clinical article
emergency ward
endotracheal intubation
family service
female
human
intensive care unit
length of stay
male
pediatric ward
preschool child
priority journal
retrospective study
school child
suicide attempt
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011076842
MEDLINE PMID
21047302 (http://www.ncbi.nlm.nih.gov/pubmed/21047302)
PUI
L361219094
DOI
10.2174/157488611794480034
FULL TEXT LINK
http://dx.doi.org/10.2174/157488611794480034
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 804
TITLE
New opioid side effects and implications for long-term therapy
AUTHOR NAMES
Raghavan S.
Harvey A.D.
Humble S.R.
AUTHOR ADDRESSES
(Raghavan S.; Humble S.R., srhumble@doctors.org.uk) Tayside Pain Service and
Dept of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY,
United Kingdom.
(Harvey A.D.) Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow G4
0SF, United Kingdom.
(Humble S.R., srhumble@doctors.org.uk) Centre for Neuroscience, University
of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United
Kingdom.
CORRESPONDENCE ADDRESS
S.R. Humble, Centre for Neuroscience, University of Dundee, Nine-wells
Hospital and Medical School, Dundee DD1 9SY, United Kingdom. Email:
srhumble@doctors.org.uk
SOURCE
Trends in Anaesthesia and Critical Care (2011) 1:1 (18-21). Date of
Publication: February 2011
ISSN
2210-8440
BOOK PUBLISHER
Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United
Kingdom.
ABSTRACT
Opioids are the foundation for the treatment of acute pain and cancer pain.
Their popularity in the chronic pain setting has waxed and waned over the
years but there has been a recent resurgence in their use. Opioid induced
side effects such as nausea, constipation, tolerance and addiction are well
known, but studies have shown that a range of subtle yet significant
complications have emerged which have the potential to increase the
morbidity of patients who are on long-term opioid therapy. They include
hypogonadism, osteoporosis, immune suppression, cognitive impairment and
hyperalgesia. Therefore it is important for clinicians to be aware of these
side effects and remain vigilant for them. Patients receiving chronic opioid
therapy may benefit from a strategy to minimise the occurrence of these side
effects. © 2010 Elsevier Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, drug toxicity, intrathecal drug
administration, oral drug administration, transdermal drug administration)
EMTREE DRUG INDEX TERMS
6 cyano 7 nitro 2,3 quinoxalinedione
anticonvulsive agent
buprenorphine
dextropropoxyphene
dizocilpine
fentanyl (drug therapy, oral drug administration, transdermal drug
administration)
hydromorphone
luteinizing hormone (endogenous compound)
morphine (intrathecal drug administration)
oxycodone
pethidine
prasterone (drug therapy)
testosterone (endogenous compound)
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
long term care
EMTREE MEDICAL INDEX TERMS
addiction (side effect)
amenorrhea
cancer pain (drug therapy)
chronic disease
chronic pain
cognitive defect
constipation (side effect)
dysmenorrhea
emergency treatment
fracture
growth hormone deficiency
human
hyperalgesia (side effect)
hypogonadism (drug therapy, side effect)
immunosuppressive treatment
libido
luteinizing hormone blood level
morbidity
nausea (side effect)
nonhuman
osteoporosis (side effect)
pain (drug therapy)
physician
priority journal
review
testosterone blood level
DRUG TRADE NAMES
mk 801
CAS REGISTRY NUMBERS
6 cyano 7 nitro 2,3 quinoxalinedione (115066-14-3)
buprenorphine (52485-79-7, 53152-21-9)
dextropropoxyphene (1639-60-7, 469-62-5)
dizocilpine (77086-21-6)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
luteinizing hormone (39341-83-8, 9002-67-9)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
prasterone (53-43-0)
testosterone (58-22-0)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Cancer (16)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011153050
PUI
L51051567
DOI
10.1016/j.cacc.2010.06.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cacc.2010.06.003
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 805
TITLE
Hospital pharmacists scrambling amid vast drug shortages
AUTHOR NAMES
McKenna M.
AUTHOR ADDRESSES
(McKenna M.)
CORRESPONDENCE ADDRESS
M. McKenna,
SOURCE
Annals of Emergency Medicine (2011) 57:2 (13A-15A). Date of Publication:
February 2011
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
atracurium besilate
bumetanide
cisatracurium
clindamycin
cotrimoxazole
epinephrine
fentanyl
fosphenytoin sodium
furosemide
hydromorphone
lidocaine
lipid emulsion
metronidazole
morphine
naloxone
propofol
rocuronium
suxamethonium
torasemide
vancomycin
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital pharmacy
pharmacist
EMTREE MEDICAL INDEX TERMS
article
clinical practice
drug manufacture
drug marketing
emergency health service
health care delivery
health care organization
medication error
physician
priority journal
risk assessment
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atracurium (64228-79-1)
bumetanide (28395-03-1)
cisatracurium (96946-41-7, 96946-42-8)
clindamycin (18323-44-9)
cotrimoxazole (8064-90-2)
fentanyl (437-38-7)
fosphenytoin sodium (92134-98-0)
furosemide (54-31-9)
hydromorphone (466-99-9, 71-68-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metronidazole (39322-38-8, 443-48-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
rocuronium (119302-91-9)
suxamethonium (306-40-1, 71-27-2)
torasemide (56211-40-6)
vancomycin (1404-90-6, 1404-93-9)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011042190
MEDLINE PMID
21322165 (http://www.ncbi.nlm.nih.gov/pubmed/21322165)
PUI
L361138854
DOI
10.1016/j.annemergmed.2010.12.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2010.12.006
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 806
TITLE
Improving emergency department access by using a regional dashboard for
ambulance diversion
AUTHOR ADDRESSES
SOURCE
EMA - Emergency Medicine Australasia (2011) 23:1 (109-111). Date of
Publication: February 2011
ISSN
1742-6731
1742-6723 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
EMTREE DRUG INDEX TERMS
flumazenil
midazolam (adverse drug reaction, drug combination)
naloxone
opiate (adverse drug reaction, drug combination)
propofol (adverse drug reaction, drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulance
emergency ward
health care access
EMTREE MEDICAL INDEX TERMS
apnea (side effect)
bronchospasm (side effect)
health care policy
hospital admission
hospital discharge
hospital patient
human
larynx spasm (side effect)
mortality
note
oxygen therapy
paramedical personnel
priority journal
respiratory tract disease (side effect)
resuscitation
sedation
therapy delay
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011067644
MEDLINE PMID
21284824 (http://www.ncbi.nlm.nih.gov/pubmed/21284824)
PUI
L361196139
DOI
10.1111/j.1742-6723.2010.01390.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1742-6723.2010.01390.x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 807
TITLE
Advances in resuscitation strategies
AUTHOR NAMES
Alam H.B.
AUTHOR ADDRESSES
(Alam H.B., hbalam@partners.org) Massachusetts General Hospital, Harvard
Medical School, Boston, MA 02114, United States.
CORRESPONDENCE ADDRESS
H.B. Alam, Massachusetts General Hospital, Harvard Medical School, Boston,
MA 02114, United States. Email: hbalam@partners.org
SOURCE
International Journal of Surgery (2011) 9:1 (5-12). Date of Publication:
2011
ISSN
1743-9191
BOOK PUBLISHER
Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom.
ABSTRACT
Shock, regardless of etiology is characterized by decreased delivery of
oxygen and nutrients to the tissues and our interventions are directed
towards reversing the cellular ischemia and preventing its consequences. The
treatment strategies that are most effective in achieving this goal
obviously depend upon the different types of shock (hemorrhagic, septic,
neurogenic and cardiogenic). This brief review focuses on the two leading
etiologies of shock in the surgical patients: bleeding and sepsis, and
addresses a number of new developments that have profoundly altered the
treatment paradigms. The emphasis here is on new research that has
dramatically altered our treatment strategies rather than the basic
pathophysiology of shock. © 2010 Surgical Associates Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diaspirin crosslinked hemoglobin (drug comparison, drug therapy)
hypertensive agent (drug therapy)
inotropic agent (drug therapy)
polymerized hemoglobin (drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
antiinflammatory agent (drug therapy)
antioxidant (drug therapy)
calcium channel blocking agent (drug therapy)
dextran (drug comparison, drug therapy)
dopamine (drug therapy)
fresh frozen plasma (drug therapy)
hemoglobin (endogenous compound)
histone deacetylase inhibitor (drug therapy)
immunomodulating agent (drug therapy)
infusion fluid (drug therapy)
naloxone (drug therapy)
noradrenalin (drug comparison, drug therapy)
opiate antagonist (drug therapy)
pentoxifylline (drug therapy)
phenylephrine (drug therapy)
phosphodiesterase inhibitor (drug therapy)
prostaglandin (drug therapy)
Ringer lactate solution (drug therapy)
sodium chloride (drug comparison, drug therapy)
steroid (drug therapy)
valproic acid (drug therapy)
vasopressin (drug comparison, drug therapy)
vorinostat (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hemorrhagic shock (drug therapy, complication, disease management, drug
therapy, etiology)
resuscitation
septic shock (drug therapy, complication, disease management, drug therapy,
etiology)
EMTREE MEDICAL INDEX TERMS
adjuvant therapy
bleeding (complication, disease management, drug therapy, etiology, therapy)
blood component therapy
blood transfusion
brain damage (complication, prevention)
burn (therapy)
clinical practice
critically ill patient
crystalloid
death
emergency treatment
evidence based practice
fluid therapy
hematocrit
hematological parameters
hemoglobin determination
human
hypotension (complication, disease management, drug therapy, etiology,
therapy)
immune system
induced hypothermia
infection risk
injury (therapy)
intensive care unit
mean arterial pressure
meta analysis (topic)
multiple organ failure (complication)
multiple trauma
nonhuman
outcomes research
pathophysiology
patient safety
penetrating trauma (therapy)
phase 2 clinical trial (topic)
phase 3 clinical trial (topic)
practice guideline
priority journal
randomized controlled trial (topic)
review
risk assessment
sepsis (complication, disease management, etiology, therapy)
shock (complication, disease management, drug therapy, etiology, therapy)
surgical patient
survival
systematic review (topic)
systemic inflammatory response syndrome (complication)
systolic blood pressure
thrombocyte transfusion
treatment outcome
DRUG TRADE NAMES
hboc 201
hemassist
hemopure
polyheme
CAS REGISTRY NUMBERS
Ringer lactate solution (8022-63-7)
dextran (87915-38-6, 9014-78-2)
dopamine (51-61-6, 62-31-7)
hemoglobin (9008-02-0)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
pentoxifylline (6493-05-6)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
polymerized hemoglobin (197252-65-6)
sodium chloride (7647-14-5)
valproic acid (1069-66-5, 99-66-1)
vasopressin (11000-17-2)
vorinostat (149647-78-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Surgery (9)
Anesthesiology (24)
Hematology (25)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2011022157
MEDLINE PMID
20833279 (http://www.ncbi.nlm.nih.gov/pubmed/20833279)
PUI
L51100577
DOI
10.1016/j.ijsu.2010.09.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ijsu.2010.09.001
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 808
TITLE
Opioid medication errors in pediatric practice: Four years' experience of
voluntary safety reporting
AUTHOR NAMES
Mc Donnell C.
AUTHOR ADDRESSES
(Mc Donnell C., conor.mcdonnell@sickkids.ca) Department of Anesthesia and
Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada.
CORRESPONDENCE ADDRESS
C. Mc Donnell, Department of Anesthesia and Pain Medicine, Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada. Email:
conor.mcdonnell@sickkids.ca
SOURCE
Pain Research and Management (2011) 16:2 (93-98). Date of Publication:
March-April 2011
ISSN
1203-6765
BOOK PUBLISHER
Hindawi Limited
ABSTRACT
BACKGROUND: Opioids are the most common source of drug error that leads to
harm in pediatric hospitals. OBJECTIVE: To undertake a comprehensive review
of experience with voluntary safety reports describing pediatric opioid
medication errors at The Hospital for Sick Children (Toronto, Ontario), and
to characterize the specific opioids involved, severity and type of error
described, hospital location and time of day that the error occurred.
METHODS: All medication-related safety reports submitted to an anonymous,
voluntary electronic safety reporting database in a university-affiliated
pediatric hospital during the first four years of its use were examined. A
database of opioid error reports was created for further analysis. RESULTS:
A total of 5935 medication-related safety reports were collected, 507 of
which described opioids. Morphine was the most frequently reported opioid,
administration was the most frequently reported stage of the medication
process (192 errors) and surgical wards were the location from which opioid
error was most frequently reported (128 reports). Twenty-two reports
described patient harm requiring urgent treatment and intervention. Errors
with codeine or hydromorphone resulted in the most significant harm
reported. A total of 162 reports described problems with inappropriate
opioid disposal, missing opioids, or incorrect opioid counts and checks.
CONCLUSIONS: Future opportunities for improvement in opioid safety should
focus on morphine, opioid administration errors in general, the safe
disposal of opioids in the hospital environment and the identification of
pain as an adverse event. ©2011 Pulsus Group Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
codeine
fentanyl
hydromorphone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medication error
pediatrics
EMTREE MEDICAL INDEX TERMS
article
Canada
drug monitoring
drug safety
drug storage
emergency ward
human
intensive care unit
pediatric hospital
prescription
surgical ward
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2012159398
MEDLINE PMID
21499584 (http://www.ncbi.nlm.nih.gov/pubmed/21499584)
PUI
L364448535
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 809
TITLE
Management of an oral ingestion of transdermal fentanyl patches: A case
report and literature review
AUTHOR NAMES
Faust A.C.
Terpolilli R.
Hughes D.W.
AUTHOR ADDRESSES
(Faust A.C., fausta@methodisthealth.org; Hughes D.W.,
darrel.hughes@uhs-sa.com) Department of Pharmacy Services, University Health
System, 4502 Medical Drive, San Antonio, TX 78229, United States.
(Faust A.C., fausta@methodisthealth.org; Hughes D.W.,
darrel.hughes@uhs-sa.com) Pharmacotherapy Division, College of Pharmacy,
University of Texas at Austin, Austin, TX 78712, United States.
(Faust A.C., fausta@methodisthealth.org; Hughes D.W.,
darrel.hughes@uhs-sa.com) Pharmacotherapy Education and Research Center,
University of Texas Health Science, Center at San Antonio, San Antonio, TX
78229, United States.
(Terpolilli R., terpolilli@uthscsa.edu) Division of Emergency Medicine,
University of Texas, Health Science Center at San Antonio, San Antonio, TX
78229, United States.
CORRESPONDENCE ADDRESS
D.W. Hughes, Department of Pharmacy Services, University Health System, 4502
Medical Drive, San Antonio, TX 78229, United States. Email:
darrel.hughes@uhs-sa.com
SOURCE
Case Reports in Medicine (2011) 2011 Article Number: 495938. Date of
Publication: 2011
ISSN
1687-9635 (electronic)
1687-9627
BOOK PUBLISHER
Hindawi Limited
ABSTRACT
Purpose. Fentanyl is available as a transdermal system for the treatment of
chronic pain in opioid-tolerant patients; however, it carries a black box
warning due to both the potency of the product and the potential for abuse.
In this report, we describe a case of transbuccal and gastrointestinal
ingestion of fentanyl patches and the management of such ingestion. Summary.
A 32-year-old man was brought to the emergency department (ED) via emergency
medical services for toxic ingestion and suicide attempt. The patient chewed
and ingested two illegally purchased transdermal fentanyl patches. In the
ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed
the patient to be afebrile and normotensive with a heart rate of 63,
respiratory rate of 16, and oxygen saturation of 100 on 2 liters nasal
cannula after administration of 2 milligrams of intravenous naloxone. The
patient was treated with whole bowel irrigation and continuous intravenous
naloxone infusion for approximately 48 hours without complications.
Conclusion. Despite numerous case reports describing oral ingestion of
fentanyl patches, information on the management of such intoxication is
lacking. We report successful management of such a case utilizing whole
bowel irrigation along with intravenous push and continuous infusion
naloxone. © Copyright 2011 Andrew C. Faust et al.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
EMTREE DRUG INDEX TERMS
alprazolam (drug toxicity)
benzodiazepine
methamphetamine
naloxone (intravenous drug administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ingestion
intoxication
suicide attempt
transdermal patch
EMTREE MEDICAL INDEX TERMS
adult
arousal
article
bipolar disorder
blood pressure
bradycardia
breathing rate
case report
continuous infusion
dizziness
drowsiness
drug dose titration
heart rate
human
intestine lavage
male
medical history
mental disease
mental health
opiate addiction
oxygen saturation
priority journal
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
benzodiazepine (12794-10-4)
fentanyl (437-38-7)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Forensic Science Abstracts (49)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2012187344
PUI
L364535992
DOI
10.1155/2011/495938
FULL TEXT LINK
http://dx.doi.org/10.1155/2011/495938
COPYRIGHT
Copyright 2017 Elsevier B.V., All rights reserved.
RECORD 810
TITLE
The effects of intravenous opioid on abdominal pain and peritoneal
irritation in patients presenting to an emergency department
ORIGINAL (NON-ENGLISH) TITLE
Aci̇l servi̇se başvuran hastalarda i̇ntravenöz opi̇oi̇d uygulamasinin akut
karin ve peri̇toneal i̇rri̇tasyon üzeri̇ndeki̇ etki̇leri̇
AUTHOR NAMES
Moharramzadeh P.
Vahdati S.S.
AUTHOR ADDRESSES
(Moharramzadeh P.; Vahdati S.S., sshamsv@yahoo.com) Tabriz University of
Medical Science, Emergency Department, Tabriz, Iran.
CORRESPONDENCE ADDRESS
S. S. Vahdati, Tabriz University of Medical Science, Emergency Department,
Tabriz, Iran. Email: sshamsv@yahoo.com
SOURCE
Marmara Medical Journal (2010) 23:2 (285-289). Date of Publication: 2010
ISSN
1019-1941
BOOK PUBLISHER
Marmara University, Haydarpasa, Istanbul, Turkey.
ABSTRACT
Objective: Concerns about possible negative actions of opioids on important
diagnostic signs and symptoms have limited the use of this efficient
analgesic in patients with abdominal pain. In this study, we have addressed
the old challenge with a statistical approach to determine whether this
medication can be administered for patients presenting to an emergency
department (ED) with signs of non-traumatic acute abdominal condition.
Methods and Materials: A randomized clinical trial was arranged with 118
patients who were five years or older who had been prepared for transfer to
the operating room in the Hazrat Rasul-e-Akram hospital. In a double blind
randomized trial, pain, tenderness and the rebound tenderness ratio were
recorded before and after receiving morphine and placebo. Result: Tenderness
and the rebound tenderness Numeric Scale Mean dropped after administration
of 0.1mg/kg morphine although this was not statistically significant. In
contrast to the rebound tenderness (Pv=0.07) the tenderness and pain Numeric
Scale Mean fell sharply, showing a statistically significant difference
(Pv=0.00, Pv=0.00). However, tenderness and rebound tenderness did not show
a significant difference (Pv=1.00, Pv=0.06). Conclusion: Using morphine does
not suppress the main signs of peritoneal irritation, although it provides a
suitable control of pain. Therefore, using moprhine as an analgesic in ED
cases with a primary impression of a non-traumatic acute abdomen remains
advisable with an initial dosage of 0.1mg/kg.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (clinical trial, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (drug therapy, drug therapy)
emergency care
peritoneal disease (drug therapy, drug therapy)
peritoneal irritation (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal tenderness
adolescent
adult
analgesia
article
clinical trial
controlled clinical trial
controlled study
double blind procedure
drug effect
emergency ward
female
human
Iran
major clinical study
male
randomized controlled trial
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
Turkish
LANGUAGE OF SUMMARY
English, Turkish
EMBASE ACCESSION NUMBER
2010664350
PUI
L360084408
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 811
TITLE
Preclinical management of intoxications - Importance of poisons centers for
the emergency service
ORIGINAL (NON-ENGLISH) TITLE
Präklinisches management von vergiftungen - Bedeutung des giftnotrufs für
den rettungsdienst
AUTHOR NAMES
Schaper A.
AUTHOR ADDRESSES
(Schaper A., aschaper@giz-nord.de) GIZ-Nord, Zentrum Pharmakologie und
Toxikologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, D-37075
Göttingen, Germany.
CORRESPONDENCE ADDRESS
A. Schaper, GIZ-Nord, Zentrum Pharmakologie und Toxikologie,
Universitätsmedizin Göttingen, Robert-Koch-Straße 40, D-37075 Göttingen,
Germany. Email: aschaper@giz-nord.de
SOURCE
Intensiv- und Notfallbehandlung (2010) 35:4 (178-185). Date of Publication:
2010
ISSN
0947-5362
BOOK PUBLISHER
Dustri-Verlag Dr. Karl Feistle, P.O. Box 1351, Deisenhofen/ Munich, Germany.
ABSTRACT
The organization and work of a poisons center is demonstrated on the basis
of GIZ-Nord Poisons Center Annual Report for 2007. In a short summary the
basic principles of clinical toxicology are elucidated: the indication for
gastric lavage and the application of activated charcoal. Moreover the means
of enhanced elimination are presented: hemodialysis, hemoperfusion,
multi-dose activated charcoal and MARS. Gastric lavage is indicated within 1
hour after ingestion of a life-threatening dose of a poison. In case of
intoxications with CNS penetrating substances gastric lavage should be
performed only after endotracheal intubation due to the risk of aspiration.
The basic management of the intoxicated patient by emergencymedicine staff
out of hospital and on the way into the hospital is presented. The "Bremen
List", a compilation of 5 antidotes (atropine, 4-DMAP, tolonium chloride,
naloxone, activated charcoal) for the out-of-hospital treatment by emergency
doctors is introduced. © 2010 Dustri-Verlag Dr. Karl Feistle.
EMTREE DRUG INDEX TERMS
activated carbon
atropine
naloxone
tolonium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
emergency health service
emergency medicine
endotracheal intubation
hemodialysis
hemoperfusion
human
poison center
review
stomach lavage
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
naloxone (357-08-4, 465-65-6)
tolonium chloride (92-31-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2011010274
PUI
L361032408
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 812
TITLE
Pre-hospital management of drug-related medical emergencies
ORIGINAL (NON-ENGLISH) TITLE
Präklinisches management von drogenintoxikationen
AUTHOR NAMES
Humpich M.
Walcher F.
Byhahn C.
AUTHOR ADDRESSES
(Humpich M., m.humpich@em.uni-frankfurt.de; Byhahn C.) Klinik für
Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der J. W.
Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt
am Main, Germany.
(Walcher F.) Klinik für Unfall-, Hand- und Wiederherstellungschirurgie,
Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany.
CORRESPONDENCE ADDRESS
M. Humpich, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie,
Klinikum der J. W. Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai
7, 60590 Frankfurt am Main, Germany. Email: m.humpich@em.uni-frankfurt.de
SOURCE
Notfall und Rettungsmedizin (2010) 13:8 (803-814). Date of Publication:
December 2010
ISSN
1434-6222
1436-0578 (electronic)
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
Intoxication due to drug abuse is common in big cities with an active drug
and party scene. Antidotes are only available for opioids and
benzodiazepines, thus only supportive (often lifesaving) care can be done in
other cases. The classical symptoms of intoxication with heroin are coma,
respiratory arrest, and miosis. Use of naloxone in areas with
over-proportional numbers of drug users goes along with some medico-legal
und practical limitations. The proposed monitoring of patients after drug
reversal is often not possible due to incompliance of drug abusers. New
drugs like 4-hydroxybutyric acid (liquid ecstasy, GHB) are mainly abused at
party events. High doses can cause unspecific symptoms with coma and
myoclonus. Additional ingestion of alcohol can lead to life threatening
situations. Emergency physicians and paramedics should have the knowledge
presented in this article, especially if working in big city areas.
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
benzodiazepine derivative (drug toxicity)
diamorphine (drug toxicity)
naloxone
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
emergency medicine
EMTREE MEDICAL INDEX TERMS
alcohol consumption
attitude to health
clinical feature
coma
drug abuse
drug alcohol interaction
emergency care
emergency physician
miosis (complication)
myoclonus
paramedical personnel
respiratory arrest
review
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2011152092
PUI
L51166256
DOI
10.1007/s10049-010-1339-2
FULL TEXT LINK
http://dx.doi.org/10.1007/s10049-010-1339-2
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 813
TITLE
Case Files of the Harvard Medical Toxicology Fellowship at Children's
Hospital Boston: An Insulin Overdose
AUTHOR NAMES
Skolnik A.B.
Ewald M.B.
AUTHOR ADDRESSES
(Skolnik A.B., askolnik@partners.org; Ewald M.B.) Harvard Affiliated
Emergency Medicine Residency, Brigham and Women's/Massachusetts General
Hospital, Division of Emergency Medicine, Harvard Medical Toxicology
Fellowship, Children's Hospital Boston (MBE), Boston, MA, United States.
(Skolnik A.B., askolnik@partners.org) Harvard Affiliated Emergency Medicine
Residency, 75 Francis Street, Neville House 236A, Boston, MA 02115, United
States.
CORRESPONDENCE ADDRESS
A. B. Skolnik, Harvard Affiliated Emergency Medicine Residency, 75 Francis
Street, Neville House 236A, Boston, MA 02115, United States. Email:
askolnik@partners.org
SOURCE
Journal of Medical Toxicology (2010) 6:4 (413-419). Date of Publication:
December 2010
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Springer Street, New York, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
insulin lispro (adverse drug reaction, drug concentration, drug dose, drug
therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
atropine
bicarbonate
C peptide (endogenous compound)
ceftriaxone (drug therapy)
cocaine
epinephrine
fosphenytoin sodium (drug dose, drug therapy)
glucagon (drug therapy)
glucose (endogenous compound, intravenous drug administration)
hydrocortisone
ketone (endogenous compound)
lorazepam (drug therapy)
naloxone
salicylic acid
vancomycin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
insulin pump
EMTREE MEDICAL INDEX TERMS
adolescent
anion gap
arterial carbon dioxide tension
arterial oxygen tension
arterial pH
article
brain ischemia
brain stem
brain stem response
case report
circulation
computer assisted tomography
continuous infusion
cyanosis (side effect)
death
defibrillation
drug blood level
drug dose titration
drug overdose
echocardiography
emergency health service
endotracheal intubation
eye
family
fever
food intake
gastrointestinal symptom
glucose blood level
gray matter
head movement
heart arrest (side effect)
heart ventricle fibrillation (side effect, therapy)
human
hypertension
hypoglycemia (drug therapy, side effect)
insulin dependent diabetes mellitus (drug therapy)
intensive care unit
loading drug dose
male
nuclear magnetic resonance imaging
pneumonia (drug therapy)
point of care testing
prognosis
protein blood level
pupil reflex
resuscitation
rhythmic head bobbing
screening test
seizure (drug therapy)
stomach distension
swallowing
syringe
tonic eye deviation
DRUG TRADE NAMES
humalog
CAS REGISTRY NUMBERS
C peptide (59112-80-0)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
ceftriaxone (73384-59-5, 74578-69-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
fosphenytoin sodium (92134-98-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
insulin lispro (133107-64-9)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
salicylic acid (63-36-5, 69-72-7)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Endocrinology (3)
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010682681
MEDLINE PMID
20725819 (http://www.ncbi.nlm.nih.gov/pubmed/20725819)
PUI
L51040791
DOI
10.1007/s13181-010-0110-x
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-010-0110-x
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 814
TITLE
The Impact of a Medical Toxicology Fellowship on the Training of Future
Emergency Medicine Residents
AUTHOR NAMES
Jang D.H.
AUTHOR ADDRESSES
(Jang D.H., Jangd01@nyumc.org) New York University, New York, NY, United
States.
(Jang D.H., Jangd01@nyumc.org) New York City Poison Center, New York, NY,
United States.
CORRESPONDENCE ADDRESS
D. H. Jang, New York University, New York, NY, United States. Email:
Jangd01@nyumc.org
SOURCE
Journal of Medical Toxicology (2010) 6:4 (371-372). Date of Publication:
December 2010
ISSN
1556-9039
1937-6995 (electronic)
BOOK PUBLISHER
Springer New York, 233 Springer Street, New York, United States.
EMTREE DRUG INDEX TERMS
benzodiazepine (drug therapy)
flumazenil (drug therapy)
hypnotic sedative agent (drug toxicity)
lorazepam (drug toxicity)
naloxone (drug therapy)
propofol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
medical education
residency education
toxicology
EMTREE MEDICAL INDEX TERMS
clinical education
drug intoxication (drug therapy, etiology)
drug overdose
editorial
health care personnel
human
medical literature
medical research
patient care
seizure (drug therapy)
teaching
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010682143
MEDLINE PMID
20922513 (http://www.ncbi.nlm.nih.gov/pubmed/20922513)
PUI
L51097581
DOI
10.1007/s13181-010-0117-3
FULL TEXT LINK
http://dx.doi.org/10.1007/s13181-010-0117-3
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 815
TITLE
Prehospital analgesia: systematic review of evidence.
AUTHOR NAMES
Park C.L.
Roberts D.E.
Aldington D.J.
Moore R.A.
AUTHOR ADDRESSES
(Park C.L.) ST4 in Anaesthetics & Intensive Care Medicine, St Georges
Hospital, London, UK.
(Roberts D.E.; Aldington D.J.; Moore R.A.)
CORRESPONDENCE ADDRESS
C.L. Park, ST4 in Anaesthetics & Intensive Care Medicine, St Georges
Hospital, London, UK.
SOURCE
Journal of the Royal Army Medical Corps (2010) 156:4 Suppl 1 (295-300). Date
of Publication: Dec 2010
ISSN
0035-8665
ABSTRACT
The purpose of this systematic review is to investigate current evidence for
analgesic use in the prehospital environment using expert military and
civilian opinion to determine the important clinical questions. There was a
high degree of agreement that pain should be no worse than mild, that pain
relief be rapid (within 10 minutes), that patients should respond to verbal
stimuli and not require ventilatory support, and that major adverse events
should be avoided. Twenty-one studies provided information about 6212
patients; the majority reported most of the outcomes of interest. With
opioids 60-70% of patients still had pain levels above 30/100 mm on a Visual
Analogue Scale after 10 minutes, falling to about 30% by 30-40 minutes.
Fascia iliaca blocks demonstrated some efficacy for femoral fractures. No
patient on opioids required ventilatory support; two required naloxone;
sedation was rare. Cardiovascular instability was uncommon. Main adverse
events were dizziness or giddiness, and pruritus with opioids. There was
little evidence regarding the prehospital use ofketamine.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
evidence based medicine
human
methodology
review
LANGUAGE OF ARTICLE
English
MEDLINE PMID
21302646 (http://www.ncbi.nlm.nih.gov/pubmed/21302646)
PUI
L361435647
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 816
TITLE
Procedural Sedation and Analgesia in the Pediatric Emergency Department: A
Review of Sedative Pharmacology
AUTHOR NAMES
Kost S.
Roy A.
AUTHOR ADDRESSES
(Kost S., skost@nemours.org; Roy A.) Jefferson Medical College,
Philadelphia, PA, United States.
(Kost S., skost@nemours.org; Roy A.) Nemours/A.I.duPont Hospital for
Children, Wilmington, DE, United States.
CORRESPONDENCE ADDRESS
S. Kost, Nemours/A.I.duPont Hospital for Children, 1600 Rockland Rd,
Wilmington, DE 19899, United States. Email: skost@nemours.org
SOURCE
Clinical Pediatric Emergency Medicine (2010) 11:4 (233-243). Date of
Publication: December 2010
ISSN
1522-8401
BOOK PUBLISHER
W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
The spectrum of sedative and analgesic agents available to those who provide
pediatric sedation and analgesia in the emergency department has broadened
considerably over the past 2 decades. Pharmacologic agents that can be used
alone or in combination in this context include nitrous oxide, midazolam,
chloral hydrate, pentobarbital, etomidate, dexmedetomidine, propofol, and
ketamine. The pharmacology, common clinical uses, advantages, and
disadvantages of each of these agents are reviewed. Pharmacokinetics of the
agents is addressed in tabular form, whereas pharmacodynamic aspects of each
agent are discussed in more detail. Clinical uses addressed include
noninvasive as well as invasive procedures. Relevant studies involving
comparison of various sedative regimens for common emergency department
procedures are reviewed. © 2010 Elsevier Inc.
EMTREE DRUG INDEX TERMS
chloral hydrate (drug comparison, oral drug administration,
pharmacokinetics, rectal drug administration)
dexmedetomidine (adverse drug reaction, buccal drug administration, drug
comparison, intranasal drug administration, intravenous drug administration,
oral drug administration)
diazepam (intravenous drug administration, oral drug administration, rectal
drug administration)
etomidate (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration, pharmacology)
fentanyl (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration)
flumazenil (intravenous drug administration)
glycopyrronium (drug therapy)
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison, intramuscular drug administration, intranasal drug
administration, intravenous drug administration, oral drug administration,
pharmacology, rectal drug administration)
methohexital (intravenous drug administration, rectal drug administration)
midazolam (adverse drug reaction, clinical trial, drug administration, drug
combination, drug comparison, intramuscular drug administration, intranasal
drug administration, intravenous drug administration, oral drug
administration, rectal drug administration)
morphine (clinical trial, drug combination, intravenous drug administration)
naloxone (intramuscular drug administration, intravenous drug
administration)
nitrous oxide (adverse drug reaction, drug combination, drug dose, drug
therapy, inhalational drug administration)
oxygen (drug combination)
pentobarbital (adverse drug reaction, drug comparison, intramuscular drug
administration, intravenous drug administration, oral drug administration,
pharmacology, rectal drug administration)
placebo
propofol (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration, pharmacology)
thiopental (rectal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatric anesthesia
sedation
EMTREE MEDICAL INDEX TERMS
agitation
article
bradycardia (drug therapy, side effect)
cardiopulmonary insufficiency (side effect)
cardiovascular disease (side effect)
clinical trial
diplopia (side effect)
distress syndrome (drug therapy)
dose response
drug contraindication
drug dose comparison
drug dose titration
drug efficacy
drug half life
drug induced headache (side effect)
drug safety
dysphoria (side effect)
emergency ward
human
hypersalivation (side effect)
hypertension (side effect)
hypoxia (side effect)
injection pain (side effect)
intracranial hypertension (side effect)
intraocular hypertension (side effect)
irritability
larynx spasm (side effect)
low drug dose
metabolic acidosis (side effect)
myoclonus (side effect)
nausea and vomiting (side effect)
nose irritation (side effect)
pain (drug therapy)
pharmacodynamics
repeated drug dose
respiration depression (side effect)
restlessness (side effect)
side effect (side effect)
tachycardia (side effect)
unspecified side effect (side effect)
visual hallucination (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
dexmedetomidine (113775-47-6)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
glycopyrronium bromide (596-51-0)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
oxygen (7782-44-7)
pentobarbital (57-33-0, 76-74-4)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010661820
PUI
L360077615
DOI
10.1016/j.cpem.2010.08.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2010.08.002
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 817
TITLE
Long-term opioid treatment of nonmalignant pain
AUTHOR NAMES
Vijayaraghavan M.
AUTHOR ADDRESSES
(Vijayaraghavan M.) University of California, San Francisco, San Francisco,
CA, United States.
CORRESPONDENCE ADDRESS
M. Vijayaraghavan, University of California, San Francisco, San Francisco,
CA, United States.
SOURCE
Journal of Clinical Outcomes Management (2010) 17:12 (538-540). Date of
Publication: December 2010
ISSN
1079-6533
BOOK PUBLISHER
Turner White Communications Inc., 125 Strafford Avenue, Suite 220, Wayne,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain
EMTREE MEDICAL INDEX TERMS
arthralgia (drug therapy)
arthritis (drug therapy)
backache (drug therapy)
emergency ward
headache (drug therapy)
human
neck pain (drug therapy)
note
pain assessment
trend study
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011023742
PUI
L361076615
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 818
TITLE
Pitfalls with the "chest compression-only" approach: the challenge of an
unusual cause.
AUTHOR NAMES
Reid B.O.
Skogvoll E.
AUTHOR ADDRESSES
(Reid B.O.) Department of Anaesthesiology and Emergency Medicine, St. Olav
University Hospital, Trondheim, Norway.
(Skogvoll E.)
CORRESPONDENCE ADDRESS
B.O. Reid, Department of Anaesthesiology and Emergency Medicine, St. Olav
University Hospital, Trondheim, Norway. Email: bjorn.ole.reid@stolav.no
SOURCE
Scandinavian journal of trauma, resuscitation and emergency medicine (2010)
18 (45). Date of Publication: 2010
ISSN
1757-7241 (electronic)
ABSTRACT
Chest compression-only (CC-only) is now incorporated in the Norwegian
protocol for dispatch guided CPR (cardiopulmonary resuscitation) in cardiac
arrest of presumed cardiac aetiology.We present a case that is unique and
instructive as well as unusual. It reminds us of the challenges that face
bystanders, dispatch centres and ambulance services when faced with possible
cardiac arrest.This case report describes a 50 year old man in a rural
community. He had suffered a heart attack 8 months previously, and was found
unconscious with respiratory arrest in his garden one morning. Due to the
proximity to the ambulance station, the paramedics were on the scene within
three minutes. A chain-saw was lying beside him, but no external injuries
were seen. The patient had no radial pulse, central cyanosis and respiratory
gasps approximately every 30 seconds. Ventilation with bag and mask was
given, and soon a femoral pulse could be palpated. Blood sugar was elevated
and ECG (electrocardiogram) was normal. GCS (Glasgow Coma Scale) was 3. Upon
arrival of the physician staffed air ambulance, further examination revealed
bilateral miosis of the pupils and continuing bradypnoea. Naloxone was given
with an immediate effect and the patient woke up. The patient denied intake
of narcotics, but additional information from the dispatch centre revealed
that he was hepatitis C positive. After a few hours, the patient admitted to
have obtained a fentanyl transdermal patch from an acquaintance, having
chewed it before falling unconscious. This case report shows the importance
as well as the challenges of identifying a non-cardiac cause of possible
cardiac arrest, and the value of providing causal therapy.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (adverse drug reaction, drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart massage
resuscitation
EMTREE MEDICAL INDEX TERMS
article
case report
emergency health service
heart infarction (therapy)
human
intoxication (complication)
male
methodology
middle aged
Norway
pathophysiology
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20707888 (http://www.ncbi.nlm.nih.gov/pubmed/20707888)
PUI
L360254201
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 819
TITLE
Part 14: Pediatric advanced life support: 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care
AUTHOR NAMES
Kleinman M.E.
Chameides L.
Schexnayder S.M.
Samson R.A.
Hazinski M.F.
Atkins D.L.
Berg M.D.
De Caen A.R.
Fink E.L.
Freid E.B.
Hickey R.W.
Marino B.S.
Nadkarni V.M.
Proctor L.T.
Qureshi F.A.
Sartorelli K.
Topjian A.
Van Der Jagt E.W.
Zaritsky A.L.
AUTHOR ADDRESSES
(Kleinman M.E.; Chameides L.; Schexnayder S.M.; Samson R.A.; Hazinski M.F.;
Atkins D.L.; Berg M.D.; De Caen A.R.; Fink E.L.; Freid E.B.; Hickey R.W.;
Marino B.S.; Nadkarni V.M.; Proctor L.T.; Qureshi F.A.; Sartorelli K.;
Topjian A.; Van Der Jagt E.W.; Zaritsky A.L.)
CORRESPONDENCE ADDRESS
M. E. Kleinman,
SOURCE
Circulation (2010) 122:SUPPL. 3 (S876-S908). Date of Publication: 2 Nov 2010
ISSN
0009-7322
1524-4539 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
EMTREE DRUG INDEX TERMS
adenosine (drug therapy, intraosseous drug administration)
amiodarone (drug therapy, intraosseous drug administration, intravenous drug
administration)
amrinone (drug administration, intraosseous drug administration, intravenous
drug administration)
atropine (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration)
bicarbonate (drug administration, intraosseous drug administration,
intravenous drug administration)
calcium chloride (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration)
catecholamine (drug therapy, intraosseous drug administration)
dobutamine (drug administration, intraosseous drug administration,
intravenous drug administration)
dopamine (drug administration, intraosseous drug administration, intravenous
drug administration)
epinephrine (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration)
glucose (drug administration, intraosseous drug administration, intravenous
drug administration)
lidocaine (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration)
magnesium sulfate (drug administration, intraosseous drug administration,
intravenous drug administration)
milrinone (drug administration, intraosseous drug administration,
intravenous drug administration)
naloxone (drug administration, intraosseous drug administration, intravenous
drug administration)
nitroprusside sodium
noradrenalin
procainamide (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular disease (drug therapy, disease management, drug therapy)
emergency care
pediatric advanced life support
resuscitation
EMTREE MEDICAL INDEX TERMS
airway
algorithm
artificial ventilation
bradycardia
clinical protocol
defibrillator
end tidal carbon dioxide tension
endotracheal tube
extracorporeal circulation
health care personnel
heart arrest (drug therapy)
heart output
heart ventricle fibrillation
human
hypovolemic shock
laryngeal mask
patient monitoring
priority journal
procedures
pulse oximetry
respiratory failure
review
shock
vascular access
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amrinone (60719-84-8)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
dobutamine (34368-04-2, 49745-95-1, 52663-81-7, 61661-06-1)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
milrinone (78415-72-2)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
procainamide (51-06-9, 614-39-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010628101
MEDLINE PMID
20956230 (http://www.ncbi.nlm.nih.gov/pubmed/20956230)
PUI
L359971038
DOI
10.1161/CIRCULATIONAHA.110.971101
FULL TEXT LINK
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.971101
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 820
TITLE
Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
AUTHOR NAMES
Kattwinkel J.
Perlman J.M.
Aziz K.
Colby C.
Fairchild K.
Gallagher J.
Hazinski M.F.
Halamek L.P.
Kumar P.
Little G.
McGowan J.E.
Nightengale B.
Ramirez M.M.
Ringer S.
Simon W.M.
Weiner G.M.
Wyckoff M.
Zaichkin J.
AUTHOR ADDRESSES
(Kattwinkel J.; Perlman J.M.; Aziz K.; Colby C.; Fairchild K.; Gallagher J.;
Hazinski M.F.; Halamek L.P.; Kumar P.; Little G.; McGowan J.E.; Nightengale
B.; Ramirez M.M.; Ringer S.; Simon W.M.; Weiner G.M.; Wyckoff M.; Zaichkin
J.)
CORRESPONDENCE ADDRESS
J. Kattwinkel,
SOURCE
Circulation (2010) 122:SUPPL. 3 (S909-S919). Date of Publication: 2 Nov 2010
ISSN
0009-7322
1524-4539 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
EMTREE DRUG INDEX TERMS
epinephrine (intravenous drug administration)
glucose
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
newborn intensive care
resuscitation
EMTREE MEDICAL INDEX TERMS
airway
algorithm
amnion fluid
assisted ventilation
body temperature monitoring
breathing
cardiovascular disease
clinical protocol
crying
endotracheal intubation
gestational age
human
laryngeal mask
meconium
muscle tone
oxygen therapy
positive end expiratory pressure
practice guideline
priority journal
pulse oximetry
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010628102
MEDLINE PMID
20956231 (http://www.ncbi.nlm.nih.gov/pubmed/20956231)
PUI
L359971039
DOI
10.1161/CIRCULATIONAHA.110.971119
FULL TEXT LINK
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.971119
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 821
TITLE
Intravenous opioids for severe acute pain in the emergency department
AUTHOR NAMES
Patanwala A.E.
Keim S.M.
Erstad B.L.
AUTHOR ADDRESSES
(Patanwala A.E., Patanwala@pharmacy.arizona.edu) College of Pharmacy,
University of Arizona, Tucson, AZ, United States.
(Keim S.M.) Department of Emergency Medicine, College of Medicine,
University of Arizona, United States.
(Erstad B.L.) College of Pharmacy, University of Arizona, United States.
CORRESPONDENCE ADDRESS
A. E. Patanwala, College of Pharmacy, University of Arizona, Tucson, AZ,
United States. Email: Patanwala@pharmacy.arizona.edu
SOURCE
Annals of Pharmacotherapy (2010) 44:11 (1800-1809). Date of Publication:
November 2010
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
OBJECTIVE: To review clinical trials of intravenous opioids for severe acute
pain in the emergency department (ED) and to provide an approach for
optimization of therapy. DATA SOURCES: Articles were identified through a
search of Ovid/MEDLINE (1948-August 2010), PubMed (1950-August 2010),
Cochrane Central Register of Controlled Trials (1991-August 2010), and
Google Scholar (1900-August 2010). The search terms used were pain, opioid,
and emergency department. STUDY SELECTION AND DATA EXTRACTION: The search
was limited by age group to adults and by publication type to comparative
studies. Studies comparing routes of administration other than intravenous
or using non-opioid comparators were not included. Bibliographies of all
retrieved articles were reviewed to obtain additional articles. The focus of
the search was to identify original research that compared intravenous
opioids used for treatment of severe acute pain for adults in the ED. DATA
SYNTHESIS: At equipotent doses, randomized controlled trials have not shown
clinically significant differences in analgesic response or adverse effects
between opioids studied. Single opioid doses less than 0.1 mg/kg of
intravenous morphine, 0.015 mg/kg of intravenous hydromorphone, or 1 μg/kg
of intravenous fentanyl are likely to be inadequate for severe, acute pain
and the need for additional doses should be anticipated. In none of the
randomized controlled trials did patients develop respiratory depression
requiring the use of naloxone. Future trials could investigate the safety
and efficacy of higher doses of opioids. Implementation of nurse-initiated
and patient-driven pain management protocols for opioids in the ED has shown
improvements in timely provision of appropriate analgesics and has resulted
in better pain reduction. CONCLUSIONS: Currently, intravenous administration
of opioids for severe acute pain in the ED appears to be inadequate. Opioid
doses in the ED should be high enough to provide adequate analgesia without
additional risk to the patient. EDs could implement institution-specific
protocols to standardize the management of pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate derivative (adverse drug reaction, clinical trial, drug therapy,
intravenous drug administration)
EMTREE DRUG INDEX TERMS
butorphanol (clinical trial, drug therapy)
fentanyl (adverse drug reaction, clinical trial, drug dose, drug therapy,
intravenous drug administration)
hydromorphone (adverse drug reaction, clinical trial, drug dose, drug
therapy, intravenous drug administration)
morphine (adverse drug reaction, clinical trial, drug dose, drug therapy,
intravenous drug administration)
naloxone (adverse drug reaction, clinical trial, drug therapy)
pethidine (adverse drug reaction, clinical trial, drug dose, drug therapy)
tramadol (clinical trial, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
analgesia
clinical protocol
clinical trial
disease severity
dizziness (side effect)
drug dose comparison
drug dose titration
drug efficacy
drug hypersensitivity (side effect)
drug safety
emergency ward
human
hypotension (side effect)
kidney colic (drug therapy)
nausea (side effect)
neurotoxicity (side effect)
nurse
pain assessment
patient care
priority journal
pruritus (side effect)
repeated drug dose
respiration depression (side effect)
review
sedation
side effect (side effect)
systolic blood pressure
treatment response
unspecified side effect (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
2010605892
MEDLINE PMID
20978218 (http://www.ncbi.nlm.nih.gov/pubmed/20978218)
PUI
L359886992
DOI
10.1345/aph.1P438
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.1P438
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 822
TITLE
Intravenous opioid dosing and outcomes in emergency patients: A prospective
cohort analysis
AUTHOR NAMES
O'Connor A.B.
Zwemer F.L.
Hays D.P.
Feng C.
AUTHOR ADDRESSES
(O'Connor A.B., alec_oconnor@urmc.rochester.edu) Department of Internal
Medicine, University of Rochester, School of Medicine and Dentistry,
Rochester, NY 14642, United States.
(Zwemer F.L.; Hays D.P.) Department of Emergency Medicine, University of
Rochester, School of Medicine and Dentistry, Rochester, NY 14642, United
States.
(Hays D.P.) Department of Pharmacy, University of Rochester, School of
Medicine and Dentistry, Rochester, NY 14642, United States.
(Feng C.) Department of Biostatistics and Computational Biology, University
of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, United
States.
CORRESPONDENCE ADDRESS
A. B. O'Connor, Box MED/HMD, Strong Memorial Hospital, Rochester, NY 14642,
United States. Email: alec_oconnor@urmc.rochester.edu
SOURCE
American Journal of Emergency Medicine (2010) 28:9 (1041-1050.e6). Date of
Publication: November 2010
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Objectives: Pain management in emergency department (ED) patients is
variable and often inadequate. This study sought to (1) describe the
variability in intravenous opioid dosing and (2) compare the outcomes that
result from the most commonly prescribed opioid doses. Methods: This
prospective cohort study enrolled emergency patients who were prescribed
intravenous morphine or hydromorphone as their initial analgesic. Subjects
were interviewed at the time of opioid administration and 1 to 2 hours after
opioid administration. Outcomes included the numeric pain score change
(using a 0-10 scale), the proportion achieving a 50% pain score reduction,
and the proportion developing side effects. Logistic regression was used to
assess the effects of demographic, clinical, and treatment variables on
outcomes. Results: Six hundred ninety-one patients were analyzed. Initial
equianalgesic dosages varied by a factor of 27 (from 1 mg morphine to 4 mg
hydromorphone). Opioid dose titration occurred in only 21% of patients.
Outcomes were similar across the range of opioid dosages before and after
adjusting for potentially confounding variables. Among patients not taking
opioids at home who received a total of 4 mg of morphine or less. 48%
achieved at least a 50% pain score reduction and 60% did not want additional
analgesics. Conclusions: We found marked opioid dosing variability and
infrequent opioid dose titration. A substantial number of ED patients with
severe pain responded well to relatively low opioid dosages. Improved
ability to predict opioid dose requirements and strategies that increase the
use of opioid dose titration in ED patients are needed. © 2010 Elsevier Inc.
All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, drug comparison, drug dose, drug
therapy, intravenous drug administration)
morphine (adverse drug reaction, drug comparison, drug dose, drug therapy,
intravenous drug administration)
EMTREE DRUG INDEX TERMS
ketorolac (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
cohort analysis
confounding variable
controlled study
demography
drug dose titration
emergency patient
female
human
logistic regression analysis
major clinical study
male
outcome assessment
pain (drug therapy)
pain assessment
prescription
priority journal
prospective study
pruritus (side effect)
sedation
side effect (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010605068
MEDLINE PMID
20825766 (http://www.ncbi.nlm.nih.gov/pubmed/20825766)
PUI
L359886237
DOI
10.1016/j.ajem.2009.06.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2009.06.009
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 823
TITLE
Pediatric advanced life support: 2010 American Heart Association guidelines
for cardiopulmonary resuscitation and emergency cardiovascular care
AUTHOR NAMES
Kleinman M.E.
Chameides L.
Schexnayder S.M.
Samson R.A.
Hazinski M.F.
Atkins D.L.
Berg M.D.
De Caen A.R.
Fink E.L.
Freid E.B.
Hickey R.W.
Marino B.S.
Nadkarni V.M.
Proctor L.T.
Qureshi F.A.
Sartorelli K.
Topjian A.
Van Der Jagt E.W.
Zaritsky A.L.
AUTHOR ADDRESSES
(Kleinman M.E.; Chameides L.; Schexnayder S.M.; Samson R.A.; Hazinski M.F.;
Atkins D.L.; Berg M.D.; De Caen A.R.; Fink E.L.; Freid E.B.; Hickey R.W.;
Marino B.S.; Nadkarni V.M.; Proctor L.T.; Qureshi F.A.; Sartorelli K.;
Topjian A.; Van Der Jagt E.W.; Zaritsky A.L.)
CORRESPONDENCE ADDRESS
M. E. Kleinman,
SOURCE
Pediatrics (2010) 126:5 (e1361-e1399). Date of Publication: November 2010
ISSN
0031-4005
1098-4275 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
EMTREE DRUG INDEX TERMS
adenosine (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration, pharmacokinetics,
pharmacology)
amiodarone (adverse drug reaction, drug administration, drug therapy,
intraosseous drug administration, intravenous drug administration,
pharmacology)
amrinone (intraosseous drug administration, intravenous drug administration)
atropine (drug administration, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration, pharmacology)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (drug therapy, intraosseous drug administration, intratracheal
drug administration, intravenous drug administration)
calcium channel blocking agent (drug toxicity)
calcium chloride (drug therapy, intraosseous drug administration,
intravenous drug administration)
catecholamine (drug administration, drug therapy, intraosseous drug
administration)
cocaine (drug toxicity)
dobutamine (intraosseous drug administration, intravenous drug
administration)
epinephrine (drug administration, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration, pharmacology)
etomidate (drug therapy)
gluconate calcium (drug therapy)
glucose (drug therapy)
glyceryl trinitrate (drug therapy)
insulin (drug therapy)
lidocaine (adverse drug reaction, drug administration, drug therapy,
intratracheal drug administration, intravenous drug administration,
pharmacology)
local anesthetic agent (adverse drug reaction)
magnesium sulfate (drug administration, drug therapy, intraosseous drug
administration, intravenous drug administration, pharmacology)
naloxone (drug administration, drug dose, drug therapy, intramuscular drug
administration, intratracheal drug administration)
narcotic agent (drug toxicity)
nitric oxide (drug therapy, inhalational drug administration)
phentolamine (drug therapy)
procainamide (adverse drug reaction, drug therapy, intraosseous drug
administration, intravenous drug administration)
prostacyclin (drug therapy)
terlipressin (drug therapy, pharmacology)
unindexed drug
vasopressin (drug therapy, pharmacology)
verapamil (drug therapy, intraosseous drug administration, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
pediatric advanced life support
resuscitation
EMTREE MEDICAL INDEX TERMS
airway obstruction (therapy)
artificial ventilation
assisted ventilation
bradycardia (therapy)
cardiopulmonary arrest (drug therapy, therapy)
cardiotoxicity (side effect)
cardioversion
clinical feature
compression
coronary artery spasm (drug therapy)
defibrillation
drowsiness (side effect)
drug delivery system
drug dose titration
drug half life
drug intoxication (drug therapy)
drug megadose
drug overdose (drug therapy)
echocardiography
electrocardiography
emergency treatment
endotracheal intubation
endotracheal tube
extracorporeal life support
heart arrest (drug therapy, side effect, therapy)
heart arrhythmia (side effect)
heart ventricle arrhythmia (drug therapy)
heart ventricle fibrillation (therapy)
heart ventricle tachycardia (therapy)
human
hypoglycemia (drug therapy)
hypomagnesemia (drug therapy)
hypotension (side effect)
hypovolemic shock (therapy)
kidney failure (side effect)
laryngeal mask
laryngoscopy
low drug dose
lower esophagus sphincter
medical society
muscle twitch
nasopharynx
negative pressure ventilation
newborn intensive care
oropharynx
oxygenation
pneumothorax
practice guideline
priority journal
pulmonary hypertension (drug therapy, therapy)
pulse oximetry
recommended drug dose
respiration depression (drug therapy)
respiratory failure (therapy)
review
seizure (side effect)
septic shock (drug therapy, therapy)
shock (therapy)
side effect (side effect)
single drug dose
sudden infant death syndrome
supraventricular tachycardia (drug therapy, therapy)
systolic blood pressure
tachycardia (drug therapy, therapy)
thorax injury
torsade des pointes (drug therapy, side effect, therapy)
vascular access
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amrinone (60719-84-8)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dobutamine (34368-04-2, 52663-81-7)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
insulin (9004-10-8)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
nitric oxide (10102-43-9)
phentolamine (50-60-2, 73-05-2)
procainamide (51-06-9, 614-39-1)
prostacyclin (35121-78-9, 61849-14-7)
terlipressin (14636-12-5)
vasopressin (11000-17-2)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010603617
MEDLINE PMID
20956434 (http://www.ncbi.nlm.nih.gov/pubmed/20956434)
PUI
L359881975
DOI
10.1542/peds.2010-2972D
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2010-2972D
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 824
TITLE
Special Report - Neonatal resuscitation: 2010 American Heart Association
guidelines for cardiopulmonary resuscitation and emergency cardiovascular
care
AUTHOR NAMES
Kattwinkel J.
Perlman J.M.
Aziz K.
Colby C.
Fairchild K.
Gallagher J.
Hazinski M.F.
Halamek L.P.
Kumar P.
Little G.
McGowan J.E.
Nightengale B.
Ramirez M.M.
Ringer S.
Simon W.M.
Weiner G.M.
Wyckoff M.
Zaichkin J.
AUTHOR ADDRESSES
(Kattwinkel J.; Perlman J.M.; Aziz K.; Colby C.; Fairchild K.; Gallagher J.;
Hazinski M.F.; Halamek L.P.; Kumar P.; Little G.; McGowan J.E.; Nightengale
B.; Ramirez M.M.; Ringer S.; Simon W.M.; Weiner G.M.; Wyckoff M.; Zaichkin
J.)
CORRESPONDENCE ADDRESS
J. Kattwinkel,
SOURCE
Pediatrics (2010) 126:5 (e1400-e1413). Date of Publication: November 2010
ISSN
0031-4005
1098-4275 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
EMTREE DRUG INDEX TERMS
epinephrine (drug therapy, intratracheal drug administration, intravenous
drug administration)
glucose (drug therapy, intravenous drug administration)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
newborn care
resuscitation
EMTREE MEDICAL INDEX TERMS
amnion fluid
artificial ventilation
assisted ventilation
body temperature
brain ischemia (therapy)
breathing
cerebral palsy (epidemiology)
clinical trial
compression
drug efficacy
emergency care
endotracheal intubation
endotracheal tube
extremely low birth weight
health program
heart arrest (drug therapy)
heart rate
hospitalization
human
hypoglycemia (drug therapy, prevention)
induced hypothermia
laryngeal mask
lung compliance
lung resistance
meconium aspiration (therapy)
medical decision making
medical society
neonatal respiratory distress syndrome (drug therapy, epidemiology, therapy)
newborn assessment
newborn morbidity
newborn mortality
oxygen saturation
oxygen therapy
positive end expiratory pressure
practice guideline
prematurity (therapy)
priority journal
pulse oximetry
review
seizure (epidemiology)
therapy effect
thermoregulation
tracheobronchial toilet
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010603618
PUI
L359881976
DOI
10.1542/peds.2010-2972E
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2010-2972E
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 825
TITLE
Baby boy blue - Why is this newborn lethargic?
AUTHOR NAMES
Rieder M.
Koren G.
AUTHOR ADDRESSES
(Rieder M.) Children's Hospital of Western Ontario, University of Western
Ontario, London, ON, Canada.
(Koren G.) Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada.
CORRESPONDENCE ADDRESS
M. Rieder, Children's Hospital of Western Ontario, University of Western
Ontario, London, ON, Canada. Email: cpsp@cps.ca
SOURCE
Paediatrics and Child Health (2010) 15:9 (571-572). Date of Publication:
November 2010
ISSN
1205-7088
BOOK PUBLISHER
Pulsus Group Inc., 2902 South Sheridan Way, Oakville, Canada.
EMTREE DRUG INDEX TERMS
codeine (drug therapy)
cytochrome P450 2D6 (endogenous compound)
morphine (drug concentration, drug toxicity)
morphine 6 glucuronide
naloxone (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, diagnosis, drug therapy, etiology)
lethargy
EMTREE MEDICAL INDEX TERMS
Apgar score
breast feeding
case report
cesarean section
clinical examination
DNA polymorphism
emergency ward
gene duplication
genetic screening
human
male
maternal care
newborn
physical examination
postoperative analgesia
postoperative pain (complication, drug therapy)
puerperium
short survey
urinalysis
CAS REGISTRY NUMBERS
codeine (76-57-3)
morphine (52-26-6, 57-27-2)
morphine 6 glucuronide (20290-10-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Pediatrics and Pediatric Surgery (7)
Human Genetics (22)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010627894
PUI
L359970688
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 826
TITLE
Pitfalls in preclinical emergency pharmacology
ORIGINAL (NON-ENGLISH) TITLE
Pharmakologische fallstricke in der notfallmedizin
AUTHOR NAMES
Ittner K.P.
Pawlik M.
Bäumel M.
Koppenberg J.
AUTHOR ADDRESSES
(Ittner K.P., karl-peter.ittner@klinik.uni-regensburg.de; Pawlik M.) Klinik
für Anästhesiologie, Universitätsklinikum Regensburg,
Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.
(Bäumel M.) Apotheke, Universitätsklinikum Regensburg, Germany.
(Koppenberg J.) Abteilung für Anästhesiologie, Schmerztherapie und
Rettungsmedizin, Center da Sandà Engiadina Bassa, Scuol, Switzerland.
CORRESPONDENCE ADDRESS
K. P. Ittner, Klinik für Anästhesiologie, Universitätsklinikum Regensburg,
Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany. Email:
karl-peter.ittner@klinik.uni-regensburg.de
SOURCE
Intensiv- und Notfallbehandlung (2010) 35:3 (107-114). Date of Publication:
2010
ISSN
0947-5362
BOOK PUBLISHER
Dustri-Verlag Dr. Karl Feistle, P.O. Box 1351, Deisenhofen/ Munich, Germany.
ABSTRACT
Preclinical emergencies have the challenge, that interindividual differences
can profoundly influence therapeutic effectiveness and adverse effects.
Accuracy in diagnosis is the keystone for the type of therapy or the
therapeutic regimen. Therapeutic success depends on the competence of the
emergency physician to integrate rapidly all information to the appropriate
drug decision. The following preclinical emergency cases display the
challenge to individualise emergency pharmacology. © 2010 Dustri-Verlag Dr.
Karl Feistle.
EMTREE DRUG INDEX TERMS
5 (2 bromovinyl) 2' deoxyuridine
acetylsalicylic acid
antihistaminic agent
antihypertensive agent
barbituric acid derivative
beta adrenergic receptor blocking agent
buprenorphine
capecitabine
chlorbutol
clopidogrel
dipyrone (intravenous drug administration)
diuretic agent
epinephrine
esmolol
fenoterol (intranasal drug administration)
fentanyl
fluorouracil
ketamine
midazolam
naloxone
noradrenalin
prednisone
rocuronium
spasmolytic agent
suxamethonium
theophylline
thiamine
thiopental
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical pharmacology
emergency medicine
EMTREE MEDICAL INDEX TERMS
acute heart infarction
anaphylaxis
asthma
clinical decision making
diagnostic accuracy
differential diagnosis
emergency physician
human
hypertension
off label drug use
respiratory failure
review
sepsis
supraventricular tachycardia
DRUG TRADE NAMES
aspirin
berotec
brevibloc
esmeron
partusisten
suprarenin
CAS REGISTRY NUMBERS
5 (2 bromovinyl) 2' deoxyuridine (69304-47-8, 82768-44-3)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
buprenorphine (52485-79-7, 53152-21-9)
capecitabine (154361-50-9)
chlorbutol (57-15-8)
clopidogrel (113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
esmolol (81147-92-4, 81161-17-3)
fenoterol (13392-18-2, 1944-12-3)
fentanyl (437-38-7)
fluorouracil (51-21-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
prednisone (53-03-2)
rocuronium (119302-91-9)
suxamethonium (306-40-1, 71-27-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiamine (59-43-8, 67-03-8)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2010566140
PUI
L359748814
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 827
TITLE
A 58-year-old woman with an unusual cause of respiratory failure
AUTHOR NAMES
Jankowske M.
Mailloux P.
Przyborowski M.
AUTHOR ADDRESSES
(Jankowske M., mark.jankowske@baystatehealth.org) Medicine-Pediatrics
Residency, Baystate Medical Center, .
(Mailloux P.) Critical Care Division, Baystate Medical Center, .
(Przyborowski M.) Mount Holyoke College, .
CORRESPONDENCE ADDRESS
M. Jankowske, Medicine-Pediatrics Residency, Baystate Medical Center, .
Email: mark.jankowske@baystatehealth.org
SOURCE
Internet Journal of Pulmonary Medicine (2010) 12:1. Date of Publication:
2010
ISSN
1531-2984 (electronic)
BOOK PUBLISHER
Internet Scientific Publications LLC, 23 Rippling Creek Drive, Sugar Land,
United States.
ABSTRACT
A 58-year-old woman presented to the emergency department (ED) after she was
found unresponsive for an unknown period of time. Upon paramedics' arrival
she had a respiratory rate of 4 breaths/min, an O(2) saturation of 71% and a
Glasgow Coma Score of 3. Her home medications included ibuprofen, fentanyl
and lorazepam. The patient's mental status deteriorated and she ultimately
required intubation and mechanical ventilation. She was managed in the
intensive care unit (ICU) for what appeared to be a drug overdose and on the
following day, after successful extubation, was transferred to the medicine
wards. We report an unexpected twist in the pathogenesis of this case. ©
Internet Scientific Publications, LLC., 1996 to 2010.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (transdermal drug administration)
EMTREE DRUG INDEX TERMS
amoxicillin plus clavulanic acid (drug therapy)
diazepam
diphenhydramine
levofloxacin (drug combination, drug therapy)
naloxone (intravenous drug administration)
piperacillin plus tazobactam (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
foreign body aspiration (diagnosis, surgery)
respiratory failure (complication, diagnosis, therapy)
transdermal patch
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
breathing rate
bronchoscopy
case report
cast application
coughing
emergency health service
emergency ward
extubation
female
Glasgow coma scale
hematothorax
hospital infection (diagnosis, drug therapy)
human
infection (drug therapy)
intensive care unit
intubation
leukocytosis
mental disease
oxygen saturation
pneumonia (diagnosis, drug therapy)
sinus tachycardia
surgical technique
tachypnea
thorax radiography
weakness
wrist fracture (therapy)
CAS REGISTRY NUMBERS
amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
levofloxacin (100986-85-4, 138199-71-0)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010545722
PUI
L359689202
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 828
TITLE
Effect of concomitant opiate ingestion on paracetamol levels in acute
overdose
AUTHOR NAMES
Reddick A.D.
Hodge K.
Morrison W.G.
AUTHOR ADDRESSES
(Reddick A.D., andrew.reddick@nhs.net; Hodge K.; Morrison W.G.) Emergency
Department, Ninewells Hospital, Dundee DD1 9SY, United Kingdom.
CORRESPONDENCE ADDRESS
A. D. Reddick, Emergency Department, Ninewells Hospital, Dundee DD1 9SY,
United Kingdom. Email: andrew.reddick@nhs.net
SOURCE
Emergency Medicine Journal (2010) 27:10 (742-744). Date of Publication:
October 2010
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Aim: To assess whether the co-ingestion of opiates in acute paracetamol
overdose has an effect on the paracetamol level 4 h after ingestion.
Methods: A prospective observational study was performed in the emergency
department of a teaching hospital. The paracetamol levels at 4 h of
consecutive patients who had taken an overdose of either paracetamol alone
or in conjunction with an opiate were collected over a 4-month period. The
data were then analysed. Results: After exclusions, the results of 21
patients who took paracetamol alone and 20 who took paracetamol and an
opiate showed that paracetamol levels were significantly lower at 4 h if
there was co-ingestion of an opiate. Analysis shows that opiate ingestion is
a predictor for paracetamol levels at 4 h. Conclusion: Co-ingestion of
opiate decreases the serum paracetamol level at 4 h. If opiate and
paracetamol are taken together, there is a case for a repeat measurement of
the paracetamol level if the level at 4 h is lower than would be expected in
selected patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (clinical trial, drug combination, drug interaction, pharmacology)
paracetamol (clinical trial, drug combination, drug interaction,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
EMTREE MEDICAL INDEX TERMS
adjuvant therapy
adolescent
adult
aged
article
clinical article
clinical trial
controlled clinical trial
controlled study
drug blood level
drug effect
emergency ward
female
human
male
observational study
prediction
priority journal
prospective study
statistical significance
teaching hospital
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010538270
MEDLINE PMID
20650915 (http://www.ncbi.nlm.nih.gov/pubmed/20650915)
PUI
L359668775
DOI
10.1136/emj.2009.083469
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2009.083469
COPYRIGHT
Copyright 2013 Elsevier B.V., All rights reserved.
RECORD 829
TITLE
Management of poisonings: Core curriculum 2010
AUTHOR NAMES
Winchester J.F.
Harbord N.B.
Rosen H.
AUTHOR ADDRESSES
(Winchester J.F., jwinches@bethisraelny.org; Harbord N.B.; Rosen H.)
Division of Nephrology and Hypertension, Beth Israel Medical Center, 350
East 17th St, 18BH20, New York, NY 10003, United States.
CORRESPONDENCE ADDRESS
J. F. Winchester, Division of Nephrology and Hypertension, Beth Israel
Medical Center, 350 East 17th St, 18BH20, New York, NY 10003, United States.
Email: jwinches@bethisraelny.org
SOURCE
American Journal of Kidney Diseases (2010) 56:4 (788-800). Date of
Publication: October 2010
ISSN
0272-6386
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy)
acetylcysteine (drug therapy)
activated carbon (drug therapy, pharmacokinetics)
alcohol (drug therapy)
antidote (drug therapy)
atropine (drug therapy, drug toxicity)
belladonna alkaloid (drug toxicity)
benzodiazepine (drug dose, drug toxicity)
bicarbonate (drug therapy)
cardiac glycoside (drug dose, drug toxicity)
Datura stramonium extract (drug toxicity)
deferoxamine (drug therapy)
digoxin antibody F(ab) fragment (drug therapy)
dimercaprol (drug therapy)
edetic acid (drug therapy)
emetic agent (drug therapy)
flumazenil (drug therapy)
ipecac (drug therapy)
laxative (drug therapy)
lithium (pharmacokinetics, pharmacology)
naloxone (drug therapy)
opiate (adverse drug reaction)
paracetamol (adverse drug reaction, drug toxicity)
physostigmine (drug therapy)
polystyrenesulfonate sodium (pharmacokinetics)
pralidoxime (drug therapy)
salicylic acid (adverse drug reaction, drug toxicity, pharmacokinetics)
sorbent (drug therapy, oral drug administration)
tricyclic antidepressant agent (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, side effect, drug therapy, side effect,
therapy)
intoxication (drug therapy, drug therapy, therapy)
kidney disease
EMTREE MEDICAL INDEX TERMS
clinical practice
continuous hemodiafiltration
continuous hemodialysis
continuous hemofiltration
curriculum
detoxification
diuresis
drug absorption
drug binding
drug clearance
drug efficacy
drug elimination
drug excretion
drug half life
drug metabolism
drug overdose (drug therapy)
emergency treatment
enteric decontamination
extracorporeal shock wave lithotripsy
gastrointestinal tract
glomerulus filtration rate
hemodialysis
human
intestine lavage
ion trap mass spectrometry
kidney function
metal intoxication (drug therapy)
metal intoxication (drug therapy)
nephrology
neurotoxicity (drug therapy)
peritoneal dialysis
purification
respiration depression (drug therapy, side effect)
review
risk factor
stomach emptying
stomach lavage
toxicokinetics
treatment indication
DRUG TRADE NAMES
digibind Glaxo SmithKline
kayexalate Sanofi Aventis
DRUG MANUFACTURERS
Glaxo SmithKline
Sanofi Aventis
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
belladonna alkaloid (8007-93-0)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
edetic acid (150-43-6, 60-00-4)
flumazenil (78755-81-4)
ipecac (8012-96-2)
lithium (7439-93-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
polystyrenesulfonate sodium (37349-16-9, 39291-70-8, 62744-35-8, 9080-79-9)
pralidoxime (6735-59-7)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Urology and Nephrology (28)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010514457
MEDLINE PMID
20692080 (http://www.ncbi.nlm.nih.gov/pubmed/20692080)
PUI
L51020953
DOI
10.1053/j.ajkd.2010.05.014
FULL TEXT LINK
http://dx.doi.org/10.1053/j.ajkd.2010.05.014
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 830
TITLE
European Resuscitation Council Guidelines for Resuscitation 2010 Section 6.
Paediatric life support
AUTHOR NAMES
Biarent D.
Bingham R.
Eich C.
López-Herce J.
Maconochie I.
Rodríguez-Núñez A.
Rajka T.
Zideman D.
AUTHOR ADDRESSES
(Biarent D., dominique.biarent@huderf.be) Paediatric Intensive Care, Hôpital
Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
(Bingham R.) Great Ormond Street Hospital for Children, London, United
Kingdom.
(Eich C.) Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin,
Universitätsmedizin Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen,
Germany.
(López-Herce J.) Pediatric Intensive Care Department, Hospital General
Universitario Gregorio Marañón, Complutense University of Madrid, Madrid,
Spain.
(Maconochie I.) St Mary's Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom.
(Rodríguez-Núñez A.) University of Santiago de Compostela FEAS, Pediatric
Emergency and Critical Care Division, Pediatric Area Hospital Clinico
Universitario de Santiago de Compostela, 15706 Santiago de Compostela,
Spain.
(Rajka T.) Oslo University Hospital, Kirkeveien, Oslo, Norway.
(Zideman D.) Imperial College Healthcare NHS Trust, London, United Kingdom.
CORRESPONDENCE ADDRESS
D. Biarent, Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15
av JJ Crocq, Brussels, Belgium. Email: dominique.biarent@huderf.be
SOURCE
Resuscitation (2010) 81:10 (1364-1388). Date of Publication: October 2010
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
EMTREE DRUG INDEX TERMS
adenosine (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacokinetics)
alpha adrenergic receptor blocking agent
amiodarone (adverse drug reaction, drug comparison, drug therapy,
pharmacology)
antipyretic agent (adverse drug reaction, drug therapy)
atropine (drug therapy, intraosseous drug administration, intravenous drug
administration, pharmacology)
bicarbonate (drug therapy, drug toxicity)
calcium (drug therapy)
dobutamine (drug therapy)
dopamine (drug therapy)
epinephrine (drug combination, drug dose, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration)
glucose
lidocaine (drug comparison, intraosseous drug administration, intravenous
drug administration)
magnesium (drug therapy)
naloxone (intraosseous drug administration, intravenous drug administration)
nitric oxide (drug therapy, inhalational drug administration)
noradrenalin (drug therapy)
oxygen
procainamide (drug therapy, pharmacology)
prostacyclin (drug therapy, intravenous drug administration)
terlipressin (drug combination, drug therapy, pharmacology)
vasopressin (drug combination, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatric advanced life support
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
airway
airway obstruction (therapy)
article
assisted ventilation
automated external defibrillator
blood glucose monitoring
bradycardia (drug therapy, side effect)
breathing
calcium channel blocking agent overdose (drug therapy)
calcium channel blocking agent overdose (drug therapy)
capnometry
cardiac channelopathy
cardiopulmonary arrest (diagnosis, drug therapy, prevention, therapy)
cardiopulmonary hemodynamics
child parent relation
child safety
childhood disease (drug therapy, therapy)
childhood mortality
clinical trial
compression therapy
consciousness
continuous infusion
cricoid cartilage
decompression
defibrillation
defibrillator
disease course
drug dose titration
drug efficacy
drug half life
drug overdose (drug therapy)
drug safety
drug substitution
electric potential
electrocardiography monitoring
emergency treatment
end tidal carbon dioxide tension
endotracheal intubation
endotracheal tube
extracorporeal circulation
family relation
fever (drug therapy)
foreign body
heart arrest (drug therapy, therapy)
heart arrhythmia (drug therapy)
heart single ventricle
heart ventricle fibrillation (therapy)
heart ventricle tachycardia (drug therapy, side effect)
human
hyperkalemia (drug therapy)
hypermagnesemia (drug therapy)
hypocalcemia (drug therapy)
hypomagnesemia (drug therapy)
intensive care
international cooperation
laryngeal mask
lung ventilation perfusion ratio
medical device
metabolic acidosis (drug therapy)
mouth
myocardial disease (complication, drug therapy)
oxygenation
patient safety
priority journal
procedures
prognosis
pulmonary hypertension (drug therapy)
pulse oximetry
respiratory failure (diagnosis, therapy)
single drug dose
supraventricular tachycardia (drug therapy)
systemic vascular resistance
tachycardia
temperature measurement
thorax
titrimetry
tricyclic antidepressant agent overdose (drug therapy)
tricyclic antidepressant agent overdose (drug therapy)
unconsciousness
unspecified side effect (side effect)
vascular access
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (14092-94-5, 7440-70-2)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium (7439-95-4)
naloxone (357-08-4, 465-65-6)
nitric oxide (10102-43-9)
noradrenalin (1407-84-7, 51-41-2)
oxygen (7782-44-7)
procainamide (51-06-9, 614-39-1)
prostacyclin (35121-78-9, 61849-14-7)
terlipressin (14636-12-5)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
CLINICAL TRIAL NUMBERS
ClinicalTrials.gov (NCT00878644, NCT00880087)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010647043
MEDLINE PMID
20956047 (http://www.ncbi.nlm.nih.gov/pubmed/20956047)
PUI
L51113409
DOI
10.1016/j.resuscitation.2010.08.012
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2010.08.012
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 831
TITLE
European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.
Cardiac arrest in special circumstances: Electrolyte abnormalities,
poisoning, drowning, accidental hypothermia, hyperthermia, asthma,
anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution
AUTHOR NAMES
Soar J.
Perkins G.D.
Abbas G.
Alfonzo A.
Barelli A.
Bierens J.J.L.M.
Brugger H.
Deakin C.D.
Dunning J.
Georgiou M.
Handley A.J.
Lockey D.J.
Paal P.
Sandroni C.
Thies K.-C.
Zideman D.A.
Nolan J.P.
AUTHOR ADDRESSES
(Soar J., jas.soar@btinternet.com) Anaesthesia and Intensive Care Medicine,
Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
(Perkins G.D.) University of Warwick, Warwick Medical School, Warwick,
United Kingdom.
(Abbas G.) Emergency Department, Al Rahba Hospital, Abu Dhabi, United Arab
Emirates.
(Alfonzo A.) Queen Margaret Hospital, Dunfermline, Fife, United Kingdom.
(Barelli A.) Intensive Care Medicine and Clinical Toxicology, Catholic
University School of Medicine, Rome, Italy.
(Bierens J.J.L.M.) Maxima Medical Centre, Eindhoven, Netherlands.
(Brugger H.) EURAC Institute of Mountain Emergency Medicine, Bozen, Italy.
(Deakin C.D.) Cardiac Anaesthesia and Critical Care, Southampton University
Hospital NHS Trust, Southampton, United Kingdom.
(Dunning J.) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom.
(Georgiou M.) Nicosia General Hospital, Nicosia, Cyprus.
(Handley A.J.) Honorary Consultant Physician, Colchester, United Kingdom.
(Lockey D.J.) Anaesthesia and Intensive Care Medicine, Frenchay Hospital,
Bristol, United Kingdom.
(Paal P.) Department of Anesthesiology and Critical Care Medicine,
University Hospital Innsbruck, Innsbruck, Austria.
(Sandroni C.) Critical Care Medicine at Policlinico Universitario Agostino
Gemelli, Catholic University School of Medicine, Rome, Italy.
(Thies K.-C.) Birmingham Children's Hospital, Birmingham, United Kingdom.
(Zideman D.A.) Imperial College Healthcare NHS Trust, London, United
Kingdom.
(Nolan J.P.) Anaesthesia and Intensive Care Medicine, Royal United Hospital,
Bath, United Kingdom.
CORRESPONDENCE ADDRESS
J. Soar, Anaesthesia and Intensive Care Medicine, Southmead Hospital, North
Bristol NHS Trust, Bristol, United Kingdom. Email: jas.soar@btinternet.com
SOURCE
Resuscitation (2010) 81:10 (1400-1433). Date of Publication: October 2010
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
EMTREE DRUG INDEX TERMS
2,4 dichlorophenoxyacetic acid (drug toxicity)
activated carbon (drug therapy)
angiotensin receptor antagonist (adverse drug reaction)
antidote (drug therapy)
benzodiazepine (drug toxicity)
beta adrenergic receptor blocking agent (adverse drug reaction, drug
toxicity)
bicarbonate (drug therapy, intravenous drug administration)
calcium chloride (drug therapy)
calcium salt (intravenous drug administration)
digoxin (adverse drug reaction, drug toxicity)
dipeptidyl carboxypeptidase inhibitor (adverse drug reaction)
diuretic agent (adverse drug reaction)
epinephrine (adverse drug reaction, clinical trial, drug administration,
drug dose, drug therapy, inhalational drug administration, intramuscular
drug administration, intravenous drug administration, pharmacology,
subconjunctival drug administration)
flumazenil (adverse drug reaction)
furosemide (drug therapy, intravenous drug administration)
hydrocortisone (drug therapy, intravenous drug administration)
laxative (adverse drug reaction)
magnesium sulfate (clinical trial, drug therapy, intravenous drug
administration)
mecoprop (drug toxicity)
naloxone (drug therapy)
nonsteroid antiinflammatory agent (adverse drug reaction)
opiate (drug toxicity)
pamidronic acid (drug therapy, intravenous drug administration)
poison (drug toxicity)
potassium (drug therapy, endogenous compound, intravenous drug
administration)
potassium chloride (drug toxicity)
potassium sparing diuretic agent (adverse drug reaction)
steroid (adverse drug reaction)
trimethoprim (adverse drug reaction)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest (drug therapy, complication, drug therapy, etiology,
prevention, surgery, therapy)
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
abnormal laboratory result
accident prevention
accidental death
accidental hypothermia (diagnosis, therapy)
airway
airway obstruction (complication, therapy)
alkalinization
amnion fluid embolism (complication)
anaphylaxis (diagnosis, drug therapy, therapy)
anticholinergic effect
article
assisted ventilation
asthma (diagnosis, drug therapy, therapy)
avalanche
benzodiazepine intoxication
beta adrenergic receptor blocking agent intoxication
blood transfusion
breathing
calcium channel blocking agent intoxication
carbon monoxide intoxication
cardiac patient
cardiopulmonary bypass
cardiopulmonary insufficiency (diagnosis, surgery, therapy)
cardiovascular disease
cardiovascular risk
cause of death
childhood disease (drug therapy)
circulation
clinical feature
clinical trial
cocaine intoxication
cyanide poisoning
defibrillation
diagnostic test
digitalis intoxication
disease association
disease classification
disease severity
drowning (etiology, therapy)
drug dosage form comparison
drug dose comparison
drug dose titration
drug efficacy
drug intoxication (drug therapy)
drug overdose
drug safety
drug treatment failure
eclampsia (complication)
electrocardiogram
electrocution (diagnosis, therapy)
electrolyte disturbance (prevention)
emergency treatment
fluid intake
follow up
gastroesophageal reflux (complication)
heart arrhythmia (drug therapy, side effect, therapy)
heart massage
heart muscle ischemia (side effect)
heart protection
heart surgery
heat exhaustion (therapy)
heat stress
heat stroke (etiology, therapy)
hemodialysis
hemolysis
homeostasis
hospital admission
hospital discharge
human
hypercalcemia (drug therapy, etiology, therapy)
hyperkalemia (prevention, side effect, therapy)
hypermagnesemia (drug therapy, etiology, therapy)
hypertension (side effect)
hyperthermia
hypocalcemia (drug therapy, etiology)
hypokalemia (complication, drug therapy, etiology, side effect)
hypomagnesemia (drug therapy, etiology)
hypotension (side effect)
induced hypothermia
injury
international cooperation
intoxication (drug therapy, therapy)
kidney function
lightning
local anesthetic agent intoxication
lung embolism (complication)
malignant hyperthermia
mast cell
maternal care
medical decision making
metabolic acidosis
nebulization
opiate intoxication (drug therapy)
opiate intoxication (drug therapy, therapy)
oxygen therapy
oxygenation
pathophysiology
patient monitoring
patient safety
pediatric surgery
pericardiocentesis
preeclampsia
pregnancy
prevalence
priority journal
rhabdomyolysis
risk factor
salicylate poisoning (drug therapy)
salicylate poisoning (drug therapy)
saluresis
seizure (side effect)
self poisoning
single drug dose
sternotomy
stomach lavage
tachycardia (side effect)
therapy effect
thoracotomy
traumatic cardiorespiratory arrest (diagnosis, surgery, therapy)
treatment failure
treatment indication
treatment outcome
treatment planning
treatment response
tricyclic antidepressant agent intoxication
tumor cell destruction
urine
warming
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
2,4 dichlorophenoxyacetic acid (2702-72-9, 94-75-7)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
digoxin (20830-75-5, 57285-89-9)
flumazenil (78755-81-4)
furosemide (54-31-9)
hydrocortisone (50-23-7)
magnesium sulfate (7487-88-9)
mecoprop (1929-86-8, 7085-19-0, 93-65-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pamidronic acid (40391-99-9, 57248-88-1)
potassium (7440-09-7)
potassium chloride (7447-40-7)
trimethoprim (738-70-5)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
CLINICAL TRIAL NUMBERS
ISRCTN (ISRCTN04417063)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010647045
MEDLINE PMID
20956045 (http://www.ncbi.nlm.nih.gov/pubmed/20956045)
PUI
L51113412
DOI
10.1016/j.resuscitation.2010.08.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2010.08.015
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 832
TITLE
Part 11: Neonatal resuscitation: 2010 International consensus on
cardiopulmonary resuscitation and emergency cardiovascular care science with
treatment recommendations
AUTHOR NAMES
Wyllie J.
Perlman J.F.
Kattwinkel J.
Atkins D.L.
Chameides L.
Goldsmith J.P.
Guinsburg R.
Hazinski M.F.
Morley C.
Richmond S.
Simon W.M.
Singhal N.
Szyld E.
Tamura M.
Velaphi S.
AUTHOR ADDRESSES
(Wyllie J., jonathan.wyllie@stees.nhs.uk) The James Cook University
Hospital, Middlesborough, United Kingdom.
(Perlman J.F.; Kattwinkel J.; Atkins D.L.; Chameides L.; Goldsmith J.P.;
Guinsburg R.; Hazinski M.F.; Morley C.; Richmond S.; Simon W.M.; Singhal N.;
Szyld E.; Tamura M.; Velaphi S.)
CORRESPONDENCE ADDRESS
J. Wyllie, The James Cook University Hospital, Middlesborough, United
Kingdom. Email: jonathan.wyllie@stees.nhs.uk
SOURCE
Resuscitation (2010) 81:1 SUPPL.1 (e260-e287). Date of Publication: October
2010
ISSN
0300-9572
1873-1570 (electronic)
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
EMTREE DRUG INDEX TERMS
atropine (intratracheal drug administration, intravenous drug
administration)
carbon dioxide
corticosteroid
epinephrine (adverse drug reaction, drug administration, intravenous drug
administration)
glucose
naloxone (drug administration, intramuscular drug administration,
intravenous drug administration, pharmacokinetics)
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
newborn intensive care
resuscitation
EMTREE MEDICAL INDEX TERMS
article
assisted ventilation
body temperature
cesarean section
clinical assessment
colorimetry
compression
corticosteroid therapy
devices
drug fatality (side effect)
drug half life
drug megadose
elective surgery
endotracheal tube
gestational age
heart auscultation
heart rate
heat
human
hyperthermia
induced hypothermia
knowledge
laryngeal mask
meconium
medical education
newborn
newborn monitoring
nonhuman
oximetry
oxygen therapy
perinatal period
positive end expiratory pressure
priority journal
return of spontaneous circulation
skill
staff training
suction
thorax compression
treatment withdrawal
vascular access
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
carbon dioxide (124-38-9, 58561-67-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2011434172
MEDLINE PMID
20956039 (http://www.ncbi.nlm.nih.gov/pubmed/20956039)
PUI
L51113424
DOI
10.1016/j.resuscitation.2010.08.029
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2010.08.029
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 833
TITLE
Methadone maintenance and the cost and utilization of health care among
individuals dependent on opioids in a commercial health plan
AUTHOR NAMES
McCarty D.
Perrin N.A.
Green C.A.
Polen M.R.
Leo M.C.
Lynch F.
AUTHOR ADDRESSES
(McCarty D., mccartyd@ohsu.edu; Leo M.C.) Oregon Health and Science
University, Portland, OR 97239, United States.
(Perrin N.A.; Green C.A.; Polen M.R.; Lynch F.) Center for Health Research,
Kaiser Permanente Northwest, Portland, OR 97227, United States.
CORRESPONDENCE ADDRESS
D. McCarty, Department of Public Health and Preventive Medicine, CB669,
Oregon Health and Science University, 3181 SW Sam Jackson Park Road,
Portland, OR 97239, United States. Email: mccartyd@ohsu.edu
SOURCE
Drug and Alcohol Dependence (2010) 111:3 (235-240). Date of Publication: 1
Oct 2010
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: Few health plans provide maintenance medication for opioid
dependence. This study assessed the cost of treating opioid-dependent
members in a commercial health plan and the impacts of methadone maintenance
on costs of care. Methods: Individuals with diagnoses of opioid dependence
(two or more diagnoses per year) and at least 9 months of health plan
eligibility each year were extracted from electronic health records for the
years 2000 through 2004 (1,518 individuals and 2,523 observations across the
study period-some individuals were in multiple years). Analyses examined the
patterns and costs of health care for three groups of patients: (1) one or
more methadone visits during the year (n= 1,298; 51%); (2) no methadone
visits and 0 or 1 visits in the Addiction Medicine Department (n= 370; 15%);
(3) no methadone visits and 2 or more visits in addiction medicine (n= 855;
34%). Results: Primary care (86%), emergency department (48%) and inpatient
(24%) visits were common. Mean total annual costs to the health plan were
$11,200 (2004 dollars) per member per year. The health plan's costs for
members receiving methadone maintenance were 50% lower ($7,163) when
compared to those with two or more outpatient addiction treatment visits but
no methadone ($14,157) and 62% lower than those with one or zero outpatient
addiction treatment visits and no methadone treatment ($18,694).
Conclusions: Use of opioid maintenance services was associated with lower
total costs of care for opioid-dependent members in a commercial health
plan. © 2010 Elsevier Ireland Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care cost
health care utilization
health insurance
opiate addiction (drug therapy, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
emergency ward
female
hospital patient
human
major clinical study
male
methadone treatment
outpatient care
primary medical care
priority journal
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010546208
MEDLINE PMID
20627427 (http://www.ncbi.nlm.nih.gov/pubmed/20627427)
PUI
L50938364
DOI
10.1016/j.drugalcdep.2010.04.018
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2010.04.018
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 834
TITLE
Emergency department visits among recipients of chronic opioid therapy
AUTHOR NAMES
Braden J.B.
Russo J.
Fan M.-Y.
Edlund M.J.
Martin B.C.
DeVries A.
Sullivan M.D.
AUTHOR ADDRESSES
(Braden J.B.; Russo J.; Fan M.-Y.; Sullivan M.D., sullimar@u.washington.edu)
Department of Psychiatry and Behavioral Sciences, University of Washington,
Box 356560, Seattle, WA 98195, United States.
(Edlund M.J.; Martin B.C.) Department of Psychiatry, University of Arkansas
for Medical Sciences, Little Rock, AR, United States.
(DeVries A.) HealthCore Inc., Wilmington, DE, United States.
CORRESPONDENCE ADDRESS
M. D. Sullivan, Department of Psychiatry and Behavioral Sciences, University
of Washington, Box 356560, Seattle, WA 98195, United States. Email:
sullimar@u.washington.edu
SOURCE
Archives of Internal Medicine (2010) 170:16 (1425-1432). Date of
Publication: 13 Sep 2010
ISSN
0003-9926
1538-3679 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Background: There has been an increase in overdose deaths and emergency
department visits (EDVs) involving use of prescription opioids, but the
association between opioid prescribing and adverse outcomes is unclear.
Methods: Data were obtained from administrative claim records from Arkansas
Medicaid and HealthCore commercially insured enrollees, 18 years and older,
who used prescription opioids for at least 90 continuous days within a
6-month period between 2000 and 2005 and had no cancer diagnoses. Regression
analysis was used to examine risk factors for EDVs and alcohol- or
drug-related encounters (ADEs) in the 12 months following 90 days or more of
prescribed opioids. Results: Headache, back pain, and preexisting substance
use disorders were significantly associated with EDVs and ADEs. Mental
health disorders were associated with EDVs in HealthCore enrollees and with
ADEs in both samples. Opioid dose per day was not consistently associated
with EDVs but doubled the risk of ADEs at morphine-equivalent doses over 120
mg/d. Use of shortacting Drug Enforcement Agency Schedule II opioids was
associated with EDVs compared with use of non-Schedule II opioids alone
(relative risk range, 1.09-1.74). Use of Schedule II long-acting opioids was
strongly associated with ADEs (relative risk range, 1.64-4.00). Conclusions:
Use of Schedule II opioids, headache, back pain, and substance use disorders
are associated with EDVs and ADEs among adults prescribed opioids for 90
days or more. It may be possible to increase the safety of chronic opioid
therapy by minimizing the prescription of Schedule II opioids in these
higher-risk recipients. ©2010 American Medical Association. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
morphine
EMTREE MEDICAL INDEX TERMS
adult
arthralgia (drug therapy)
arthritis (drug therapy)
article
backache (drug therapy)
case report
chronic drug administration
controlled study
drug indication
drug overdose
drug safety
drug withdrawal
emergency ward
female
headache (drug therapy)
high risk patient
human
male
neck pain (drug therapy)
prescription
priority journal
recipient
risk assessment
risk factor
substance abuse
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Arthritis and Rheumatism (31)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010516232
MEDLINE PMID
20837827 (http://www.ncbi.nlm.nih.gov/pubmed/20837827)
PUI
L359594695
DOI
10.1001/archinternmed.2010.273
FULL TEXT LINK
http://dx.doi.org/10.1001/archinternmed.2010.273
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 835
TITLE
Amitriptyline and tianeptine poisoning treated by naloxone
AUTHOR NAMES
Ari M.
Oktar S.
Duru M.
AUTHOR ADDRESSES
(Ari M.) Department of Psychiatry, Medical Faculty of Mustafa, Kemal
University, Hatay, Turkey.
(Oktar S., suleymanoktar@yahoo.com) Department of Pharmacology, Medical
Faculty of Mustafa, Kemal University, Hatay 31040, Turkey.
(Duru M.) Department of Emergency Medicine, Medical Faculty of Mustafa,
Kemal University, Hatay, Turkey.
CORRESPONDENCE ADDRESS
S. Oktar, Department of Pharmacology, Medical Faculty of Mustafa, Kemal
University, Hatay 31040, Turkey. Email: suleymanoktar@yahoo.com
SOURCE
Human and Experimental Toxicology (2010) 29:9 (793-795). Date of
Publication: September 2010
ISSN
0960-3271
1477-0903 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
Introduction: Severe amitriptyline toxicity may cause cardiac dysrhythmias,
severe hypotension, convulsions and CNS depression, including coma.
Management with gastric lavage, activated charcoal, alkalinization and
supportive care with mechanical ventilation, antiarrhythmics and
anticonvulsants, if required, is the general approach. Case report: A
33-year-old woman who has taken overdose antidepressants (amitriptyline and
tianeptine) was admitted to the emergency service. She was intubated because
she had pure respiratory arrest. Besides hypotension (80/60 mmHg), she was
unresponsive to verbal and painful stimuli and her Glasgow coma score was 6.
Hemogram and serum biochemical parameters and electrocardiography were
within normal limits. The patient was examined for substance dependence and
no trace of the injector was found in the body. Patient underwent a coma
cocktail (naloxone 2 mg/kg, 5% dextrose 25 g/body and tiamin 100 g/body).
Activated charcoal and intravenous alkalinization by NaHCO (3) were
initiated. Spontaneous respiration started again 20 min after being given
the coma cocktail. She became responsive to verbal stimuli first hour after
the coma cocktail, and her Glasgow coma score improved to 13. She had spent
2 days in the service and was discharged by the second day of admission,
without any complications. Discussion: Herein, we report successful
treatment in a case of severe amitriptyline and tianeptine poisoning by
naloxone in addition to the above supportive care. Naloxone treatment may
have a beneficial role in lethal doses of amitriptyline ingestion because
amitriptyline may affect opioid receptors. © 2010 The Author(s).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amitriptyline (drug dose, drug toxicity)
naloxone (drug combination, drug therapy)
tianeptine (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
acetiamine (drug combination, drug therapy)
activated carbon
bicarbonate (drug therapy, intravenous drug administration)
glucose (drug combination, drug therapy)
opiate receptor (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alkalinization
article
case report
disease severity
drug overdose
electrocardiography
emergency ward
female
Glasgow coma scale
hospital discharge
human
hypotension
ingestion
intubation
priority journal
respiratory arrest
stimulus response
substance abuse
treatment response
DRUG TRADE NAMES
laroxyl
stablon
CAS REGISTRY NUMBERS
acetiamine (299-89-8)
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
bicarbonate (144-55-8, 71-52-3)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
tianeptine (66981-73-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010462313
MEDLINE PMID
20498036 (http://www.ncbi.nlm.nih.gov/pubmed/20498036)
PUI
L359416079
DOI
10.1177/0960327110372403
FULL TEXT LINK
http://dx.doi.org/10.1177/0960327110372403
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 836
TITLE
Antiemetic therapy for nausea and vomiting in the emergency department
AUTHOR NAMES
Patanwala A.E.
Amini R.
Hays D.P.
Rosen P.
AUTHOR ADDRESSES
(Patanwala A.E.) Department of Pharmacy Practice and Science, University of
Arizona College of Pharmacy, 1295 N. Martin, Tucson, AZ 85721-0207, United
States.
(Amini R.) Department of Emergency Medicine, College of Medicine, University
of Arizona, Tucson, AZ, United States.
(Hays D.P.) Department of Pharmacy Services, University Medical Center,
University of Arizona, Tucson, AZ, United States.
(Rosen P.) Department of Medicine, Harvard Medical School, Boston, MA,
United States.
CORRESPONDENCE ADDRESS
A. E. Patanwala, Department of Pharmacy Practice and Science, University of
Arizona College of Pharmacy, 1295 N. Martin, Tucson, AZ 85721-0207, United
States.
SOURCE
Journal of Emergency Medicine (2010) 39:3 (330-336). Date of Publication:
September 2010
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Background: Antiemetic agents are among the most frequently prescribed
medications in the emergency department (ED). Nevertheless, there are no
widely accepted evidence-based guidelines to optimize the use of these
medications for nausea or vomiting in this setting. Objective: The objective
of this article is to briefly review the evidence supporting the use of
antiemetic agents for the treatment of nausea or vomiting for adults in the
ED, and to provide recommendations to help guide therapy. Discussion: The
antiemetic agents studied include droperidol, promethazine,
prochlorperazine, metoclopramide, and ondansetron. Droperidol was commonly
used in the past, and is more effective than prochlorperazine or
metoclopramide, but due to the US Food and Drug Administration black box
warning regarding the potential for QT prolongation with this drug, its use
is limited to refractory cases. Promethazine is more sedating than other
comparative agents, and also has the potential for vascular damage upon
intravenous administration. It may be a suitable option when sedation is
desirable. Patients given prochlorperazine or metoclopramide must be
monitored for akathisia that can develop at any time over 48 h post
administration. Decreasing the infusion rate can reduce the incidence of
this adverse effect, and the effect can be treated with intravenous
diphenhydramine. Ondansetron is as effective as promethazine, and is not
associated with sedation or akathisia. Conclusion: Based on the safety and
efficacy of ondansetron, it may be used as a first-line agent for relief of
nausea or vomiting for most patient populations in the ED. © 2010 Elsevier
Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antiemetic agent (drug therapy, pharmacoeconomics, pharmacology)
droperidol (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration, pharmacoeconomics)
metoclopramide (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacoeconomics)
ondansetron (adverse drug reaction, drug comparison, drug dose, drug
therapy, intravenous drug administration, pharmacoeconomics)
prochlorperazine (adverse drug reaction, drug comparison, drug dose, drug
therapy, intravenous drug administration, pharmacoeconomics, pharmacology)
promethazine (adverse drug reaction, drug comparison, drug dose, drug
therapy, intravenous drug administration, pharmacoeconomics, pharmacology)
EMTREE DRUG INDEX TERMS
antihistaminic agent (drug therapy)
diphenhydramine (drug therapy)
histamine H1 receptor antagonist (drug therapy)
morphine (adverse drug reaction, drug interaction, intravenous drug
administration)
naloxone (drug dose, drug interaction)
opiate (adverse drug reaction)
phenothiazine (adverse drug reaction, drug therapy, pharmacoeconomics,
pharmacology)
pyridoxine (drug therapy)
serotonin antagonist (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
hyperemesis gravidarum (drug therapy, disease management, drug therapy,
prevention)
nausea (drug therapy, side effect, disease management, drug therapy,
etiology, prevention, side effect)
vomiting (drug therapy, side effect, disease management, drug therapy,
etiology, prevention, side effect)
EMTREE MEDICAL INDEX TERMS
adult
akathisia (complication, drug therapy, etiology, side effect)
blood vessel injury (side effect)
child
child health care
disease association
drug cost
drug efficacy
drug induced disease (complication, prevention)
drug megadose
drug safety
electrocardiogram
emergency ward
evidence based practice
food and drug administration
ginger
human
injection site necrosis (side effect)
long term care
low drug dose
migraine
motion sickness
pathophysiology
practice guideline
pregnancy
priority journal
pruritus (side effect)
QT prolongation (complication, etiology, side effect)
repeated drug dose
review
single drug dose
stomach paresis
treatment indication
treatment outcome
CAS REGISTRY NUMBERS
diphenhydramine (147-24-0, 58-73-1)
droperidol (548-73-2)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenothiazine (92-84-2)
prochlorperazine (58-38-8)
promethazine (58-33-3, 60-87-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010486510
MEDLINE PMID
20022195 (http://www.ncbi.nlm.nih.gov/pubmed/20022195)
PUI
L50739148
DOI
10.1016/j.jemermed.2009.08.060
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2009.08.060
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 837
TITLE
Therapeutic use, abuse, and nonmedical use of opioids: A ten-year
perspective
AUTHOR NAMES
Manchikanti L.
Fellows B.
Ailinani H.
Pampati V.
AUTHOR ADDRESSES
(Manchikanti L., drlm@thepainmd.com; Fellows B.; Pampati V.) Pain Management
Center of Paducah, Paducah, KY, United States.
(Ailinani H.) Shore-Long Island Jewish Health System, Bayside, NY, United
States.
CORRESPONDENCE ADDRESS
L. Manchikanti, 2831 Lone Oak Road, Paducah, KY 42003, United States. Email:
drlm@thepainmd.com
SOURCE
Pain Physician (2010) 13:5 (401-435). Date of Publication: September/October
2010
ISSN
1533-3159
BOOK PUBLISHER
American Society of Interventional Pain Physicians, Pain Physicians, 81
Lakeview Drive, Paducah, United States.
ABSTRACT
The treatment of chronic pain, therapeutic opioid use and abuse, and the
nonmedical use of prescription drugs have been topics of intense focus and
debate. After the liberalization of laws governing opioid prescribing for
the treatment of chronic non-cancer pain by state medical boards in the late
1990s, and with the introduction of new pain management standards
implemented by the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) in 2000, opioids, in general, and the most potent
forms of opioids including Schedule II drugs, in particular, have
dramatically increased. Despite the escalating use and abuse of therapeutic
opioids, nearly 15 to 20 years later the scientific evidence for the
effectiveness of opioids for chronic non-cancer pain remains unclear.
Concerns continue regarding efficacy; problematic physiologic effects such
as hyperalgesia, hypogonadism and sexual dysfunction; and adverse side
effects - especially the potential for misuse and abuse - and the increase
in opioid-related deaths. Americans, constituting only 4.6% of the world's
population, have been consuming 80% of the global opioid supply, and 99% of
the global hydrocodone supply, as well as two-thirds of the world's illegal
drugs. Retail sales of commonly used opioid medications (including
methadone, oxycodone, fentanyl base, hydromorphone, hydrocodone, morphine,
meperidine, and codeine) have increased from a total of 50.7 million grams
in 1997 to 126.5 million grams in 2007. This is an overall increase of 149%
with increases ranging from 222% for morphine, 280% for hydrocodone, 319%
for hydromorphone, 525% for fentanyl base, 866% for oxycodone, to 1,293% for
methadone. Average sales of opioids per person have increased from 74
milligrams in 1997 to 369 milligrams in 2007, a 402% increase. Surveys of
nonprescription drug abuse, emergency department visits for prescription
controlled drugs, unintentional deaths due to prescription controlled
substances, therapeutic use of opioids, and opioid abuse have been steadily
rising. This manuscript provides an updated 10-year perspective on
therapeutic use, abuse, and non-medical use of opioids and their
consequences.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, clinical trial, drug dose, drug therapy,
pharmacoeconomics)
EMTREE DRUG INDEX TERMS
cannabis
cocaine
dextropropoxyphene (drug therapy)
fentanyl (adverse drug reaction)
hydrocodone (adverse drug reaction, drug therapy)
methadone (adverse drug reaction, drug therapy)
oxycodone (drug therapy)
psychedelic agent
EMTREE MEDICAL INDEX TERMS
analgesic agent abuse
backache (drug therapy)
chronic pain (drug therapy)
clinical trial
cognitive defect (side effect)
constipation (side effect)
criminal behavior
disease severity
distress syndrome
dizziness (side effect)
dose response
drug abuse pattern
drug control
drug cost
drug dose escalation
drug efficacy
drug fatality (side effect)
drug intoxication
drug marketing
drug misuse
drug overdose
drug safety
drug withdrawal
dysphoria (side effect)
emergency ward
employment status
euphoria
evidence based medicine
fever (side effect)
gastrointestinal disease (side effect)
headache (side effect)
human
hyperalgesia (side effect)
long term care
low back pain (drug therapy)
major depression
mental health service
muscle rigidity (side effect)
myoclonus (side effect)
nausea (side effect)
neuropathic pain (drug therapy)
opiate addiction
pain (drug therapy)
pain assessment
patient compliance
perception deafness (side effect)
prescription
pruritus (side effect)
psychogenic pain (drug therapy)
psychomotor disorder (side effect)
respiration depression (side effect)
review
risk benefit analysis
sedation
sex difference
sexual dysfunction (side effect)
side effect (side effect)
sleep disorder (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010576242
MEDLINE PMID
20859312 (http://www.ncbi.nlm.nih.gov/pubmed/20859312)
PUI
L359779968
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 838
TITLE
Opiate-positive immunoassay screen in a pediatric patient: Commentary
AUTHOR NAMES
Lowry J.A.
AUTHOR ADDRESSES
(Lowry J.A., jlowry@cmh.edu) Department of Pediatrics, University of
Missouri-Kansas City, School of Medicine, Kansas City, MO, United States.
(Lowry J.A., jlowry@cmh.edu) Division of Clinical Pharmacology and Medical
Toxicology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas
City, MO 64108, United States.
CORRESPONDENCE ADDRESS
J. A. Lowry, Division of Clinical Pharmacology and Medical Toxicology,
Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO
64108, United States. Email: jlowry@cmh.edu
SOURCE
Clinical Chemistry (2010) 56:8 (1224-1225). Date of Publication: August 2010
ISSN
0009-9147
1530-8561 (electronic)
BOOK PUBLISHER
American Association for Clinical Chemistry Inc., 2101 L Street NW, Suite
202, Washington, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
dextromethorphan
diphenhydramine
fentanyl
methadone
morphine
oxycodone
quinine
quinoline
rifampicin
verapamil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (diagnosis)
EMTREE MEDICAL INDEX TERMS
clinical laboratory
clinical practice
emergency ward
false positive result
gas chromatography
human
immunoassay
mass spectrometry
note
point of care testing
urinalysis
CAS REGISTRY NUMBERS
dextromethorphan (125-69-9, 125-71-3)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
quinine (130-89-2, 130-95-0, 14358-44-2, 549-48-4, 549-49-5, 60-93-5,
7549-43-1)
quinoline (91-22-5)
rifampicin (13292-46-1)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010420792
MEDLINE PMID
20668171 (http://www.ncbi.nlm.nih.gov/pubmed/20668171)
PUI
L359292338
DOI
10.1373/clinchem.2010.149666
FULL TEXT LINK
http://dx.doi.org/10.1373/clinchem.2010.149666
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 839
TITLE
A survey of intranasal medication use in the paediatric emergency setting in
England and Wales
AUTHOR NAMES
Hadley G.
Maconochie I.
Jackson A.
AUTHOR ADDRESSES
(Hadley G., ghadley@doctors.org.uk; Maconochie I.; Jackson A.) Paediatric
Accident and Emergency Department, St. Mary's Hospital, Praed Street,
Paddington, London W2 1NY, United Kingdom.
CORRESPONDENCE ADDRESS
G. Hadley, Paediatric Accident and Emergency Department, St. Mary's
Hospital, Praed Street, Paddington, London W2 1NY, United Kingdom. Email:
ghadley@doctors.org.uk
SOURCE
Emergency Medicine Journal (2010) 27:7 (553-554). Date of Publication: July
2010
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
For analgesia and sedation in the paediatric setting, intranasal medication
is favourable for several reasons, in particular ease of administration and
rapid onset of action. A survey was conducted of all Emergency Departments
in England and Wales regarding their use of intranasal medication in
children. Approximately 50% use intranasal medication, commonly intranasal
diamorphine with sporadic use of other opiates. Intranasal midazolam is used
for sedation but is less well tolerated than when administered orally.
Intranasal diamorphine, however, is safe and effective in the management of
pain in the paediatric emergency setting and its ease of administration
makes it ideal for use in the already traumatised child.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug administration, drug comparison, drug concentration, drug
therapy, intranasal drug administration, pharmacokinetics, pharmacology)
midazolam (drug administration, intranasal drug administration,
pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
morphine (drug comparison, drug therapy, intramuscular drug administration)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pediatric ward
United Kingdom
EMTREE MEDICAL INDEX TERMS
article
child
drug absorption
drug blood level
drug efficacy
drug potency
drug safety
drug solubility
follow up
human
pain (drug therapy)
pain receptor
pH
powder
priority journal
questionnaire
respiration depression
safety
sedation
trigeminal nerve
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010366060
MEDLINE PMID
20522437 (http://www.ncbi.nlm.nih.gov/pubmed/20522437)
PUI
L359099822
DOI
10.1136/emj.2009.072538
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2009.072538
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 840
TITLE
Hospice, opiates, and acute care service use among the elderly before death
from heart failure or cancer
AUTHOR NAMES
Setoguchi S.
Glynn R.J.
Stedman M.
Flavell C.M.
Levin R.
Stevenson L.W.
AUTHOR ADDRESSES
(Setoguchi S., ssetoguchi@partners.org; Glynn R.J.; Stedman M.; Levin R.)
Department of Medicine, Harvard Medical School, Brigham and Women's
Hospital, Boston, MA, United States.
(Flavell C.M.; Stevenson L.W.) Department of Medicine, Advanced Heart
Disease Section, Brigham and Women's Hospital, Boston, United Kingdom.
CORRESPONDENCE ADDRESS
S. Setoguchi, Division of Pharmacoepidemiology and Pharmacoeconomics, 1620
Tremont Street, Boston, MA 02130, United States. Email:
ssetoguchi@partners.org
SOURCE
American Heart Journal (2010) 160:1 (139-144). Date of Publication: July
2010
ISSN
0002-8703
1097-6744 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Background: Advances in heart failure (HF) treatments have prolonged
survival, but more patients die of HF than of any type of cancer. Little is
known about the current practice in end-of-life (EOL) care in HF. Methods:
Two EOL cohorts (HF and cancer) were identified using Medicare data linked
with pharmacy and cancer registry data. We assessed use of hospice, opiates,
and acute care services (hospitalizations, emergency department [ED] visits,
intensive care unit [ICU] admissions, and death in acute care). Time trends
and predictors of use were assessed using multivariate regression including
demographics and cardiovascular and noncardiovasuclar comorbidities.
Results: Among 5,836 HF patients with median age of 85, 77% female and 4%
black, 20% were referred to hospice compared to 51% of 7,565 cancer
patients. A modest rise in hospice use over time was parallel in the 2
groups. Twenty-two percent of HF patients filled opiate prescriptions during
60 days before death compared to 46% of cancer patients. Use of acute care
services in the 30 days before death was higher for HF (64% vs 39% for ED
visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission).
More HF patients died during acute hospitalizations than cancer patients
(39% vs 21%). Conclusion: Patients dying of HF were less likely to be
supported by hospice and opiates but more likely to die in hospitals than
patients with cancer. Our study suggests that opportunities may exist to
improve hospice and opiate use in HF patients. © 2010, Mosby, Inc. All
rights reserved.
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart failure
neoplasm
EMTREE MEDICAL INDEX TERMS
aged
article
atrial fibrillation
cerebrovascular disease
chronic kidney failure
chronic lung disease
clinical assessment
comorbidity
coronary artery disease
death
dementia
depression
diabetes mellitus
dialysis
emergency ward
female
health care quality
health care utilization
heart infarction
hospice care
hospitalization
human
hypertension
intensive care unit
major clinical study
male
nursing home
peripheral vascular disease
prescription
priority journal
trend study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010447370
MEDLINE PMID
20598984 (http://www.ncbi.nlm.nih.gov/pubmed/20598984)
PUI
L359362632
DOI
10.1016/j.ahj.2010.03.038
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ahj.2010.03.038
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 841
TITLE
Non-suicidal self-injurious behavior, endogenous opioids and monoamine
neurotransmitters
AUTHOR NAMES
Stanley B.
Sher L.
Wilson S.
Ekman R.
Huang Y.-y.
Mann J.J.
AUTHOR ADDRESSES
(Stanley B., bhs2@columbia.edu; Sher L.; Wilson S.; Huang Y.-y.; Mann J.J.)
Department of Molecular Imaging and Neuropathology, New York State
Psychiatric Institute, New York, NY, United States.
(Stanley B., bhs2@columbia.edu; Sher L.; Wilson S.; Mann J.J.) Department of
Psychiatry, College of Physicians and Surgeons, Columbia University, New
York, NY, United States.
(Ekman R.) Institute of Clinical Neuroscience, Experimental Neuroscience
Section, Unit of Neurochemistry, Sweden.
CORRESPONDENCE ADDRESS
B. Stanley, Department of Molecular Imaging and Neuropathology, New York
State Psychiatric Institute, New York, NY, United States. Email:
bhs2@columbia.edu
SOURCE
Journal of Affective Disorders (2010) 124:1-2 (134-140). Date of
Publication: July 2010
ISSN
0165-0327
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Background: Self-inflicted injury, including cutting or burning, is the most
frequent reason for psychiatric visits to medical emergency departments.
This behavior, particularly when there is no apparent suicidal intent, is
poorly understood from both biological and clinical perspectives. Objective:
To examine the role of endogenous opioids and monoamine neurotransmitters in
non-suicidal self-injury (NSSI). Methods: We compared cerebrospinal fluid
(CSF) levels of endogenous opioids, 5 hydroxyindolacetic acid (5-HIAA) and
homovanillic acid (HVA) in individuals with a history of repetitive
non-suicidal self-injury with a diagnostically-matched group of individuals
who had never engaged in non-suicidal self-injury. History of suicidal
behavior, demographic background and psychopathology was assessed. All
patients were diagnosed with a Cluster B personality disorder (i.e.
borderline, antisocial, narcissistic or histrionic) (N = 29) and had a
history of at least one suicide attempt. Fourteen participants had a history
of repeated non-suicidal self-injurious behavior (NSSI) in adulthood and 15
did not (no NSSI). Results: The NSSI group had significantly lower levels of
CSF β-endorphin and met-enkephalin when compared with the non-NSSI group.
CSF dynorphin, HVA and 5-HIAA levels did not differ. Severity of depression,
hopelessness and overall psychopathology was greater in the NSSI group.
Conclusion: β-endorphin and met-enkephalin, opioids acting upon receptors
involved in mediating stress-induced and physical pain analgesia
respectively, are implicated in NSSI. Serotonergic and dopaminergic
dysfunctions do not appear to be related to NSSI. Based on our findings, we
propose a model of non-suicidal self-injury. Our results suggest that drugs
acting on the opioid system warrant exploration as pharmacological
treatments for NSSI. © 2009 Elsevier B.V. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
endorphin (endogenous compound)
neurotransmitter (endogenous compound)
EMTREE DRUG INDEX TERMS
5 hydroxyindoleacetic acid (endogenous compound)
beta endorphin (endogenous compound)
dynorphin (endogenous compound)
homovanillic acid (endogenous compound)
metenkephalin (endogenous compound)
monoamine (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
automutilation (etiology)
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
cerebrospinal fluid analysis
clinical article
controlled study
depression
disease severity
female
hopelessness
human
male
mental disease
personality disorder
priority journal
psychologic assessment
suicide attempt
CAS REGISTRY NUMBERS
5 hydroxyindoleacetic acid (1321-73-9, 54-16-0)
beta endorphin (59887-17-1)
dynorphin (74913-18-1)
endorphin (60118-07-2)
homovanillic acid (306-08-1)
metenkephalin (58569-55-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010276389
MEDLINE PMID
19942295 (http://www.ncbi.nlm.nih.gov/pubmed/19942295)
PUI
L50715076
DOI
10.1016/j.jad.2009.10.028
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jad.2009.10.028
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 842
TITLE
Respiratory failure following delayed intrathecal morphine pump refill: A
valuable, but costly lesson
AUTHOR NAMES
Ruan X.
Couch J.P.
Liu H.
Shah R.
Wang F.
Chiravuri S.
AUTHOR ADDRESSES
(Ruan X., xiuluruan@yahoo.com; Couch J.P.) Physicians Pain Specialists of
Alabama, Mobile AL 36607, United States.
(Liu H.) Dept. of Urology, QiLu Hospital, Shandong University, Jinan, China.
(Shah R.) Department of Anesthesiology, Guthrie Clinic, Sayre, PA, United
States.
(Wang F.) College of Medicine, University of South Alabama, Mobile AL,
United States.
(Chiravuri S.) Dept. of Anesthesiology, Center for Interventional Pain
Medicine, University of Michigan Health System, Ann Arbor MI, United States.
CORRESPONDENCE ADDRESS
X. Ruan, 2001 Springhill Ave, Mobile AL 36607, United States. Email:
xiuluruan@yahoo.com
SOURCE
Pain Physician (2010) 13:4 (337-341). Date of Publication: July/August 2010
ISSN
1533-3159
BOOK PUBLISHER
American Society of Interventional Pain Physicians, Pain Physicians, 81
Lakeview Drive, Paducah, United States.
ABSTRACT
Background: Spinal analgesia, mediated by opioid receptors, requires only a
fraction of the opioid dose that is needed systemically. By infusing a small
amount of opioid into the cerebrospinal fluid in close proximity to the
receptor sites in the spinal cord, profound analgesia may be achieved while
sparing some of the side effects due to systemic opioids. Intraspinal drug
delivery (IDD) has been increasingly used in patients with intractable
chronic pain, when these patients have developed untoward side effects with
systemic opioid usage. The introduction of intrathecal opioids has been
considered one of the most important breakthroughs in pain management in the
past three decades. A variety of side effects associated with the long-term
usage of IDD have been recognized. Among them, respiratory depression is the
most feared. Objective: To describe a severe adverse event, i.e.,
respiratory failure, following delayed intrathecal morphine pump refill.
Case Report: A 65-year-old woman with intractable chronic low back pain, due
to degenerative disc disease, and was referred to our clinic for an
intraspinal drug delivery evaluation, after failing to respond to
multidisciplinary pain treatment. Following a psychological evaluation
confirming her candidacy, she underwent an outpatient patient-controlled
continuous epidural morphine infusion trial. The infusion trial lasted 12
days and was beneficial in controlling her pain. The patient reported more
than 90% pain reduction with improved distance for ambulation. She
subsequently consented and was scheduled for permanent intrathecal morphine
pump implantation. The intrathecal catheter was inserted at right paramedian
L3-L4, with catheter tip advanced to L1, confirmed under fluoroscopy.
Intrathecal catheter placement was confirmed by positive CSF flow and by
myelogram. A non-programmable Codman 3000 constant-flow rate infusion pump
was placed in the right mid quandrant between right rib cage and right iliac
crest. The intrathecal infusion consisted of preservative free morphine,
delivering 1.0 mg/day. Over the following 6 months, the dosage was gradually
titrated up to 4 mg/day with satisfactory pain control without significant
side effects. However, the patient was not able to return to the clinic for
pump refill until 12 days later than the previously scheduled pump-refill
date. Her pump was accessed and was noted to be empty. Her intrathecal pump
was refilled with preservative free morphine, delivering 4 mg/day (the same
daily dose as her previous refill). However, on the night of pump refill, 10
hours after the pump refill, the patient was found to be unresponsive by her
family members. 911 was called. Upon arriving, paramedics found her in
respiratory failure, with shallow breathing at a rate of 5/min, pulse
oxymetry showing oxygen saturation about 55-58%. She was emergently
intubated on site and rushed to local hospital ER. The on call physician for
our clinic was immediately contacted, and advised the administration of
intravenous Naloxone. Her respiratory effort improved dramatically after
receiving a total of 0.6 mg IV Naloxone IV over 25 minutes. Her intrathecal
pump was immediately accessed by clinic on call physician and the remainder
of the medication in the catheter space was aspirated. The pump infusate was
immediately diluted with preservative free normal saline, to deliver
preservative free morphine at 1mg/day. She was transferred to the intensive
care unit and extubated the next morning. She recovered fully without any
sequelae. Conclusion: Loss of opioid tolerance due to delayed pump refill
may subject patients to the development of severe respiratory depression.
Meticulous approach should be employed when refilling pumps in these
patients when their pumps are completely empty. To our knowledge, this is
the first reported case of this type.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug administration, drug therapy, epidural
drug administration, intrathecal drug administration, pharmaceutics)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
minipump
respiratory failure (drug therapy, side effect, drug therapy, side effect)
therapy delay
EMTREE MEDICAL INDEX TERMS
aged
article
breathing rate
case report
catheterization
continuous infusion
drug administration route
emergency ward
endotracheal intubation
female
fluoroscopy
human
intensive care unit
intervertebral disk degeneration
low back pain (drug therapy)
oxygen saturation
pulse oximetry
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010410202
MEDLINE PMID
20648202 (http://www.ncbi.nlm.nih.gov/pubmed/20648202)
PUI
L359253581
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 843
TITLE
Dextromethorphan abuse and dependence in adolescents
AUTHOR NAMES
Akerman S.C.
Hammel J.L.
Brunette M.F.
AUTHOR ADDRESSES
(Akerman S.C.; Hammel J.L.) Department of Psychiatry, Dartmouth Medical
School, Lebanon, NH, United States.
(Hammel J.L.) Substance Abuse Services, VA Medical Center, White River
Junction, VT, United States.
(Brunette M.F., mary.f.brunette@dartmouth.edu) Dartmouth Psychiatric
Research Center, Department of Psychiatry, Dartmouth Medical School, 105
Pleasant St., Concord, NH 03301, United States.
CORRESPONDENCE ADDRESS
M. F. Brunette, Dartmouth Psychiatric Research Center, Department of
Psychiatry, Dartmouth Medical School, 105 Pleasant St., Concord, NH 03301,
United States. Email: mary.f.brunette@dartmouth.edu
SOURCE
Journal of Dual Diagnosis (2010) 6:3-4 (266-278). Date of Publication: July
2010
ISSN
1550-4263
1550-4271 (electronic)
BOOK PUBLISHER
Routledge, 325 Chestnut Street, Philadelphia, United States.
ABSTRACT
Dextromethorphan, a semi-synthetic morphine derivative, is a widely
available antitussive in many over-the-counter cough and cold preparations.
When taken in large amounts, it produces a high and effects similar to PCP.
Emergency room and poison control data suggest that abuse of this substance
has increased in the past decade. Adolescents, particularly those with
co-occurring psychiatric and substance use disorders, seem to be at higher
risk for abuse of and dependence on dextromethorphan than children and
adults. Multiple case reports, including the one presented here, have
demonstrated the symptoms of intoxication, the potential for abuse, the
development of dependence, as well as the acute physical withdrawal and
prolonged psychological withdrawal syndromes that can occur with
dextromethorphan-containing products. Screening for substance use disorders
is important in patients with any psychiatric disorder and should include
questions regarding over-the-counter medications. For patients who present
with acute intoxication, management is mainly supportive. Similar to
treatment of other substance use disorders, treatment of dextromethorphan
dependence includes motivational interventions, psychosocial treatments to
promote abstinence, and concurrent treatment of any co-occurring psychiatric
disorders. In order to prevent over-the-counter medication abuse among young
people, clinicians can educate patients and their parents about the risks of
over-the-counter medicines and their safe storage. Further, legislation is
being considered to limit access to dextromethorphan-containing products.
Copyright © 2010 Taylor &Francis Group, LLC.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dextromethorphan
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
atomoxetine (drug therapy)
benzodiazepine derivative (drug therapy)
central stimulant agent (drug therapy)
clonidine (drug therapy)
naloxone (drug therapy)
non prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dextromethorphan abuse (prevention, therapy)
dextromethorphan dependence (prevention, therapy)
drug dependence (drug therapy, drug therapy, prevention, therapy)
EMTREE MEDICAL INDEX TERMS
abstinence
adolescent
article
attention deficit disorder (diagnosis, drug therapy)
case report
drug intoxication (drug therapy)
drug legislation
drug storage
education
human
male
screening
withdrawal syndrome
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atomoxetine (82248-59-7, 82857-39-4, 82857-40-7, 83015-26-3)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
dextromethorphan (125-69-9, 125-71-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010707401
PUI
L360217828
DOI
10.1080/15504263.2010.537515
FULL TEXT LINK
http://dx.doi.org/10.1080/15504263.2010.537515
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 844
TITLE
Social pain and opioid use
AUTHOR NAMES
De Couto J.
AUTHOR ADDRESSES
(De Couto J.)
CORRESPONDENCE ADDRESS
J. De Couto, Burnaby, BC, Canada.
SOURCE
CMAJ (2010) 182:1 (64). Date of Publication: 2010
ISSN
0820-3946
1488-2329 (electronic)
BOOK PUBLISHER
Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, Canada.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
methadone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
pain (drug therapy, drug therapy)
social pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
chronic pain (drug therapy)
emergency health service
general practitioner
letter
medical ethics
physician
prescription
urinalysis
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010270977
MEDLINE PMID
20064966 (http://www.ncbi.nlm.nih.gov/pubmed/20064966)
PUI
L358792157
DOI
10.1503/cmaj.110-2000
FULL TEXT LINK
http://dx.doi.org/10.1503/cmaj.110-2000
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 845
TITLE
A delayed methadone encephalopathy: Clinical and neuroradiological findings
AUTHOR NAMES
Zanin A.
Masiero S.
Severino M.S.
Calderone M.
Da Dalt L.
Laverda A.M.
AUTHOR ADDRESSES
(Zanin A., anna.zanin@unipd.it; Masiero S.; Da Dalt L.) Paediatric Emergency
Unit, Paediatric Department, University of Padua, Via Giustiniani 3, 35100
Padua, Italy.
(Severino M.S.) Neuroradiology Unit, Paediatric Department, University of
Padua, Padua, Italy.
(Calderone M.; Laverda A.M.) Paediatric Neurology, Paediatric Department,
University of Padua, Padua, Italy.
CORRESPONDENCE ADDRESS
A. Zanin, Paediatric Emergency Unit, Paediatric Department, University of
Padua, Via Giustiniani 3, 35100 Padua, Italy. Email: anna.zanin@unipd.it
SOURCE
Journal of Child Neurology (2010) 25:6 (748-751). Date of Publication: June
2010
ISSN
0883-0738
1708-8283 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
Several studies on opiates demonstrated that selected brain areas as
cerebellum and limbic system have the greatest density of opioid receptors.
Recently, few cases of severe cerebellitis following methadone poisoning
have been reported in children. We present the case of a 30-month-old girl
who developed a delayed encephalopathy after methadone intoxication. She was
admitted to our emergency department in coma, and after naloxone infusion,
she completely recovered. Five days after intoxication, she developed
psychomotor agitation, slurred speech, abnormal movements, and ataxia
despite a negative neuroimaging finding. A repeat magnetic resonance imaging
(MRI) performed 19 days after the intoxication for persistent symptoms
showed signal abnormalities in the temporomesial regions, basal ganglia, and
substantia nigra. To our knowledge, this is the first report of these
delayed MRI findings associated with synthetic opioid intoxication. © 2010
The Author(s).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
clonazepam (drug therapy)
lorazepam (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain disease (drug therapy, diagnosis, drug therapy)
delayed neurotoxicity (drug therapy, diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
brain radiography
case finding
case report
child
clinical feature
disease course
drug intoxication (drug therapy)
EEG abnormality (diagnosis)
electroencephalogram
female
human
nuclear magnetic resonance imaging
preschool child
priority journal
symptom
CAS REGISTRY NUMBERS
clonazepam (1622-61-3)
lorazepam (846-49-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010304921
MEDLINE PMID
19808992 (http://www.ncbi.nlm.nih.gov/pubmed/19808992)
PUI
L358912669
DOI
10.1177/0883073809343318
FULL TEXT LINK
http://dx.doi.org/10.1177/0883073809343318
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 846
TITLE
What Current Studies Mean to EMS.
AUTHOR NAMES
Criss E.A.
AUTHOR ADDRESSES
(Criss E.A.)
CORRESPONDENCE ADDRESS
E.A. Criss,
SOURCE
JEMS : a journal of emergency medical services (2010) 35:6 (42). Date of
Publication: Jun 2010
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
research
EMTREE MEDICAL INDEX TERMS
aged
article
blast injury (therapy)
human
hypothermia (therapy)
injury (therapy)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20569863 (http://www.ncbi.nlm.nih.gov/pubmed/20569863)
PUI
L359244694
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 847
TITLE
Management of cancer-related pain
AUTHOR NAMES
DeSandre P.L.
Quest T.E.
AUTHOR ADDRESSES
(DeSandre P.L.) Department of Emergency Medicine, Beth Israel Medical
Center, First Avenue, 16th Street, NY 10003, United States.
(Quest T.E., tquest@emory.edu) Department of Emergency Medicine, Emory
University School of Medicine, 69 Jesse Hill Jr Drive, Atlanta, GA 30303,
United States.
CORRESPONDENCE ADDRESS
T.E. Quest, Department of Emergency Medicine, Emory University School of
Medicine, 69 Jesse Hill Jr Drive, Atlanta, GA 30303, United States. Email:
tquest@emory.edu
SOURCE
Hematology/Oncology Clinics of North America (2010) 24:3 (643-658). Date of
Publication: June 2010
ISSN
0889-8588
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Patients and families struggling with cancer fear pain more than any other
physical symptom. There are also significant barriers to optimal pain
management in the emergency setting, including lack of knowledge,
inexperienced clinicians, myths about addiction, and fears of complications
after discharge. In this article, we review the assessment and management
options for cancer-related pain based on the World Health Organization (WHO)
3-step approach. © 2010 Elsevier Inc.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, drug therapy, pharmacokinetics)
antiemetic agent (drug therapy)
antihistaminic agent (drug therapy, oral drug administration)
codeine (adverse drug reaction, drug therapy, oral drug administration,
parenteral drug administration, pharmacokinetics, rectal drug
administration)
corticosteroid (drug therapy)
dexamethasone (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration, pharmacokinetics)
diclofenac (drug therapy, transdermal drug administration)
diphenhydramine (drug therapy, oral drug administration)
fentanyl (drug therapy, pharmacokinetics, transdermal drug administration)
fexofenadine (drug therapy, oral drug administration)
haloperidol (drug therapy)
hydrocodone (drug therapy, oral drug administration, parenteral drug
administration, pharmacokinetics, rectal drug administration)
hydromorphone (drug therapy, oral drug administration, parenteral drug
administration, pharmacokinetics, rectal drug administration)
ketorolac (drug therapy, intramuscular drug administration, intravenous drug
administration)
loratadine (drug therapy, oral drug administration)
methadone (pharmacokinetics)
metoclopramide (drug therapy)
misoprostol (drug therapy)
morphine (drug therapy, oral drug administration, parenteral drug
administration, pharmacokinetics, rectal drug administration, topical drug
administration)
naloxone (adverse drug reaction, drug therapy, pharmacokinetics)
narcotic analgesic agent (adverse drug reaction, drug administration, drug
dose, drug therapy, intramuscular drug administration, intravenous drug
administration, oral drug administration, pharmacokinetics, rectal drug
administration, subcutaneous drug administration, topical drug
administration, transdermal drug administration)
nonsteroid antiinflammatory agent (adverse drug reaction, drug therapy,
pharmacokinetics)
norpethidine (adverse drug reaction, pharmacokinetics)
omeprazole (drug therapy)
opiate agonist (drug therapy, oral drug administration, pharmacokinetics)
oxycodone (drug therapy, oral drug administration, parenteral drug
administration, pharmacokinetics, rectal drug administration)
paracetamol (adverse drug reaction, drug therapy)
pethidine (pharmacokinetics)
prochlorperazine (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy, complication, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adjuvant therapy
anorexia (drug therapy)
bone metastasis (complication, radiotherapy)
bone pain (drug therapy)
cancer radiotherapy
clinical protocol
confusion (side effect)
constipation (prevention, side effect, therapy)
depression (drug therapy)
dose kidney function relation
drowsiness (side effect)
drug cross tolerance
drug dose titration
drug efficacy
drug half life
drug hypersensitivity (side effect)
drug intermittent therapy
drug safety
drug tolerance
dysphoria (side effect)
emergency ward
fluid retention
gastrointestinal disease (drug therapy, prevention)
headache (drug therapy)
human
kidney failure (side effect)
liver function
maximum plasma concentration
myoclonus (side effect)
nausea (drug therapy, side effect)
neuropathic pain (drug therapy)
osteoarthritis (drug therapy)
pain assessment
pain threshold
patient care
priority journal
pruritus (drug therapy, side effect)
rash (drug therapy)
respiration depression (drug therapy, side effect)
review
risk factor
seizure (side effect)
side effect (side effect)
sodium retention
spinal cord compression (drug therapy)
stomach disease (side effect)
thrombocyte aggregation inhibition
tremor (side effect)
unspecified side effect (side effect)
urticaria (side effect)
visceral pain (drug therapy)
vomiting (drug therapy, side effect)
wound infection (drug therapy)
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
codeine (76-57-3)
dexamethasone (50-02-2)
diclofenac (15307-79-6, 15307-86-5)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
fexofenadine (138452-21-8)
haloperidol (52-86-8)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ketorolac (74103-06-3)
loratadine (79794-75-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
misoprostol (59122-46-2, 59122-48-4)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
norpethidine (77-17-8)
omeprazole (73590-58-6, 95510-70-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
prochlorperazine (58-38-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Cancer (16)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010306151
PUI
L358915666
DOI
10.1016/j.hoc.2010.03.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.hoc.2010.03.002
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 848
TITLE
Diuretic, opiate and nitrate use in severe acidotic acute cardiogenic
pulmonary oedema: Analysis from the 3CPO trial
AUTHOR NAMES
Gray A.
Goodacre S.
Seah M.
Tilley S.
AUTHOR ADDRESSES
(Gray A., alasdair.gray@luht.scot.nhs.uk) Department of Emergency Medicine,
Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
(Goodacre S.; Tilley S.) School of Health and Related Research, The
University of Sheffield, Edinburgh, EH16 4SA, United Kingdom.
(Seah M.) The University of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
CORRESPONDENCE ADDRESS
A. Gray, Emergency Medicine Research Group, Department of Emergency
Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
Email: alasdair.gray@luht.scot.nhs.uk
SOURCE
QJM (2010) 103:8 (573-581) Article Number: hcq077. Date of Publication:
August 2010
ISSN
1460-2725
1460-2393 (electronic)
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
ABSTRACT
Background: Drug treatments for acute cardiogenic pulmonary oedema (ACPO)
have not been rigorously evaluated and recent observational data suggests
some agents are related to poorer outcome. Aim: We aimed to examine the
effect of treatment with diuretics, nitrates and opiates on 7-day mortality,
acidosis and respiratory distress in UK Emergency Department (ED) patients
with severe acidotic pulmonary oedema. Design: Analysis of data from the
3CPO trial; a multicentre randomized controlled trial. Methods: Data were
analysed from patients recruited with severe acidotic pulmonary oedema to
the 3CPO trial in 26 UK EDs between 2003 and 2007. The effects of these
treatments on 7-day mortality, improvement in acidosis (pH change between
baseline and 1 h) and improvement in respiratory distress (patient measured
breathlessness using a Visual Analogue Score between baseline and 1 h) were
tested using univariate logistic regression analysis, and a regression model
used to adjust for confounding baseline differences. Results: Nitrates were
given to 947/1048 (90.4%) patients, diuretics to 934/1049 (89.0%) patients
and opiates to 541/1052 patients (51.4%). Adjusted analysis showed that
opiate treatment was associated with less improvement in acidosis
[difference in improvement in pH -0.022, 95% confidence interval (CI) -0.014
to -0.030, P<0.001], but no difference in mortality or improvement in
respiratory distress. We found no evidence that nitrate or diuretic use were
associated with any difference in mortality, improvement in acidosis or
respiratory distress. Conclusions: Opiate use is associated with less
improvement in acidosis during initial treatment and may attenuate effective
treatment of severe acidotic ACPO. © The Author 2010. Published by Oxford
University Press on behalf of the Association of Physicians. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
furosemide (clinical trial, drug therapy, intravenous drug administration)
nitrate (buccal drug administration, clinical trial, drug therapy,
intravenous drug administration)
opiate (clinical trial, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute cardiogenic pulmonary edema (drug therapy, drug therapy, therapy)
lung edema (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
aged
article
clinical trial
continuous infusion
controlled clinical trial
controlled study
drug effect
female
fibrinolytic therapy
human
major clinical study
male
mortality
oxygen therapy
priority journal
randomized controlled trial
respiratory acidosis
respiratory distress
United Kingdom
visual analog scale
CAS REGISTRY NUMBERS
furosemide (54-31-9)
nitrate (14797-55-8)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
CLINICAL TRIAL NUMBERS
ISRCTN (ISRCTN07448447)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010412479
MEDLINE PMID
20511258 (http://www.ncbi.nlm.nih.gov/pubmed/20511258)
PUI
L359259385
DOI
10.1093/qjmed/hcq077
FULL TEXT LINK
http://dx.doi.org/10.1093/qjmed/hcq077
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 849
TITLE
Drugs adverse reactions (ADR) in the emergency room
ORIGINAL (NON-ENGLISH) TITLE
Le reazioni avverse ai farmaci (ADR) in pronto soccorso
AUTHOR NAMES
Cagliano S.
Addobbati A.
AUTHOR ADDRESSES
(Cagliano S., s.cagliano@mclink.it; Addobbati A.) Pronto Soccorso, Ospedale
Belcolle, Viterbo, Italy.
CORRESPONDENCE ADDRESS
S. Cagliano, Pronto Soccorso, Ospedale Belcolle, Viterbo, Italy. Email:
s.cagliano@mclink.it
SOURCE
Ricerca e Pratica (2010) 26:3 (106-114). Date of Publication: May-June 2010
ISSN
1120-379X
BOOK PUBLISHER
Il Pensiero Scientifico Editore s.r.l., Via Bradano 3/C, Roma, Italy.
EMTREE DRUG INDEX TERMS
acetylcysteine
anticoagulant agent
atropine
benzodiazepine (adverse drug reaction)
beta adrenergic receptor blocking agent (adverse drug reaction)
bicarbonate
calcium antagonist (adverse drug reaction)
cholinergic receptor blocking agent
cyproheptadine
dantrolene
digitalis
diuretic agent
dopamine
epinephrine
flumazenil
glucagon
gluconate calcium
heparin
insulin
naloxone
nifedipine
noradrenalin
paracetamol
phytomenadione
protamine
serotonin uptake inhibitor (adverse drug reaction)
tricyclic antidepressant agent
unindexed drug
verapamil
warfarin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse outcome
emergency ward
EMTREE MEDICAL INDEX TERMS
apnea (side effect)
cardiogenic shock (side effect)
confusion (side effect)
convulsion (side effect)
drug surveillance program
human
mydriasis (side effect)
nausea (side effect)
review
somnolence (side effect)
tachycardia (side effect)
tremor (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
cyproheptadine (129-03-3, 969-33-5)
dantrolene (14663-23-1, 7261-97-4)
digitalis (8031-42-3, 8053-83-6)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
noradrenalin (1407-84-7, 51-41-2)
paracetamol (103-90-2)
phytomenadione (11104-38-4, 84-80-0)
protamine (11061-43-1, 9007-31-2, 9012-00-4)
verapamil (152-11-4, 52-53-9)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
Italian
EMBASE ACCESSION NUMBER
2010357712
PUI
L359074306
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 850
TITLE
Regulatory issues for prescribing schedule II opioids at the end of life
#198
AUTHOR NAMES
Ellison N.M.
AUTHOR ADDRESSES
(Ellison N.M., nellison@geisinger.edu) Palliative Medicine, Geisinger
Medical Center, 100 North Academy Drive, Danville, PA 17822-0140, United
States.
CORRESPONDENCE ADDRESS
N. M. Ellison, Palliative Medicine, Geisinger Medical Center, 100 North
Academy Drive, Danville, PA 17822-0140, United States. Email:
nellison@geisinger.edu
SOURCE
Journal of Palliative Medicine (2010) 13:5 (605-606). Date of Publication: 1
May 2010
ISSN
1096-6218
BOOK PUBLISHER
Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States.
EMTREE DRUG INDEX TERMS
hydromorphone
methadone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug control
prescription
terminal care
EMTREE MEDICAL INDEX TERMS
drug information
drug program
emergency treatment
fax
hospice care
long term care
opiate addiction
pain
patient information
pharmacist attitude
short survey
treatment duration
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010301760
MEDLINE PMID
20491551 (http://www.ncbi.nlm.nih.gov/pubmed/20491551)
PUI
L358901196
DOI
10.1089/jpm.2010.9835
FULL TEXT LINK
http://dx.doi.org/10.1089/jpm.2010.9835
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 851
TITLE
Detecting adverse drug events using a nursing home-specific trigger tool
AUTHOR NAMES
Handler S.M.
Hanlon J.T.
AUTHOR ADDRESSES
(Handler S.M.) Department of Biomedical Informatics, School of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States.
(Handler S.M.) Division of Geriatric Medicine, University of Pittsburgh,
Geriatric Research Education and Clinical Center (GRECC), United States.
(Handler S.M.) Center for Health Equity Research and Promotion (CHERP),
VAPHS, Pittsburgh, United States.
(Hanlon J.T.) Division of Geriatric Medicine, Department of Medicine,
University of Pittsburgh, United States.
CORRESPONDENCE ADDRESS
S. M. Handler, Department of Biomedical Informatics, School of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States.
SOURCE
Annals of Long-Term Care (2010) 18:5 (17-22). Date of Publication: May 2010
ISSN
1524-7929
BOOK PUBLISHER
HMP Communications LLP, 4365 U.S. Highway 1 Suite 250, Princeton, United
States.
EMTREE DRUG INDEX TERMS
amikacin
aminoglycoside antibiotic agent
antidiabetic agent
carbamazepine
digoxin
diphenhydramine
disopyramide
epinephrine
gentamicin
glucagon
heparin
lepirudin
lithium
metronidazole (intravenous drug administration, oral drug administration)
naloxone
narcotic analgesic agent
phenobarbital
phenytoin
phytomenadione (intravenous drug administration, oral drug administration,
subcutaneous drug administration)
primidone
procainamide
protamine sulfate
quinidine
theophylline
tobramycin
unindexed drug
valproic acid
vancomycin (oral drug administration)
vitamin K group
warfarin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
diagnostic test
nursing home
trigger tool methodology
EMTREE MEDICAL INDEX TERMS
agranulocytosis
cognition
comorbidity
emergency ward
falling
functional status
health care cost
hospitalization
hyperkalemia
hypoglycemia
hypokalemia
hyponatremia
international normalized ratio
leukopenia
medical record review
nausea and vomiting
neutropenia
partial thromboplastin time
polypharmacy
rash
review
thrombocytopenia
total quality management
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amikacin (37517-28-5, 39831-55-5)
carbamazepine (298-46-4, 8047-84-5)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
disopyramide (3737-09-5)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
lepirudin (138068-37-8)
lithium (7439-93-2)
metronidazole (39322-38-8, 443-48-1)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
phytomenadione (11104-38-4, 84-80-0)
primidone (125-33-7)
procainamide (51-06-9, 614-39-1)
protamine sulfate (9009-65-8)
quinidine (56-54-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
tobramycin (32986-56-4)
valproic acid (1069-66-5, 99-66-1)
vancomycin (1404-90-6, 1404-93-9)
vitamin K group (12001-79-5)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010381450
PUI
L359150728
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 852
TITLE
Evaluation of an overdose prevention and response training programme for
injection drug users in the Skid Row area of Los Angeles, CA
AUTHOR NAMES
Wagner K.D.
Valente T.W.
Casanova M.
Partovi S.M.
Mendenhall B.M.
Hundley J.H.
Gonzalez M.
Unger J.B.
AUTHOR ADDRESSES
(Wagner K.D., kdwagner@usc.edu; Valente T.W.; Mendenhall B.M.; Unger J.B.)
Institute for Health Promotion and Disease Prevention Research, Keck School
of Medicine, University of Southern California, 1000 S. Fremont Ave, Unit 8,
Alhambra, CA 91803, United States.
(Casanova M.; Partovi S.M.; Hundley J.H.; Gonzalez M.) Homeless Health Care
Los Angeles, Los Angeles, CA, United States.
CORRESPONDENCE ADDRESS
K.D. Wagner, Institute for Health Promotion and Disease Prevention Research,
Keck School of Medicine, University of Southern California, 1000 S. Fremont
Ave, Unit 8, Alhambra, CA 91803, United States. Email: kdwagner@usc.edu
SOURCE
International Journal of Drug Policy (2010) 21:3 (186-193). Date of
Publication: May 2010
ISSN
0955-3959
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Background: Fatal opioid overdose is a significant cause of mortality among
injection drug users (IDUs). Methods: We evaluated an overdose prevention
and response training programme for IDUs run by a community-based
organisation in Los Angeles, CA. During a 1-h training session participants
learned skills to prevent, recognise, and respond to opioid overdoses,
including: calling for emergency services, performing rescue breathing, and
administering an intramuscular injection of naloxone (an opioid antagonist).
Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66
(71%) enrolled in the evaluation study and 47 participants (71%) completed
an interview at baseline and 3-month follow-up. Results: Twenty-one percent
of participants were female, 42% were white, 29% African American, and 18%
Latino. Most were homeless or lived in temporary accommodation (73%). We
found significant increases in knowledge about overdose, in particular about
the use of naloxone. Twenty-two participants responded to 35 overdoses
during the follow-up period. Twenty-six overdose victims recovered, four
died, and the outcome of five cases was unknown. Response techniques
included: staying with the victim (85%), administering naloxone (80%),
providing rescue breathing (66%), and calling emergency services (60%). The
average number of appropriate response techniques used by participants
increased significantly from baseline to follow-up (p<0.05). Half (53%) of
programme participants reported decreased drug use at follow-up. Conclusion:
Overdose prevention and response training programmes may be associated with
improved overdose response behaviour, with few adverse consequences and some
unforeseen benefits, such as reductions in personal drug use. © 2009
Elsevier B.V.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (intramuscular drug administration)
opiate antagonist
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (prevention)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
African American
article
breathing
Caucasian
community
drug abuse
emergency health service
female
follow up
Hispanic
homelessness
human
interview
male
priority journal
rescue work
skill
training
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010205570
MEDLINE PMID
19268564 (http://www.ncbi.nlm.nih.gov/pubmed/19268564)
PUI
L50445771
DOI
10.1016/j.drugpo.2009.01.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugpo.2009.01.003
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 853
TITLE
Nerve growth factor-regulated emergence of functional δ-opioid receptors
AUTHOR NAMES
Bie B.
Zhang Z.
Cai Y.-Q.
Zhu W.
Zhang Y.
Dai J.
Lowenstein C.J.
Weinman E.J.
Pan Z.Z.
AUTHOR ADDRESSES
(Bie B.; Zhang Z.; Cai Y.-Q.; Zhu W.; Zhang Y.; Pan Z.Z.,
zzpan@mdanderson.org) Department of Anesthesiology and Pain Medicine,
University of Texas-MD, Anderson Cancer Center, 1515 Holcombe Boulevard,
Houston, TX 77030, United States.
(Dai J.) Department of Molecular Pathology, University of Texas-MD, Anderson
Cancer Center, Houston, TX 77030, United States.
(Lowenstein C.J.) Department of Medicine, Johns Hopkins University, School
of Medicine, Baltimore, MD 21205, United States.
(Lowenstein C.J.) Department of Pathology, Johns Hopkins University, School
of Medicine, Baltimore, MD 21205, United States.
(Weinman E.J.) Division of Nephrology, University of Maryland Hospital,
Baltimore, MD 21201, United States.
CORRESPONDENCE ADDRESS
Z. Z. Pan, Department of Anesthesiology and Pain Medicine, University of
Texas-MD, Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX
77030, United States. Email: zzpan@mdanderson.org
SOURCE
Journal of Neuroscience (2010) 30:16 (5617-5628). Date of Publication: 21
Apr 2010
ISSN
0270-6474
1529-2401 (electronic)
BOOK PUBLISHER
Society for Neuroscience, 1121 14th Street,NW, Suite 1010, Washington,
United States.
ABSTRACT
Sorting of intracellular G-protein-coupled receptors (GPCRs) either to
lysosomes for degradation or to plasma membrane for surface insertion and
functional expression is a key process regulating signaling strength of
GPCRs across the plasma membrane in adult mammalian cells. However, little
is known about the molecular mechanisms governing the dynamic process of
receptor sorting to the plasma membrane for functional expression under
normal and pathological conditions. In this study, we demonstrate that
δ-opioid receptor (DOPr), a GPCR constitutively targeted to intracellular
compartments, is driven to the surface membrane of central synaptic
terminals and becomes functional by the neurotrophin nerve growth factor
(NGF) in native brainstem neurons. The NGF-triggered DOPr translocation is
predominantly mediated by the signaling pathway involving the tyrosine
receptor kinase A, Ca(2+)-mobilizing phospholipase C, and
Ca(2+)/calmodulin-dependent protein kinase II. Importantly, it requires
interactions with the cytoplasmic sorting protein NHERF-1 (Na(+)/H(+)
exchange regulatory factor-1) and N-ethyl-maleimide-sensitive
factor-regulated exocytosis. In addition, this NGF-mediated mechanism is
likely responsible for the emergence of functional DOPr induced by chronic
opioids. Thus, NGF may function as a key molecular switch that redirects the
sorting of intracellularly targeted DOPr to plasma membrane, resulting in
new functional DOPr on central synapses under chronic opioid conditions.
Copyright©2010 the authors.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
delta opiate receptor (endogenous compound)
nerve growth factor (endogenous compound)
EMTREE DRUG INDEX TERMS
calcium calmodulin dependent protein kinase II (endogenous compound)
calcium ion (endogenous compound)
G protein coupled receptor (endogenous compound)
n ethylmaleimide
neurotrophin (endogenous compound)
phospholipase C (endogenous compound)
protein tyrosine kinase A (endogenous compound)
sodium proton exchange protein 1 (endogenous compound)
EMTREE MEDICAL INDEX TERMS
animal cell
animal tissue
article
brain stem
cell membrane
controlled study
cytoplasm
exocytosis
male
molecular dynamics
nerve cell
newborn
nonhuman
priority journal
protein expression
protein protein interaction
protein targeting
rat
regulatory mechanism
signal transduction
synaptic membrane
synaptic transmission
CAS REGISTRY NUMBERS
calcium calmodulin dependent protein kinase II (141467-21-2)
calcium ion (14127-61-8)
n ethylmaleimide (128-53-0)
nerve growth factor (9061-61-4)
phospholipase C (9001-86-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Biochemistry (29)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010247297
MEDLINE PMID
20410114 (http://www.ncbi.nlm.nih.gov/pubmed/20410114)
PUI
L358716985
DOI
10.1523/JNEUROSCI.5296-09.2010
FULL TEXT LINK
http://dx.doi.org/10.1523/JNEUROSCI.5296-09.2010
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 854
TITLE
Effectiveness and safety of fentanyl compared with morphine for
out-of-hospital analgesia.
AUTHOR NAMES
Fleischman R.J.
Frazer D.G.
Daya M.
Jui J.
Newgard C.D.
AUTHOR ADDRESSES
(Fleischman R.J.) Center for Policy and Research in Emergency Medicine,
Department of Emergency Medicine, Oregon Health & Science University,
Portland, Oregon 97239, USA.
(Frazer D.G.; Daya M.; Jui J.; Newgard C.D.)
CORRESPONDENCE ADDRESS
R.J. Fleischman, Center for Policy and Research in Emergency Medicine,
Department of Emergency Medicine, Oregon Health & Science University,
Portland, Oregon 97239, USA. Email: fleischr@ohsu.edu
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (2010)
14:2 (167-175). Date of Publication: 6 Apr 2010
ISSN
1545-0066 (electronic)
ABSTRACT
BACKGROUND: Fentanyl has several potential advantages for out-of-hospital
analgesia, including rapid onset, short duration, and less histamine
release. Objective. To compare the effectiveness and safety of fentanyl with
that of morphine. METHODS: This was a retrospective before-and-after study
of a protocol change from morphine to fentanyl in an advanced life support
emergency medical services system in January 2007. Charts from nine months
prior to the change and for nine months afterward were abstracted by two
reviewers using a standardized instrument. The first three months after the
change were excluded. Effectiveness was measured by change in pain scores on
a 0-10 scale. A priori-defined adverse events included out-of-hospital
events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic
blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or
vomiting, intubation, and use of antiemetic agents or naloxone. Emergency
department charts were reviewed for initial pain scores and the same adverse
events during the first two hours. Events clearly not attributable to the
opioid were discounted. The changes in pain scores were also compared
adjusting for confounders by multivariable linear regression. RESULTS: Three
hundred fifty-five patients aged 13 to 99 years received morphine during the
nine months before the protocol change and 363 received fentanyl following
the washout period. Initial pain scores for morphine (8.1) and fentanyl
(8.3) were comparable (95% confidence interval [CI] for difference -1.1 to
0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg
morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the
difference 0.9 to 2.3). The mean decreases in pain score were similar
between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference
-0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients
and 6.6% of the fentanyl patients experienced an adverse event in the field
(CI for the difference -0.8 to 7.3%). The most common event was nausea, with
a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference
-0.1% to 6.5%). CONCLUSION: Morphine and fentanyl provide similar degrees of
out-of-hospital analgesia, although this was achieved with a higher dose of
fentanyl. Both medications had low rates of adverse events, which were
easily controlled.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, drug therapy)
morphine (adverse drug reaction, drug therapy)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
clinical audit
comparative study
female
human
male
middle aged
retrospective study
treatment outcome
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20199230 (http://www.ncbi.nlm.nih.gov/pubmed/20199230)
PUI
L358929016
DOI
10.3109/10903120903572301
FULL TEXT LINK
http://dx.doi.org/10.3109/10903120903572301
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 855
TITLE
Availability of antidotes for the treatment of acute poisoning in Queensland
public hospitals.
AUTHOR NAMES
Nissen L.M.
Wong K.H.
Jones A.
Roberts D.M.
AUTHOR ADDRESSES
(Nissen L.M.) University of Queensland, Brisbane, Australia.
(Wong K.H.; Jones A.; Roberts D.M.)
CORRESPONDENCE ADDRESS
L.M. Nissen, University of Queensland, Brisbane, Australia.
SOURCE
The Australian journal of rural health (2010) 18:2 (78-84). Date of
Publication: Apr 2010
ISSN
1440-1584 (electronic)
ABSTRACT
OBJECTIVE: To determine the sufficiency of stock levels of 13 antidotes in
Queensland hospitals. DESIGN: A self-report survey was sent to 128
Queensland hospitals with acute care facilities. The stock level of the
following antidotes was determined: acetylcysteine, anti-digoxin Fab
antibodies (digibind), atropine, calcium gluconate, cyanokit,
desferrioxamine, flumazenil, glucagon, intravenous ethanol, methylene blue,
naloxone, pralidoxime and pyridoxine. Other factors sampled were bed
capacity, rural, remote and metropolitan areas classification, use of formal
stock reviews by pharmacists or nurses, existence of formal borrowing
agreements with other facilities for non-stocked antidotes, distance to the
nearest referral hospital and time taken to transfer antidotes from another
hospital. PARTICIPANTS: Pharmacists or nurses responsible for maintaining
antidote stocks in Queensland hospitals. MAIN OUTCOME MEASURES: Proportions
of hospitals with sufficient antidote stock to treat a 70-kg adult for four
or more hours using previously published guidelines. RESULTS: Survey
response rate was 73.4%. No hospital had sufficient stock of all 13
antidotes. The proportion of hospitals with sufficient stocks varied from 0%
(pyridoxine) to 68.1% (acetylcysteine). Larger hospitals had a higher
frequency of sufficient antidote stocks. Only 16% of hospitals claimed to be
able to acquire an antidote from another facility within 30 min.
CONCLUSIONS: Most Queensland hospitals stocked some important antidotes, but
few had sufficient stock to treat a 70-kg patient or acquire an antidote
within the recommended time frame of 30 min. Specific antidote stocking
guidelines might be required for Queensland hospitals. A formalised program
for stock rotation with rural facilities should be explored.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (therapy)
public hospital
EMTREE MEDICAL INDEX TERMS
adult
article
Australia
emergency health service
human
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20398048 (http://www.ncbi.nlm.nih.gov/pubmed/20398048)
PUI
L359298794
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 856
TITLE
Costs of gastrointestinal events after outpatient opioid treatment for
non-cancer pain
AUTHOR NAMES
Kwong W.J.
Diels J.
Kavanagh S.
AUTHOR ADDRESSES
(Kwong W.J.) Worldwide Health Economics and Pricing, Johnson and Johnson
Pharmaceutical Services, LLC, Raritan, NJ, United States.
(Kwong W.J.) Health Economics and Outcomes Research, Daiichi Sankyo Inc.,
Parsippany, NJ, United States.
(Diels J.; Kavanagh S., skavanag@its.jnj.com) Worldwide Health Economics and
Pricing, Johnson and Johnson Pharmaceutical Services, Turnhoutseweg 30,
B-2340, Beerse, Belgium.
CORRESPONDENCE ADDRESS
S. Kavanagh, Worldwide Health Economics and Pricing, Johnson and Johnson
Pharmaceutical Services, Turnhoutseweg 30, B-2340, Beerse, Belgium. Email:
skavanag@its.jnj.com
SOURCE
Annals of Pharmacotherapy (2010) 44:4 (630-640). Date of Publication: April
2010
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
Background: Gastrointestinal (GI) adverse effects are common with oral
opioid treatment. objective: To estimate the costs associated with GI events
after oral short-acting opioid treatment, from the payer perspective.
methods: Medical and pharmacy claims from the PharMetrics' Patient-Centric
Database were used to identify opioid-naive patients who received a new
prescription for oxycodone-or hydrocodone-containing immediate-release oral
products between 2002 and 2006. Health-care resource use and costs were
determined for patients with claims associated with ICD-9 CM (International
Classification of Diseases - 9th Clinical Modification) codes for
nausea/vomiting (787.0x), constipation (564.0x), bowel obstruction (560,
560.1, 560.3, 560.39, 564.81), or antiemetic and laxative prescriptions
during the 3 months after opioid index prescription and compared with
patients without these GI event medical or prescription claims. Resource use
data were compared using negative binomial regression and cost data were
compared using ordinary least squares confirmed by generalized gamma
regression analysis while controlling for demographics, treatment duration,
and comorbidities. results: Data from 237,447 patients were analyzed.
Patients with GI event claims had significantly more hospitalizations
(adjusted mean 0.20 to 0.97 vs 0.17, respectively, p < 0.001), days in the
hospital (1.12 to 12.05 vs 1.00 days, p < 0.001), emergency department
visits ( 0.36 to 1.44 vs 0.25 visits, p < 0.001), outpatient office visits
(5.68 to 11.81 vs 4.11 visits, p < 0.001), and prescription claims (7.46 to
8.21 vs 6.06 claims, p < 0.001) than did patients without any GI event
claims in the 3 months after index opioid prescription. Compared with
patients without any GI event claims, incremental adjusted mean total
health-care costs for patients with any of the GI event claims ranged from
$4,880 to $36,152 and were significant (p < 0.001). conclusions: The
economic burden of GI events coincident with opioid treatment is significant
for patients with a GI event recorded in claims. Reducing GI adverse effects
has potential cost savings for the health-care system.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydrocodone (adverse drug reaction, drug therapy, oral drug administration)
oxycodone (adverse drug reaction, drug therapy, oral drug administration)
EMTREE DRUG INDEX TERMS
aprepitant (drug therapy)
bisacodyl (drug therapy)
cellulose (drug therapy)
diphenhydramine (drug therapy)
docusate sodium (drug therapy)
dolasetron mesilate (drug therapy)
dronabinol (drug therapy)
glycerol (drug therapy)
granisetron (drug therapy)
hydroxyzine (drug therapy)
ispagula (drug therapy)
lactulose (drug therapy)
macrogol (drug therapy)
magnesium citrate (drug therapy)
magnesium hydroxide (drug therapy)
meclozine (drug therapy)
methylcellulose (drug therapy)
mineral oil (drug therapy)
ondansetron (drug therapy)
opiate
palonosetron (drug therapy)
polycarbophil calcium (drug therapy)
prochlorperazine (drug therapy)
promethazine (drug therapy)
scopolamine (drug therapy)
sodium dihydrogen phosphate (drug therapy)
thiethylperazine (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation (drug therapy, side effect, diagnosis, disease management, drug
therapy, side effect)
health care cost
intestine obstruction (drug therapy, side effect, diagnosis, disease
management, drug therapy, side effect)
nausea and vomiting (drug therapy, side effect, diagnosis, disease
management, drug therapy, side effect)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical pharmacy
comorbidity
comparative study
controlled study
cost control
data analysis
data base
demography
disease classification
drug release
emergency ward
female
gastrointestinal disease
health care
health care system
health economics
hospitalization
human
major clinical study
male
outpatient
prescription
priority journal
regression analysis
treatment duration
CAS REGISTRY NUMBERS
aprepitant (170729-80-3, 221350-96-5)
bisacodyl (603-50-9)
cellulose (61991-22-8, 68073-05-2, 9004-34-6)
diphenhydramine (147-24-0, 58-73-1)
docusate sodium (577-11-7)
dolasetron mesilate (115956-13-3)
dronabinol (7663-50-5)
glycerol (56-81-5)
granisetron (107007-99-8, 109889-09-0)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ispagula (77462-61-4, 8063-16-9)
lactulose (4618-18-2)
macrogol (25322-68-3)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
magnesium hydroxide (1309-42-8, 1317-43-7)
meclozine (1104-22-9, 36236-67-6, 569-65-3, 8054-07-7, 8064-07-1)
methylcellulose (79484-92-7, 9004-67-5)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
palonosetron (135729-61-2, 135729-62-3)
polycarbophil calcium (126040-58-2)
prochlorperazine (58-38-8)
promethazine (58-33-3, 60-87-7)
scopolamine (138-12-5, 51-34-3, 55-16-3)
sodium dihydrogen phosphate (7558-80-7, 7632-05-5)
thiethylperazine (1420-55-9)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
2010214066
MEDLINE PMID
20197473 (http://www.ncbi.nlm.nih.gov/pubmed/20197473)
PUI
L358597605
DOI
10.1345/aph.1M520
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.1M520
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 857
TITLE
The impact of a supervised injecting facility on ambulance call-outs in
Sydney, Australia.
AUTHOR NAMES
Salmon A.M.
van Beek I.
Amin J.
Kaldor J.
Maher L.
AUTHOR ADDRESSES
(Salmon A.M.) National Centre HIV Epidemiology and Clinical Research,
University of New South Wales, Darlinghurst, NSW, Australia.
(van Beek I.; Amin J.; Kaldor J.; Maher L.)
CORRESPONDENCE ADDRESS
A.M. Salmon, National Centre HIV Epidemiology and Clinical Research,
University of New South Wales, Darlinghurst, NSW, Australia.
SOURCE
Addiction (Abingdon, England) (2010) 105:4 (676-683). Date of Publication:
Apr 2010
ISSN
1360-0443 (electronic)
ABSTRACT
AIMS: Supervised injecting facilities (SIFs) are effective in reducing the
harms associated with injecting drug use among their clientele, but do SIFs
ease the burden on ambulance services of attending to overdoses in the
community? This study addresses this question, which is yet to be answered,
in the growing body of international evidence supporting SIFs efficacy.
DESIGN: Ecological study of patterns in ambulance attendances at
opioid-related overdoses, before and after the opening of a SIF in Sydney,
Australia. SETTING: A SIF opened as a pilot in Sydney's 'red light' district
with the aim of accommodating a high throughput of injecting drug users
(IDUs) for supervised injecting episodes, recovery and the management of
overdoses. MEASUREMENTS: A total of 20,409 ambulance attendances at
opioid-related overdoses before and after the opening of the Sydney SIF.
Average monthly ambulance attendances at suspected opioid-related overdoses,
before (36 months) and after (60 months) the opening of the Sydney Medically
Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the
rest of New South Wales (NSW). RESULTS: The burden on ambulance services of
attending to opioid-related overdoses declined significantly in the vicinity
of the Sydney SIF after it opened, compared to the rest of NSW. This effect
was greatest during operating hours and in the immediate MSIC area,
suggesting that SIFs may be most effective in reducing the impact of
opioid-related overdose in their immediate vicinity. CONCLUSIONS: By
providing environments in which IDUs receive supervised injection and
overdose management and education SIF can reduce the demand for ambulance
services, thereby freeing them to attend other medical emergencies within
the community.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (adverse drug reaction)
narcotic agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
health service
preventive health service
substance abuse (rehabilitation)
EMTREE MEDICAL INDEX TERMS
ambulance
article
Australia (epidemiology)
demography
epidemiology
evaluation study
harm reduction
health care quality
human
intoxication (epidemiology, therapy)
organization and management
statistics
time
utilization review
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20148794 (http://www.ncbi.nlm.nih.gov/pubmed/20148794)
PUI
L359684223
DOI
10.1111/j.1360-0443.2009.02837.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.2009.02837.x
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 858
TITLE
Emergencies and treatment of complications
AUTHOR NAMES
Fassoulaki A.
Staikou C.
Tsaroucha A.
AUTHOR ADDRESSES
(Fassoulaki A., fassoula@aretaieio.uoa.gr; Staikou C.; Tsaroucha A.)
Department of Anesthesiology, Aretaieio Hospital, University of Athens, 76
Vassilissis Sofias Ave, GR11528 Athens, Greece.
CORRESPONDENCE ADDRESS
A. Fassoulaki, Department of Anesthesiology, Aretaieio Hospital, University
of Athens, 76 Vassilissis Sofias Ave, GR11528 Athens, Greece. Email:
fassoula@aretaieio.uoa.gr
SOURCE
Digestion (2010) 82:2 (97-99). Date of Publication: April 2010
ISSN
0012-2823
BOOK PUBLISHER
S. Karger AG, Allschwilerstrasse 10, P.O. Box, Basel, Switzerland.
ABSTRACT
Sedation for gastrointestinal endoscopy may induce central respiratory
depression and/or airway obstruction. Early diagnosis and treatment of these
complications is mandatory as the resulting hypoxia may cause irreversible
damage, particularly to vital organs, or death. Sedatives and centrally
acting analgesics depress respiration in a dose-dependent manner. However,
significant untoward events are preventable by titrating the doses for
sedation and by monitoring patient oxygenation and respiration.
Cardiovascular adverse events may also occur during gastrointestinal
endoscopy, and can be major or minor. Hypotension needs treatment as well as
severe hypertension. Cardiac dysrhythmias may occur due to stress, pain
and/or hypercarbia, which may accompany endoscopies. The anesthesia provider
must be able to diagnose, assess the risk and treat all the adverse events
during gastrointestinal endoscopy. The resuscitation equipment, including
the defibrillator, must be readily accessible. Copyright © 2010 S. Karger
AG, Basel.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
aminophylline (drug therapy)
analgesic agent (pharmacology)
anesthetic agent (adverse drug reaction)
benzodiazepine (adverse drug reaction)
beta 1 adrenergic receptor blocking agent (drug therapy)
corticosteroid (drug therapy)
ephedrine (intravenous drug administration, pharmacology)
epinephrine (drug therapy, intramuscular drug administration, intravenous
drug administration, pharmacology)
esmolol (drug therapy, pharmacology)
flumazenil (pharmacology)
glyceryl trinitrate (drug therapy, sublingual drug administration)
infusion fluid
labetalol (drug therapy, intravenous drug administration)
naloxone (intravenous drug administration, pharmacology)
opiate (adverse drug reaction)
phenylephrine (pharmacology)
salbutamol (drug therapy, inhalational drug administration)
sedative agent (adverse drug reaction, pharmacology)
suxamethonium (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia complication
emergency care
EMTREE MEDICAL INDEX TERMS
airway obstruction (complication, etiology)
angina pectoris (drug therapy)
bronchospasm (drug therapy)
defibrillator
drug dose titration
gastrointestinal endoscopy
heart arrhythmia (complication, etiology)
heart infarction
human
hypertension (complication, drug therapy, etiology)
hypertensive crisis (complication, drug therapy)
hypotension (complication, etiology)
hypoxia (complication)
larynx spasm (complication, drug therapy)
oxygenation
patient monitoring
priority journal
respiration depression (complication, etiology, side effect)
sedation
short survey
sinus tachycardia (complication, drug therapy)
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
benzodiazepine (12794-10-4)
ephedrine (299-42-3, 50-98-6)
esmolol (81147-92-4, 81161-17-3)
flumazenil (78755-81-4)
glyceryl trinitrate (55-63-0)
labetalol (32780-64-6, 36894-69-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
salbutamol (18559-94-9, 35763-26-9)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010243150
MEDLINE PMID
20407254 (http://www.ncbi.nlm.nih.gov/pubmed/20407254)
PUI
L358700917
DOI
10.1159/000285524
FULL TEXT LINK
http://dx.doi.org/10.1159/000285524
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 859
TITLE
Intranasal naloxone delivery is an alternative to intravenous naloxone for
opioid overdoses
AUTHOR NAMES
Merlin M.A.
Saybolt M.
Kapitanyan R.
Alter S.M.
Jeges J.
Liu J.
Calabrese S.
Rynn K.O.
Perritt R.
Pryor II P.W.
AUTHOR ADDRESSES
(Merlin M.A., merlinma@umdnj.edu) Department of Emergency Medicine and
Pediatrics, University of Medicine and Dentistry, New Jersey-Robert Wood
Johnson Medical School, New Brunswick, NJ, United States.
(Merlin M.A., merlinma@umdnj.edu; Calabrese S.; Rynn K.O.; Perritt R.)
Robert Wood Johnson University Hospital, New Brunswick, NJ, United States.
(Saybolt M.; Alter S.M.) University of Medicine and Dentistry, New
Jersey-Robert Wood Johnson Medical School Piscataway, NJ, United States.
(Kapitanyan R.; Jeges J.; Liu J.; Pryor II P.W.) Department of Emergency
Medicine, University of Medicine and Dentistry, New Jersey-Robert Wood
Johnson Medical School, New Brunswick, NJ, United States.
(Liu J.) Department of Biostatistics, School of Public Health, University of
Medicine and Dentistry of New Jersey, Piscataway, NJ, United States.
(Rynn K.O.; Perritt R.) Department of Pharmacy Practice, Rutgers University,
School of Pharmacy, Piscataway, NJ, United States.
CORRESPONDENCE ADDRESS
M.A. Merlin, Department of Emergency Medicine and Pediatrics, University of
Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, New
Brunswick, NJ, United States. Email: merlinma@umdnj.edu
SOURCE
American Journal of Emergency Medicine (2010) 28:3 (296-303). Date of
Publication: March 2010
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Introduction: This study proposes that intranasal (IN) naloxone
administration is preferable to intravenous (IV) naloxone by emergency
medical services for opioid overdoses. Our study attempts to establish that
IN naloxone is as effective as IV naloxone but without the risk of needle
exposure. We also attempt to validate the use of the Glasgow Coma Scale
(GCS) in opioid intoxication. Methods: A retrospective chart review of
prehospital advanced life support patients was performed on confirmed opioid
overdose patients. Initial and final unassisted respiratory rates (RR) and
GCS, recorded by paramedics, were used as indicators of naloxone
effectiveness. The median changes in RR and GCS were determined. Results:
Three hundred forty-four patients who received naloxone by paramedics from
January 1, 2005, until December 31, 2007, were evaluated. Of confirmed
opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group
(P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P =
.19). Correlations between RR and GCS for initial, final, and change were
significant at the 0.01 level (ρ = 0.577, 0.462, 0.568, respectively).
Conclusion: Intranasal naloxone is statistically as effective as IV naloxone
at reversing the effects of opioid overdose. The IV and IN groups had
similar average increases in RR and GCS. Based on our results, IN naloxone
is a viable alternative to IV naloxone while posing less risk of needle
stick injury. Additionally, we demonstrated that GCS is correlated with RR
in opioid intoxication. © 2010 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug dose, drug therapy, intranasal drug
administration, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
opioid overdose (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
breathing rate
controlled study
critically ill patient
drug delivery system
drug efficacy
female
Glasgow coma scale
human
major clinical study
male
medical record review
mental health
priority journal
retrospective study
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010147877
MEDLINE PMID
20223386 (http://www.ncbi.nlm.nih.gov/pubmed/20223386)
PUI
L358390174
DOI
10.1016/j.ajem.2008.12.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2008.12.009
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 860
TITLE
Opioid use patterns and health care resource utilization in patients
prescribed opioid therapy with and without constipation.
AUTHOR NAMES
Iyer S.
Davis K.L.
Candrilli S.
AUTHOR ADDRESSES
(Iyer S.; Davis K.L.; Candrilli S.) Global Health Outcomes Assessment,
Pfizer Inc, 500 Arcola Road, E4269, Collegeville, PA,19426, USA.
CORRESPONDENCE ADDRESS
S. Iyer, Global Health Outcomes Assessment, Pfizer Inc, 500 Arcola Road,
E4269, Collegeville, PA,19426, USA. Email: Shrividya.lyer@pfizer.com
SOURCE
Managed care (Langhorne, Pa.) (2010) 19:3 (44-51). Date of Publication: Mar
2010
ISSN
1062-3388
ABSTRACT
PURPOSE: The main objective of this study was to compare the opioid use
patterns, resource utilization, and costs of patients on opioid therapy who
have constipation with those who do not. DESIGN: Retrospective,
observational matched cohort design METHODOLOGY: Patients initiating opioid
therapy between Jan. 1, 1999 and Dec. 31, 2005 were identified from a
longitudinal insurance claims database. Patients had > or = 30 days of
opioid use and continuous plan coverage for > or = 6 months before and > or
= 12 months after their index date, defined as the date of the first
pharmacy claim for an opioid. Constipation was defined as having one or more
ICD-9 codes of 564.0 during the follow-up period. Patterns of opioid use and
resource utilization were compared between patients with constipation and a
demographically matched (1:1) cohort of opioid initiators without consti-
pation using t-tests and Chi-square (chi2) tests. PRINCIPAL FINDINGS: We
identified 39,485 patients, of whom 2,519 (6.4%) had constipation. Most
patients with constipation were female (66%) and > or = 45 years old (68%).
Compared to controls, the constipation group had significantly higher rates
of concurrent use of > or = 2 opioids (p < 0.0001), discontinuation, and
switching between opioids. Patients with constipation had statistically
significant higher hospital admissions, emergency room visits, home health
services, nursing home care, physician office visits, other outpatient/
ancillary care, and laboratory tests. Patients with constipation had
significantly higher mean all-cause costs for emergency, physician visits,
nursing facility, home health, and prescription drug services compared to
patients without constipation. CONCLUSION: Opioid-treated patients with
constipation were found to have significant differences in opioid use
patterns and significantly higher health care utilization and associated
costs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
constipation
health service
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
chemically induced disorder
cohort analysis
comparative study
data base
female
health care cost
human
male
middle aged
retrospective study
utilization review
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20361548 (http://www.ncbi.nlm.nih.gov/pubmed/20361548)
PUI
L358759828
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 861
TITLE
Glasgow Coma Scale in acute poisonings before and after use of antidote in
patients with history of use of psychotropic agents.
AUTHOR NAMES
Poplas-Susić T.
Klemenc-Ketis Z.
Komericki-Grzinić M.
Kersnik J.
AUTHOR ADDRESSES
(Poplas-Susić T.) Department of Family Medicine, Ljubljana, Slovenia.
(Klemenc-Ketis Z.; Komericki-Grzinić M.; Kersnik J.)
CORRESPONDENCE ADDRESS
T. Poplas-Susić, Department of Family Medicine, Ljubljana, Slovenia.
SOURCE
Srpski arhiv za celokupno lekarstvo (2010) 138:3-4 (210-213). Date of
Publication: 2010 Mar-Apr
ISSN
0370-8179
ABSTRACT
INTRODUCTION: Data on emergency interventions in poisonings are scarce.
Objective To determine the effectiveness of antidote therapy in acute
poisoning-related emergency medical services (EMS) interventions. METHODS: A
prospective observational study included all poisoning-related intervention
cases over 3 years (1999-2001) in the Celje region, Slovenia, covering
125,000 inhabitants. Data were recorded on an EMS form. RESULTS:
Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS
interventions. Prescription drugs were a cause of intoxication in 93 (39.2%)
cases alone or in combination with alcohol or illegal drugs. More than one
fifth of poisonings were due to the use of illegal drugs in 52 (21.9%)
cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival,
more patients who ingested illegal drugs were in coma or comatose than the
rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p <
0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients
who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p =
0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%)
naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after
intervention was higher in all cases but significantly higher in illegal
drug cases, 13.4 vs. 12.2 (p = 0.001), with a mean positive change in GCS of
4.5 vs. 0.6 (p < 0.001). In illegal drug users, mean change after antidote
administration was 8.2 vs. 0.5 without antidote administration (p < 0.001).
CONCLUSION: High rate of successful antidote use during the intervention
indicated the importance of good EMS protocols and the presence of a skilled
doctor in the EMS team.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
EMTREE DRUG INDEX TERMS
flumazenil (drug therapy)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
psychotropic agent (drug therapy, drug toxicity)
street drug (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (diagnosis)
Glasgow coma scale
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
chemically induced disorder
child
female
human
male
middle aged
pathophysiology
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20499502 (http://www.ncbi.nlm.nih.gov/pubmed/20499502)
PUI
L358987569
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 862
TITLE
Recognition and management of acute medication poisoning
AUTHOR NAMES
Frithsen I.L.
Simpson Jr. W.M.
AUTHOR ADDRESSES
(Frithsen I.L., frithse@musc.edu; Simpson Jr. W.M.) Medical University of
South Carolina, 295 Calhoun St., Charleston, SC 29425, United States.
(Frithsen I.L., frithse@musc.edu; Simpson Jr. W.M.) Department of Family
Medicine, Medical University of South Carolina, Charleston, SC, United
States.
CORRESPONDENCE ADDRESS
I. L. Frithsen, Medical University of South Carolina, 295 Calhoun St.,
Charleston, SC 29425, United States. Email: frithse@musc.edu
SOURCE
American Family Physician (2010) 81:3 (316-323). Date of Publication: 1 Feb
2010
ISSN
0002-838X
0002-838X (electronic)
BOOK PUBLISHER
American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Suite
440, Leawood, United States.
ABSTRACT
Poisoning is a common cause of morbidity and mortality in the United States,
with several million episodes reported annually. Acute medication poisonings
account for nearly one half of all poisonings reported in the United States
and should be considered in persons with an acute change in mental status.
The initial approach to a person who has been poisoned should be to assess
the airway, breathing, and circulation, and to take a thorough history. Less
than 1 percent of poisonings are fatal; therefore, management in most cases
is supportive unless a specific antidote is available. Single-dose activated
charcoal is the gastrointestinal decontamination modality of choice, but
should not be used universally. Toxidromes are constellations of symptoms
commonly encountered with certain drug classes, including anticholinergics,
cholinergics, opioids, and sympathomimetics. Evaluation of possible
medication poisonings should include basic laboratory studies, such as a
complete metabolic profile, to determine electrolyte imbalances and liver
and renal function. Most other laboratory studies should be performed based
on clinical presentation and history. Ongoing treatment of unstable patients
with toxic medication ingestions should focus on correcting hypoxia and
acidosis while maintaining adequate circulation. These patients can have
rapid decline in mental or hemodynamic status even when they appear to be
compensating. Children can experience more profound effects from small
amounts of medication. Disposition of a person who has been poisoned
warrants careful consideration of multiple factors, and those exhibiting
signs or symptoms of toxicity must be monitored longer. Copyright © 2010
American Academy of Family Physicians.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy, oral drug administration)
activated carbon
atropine (drug therapy)
benzodiazepine (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (drug therapy)
calcium channel blocking agent (drug toxicity)
clonidine (drug toxicity)
dopamine (drug therapy)
epinephrine (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
gluconate calcium (drug therapy)
glucose
insulin (drug therapy)
ipecac
laxative
naloxone (drug therapy, intramuscular drug administration)
noradrenalin
octreotide (drug therapy, subcutaneous drug administration)
opiate (drug toxicity)
paracetamol (drug toxicity)
salicylic acid (drug toxicity)
sulfonylurea (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy, therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
acidemia
acidosis
acute toxicity
anticholinergic effect
apnea
article
behavior change
child
cyanosis
drug contraindication
drug dose titration
drug indication
electrolyte disturbance
emergency health service
emergency ward
fatality
fluid resuscitation
general practitioner
hemodialysis
home care
human
hyperthermia
hypotension
hypothermia
hypoxia
kidney function
laboratory test
lethargy
liver function
loading drug dose
mental disease
mental health
opiate addiction (drug therapy)
palliative therapy
patient positioning
physical disease by body function
poison center
pulse oximetry
respiratory distress
stomach lavage
teleconsultation
transdermal patch
vital sign
DRUG TRADE NAMES
narcan
romazicon
sandostatin
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
octreotide (83150-76-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010146971
MEDLINE PMID
20112890 (http://www.ncbi.nlm.nih.gov/pubmed/20112890)
PUI
L358388858
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 863
TITLE
Wake-up call.
AUTHOR NAMES
Dymes M.
AUTHOR ADDRESSES
(Dymes M.)
CORRESPONDENCE ADDRESS
M. Dymes,
SOURCE
JEMS : a journal of emergency medical services (2010) 35:2 (16). Date of
Publication: Feb 2010
ISSN
0197-2510
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
human
letter
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
20219502 (http://www.ncbi.nlm.nih.gov/pubmed/20219502)
PUI
L358678562
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 864
TITLE
Brugada-pattern electrocardiogram in propranolol intoxication
AUTHOR NAMES
Rennyson S.L.
Littmann L.
AUTHOR ADDRESSES
(Rennyson S.L.; Littmann L., laszlo.littmann@carolinashealthcare.org)
Department of Internal Medicine, Carolinas Medical Center, PO Box 32861,
Charlotte, NC 28232, United States.
CORRESPONDENCE ADDRESS
S.L. Rennyson, Department of Internal Medicine, Carolinas Medical Center, PO
Box 32861, Charlotte, NC 28232, United States.
SOURCE
American Journal of Emergency Medicine (2010) 28:2 (256.e7-256.e8). Date of
Publication: February 2010
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Brugada syndrome is characterized by the electrocardiographic (ECG) pattern
of right bundle-branch block (RBBB) with a high take-off, coved ST-segment
elevation in the precordial leads V(1) to V(3), and the risk of sudden
cardiac death [1]. Typically, there is no evidence of structural heart
disease. In many cases, Brugada syndrome has been linked to a mutation of
the gene SCN5A, which encodes for the fast cardiac sodium channel. In
patients with the Brugada syndrome, pharmacologic sodium channel blockade
can increase the degree of ST-segment elevation [2]. Interestingly, even in
patients with a normal baseline ECG and no clinical suggestion of the
Brugada syndrome, toxic doses of class I antiarrhythmic agents as well as
toxicities with several non-antiarrhythmic drugs that possess sodium channel
blocking properties can induce the Brugada ECG abnormality [3-5].
Specifically, the β-receptor blocker propranolol, at high doses, binds to
the cardiac sodium channels and inhibits sodium uptake [6]. In this report,
we describe a case of severe propranolol toxicity, which resulted in the
Brugada ECG pattern in an otherwise healthy individual who had no clinical
or ECG suggestion of the genetically determined Brugada syndrome. A
34-year-old white woman with a long history of major depressive disorder and
multiple prior suicide attempts presented to our emergency department after
ingestion of "large amounts" of clonazepam and propranolol. The exact
quantities of tablets were not known. Upon arrival, the patient was
unresponsive, bradycardic, and hypotensive with shallow respirations
requiring immediate intubation and mechanical ventilation. She received
glucagon and naloxone. The initial electrocardiogram (ECG) demonstrated
widened QRS complexes with a RBBB pattern, and high take-off, coved
ST-segment elevation followed by negative T waves in leads V(1) and V(2)
(Fig. 1A). This ECG finding is consistent with a type I Brugada pattern [7].
On the second hospital day, the patient was extubated. She denied any
history of syncopal episodes. She had no known family member with a history
of unexplained syncope or sudden cardiac death. Repeat ECGs revealed a
gradual narrowing of the QRS complexes and resolution of both the RBBB
pattern and the ST-segment elevation in leads V(1) and V(2) (Fig. 1B). The
patient had an uneventful hospital stay and was discharged to an inpatient
psychiatric facility. Initial laboratory evaluation revealed a normal
metabolic panel. The urine drug screen was notable for barbiturates,
benzodiazepines, and propranolol. The quantitative urine propranolol level
was extremely high at more than 50 000 ng/mL (normal, <5 ng/mL).
Propranolol, a nonselective β-adrenergic blocker, decreases the heart rate,
blood pressure, myocardial contractility, and myocardial oxygen demand.
β-Blocker toxicity, in general, is associated with ECG changes including
sinus bradycardia, first-degree AV block, prolongation of the QRS interval,
and prolonged QTc [8]. The prolonged QRS or intraventricular conduction
delay appears to be specific for propranolol toxicity; it is thought to be
related to its membrane-stabilizing or sodium channel blocking properties
[9,10]. In the genetic Brugada syndrome, the differential expression of the
cardiac sodium channel between the epicardium and endocardium yields both
the characteristic electrocardiographic findings and the increased risk for
ventricular tachyarrhythmias and sudden cardiac death [7]. The ability of
severe propranolol toxicity to induce the electrocardiographic Brugada
pattern in patients who do not have the genetic Brugada syndrome may be
related to the fact that propranolol, in high doses, causes an abbreviation
in the action potential duration in the ventricular endocardium but
prolongation of the action potential duration in the epicardium [11]. In a
recent case report, the Brugada syndrome was unmasked in a patient who had
an intentional intoxication with propranolol [12]. To our knowledge, the
current report is the first to describe a case of the Brugada ECG pattern
induced by severe propranolol toxicity in a subject who did not have any
clinical or ECG suggestion of the genetic Brugada abnormality. © 2010
Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
propranolol (drug concentration, drug toxicity, pharmacology)
EMTREE DRUG INDEX TERMS
barbituric acid derivative
benzodiazepine
clonazepam (drug therapy, drug toxicity)
glucagon (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
Brugada syndrome (diagnosis, etiology)
drug intoxication (drug therapy, drug therapy)
ECG abnormality
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
bradycardia
breathing pattern
case report
disease severity
drug urine level
emergency ward
female
heart right bundle branch block
hospital discharge
hospitalization
human
hypotension
intubation
major depression (drug therapy)
priority journal
QRS complex
sinus bradycardia
ST segment elevation
sudden death
suicide attempt
treatment outcome
unconsciousness
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
clonazepam (1622-61-3)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010099265
MEDLINE PMID
20159410 (http://www.ncbi.nlm.nih.gov/pubmed/20159410)
PUI
L358266219
DOI
10.1016/j.ajem.2009.05.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2009.05.020
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 865
TITLE
Opioid harm reduction strategies: Focus on expanded access to intranasal
naloxone
AUTHOR NAMES
Wermeling D.P.
AUTHOR ADDRESSES
(Wermeling D.P., dwermel@uky.edu) Department of Pharmacy Practice and
Science, University of Kentucky College of Pharmacy, 789 South Limestone
Street, Lexington, KY 40536, United States.
CORRESPONDENCE ADDRESS
D. P. Wermeling, Department of Pharmacy Practice and Science, University of
Kentucky College of Pharmacy, 789 South Limestone Street, Lexington, KY
40536, United States. Email: dwermel@uky.edu
SOURCE
Pharmacotherapy (2010) 30:7 (627-631). Date of Publication: July 2010
ISSN
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (clinical trial, drug administration, drug therapy, intramuscular
drug administration, intranasal drug administration, intravenous drug
administration, pharmaceutics)
EMTREE MEDICAL INDEX TERMS
clinical trial
drug delivery system
drug overdose (drug therapy)
editorial
emergency health service
harm reduction
heroin dependence (drug therapy)
human
medical education
pharmacist attitude
prescription
risk assessment
treatment response
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010363497
MEDLINE PMID
20575626 (http://www.ncbi.nlm.nih.gov/pubmed/20575626)
PUI
L359092406
DOI
10.1592/phco.30.7.627
FULL TEXT LINK
http://dx.doi.org/10.1592/phco.30.7.627
COPYRIGHT
Copyright 2015 Elsevier B.V., All rights reserved.
RECORD 866
TITLE
Adult metaxalone ingestions reported to Texas poison control centers,
2000-2006
AUTHOR NAMES
Forrester M.B.
AUTHOR ADDRESSES
(Forrester M.B., mathias.forrester@dshs.state.tx.us) Epidemiology and
Disease Surveillance Unit, Texas Department of State Health Services, 1100 W
49th Street, Austin, TX 78756, United States.
CORRESPONDENCE ADDRESS
M. B. Forrester, Epidemiology and Disease Surveillance Unit, Texas
Department of State Health Services, 1100 W 49th Street, Austin, TX 78756,
United States. Email: mathias.forrester@dshs.state.tx.us
SOURCE
Human and Experimental Toxicology (2010) 29:1 (55-62). Date of Publication:
January 2010
ISSN
0960-3271
1477-0903 (electronic)
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
Few data exist on potentially adverse metaxalone (Skelaxin«) ingestions in
adults. All metaxalone ingestions involving patients aged ≥20 years during
2000-2006 were retrieved from Texas poison control centers. Exclusion
criteria were lack of follow-up or multiple substance ingestion. Cases were
analyzed for selected demographic and clinical factors. Of the 142 patients,
66.2% were female. Dose ingested was reported for 61 patients. Of those
cases with a reported dose, distribution by management site was 29.5%
on-site, 59.0% already at/en route to health care facility, and 11.5%
referred to health care facility. Final medical outcome was no effect for
50.8% cases, minor effect for 31.1%, and moderate effect for 18.0%. The more
common adverse clinical effects reported were drowsiness (27.9%),
tachycardia (6.6%), agitation (6.6%), nausea (4.9%), dizziness (4.9%),
slurred speech (4.9%), and tremor (4.9%). A moderate medical outcome
occurred in 13.6% of ingestions of ≥2400 mg and 20.5% of ingestions of >2400
mg. Management involved a health care facility in 18.2% of ingestions of
≥2400 mg and 100.0% of ingestions of >2400 mg. This study found that adult
ingestions of higher doses of metaxalone, particularly >2400 mg, were
associated with more serious medical outcomes and were managed at health
care facilities. This study also proposes triage guidelines for when
ingestions can be safely managed at home.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
metaxalone (adverse drug reaction, drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
antiarrhythmic agent (drug therapy)
anticonvulsive agent (drug therapy)
antihistaminic agent (drug therapy)
antihypertensive agent (drug therapy)
benzodiazepine (drug therapy)
hypertensive factor (drug therapy)
infusion fluid (drug therapy)
naloxone (drug therapy)
oxygen (drug therapy)
physostigmine (drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
adult
article
ataxia (side effect)
bradycardia (side effect)
coma (side effect)
confusion (side effect)
controlled study
demography
diaphoresis
dizziness (side effect)
drowsiness (side effect)
drug distribution
emergency health service
faintness (side effect)
female
fever (side effect)
hallucination (side effect)
headache (side effect)
health care facility
human
hypertension (drug therapy, side effect)
hypotension (side effect)
intoxication (drug therapy, therapy)
lethargy (side effect)
major clinical study
male
muscle rigidity (side effect)
mydriasis (side effect)
nausea (side effect)
outcome assessment
pain (side effect)
pallor (side effect)
poison center
practice guideline
priority journal
pruritus (side effect)
rash (side effect)
respiration depression (side effect)
sedation
seizure (side effect)
side effect (side effect)
skin irritation (side effect)
slurred speech (side effect)
tachycardia (side effect)
tremor (side effect)
urine retention (side effect)
ventilator
vertigo (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
benzodiazepine (12794-10-4)
metaxalone (1665-48-1)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010058023
MEDLINE PMID
19933254 (http://www.ncbi.nlm.nih.gov/pubmed/19933254)
PUI
L358155598
DOI
10.1177/0960327108098150
FULL TEXT LINK
http://dx.doi.org/10.1177/0960327108098150
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 867
TITLE
No Opiates for Headache-Reply
AUTHOR NAMES
Lavoie F.W.
AUTHOR ADDRESSES
(Lavoie F.W.) Southern Maine Medical Center, Biddeford, ME, United States.
CORRESPONDENCE ADDRESS
F.W. Lavoie, Southern Maine Medical Center, Biddeford, ME, United States.
SOURCE
Journal of Emergency Medicine (2010) 38:1 (61). Date of Publication: January
2010
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
headache (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical practice
emergency ward
human
letter
medical decision making
physician attitude
priority journal
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2010040413
MEDLINE PMID
19796908 (http://www.ncbi.nlm.nih.gov/pubmed/19796908)
PUI
L50658155
DOI
10.1016/j.jemermed.2009.07.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2009.07.001
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 868
TITLE
The use of carnitine rather than renal replacement therapy for sodium
valproate poisoning
AUTHOR NAMES
Leitch A.W.
Williams M.
AUTHOR ADDRESSES
(Leitch A.W., AndrewLeitch@doctors.org.uk; Williams M.) Department of
Critical Care, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust,
United Kingdom.
CORRESPONDENCE ADDRESS
A. W. Leitch, Department of Critical Care, Queen Alexandra Hospital,
Portsmouth Hospitals NHS Trust, United Kingdom. Email:
AndrewLeitch@doctors.org.uk
SOURCE
Journal of the Intensive Care Society (2010) 11:1 (40-43). Date of
Publication: January 2010
ISSN
1751-1437
BOOK PUBLISHER
Stansted News Ltd, 134 South Street, Bishop's Stortford, Hertfordshire,
Essex, United Kingdom.
ABSTRACT
Valproate toxicity can be complicated by the development of hyperammonaemia,
which can cause cerebral oedema and encephalopathy. We report the successful
management of a case of valproate overdose using carnitine and review the
metabolic pathways responsible for its therapeutic effects. © The Intensive
Care Society 2010.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carnitine (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration)
valproic acid (drug concentration, drug toxicity)
EMTREE DRUG INDEX TERMS
ammonia
atropine (drug combination, drug therapy)
clonazepam
flupentixol
glucagon (drug combination, drug therapy)
naloxone (drug therapy)
oxazepam
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy, therapy)
renal replacement therapy
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
blood pressure measurement
bradycardia (complication, drug therapy)
case report
consciousness level
dose response
drug blood level
drug overdose
emergency ward
female
Glasgow coma scale
human
intensive care unit
intubation
laboratory test
loading drug dose
neurologic disease (side effect)
patient care planning
patient referral
sedation
treatment response
CAS REGISTRY NUMBERS
ammonia (14798-03-9, 51847-23-5, 7664-41-7)
atropine (51-55-8, 55-48-1)
carnitine (461-06-3, 541-15-1, 56-99-5)
clonazepam (1622-61-3)
flupentixol (2413-38-9, 2709-56-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
naloxone (357-08-4, 465-65-6)
oxazepam (604-75-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010298028
PUI
L358888236
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 869
TITLE
Acute opioid withdrawal precipitated by ingestion of crushed Embeda
(morphine extended release with sequestered naltrexone): Case report and the
focused review of the literature
AUTHOR NAMES
Ruan X.
Chen T.
Gudin J.
Couch J.P.
Chiravuri S.
AUTHOR ADDRESSES
(Ruan X.) Physicians' Pain Specialists of Alabama, Mobile, AL, United
States.
(Ruan X.; Couch J.P.) Department of Neurology, College of Medicine,
University of South Alabama, Mobile, AL, United States.
(Chen T.) Interventional Pain Medicine, Physicians' Pain Specialists of
Alabama, Mobile, AL, United States.
(Gudin J.) Englewood Hospital and Medical Center, Mt. Sinai University,
School of Medicine Affiliate, Englewood, NJ, United States.
(Couch J.P.) Department of Neurology, Physicians' Pain Specialists of
Alabama, Mobile, AL, United States.
(Chiravuri S.) Department of Anesthesiology, University of Michigan Health
System, Ann Arbor, MI, United States.
CORRESPONDENCE ADDRESS
X. Ruan, Physicians' Pain Specialists of Alabama, Mobile, AL, United States.
SOURCE
Journal of Opioid Management (2010) 6:4 (300-303). Date of Publication:
July-August 2010
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, jom@pnpco.com
ABSTRACT
Background: The introduction of newly formulated extended release (ER)
morphine with sequestered naltrexone (Embeda) has provided another treatment
option for moderate to severe persistent pain. Embeda was designed to be an
abuse-deterrent opioid formulation. Naltrexone is a centrally acting opioid
receptor antagonist that blocks the action of opioid. When taken as
directed, insignificant amount of sequestered naltrexone would reach
systemic circulation, but upon tampering, the released naltrexone may blunt
the euphoria of opioids, and possibly precipitate opioid withdrawal in
opioid-dependent patient. Objective: To describe a case report of a
50-year-old opioid-dependent male who developed acute opioid withdrawal
after taking crushed Embeda. Case report: A 50-year-old male with severe,
chronic low back pain due to degenerative disc disease was referred to our
clinic for pain management. He was taking ER oxycodone 80 mg tid and
Roxicodone 30 mg qid prn, with inadequate pain relief A trial of ER
oxymorphone was decided, at 40 mg 1-2 doses bid. The patient returned to the
clinic 1 week early, out of his ER oxymorphone. At this time, the decision
to switch him to Embeda was made, at 80 mg/3-2 mg, 1-2 doses bid. The
patient and his family members were counseled about risk involved with
tampering with Embeda. A few hours later, our clinic was informed that the
patient was brought to emergency room by ambulance, in severe opioid
withdrawal. He was treated with IV fluid, antiemetics, Clonidine, and IV
hydromorphone. His condition improved and he was discharged home the next
morning. Later on, the patient admitted that he took two prescribed Embeda
within half an hour, the 1st one whole and the 2nd one crushed. He further
admitted that he did so against our medical advice. Conclusion: Taking
tampered Embeda may precipitate opioid withdrawal in opioid-tolerant
patient. To the best of our knowledge, this is the first report of induced
opioid withdrawal following consumption of crushed Embeda. © 2010 Journal of
Opioid Management, All Rights Reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug combination, drug therapy)
naltrexone (adverse drug reaction, drug combination, drug therapy)
EMTREE DRUG INDEX TERMS
antiemetic agent (intravenous drug administration)
clonidine (intravenous drug administration)
hydromorphone (intravenous drug administration)
oxycodone (drug therapy)
oxymorphone
oxymorphone (drug therapy)
promethazine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opioid withdrawal (side effect, diagnosis, side effect)
withdrawal syndrome (side effect, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
adult
article
blood pressure
case report
drug release
drug treatment failure
drug urine level
emergency treatment
heart rate
human
intervertebral disk disease
low back pain (complication, drug therapy)
male
patient compliance
patient counseling
pupil
sweating
DRUG TRADE NAMES
opana
roxicodone
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naltrexone (16590-41-3, 16676-29-2)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
Chinese
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2010544990
MEDLINE PMID
20862910 (http://www.ncbi.nlm.nih.gov/pubmed/20862910)
PUI
L359687432
DOI
10.5055/jom.2010.0028
FULL TEXT LINK
http://dx.doi.org/10.5055/jom.2010.0028
COPYRIGHT
Copyright 2016 Elsevier B.V., All rights reserved.
RECORD 870
TITLE
Evaluation and Management of Acute Cervical Spine Trauma
AUTHOR NAMES
Pimentel L.
Diegelmann L.
AUTHOR ADDRESSES
(Pimentel L., lpimentel@memn.org; Diegelmann L.) Department of Emergency
Medicine, University of Maryland School of Medicine, 110 South Paca Street,
6th Floor, Suite 200, Baltimore, MD 21201, United States.
(Pimentel L., lpimentel@memn.org) Department of Emergency Medicine, Maryland
Emergency Medicine Network, 110 South Paca Street, Baltimore, MD 21201,
United States.
(Diegelmann L.) Department of Emergency Medicine, University of Maryland
Medical Center, 110 South Paca Street, Baltimore, MD 21201, United States.
CORRESPONDENCE ADDRESS
L. Pimentel, Department of Emergency Medicine, University of Maryland School
of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD
21201, United States. Email: lpimentel@memn.org
SOURCE
Emergency Medicine Clinics of North America (2010) 28:4 (719-738). Date of
Publication: November 2010
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The evaluation and management of cervical spine injuries is a core component
of the practice of emergency medicine. This article focuses on evaluation
and management of blunt cervical spine trauma by the emergency physician.
Pertinent anatomy of the cervical spine and specific cervical spine
fractures are discussed, with an emphasis on unstable injuries and
associated spinal cord pathology. The association of vertebral artery injury
with cervical spine fracture is addressed, followed by a review of the most
recent literature on prehospital care. Initial considerations in the
emergency department, including cervical spine stabilization and airway
management, are reviewed. The most current recommendations for cervical
spine imaging with regard to indications and modalities are covered.
Finally, emergency department management and disposition of patients with
spinal cord injuries are reviewed. © 2010 Elsevier Inc.
EMTREE DRUG INDEX TERMS
analgesic agent
cyclobenzaprine (adverse drug reaction, drug combination, drug therapy)
dopamine
epinephrine
hypertensive factor (drug therapy)
ibuprofen (drug combination, drug therapy)
methylprednisolone (adverse drug reaction, clinical trial, drug dose, drug
therapy)
muscle relaxant agent
naloxone (drug therapy)
nonsteroid antiinflammatory agent
noradrenalin
paracetamol
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cervical spine fracture (disease management, etiology, therapy)
cervical spine injury (disease management, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
airway
atlantoaxial fracture dislocation (etiology)
bradycardia (drug therapy)
causal attribution
central nervous system disease (side effect)
clinical assessment
clinical evaluation
clinical trial
computer assisted tomography
dosage schedule comparison
drug efficacy
drug safety
emergency care
emergency physician
flexion injury (etiology)
fracture immobilization
human
hypotension (drug therapy)
jefferson fracture (diagnosis, etiology)
muscle spasm (drug therapy)
muscle strain (drug therapy)
mycofacial strain (drug therapy)
mycofacial strain (drug therapy)
myofacial strain (drug therapy)
myofacial strain (drug therapy)
neurologic disease
nuclear magnetic resonance imaging
odontoid process fracture (etiology, surgery)
partial cord sydrome
pathogenesis
physiotherapy
pneumonia (side effect)
practice guideline
priority journal
recommended drug dose
review
sepsis (side effect)
spinal cord injury
spine injury (drug therapy)
treatment duration
treatment indication
vertebral artery injury (etiology)
vertebral artery stenosis
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
cyclobenzaprine (303-53-7, 6202-23-9)
dopamine (51-61-6, 62-31-7)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
methylprednisolone (6923-42-8, 83-43-2)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
General Pathology and Pathological Anatomy (5)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010585433
MEDLINE PMID
20971389 (http://www.ncbi.nlm.nih.gov/pubmed/20971389)
PUI
L359816380
DOI
10.1016/j.emc.2010.07.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2010.07.003
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 871
TITLE
Drugs of Abuse: The Highs and Lows of Altered Mental States in the Emergency
Department
AUTHOR NAMES
Meehan T.J.
Bryant S.M.
Aks S.E.
AUTHOR ADDRESSES
(Meehan T.J., tmeeha3@gmail.com; Bryant S.M.; Aks S.E.) Toxikon Consortium,
Chicago, IL, United States.
(Meehan T.J., tmeeha3@gmail.com) Department of Emergency Medicine (MC 724),
University of Illinois - Chicago, 808 South Wood Street, 4th Floor, Chicago,
IL 60612, United States.
(Bryant S.M.) Department of Emergency Medicine, Cook County Hospital
(Stroger), Chicago, IL, United States.
(Bryant S.M.) Illinois Poison Center, Chicago, IL, United States.
(Aks S.E.) Division of Toxicology, Department of Emergency Medicine, Cook
County Hospital (Stroger), Chicago, IL, United States.
(Aks S.E.) Department of Emergency Medicine, Rush University, Chicago, IL,
United States.
CORRESPONDENCE ADDRESS
T.J. Meehan, Department of Emergency Medicine (MC 724), University of
Illinois - Chicago, 808 South Wood Street, 4th Floor, Chicago, IL 60612.,
United States. Email: tmeeha3@gmail.com
SOURCE
Emergency Medicine Clinics of North America (2010) 28:3 (663-682). Date of
Publication: August 2010
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The diagnosis and management of poisoned patients presenting with
alterations in mental status can be challenging, as patients are often
unable (or unwilling) to provide an adequate history. Several toxidromes
exist. Recognition hinges upon vital signs and the physical examination.
Understanding these " toxic syndromes" may guide early therapy and
management, providing insight into the patient's underlying medical problem.
Despite toxidrome recognition guiding antidotal therapy, the fundamental
aspect of managing these patients involves meticulous supportive care. The
authors begin with a discussion of various toxidromes and then delve into
the drugs responsible for each syndrome. They conclude with a discussion on
drug-facilitated sexual assault (" date rape" ), which is both an
underrecognized problem in the emergency department (ED) and representative
of the drug-related problems faced in a modern ED. © 2010.
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent (drug toxicity)
amphetamine (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
cocaine (drug toxicity)
dextropropoxyphene (drug toxicity)
flumazenil (adverse drug reaction, drug therapy)
hypnotic sedative agent (drug toxicity)
lysergide (drug toxicity)
mescaline (adverse drug reaction)
methylxanthine derivative (drug toxicity)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
pethidine (drug toxicity)
phencyclidine (drug toxicity)
physostigmine (drug therapy)
psilocin (drug toxicity)
psilocybine (drug toxicity)
psychedelic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
mental disease
EMTREE MEDICAL INDEX TERMS
ataxia (side effect)
brain injury
disease severity
dizziness (side effect)
drug classification
drug dependence
drug detoxification
drug intoxication (drug therapy)
emergency ward
headache (side effect)
human
hypertension (side effect)
mental health
mushroom poisoning
patient assessment
priority journal
review
seizure (side effect)
tachycardia (side effect)
CAS REGISTRY NUMBERS
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextropropoxyphene (1639-60-7, 469-62-5)
flumazenil (78755-81-4)
lysergide (50-37-3)
mescaline (11006-96-5, 54-04-6, 832-92-8)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phencyclidine (77-10-1, 956-90-1)
physostigmine (57-47-6, 64-47-1)
psilocin (26159-83-1, 520-53-6)
psilocybine (520-52-5)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010445401
MEDLINE PMID
20709248 (http://www.ncbi.nlm.nih.gov/pubmed/20709248)
PUI
L359359505
DOI
10.1016/j.emc.2010.03.012
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2010.03.012
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 872
TITLE
The present state of initial treatment of neurological abnormalities and the
development faculties of emergency physicians
AUTHOR NAMES
Unemoto K.
Yokota H.
AUTHOR ADDRESSES
(Unemoto K.) Department of Emergency and Critical Care Medicine, Nippon
Medical School Musashikosugi Hospital, 1-396 Musashikosugi, Nakahara-ku,
Kawasaki, Kanagawa 211-8533, Japan.
(Yokota H.) Department of Emergency and Critical Care Medicine, Main
Hospital, Nippon Medical School, .
CORRESPONDENCE ADDRESS
K. Unemoto, Department of Emergency and Critical Care Medicine, Nippon
Medical School Musashikosugi Hospital, 1-396 Musashikosugi, Nakahara-ku,
Kawasaki, Kanagawa 211-8533, Japan.
SOURCE
Brain and Nerve (2010) 62:1 (35-42). Date of Publication: January 2010
ISSN
1881-6096
BOOK PUBLISHER
Igaku-Shoin Ltd, 5-24-3 Hongo, Bunkyo-ku, Tokyo, Japan.
ABSTRACT
In an emergency room, attending doctors encounter various neurological
symptoms and signs on a daily basis. Every doctor aims to identify abnormal
findings, achieve a diagnosis, and offer appropriate management. In Japan,
currently, only approximately 35% of leading emergency centers have
neurologists, neurosurgeons, and psychiatrists performing exclusive
functions. Therefore, the initial or tentative diagnosis of a patient with
cerebral symptoms is dealt by emergency physicians. For instance, in a
patient presenting with hemiparesis, prompt detection of an acute cerebral
infarction, which has a highly limited therapeutic window for thrombolytic
therapy, is crucial. However, this symptom may also be observed in some
cases of severe hypoglycemia, psychogenic reaction (conversion hysteria),
etc. This report describes a strategy for accurate diagnosis and medical
treatment of neurological abnormalities at the emergency rooms of hospitals,
which are expected to provide this support.
EMTREE DRUG INDEX TERMS
alcohol
alteplase
carbon dioxide
electrolyte (endogenous compound)
glucose
insulin (endogenous compound)
naloxone
opiate
oxygen
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
neurologic disease
physician
EMTREE MEDICAL INDEX TERMS
acute disseminated encephalomyelitis
alcohol consumption
arterial carbon dioxide tension
arterial oxygen tension
article
brain disease
brain infarction
cerebrovascular accident
computed tomographic angiography
computer assisted tomography
consciousness disorder
conversion disorder
Cushing disease
diagnostic accuracy
diastolic blood pressure
disease severity
drug overdose
emergency health service
emergency ward
encephalomyelitis
endocrine disease
faintness
fibrinolytic therapy
Glasgow coma scale
Guillain Barre syndrome
hemiparesis
human
hypoglycemia
infection
injury
Japan
japan coma scale
mean arterial pressure
medical education
National Institutes of Health Stroke Scale
neoplasm
neurosurgery
nuclear magnetic resonance imaging
positive end expiratory pressure
psychiatrist
psychogenesis
rating scale
resuscitation
seizure
shock
Sturge Weber syndrome
subarachnoid hemorrhage
systolic blood pressure
temperature
three dimensional imaging
uremia
Wernicke encephalopathy
CAS REGISTRY NUMBERS
alcohol (64-17-5)
alteplase (105857-23-6)
carbon dioxide (124-38-9, 58561-67-4)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Japanese
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010090160
MEDLINE PMID
20112790 (http://www.ncbi.nlm.nih.gov/pubmed/20112790)
PUI
L358241515
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 873
TITLE
Two cases of sudden sensorineural hearing loss after methadone overdose
AUTHOR NAMES
Christenson B.J.
Marjala A.R.P.
Foss M.
AUTHOR ADDRESSES
(Christenson B.J.; Marjala A.R.P.) College of Pharmacy, University of
Minnesota, Unity Hospital, Fridley, MN, United States.
(Foss M., mary.foss@allina.com)
CORRESPONDENCE ADDRESS
M. Foss, Unity Hospital, Fridley MNC/O Unity Hospital Pharmacy, Mail Route
52570, 550 Osborne Rd. NE, Fridley, MN 55432, United States. Email:
mary.foss@allina.com
SOURCE
Annals of Pharmacotherapy (2010) 44:1 (207-210). Date of Publication:
January 2010
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
OBJECTIVE: To document the presentation of 2 cases of sudden sensorineural
hearing loss (SSHL) following methadone overdose. CASE SUMMARY: We report 2
cases of acute, bilateral methadone-induced hearing loss that took place on
the same night in our emergency department. A 30-year-old male and his
25-year-old wife were found unresponsive in their home after ingesting an
unknown, but presumably large, quantity of methadone. Drugs that are
typically categorized as ototoxic were ruled out in each patient via rapid
in-house urine drug screens as well with a comprehensive analysis via gas
chromatography mass spectrometry. Methadone and tetrahydrocannabinol (THC)
were the only drugs found in the toxicology screenings that were common to
both patients. The man had a long treatment course that included several
days in the intensive care unit. The woman recovered completely and was
discharged within a day of admission. The hearing loss in both patients
reversed completely within 24 hours. DISCUSSION: Several medications are
commonly associated with ototoxicity, including nonsteroidal
antiinflammatory drugs, antibiotics, loop diuretics, and chemotherapy
agents. Although rare, drug-induced SSHL has been documented particularly
among intravenous drug abusers after heroin injection. Until now, there has
been only one published case report documenting drug-induced SSHL attributed
to methadone. CONCLUSIONS: We believe methadone to be the probable cause of
SSHL in both patients, because it and THC were the only common drugs found
on toxicology screens, a recent case report involved methadone-induced SSHL,
and because of the suddenness of the onset and recovery of the patient's
hearing coinciding with the time frame of the ingestion. The Naranjo
probability scale score revealed that the adverse reaction was probable for
each patient.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug therapy, drug toxicity)
tetrahydrocannabinol
EMTREE DRUG INDEX TERMS
etomidate (intravenous drug administration)
naloxone
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
perception deafness (diagnosis, etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
cannabis addiction
cannabis smoking
case report
drug screening
female
heroin dependence (drug therapy)
human
intensive care
male
mass fragmentography
methadone treatment
ototoxicity
priority journal
urinalysis
CAS REGISTRY NUMBERS
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
tetrahydrocannabinol (1972-08-3)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010050596
MEDLINE PMID
20028962 (http://www.ncbi.nlm.nih.gov/pubmed/20028962)
PUI
L358138243
DOI
10.1345/aph.1M250
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.1M250
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 874
TITLE
Tricyclic antidepressant toxicity treated with massive sodium bicarbonate
AUTHOR NAMES
Pierog J.E.
Kane K.E.
Kane B.G.
Donovan J.W.
Helmick T.
AUTHOR ADDRESSES
(Pierog J.E.; Kane K.E., katekane831@hotmail.com; Kane B.G.) Lehigh Valley
Hospital, Bethlehem, PA 18107, United States.
(Donovan J.W.) PinnacleHealth Toxicology Center, Pennsylvania State
University, Harrisburg Hospital, Harrisburg, PA, United States.
(Helmick T.) Harrisburg Hospital, Harrisburg, PA, United States.
CORRESPONDENCE ADDRESS
J.E. Pierog, Lehigh Valley Hospital, Bethlehem, PA 18107, United States.
SOURCE
American Journal of Emergency Medicine (2009) 27:9 (1168.e3-1168.e7). Date
of Publication: November 2009
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Tricyclic antidepressant (TCA) morbitity is primarily due to cardiac
arrhythmias and hypotension, which become more refractory to treatment as
acidosis progresses (Ann Emerg Med. 1985;14:1-9; Clin Toxicol.
2007;45:203-233; Flomenbaum N, Goldfrank L, Hoffman R, et al. Goldfrank's
toxicologic emergencies. 8th ed. McGraw-Hill Companies, Inc, 2006). Early
recognition and aggressive treatment are necessary for patient survival. The
study aimed to discuss the treatment of TCA toxicity with the administration
of sodium bicarbonate as dictated by electrocardiogram, vital signs, and
clinical course. We describe the case of a 53-year-old woman with severe TCA
toxicity manifested by altered mental status, hypotension, and cardiac
conduction abnormalities. Seventy-five 50-mL ampules of 7.5% sodium
bicarbonate were required over a 10-hour period as boluses and part of a
continuous infusion. Criteria for administration of boluses included
hypotension, conduction abnormalities, or deviation from goal pH on arterial
blood gas. No previous publications describe this quantity of sodium
bicarbonate administration, given within this short amount of time, with a
successful patient outcome. Successful treatment of severe TCA poisoning
requires clinical recognition of the ingestion; it may also require massive
serum alkalinization and electrolyte replacement. Sodium bicarbonate can be
given as frequently as needed with dosages based on clinical findings,
including blood pressure, degree of conduction delay, arterial blood gas,
and electrolytes. Based on this case, massive amounts of sodium bicarbonate
can be given with both successful case outcome and without negative
sequelae. Tricyclic antidepressant (TCA) toxicity can be a severe and
life-threatening condition [1-3]. The lethality of TCA overdose is primarily
due to cardiac arrhythmias [1,2,4]. We describe the case of a 53-year-old
woman whose treatment included seventy-five 50-mL ampules of 7.5% sodium
bicarbonate (NaHCO(3)) administered over a 10-hour period based on the
patient's clinical course. No previous publications describe this quantity
of sodium bicarbonate, given within this short amount of time, with a
successful patient outcome. A 53-year-old woman was found by emergency
medical services at home, unresponsive with agonal respirations, surrounded
by empty pill bottles. The patient's medical history is remarkable for
depression with a previous suicide attempt. Her medications include
amitriptyline, venlafaxine, and desipramine. In addition, she had access to
her late husband's medications including hydrocodone/APAP. The patient later
admitted to taking 20 hydrocodone/APAP (7.5 mg/325 mg) tablets, 10
desipramine (100 mg) tablets, and 10 venlafaxine (150 mg) tablets 4 to 7
hours before being discovered. The patient arrived in a local emergency
department (ED) with a Glasgow coma score of 3 and was intubated without
medications. On exam, pupils were 4 mm, equal, round and sluggishly reactive
to light. Initial telemetry recordings showed a widened QRS interval and
peaked T waves (Fig. 1). The patient's blood pressure cuff measurements of
50-70/24-35 were confirmed with an arterial line. Initial treatment included
2 L of normal saline, 2 mg of naloxone IV bolus, and sodium bicarbonate 100
mEq IV bolus followed by a sodium bicarbonate drip composed of 150 mEq in 1
L of D5W (concentration used throughout) at a rate of 250 mL/h. There was no
change in mental status after these medications. One hour after the
patient's arrival to the ED, the electrocardiogram (ECG) revealed a normal
sinus rhythm with flattened P waves (Fig. 2, Table 1). At this point, the
patient was transferred to the regional toxicology center. En route, medevac
administered sodium bicarbonate 100 mEq IV, 4 mg IV lorazepam for sedation,
and drips of norepinephrine at 9 μg/min, dopamine at 18 μg/kg per minute,
and sodium bicarbonate at 500 mL/h. On arrival to the toxicology center, the
patient had no gag reflex, minimal corneal reflexes, and exhibited no
spontaneous movement. Initial vital signs were as follows: blood pressure
70/40, P 100, core body temperature 34°C, saturated oxygen 100% ventilated,
weight 70.45 kg. Pupils remained 4 mm, equal, round, and sluggishly
reactive. Despite a lack of paralysis, extremities were flaccid and no deep
tendon reflexes were noted. An ECG showed a sinus tachycardia at 101 (Fig.
3, Table 1). Infusions of norepinephrine at 30 μg/min and dopamine at 20
μg/kg per minute were followed with a central venous pressure monitor; goal
established as 10 cm H(2)O. The sodium bicarbonate drip was continued at 500
mL/h, and an ideal arterial pH was set at 7.5 to 7.55, with the ultimate
goal being persistent narrowing of the QRS interval [5]. During treatment,
the patient's blood pressure quickly responded to sodium bicarbonate
boluses. The QRS duration also shortened and central venous pressure
improved. The bolus dosages ranged from 2 to 4 ampules of 7.5% sodium
bicarbonate based on the clinical response. Arterial blood gases were drawn
frequently; results were used to titrate her bicarbonate drip. Within the
first 10 hours, the patient had received 1500 mEq of sodium bicarbonate IV
bolus and 1000 mEq via continuous IV infusion. In addition to the
bicarbonate described above, the patient received 86.4 mEq of calcium
chloride (6 ampules), 6 g of magnesium sulfate, 120 mEq potassium chloride,
63 mmol of potassium phosphate, and 17 L of fluid. The patient's serial
chemistries are presented in detail in Table 2. The bicarbonate drip was
slowly weaned over 24 hours as her hemodynamic and acid/base status
normalized. As her metabolic derangements improved, her neurologic status
improved. Ten hours after intensive care unit (ICU) admission, the patient's
Glasgow coma score had improved to 10T. After 48 hours of ICU care, her ECG
showed sinus tachycardia at 113 (Fig. 4, Table 1). At the time of discharge
from the toxicology center to the inpatient psychiatric facility, she was
back to her baseline and able to perform all activities of daily living.
Tricyclic antidepressant toxicity can occur with ingestion of 10 mg/kg body
weight, although doses of less than 20 mg/kg are unlikely to result in
severe complications or fatalities [4,6,7]. Symptoms correlate poorly with
quantity ingested because of individual variation in absorption, metabolism,
and protein binding, thereby limiting clinical prediction [6,7]. Measured
serum drug levels have the same limitations. Therefore, the dose ingested,
even if reliably confirmed, is a poor predictor of the subsequent clinical
outcome [1]. Tricyclic antidepressants are variably bound to albumin in a
pH-sensitive fashion [8,9]. As serum pH increases, cyclic antidepressants
become increasingly albumin bound with less free drug available to impair
the myocardial cells [8,9]. Alkalinizing the serum minimizes drug
distribution and enhances the elimination [10,11]. Dialysis is not an option
for drug removal because of the combination of the high volume of
distribution and high protein binding. Thus, treatment focuses on serum
alkalinization with pH goal of 7.50 to 7.55 if the QRS complex is 111
milliseconds or greater, or the terminal right-axis deviation is more than
120° [3]. Sodium bicarbonate also narrows the QRS complex and decreases
dysrhythmias. Previous reports have not provided a minimum or maximum dose
for sodium bicarbonate therapy. The suggested bicarbonate dose is 1 to 2
mEq/kg [5-7,12]. In the myocardium, TCAs decrease influx of sodium through
gated fast channels. This blockade leads to a widened QRS complex,
prolongation of PR and QT intervals, and decreases in phase 0 of the cardiac
cell cycle. The blockade of the sodium channels prolongs the cardiac action
potential, refractory period, and atrioventricular conduction. In vitro
studies have shown that TCAs directly decrease myocardial contractility in a
dose-dependent manner [1,2,7]. In addition, TCAs prevent norepinephrine and
serotonin uptake and cause peripheral α-adrenergic blockade. The clinical
result is hypotension and dysrhythmias. The sodium bicarbonate infusion was
initiated to counteract the effects of the TCA and acidosis; however, doses
considered standard did not result in improvement in the patient's
condition. As a result, additional dosages were administered in bolus form.
In this case study, we report 2500 mEq of sodium bicarbonate given in the
initial 10 hours and a total of 3750 mEq sodium bicarbonate given over a
48-hour ICU stay. Total bicarbonate administered was in excess of 50 mEq/kg.
Concomitant electrolyte therapy was also necessary. It is difficult to draw
definitive conclusions from a single case, notably one with multiple
ingestions. This case study illustrates the survivability of a severe TCA
overdose when sodium bicarbonate administration is dictated by abnormal ECG
and vital signs. The current recommended dose of sodium bicarbonate
administration may be inadequate both for initial and subsequent sodium
bicarbonate dosages. Based on our experience, sodium bicarbonate should be
given as frequently as needed when prompted by changes in vital signs,
continuous cardiac monitoring, electrolyte assessment, and arterial blood
gas samples, exceeding the current recommendations. © 2009 Elsevier Inc. All
rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amitriptyline (drug therapy, drug toxicity)
bicarbonate (drug combination, drug dose, drug therapy, intravenous drug
administration)
desipramine (drug therapy, drug toxicity)
venlafaxine (drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
calcium chloride (drug combination, drug therapy)
hydrocodone
magnesium sulfate (drug combination, drug therapy)
naloxone (intravenous drug administration)
paracetamol
potassium chloride (drug combination, drug therapy)
potassium dihydrogen phosphate (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
acidosis
add on therapy
adult
article
case report
continuous infusion
depression (drug therapy)
disease course
drug dose titration
electrocardiogram
female
heart arrhythmia
heart muscle conduction disturbance
human
hypotension
mental health
morbidity
priority journal
sinus tachycardia (diagnosis)
suicide attempt
survival
vital sign
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
desipramine (50-47-5, 58-28-6)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
potassium chloride (7447-40-7)
potassium dihydrogen phosphate (7778-77-0)
venlafaxine (93413-69-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009594088
MEDLINE PMID
19931778 (http://www.ncbi.nlm.nih.gov/pubmed/19931778)
PUI
L355630908
DOI
10.1016/j.ajem.2008.11.026
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2008.11.026
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 875
TITLE
Pediatric adverse drug events in the outpatient setting: An 11-year national
analysis
AUTHOR NAMES
Bourgeois F.T.
Mandl K.D.
Valim C.
Shannon M.W.
AUTHOR ADDRESSES
(Bourgeois F.T., florence.bourgeois@childrens.harvard.edu; Mandl K.D.;
Shannon M.W.) Children's Hospital Boston, Division of Emergency Medicine,
300 Longwood Ave, Boston, MA 02115, United States.
(Bourgeois F.T., florence.bourgeois@childrens.harvard.edu; Mandl K.D.;
Shannon M.W.) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States.
(Mandl K.D.) Children's Hospital Informatics Program, Children's Hospital
Boston, Boston, MA, United States.
(Valim C.) Division of Biostatistics, Clinical Research Program, Children's
Hospital Boston, Boston, MA, United States.
(Valim C.) Department of Surgery, Harvard Medical School, Boston, MA, United
States.
CORRESPONDENCE ADDRESS
F. T. Bourgeois, Children's Hospital Boston, Division of Emergency Medicine,
300 Longwood Ave, Boston, MA 02115, United States. Email:
florence.bourgeois@childrens.harvard.edu
SOURCE
Pediatrics (2009) 124:4 (e744-e750). Date of Publication: 2009
ISSN
0031-4005
1098-4275 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
OBJECTIVE: Adverse drug events (ADEs) are a common complication of medical
care, but few pediatric data are available describing the frequency or
epidemiology of these events. We estimated the national incidence of
pediatric ADEs requiring medical treatment, described the pediatric
population seeking care for ADEs, and characterized the events in terms of
patient symptoms and medications implicated. METHODS: Data were obtained
from the National Center for Health Statistics, which collects information
on patient visits to outpatient clinics and emergency departments throughout
the United States. We analyzed data for children 0 to 18 years of age
seeking medical treatment for an ADE between 1995 and 2005. RESULTS: The
mean annual number of ADE-related visits was 585 922 (95% confidence
interval [CI]: 503 687-668 156) of which 78% occurred in outpatient clinics
and 12% occurred in emergency departments. Children 0 to 4 years of age had
the highest incidence of ADE-related visits, accounting for 43.2% (95% CI:
35.6%-51.2%) of visits. The most common symptom manifestations were
dermatologic conditions (45.4% [95% CI: 36.9%-54.1%]) and gastrointestinal
symptoms (16.5% [95% CI: 11.1%-23.8%]). The medication classes most
frequently implicated in an ADE were antimicrobial agents (27.5% [95% CI:
21.5%-34.5%]), central nervous system agents (6.5% [95% CI: 4.0%-10.5%]),
and hormones (6.1% [95% CI: 3.1%-11.6%]). While ADEs related to
antimicrobial agents were most common among children 0 to 4 years old and
decreased in frequency among older children, ADEs resulting from central
nervous system agents and hormones increased in frequency among children 5
to 11 and 12 to 18 years old. CONCLUSIONS: ADEs result in a substantial
number of health care visits, particularly in outpatient clinics. The
incidence of ADEs and medications implicated vary by age, indicating that
age-specific approaches for monitoring and preventing ADEs may be most
effective. Copyright © 2009 by the American Academy of Pediatrics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidepressant agent (adverse drug reaction)
antiinfective agent (adverse drug reaction)
central stimulant agent (adverse drug reaction)
hormone (adverse drug reaction)
EMTREE DRUG INDEX TERMS
antineoplastic agent (adverse drug reaction)
cephalosporin (adverse drug reaction)
diphenhydramine
immunosuppressive agent (adverse drug reaction)
naloxone
penicillin G (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
allergy (side effect)
article
cardiovascular disease (side effect)
child
dizziness (side effect)
drug fever (side effect)
edema (side effect)
emergency ward
endocrine disease (side effect)
faintness (side effect)
female
gastrointestinal symptom (side effect)
human
infant
malaise (side effect)
male
mental disease (side effect)
neurologic disease (side effect)
newborn
outpatient
preschool child
priority journal
respiratory tract disease (side effect)
school child
skin disease (side effect)
swelling (side effect)
United States
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
cephalosporin (11111-12-9)
diphenhydramine (147-24-0, 58-73-1)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009529698
MEDLINE PMID
19786435 (http://www.ncbi.nlm.nih.gov/pubmed/19786435)
PUI
L355385624
DOI
10.1542/peds.2008-3505
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2008-3505
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 876
TITLE
Intranasal naloxone is a viable alternative to intravenous naloxone for
prehospital narcotic overdose
AUTHOR NAMES
Robertson T.M.
Hendey G.W.
Stroh G.
Shalit M.
AUTHOR ADDRESSES
(Robertson T.M.; Stroh G.; Shalit M.) Department of Emergency Medicine,
UCSF-Fresno, Medical Education Program, Fresno, CA, United States.
(Hendey G.W., ghendey@fresno.ucsf.edu) UCSF Fresno, Medical Education and
Research Center, Department of Emergency Medicine, 155 North Fresno Street,
Fresno, CA 93701, United States.
CORRESPONDENCE ADDRESS
G. W. Hendey, UCSF Fresno, Medical Education and Research Center, Department
of Emergency Medicine, 155 North Fresno Street, Fresno, CA 93701, United
States. Email: ghendey@fresno.ucsf.edu
SOURCE
Prehospital Emergency Care (2009) 13:4 (512-515). Date of Publication: 2009
ISSN
1090-3127
1545-0066 (electronic)
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
ABSTRACT
Objective. To compare the prehospital time intervals from patient contact
and medication administration to clinical response for intranasal (IN)
versus intravenous (IV) naloxone in patients with suspected narcotic
overdose. Methods. This was a retrospective review of emergency medical
services (EMS) and hospital records, before and after implementation of a
protocol for administration of intranasal naloxone by the Central California
EMS Agency. We included patients with suspected narcotic overdose treated in
the prehospital setting over 17 months, between March 2003 and July 2004.
Paramedics documented dose, route of administration, and positive response
times using an electronic record. Clinical response was defined as an
increase in respiratory rate (breaths/min) or Glasgow Coma Scale score of at
least 6. Main outcome variables included time from medication to clinical
response and time from patient contact to clinical response. Secondary
variables included numbers of doses administered and rescue doses given by
an alternate route. Between-group comparisons were accomplished using
t-tests and chi-square tests as appropriate. Results. One hundred fifty-four
patients met the inclusion criteria, including 104 treated with IV and 50
treated with IN naloxone. Clinical response was noted in 33 (66%) and 58
(56%) of the IN and IV groups, respectively (p = 0.3). The mean time between
naloxone administration and clinical response was longer for the IN group
(12.9 vs. 8.1 min, p = 0.02). However, the mean times from patient contact
to clinical response were not significantly different between the IN and IV
groups (20.3 vs. 20.7 min, p = 0.9). More patients in the IN group received
two doses of naloxone (34% vs. 18%, p = 0.05), and three patients in the IN
group received a subsequent dose of IV or IM naloxone. Conclusions. The time
from dose administration to clinical response for naloxone was longer for
the IN route, but the overall time from patient contact to response was the
same for the IV and IN routes. Given the difficulty and potential hazards in
obtaining IV access in many patients with narcotic overdose, IN naloxone
appears to be a useful and potentially safer alternative.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intranasal drug administration, intravenous drug
administration)
narcotic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy)
narcotic dependence (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
breathing rate
child
controlled study
drug administration route
female
Glasgow coma scale
human
intermethod comparison
major clinical study
male
preschool child
school child
treatment response
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009482922
MEDLINE PMID
19731165 (http://www.ncbi.nlm.nih.gov/pubmed/19731165)
PUI
L355245316
DOI
10.1080/10903120903144866
FULL TEXT LINK
http://dx.doi.org/10.1080/10903120903144866
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 877
TITLE
Randomized Clinical Trial Comparing a Patient-Driven Titration Protocol of
Intravenous Hydromorphone With Traditional Physician-Driven Management of
Emergency Department Patients With Acute Severe Pain
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Davitt M.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K., achang@montefiore.org; Bijur P.E.; Davitt M.; Gallagher E.J.)
Department of Emergency Medicine, Albert Einstein College of Medicine,
Montefiore Medical Center, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY, United States. Email:
achang@montefiore.org
SOURCE
Annals of Emergency Medicine (2009) 54:4 (561-567.e2). Date of Publication:
October 2009
ISSN
0196-0644
1097-6760 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: We test the null hypothesis that the "1+1" hydromorphone
patient-driven protocol is clinically and statistically equivalent in safety
and efficacy to that of traditional physician-driven administration of
opioids for emergency department (ED) treatment of acute severe pain.
Methods: This was a prospective randomized clinical trial of nonelderly
adults presenting to an urban academic ED with acute pain of sufficient
severity to warrant intravenous (IV) opioids in the judgment of the
attending physician. Patients randomized to the 1+1 hydromorphone
patient-driven protocol received 1 mg IV hydromorphone followed by a second
1-mg dose 15 minutes later if the patient responded affirmatively to the
question, "Do you want more pain medication?" Patients in the
physician-driven group received any IV opioid in the dose chosen by the ED
attending physician, with any additional analgesia provided at the
discretion of that physician. The primary outcome was the difference in
improvement in pain between the 2 groups at 60 minutes, as measured by a
validated and reproducible numeric rating scale. Secondary outcomes included
incidence of oxygen desaturation, hypoventilation, hypotension, bradycardia,
nausea, vomiting, pruritus, and use of naloxone. Results: The mean decrease
in numeric rating scale pain scores for the 1+1 hydromorphone patient-driven
group was 5.6 versus 4.5 in the physician-driven group. The difference of
1.1 numeric rating scale units (95% confidence interval 0.3 to 1.9) was
statistically significant but fell 0.2 numeric rating scale units short of
the 1.3 numeric rating scale unit threshold required to attain clinically
significant efficacy. Safety profiles were similarly satisfactory in both
groups. Ninety-four percent of the 1+1 hydromorphone patient-driven group
achieved adequate analgesia (as defined by the patient) within 60 minutes of
protocol initiation. Conclusion: The 1+1 hydromorphone patient-driven
protocol is statistically superior and at least as clinically efficacious
and safe as traditional physician-driven treatment of ED patients with acute
severe pain. More than 9 of 10 patients randomized to the study protocol
achieved satisfactory pain control, as defined by the patient, within an
hour or less. © 2009 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, clinical trial, drug dose, drug
therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
bradycardia (side effect)
breathing rate
clinical protocol
clinical trial
controlled clinical trial
controlled study
drug dose titration
drug efficacy
drug safety
drug use
emergency care
emergency ward
female
human
hypotension (side effect)
hypoventilation (side effect)
major clinical study
male
nausea (side effect)
oxygen saturation
pain assessment
patient controlled analgesia
priority journal
prospective study
pruritus (side effect)
pulse rate
randomized controlled trial
rating scale
side effect (side effect)
systolic blood pressure
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009492985
MEDLINE PMID
19560838 (http://www.ncbi.nlm.nih.gov/pubmed/19560838)
PUI
L50563272
DOI
10.1016/j.annemergmed.2009.05.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2009.05.003
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 878
TITLE
Drug abuse and the emergency physician
AUTHOR NAMES
Chung C.H.
Man C.Y.
AUTHOR ADDRESSES
(Chung C.H., chunch@ha.org.hk; Man C.Y.) North District Hospital, Accident
and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong.
CORRESPONDENCE ADDRESS
C. H. Chung, North District Hospital, Accident and Emergency Department, 9
Po Kin Road, Sheung Shui, N.T., Hong Kong. Email: chunch@ha.org.hk
SOURCE
Hong Kong Journal of Emergency Medicine (2009) 16:4 (195-197). Date of
Publication: October 2009
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, Room 808, Two Chinachem Exchange Square, 338 King's Road,
North Point, Hong Kong.
EMTREE DRUG INDEX TERMS
benzodiazepine
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
emergency physician
EMTREE MEDICAL INDEX TERMS
drug overdose (drug therapy)
editorial
emergency ward
endocarditis
falling
health care personnel
hepatitis
Hong Kong
human
Human immunodeficiency virus infection
law
occupational accident
opiate addiction (drug therapy)
physician
psychosis
traffic accident
violence
withdrawal syndrome
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009534361
PUI
L355405038
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 879
TITLE
Evaluation and management of substance abuse emergencies
AUTHOR NAMES
Baron D.
Garbely J.
Boyd R.L.
AUTHOR ADDRESSES
(Baron D., dbaron@temple.edu; Garbely J.; Boyd R.L.) Department of
Psychiatry, Temple University School of Medicine, Philadelphia, PA 19125,
United States.
CORRESPONDENCE ADDRESS
D. Baron, Department of Psychiatry, Temple University School of Medicine,
Philadelphia, PA 19125, United States. Email: dbaron@temple.edu
SOURCE
Primary Psychiatry (2009) 16:9 (41-47). Date of Publication: September 2009
ISSN
1082-6319
BOOK PUBLISHER
MBL Communications, 333 Hudson St. 7th Floor, United States.
ABSTRACT
This article focuses on the clinical evaluation and initial treatment of
patients with substance abuse problems who present to an emergency
department. The importance of making an accurate differential diagnosis and
consideration of all relevant biopsychosocial factors is highlighted. The
authors offer a treatment algorithm for emergency department clinicians and
psychiatrists working in an emergency department setting to consider when
assessing patients with intoxication or withdrawal from drugs of abuse. As
emergency departments serve an important triage function, level of care
determinates are highlighted. Three important clinical federal guidelines
developed by the Center for Substance Abuse Treatment are presented and
discussed, which are relevant to all emergency department clinicians who
evaluate patients who are intoxicated or in withdrawal. These include the
following: First, never give medications to an intoxicated patient and
immediately discharge them. Second, avoid discharging any intoxicated
patient to the street. Last, differentiate between acute intoxication and
withdrawal and assess the potential for self harm, intentional and
non-intentional. © MBL Communications Inc.
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
anxiolytic agent (drug toxicity)
benzodiazepine (drug therapy)
buprenorphine (adverse drug reaction, drug combination, drug concentration,
drug therapy, pharmacokinetics, sublingual drug administration)
central stimulant agent (adverse drug reaction, drug toxicity)
clonidine (drug therapy)
hypnotic agent (drug toxicity)
lorazepam (drug therapy)
lysergide (drug toxicity)
methadone (adverse drug reaction, drug concentration, drug dose, drug
therapy, pharmacokinetics)
midomafetamine (adverse drug reaction, drug toxicity)
naloxone (drug concentration, drug therapy, parenteral drug administration,
pharmacokinetics)
naltrexone (drug combination, drug therapy)
neuroleptic agent (drug therapy)
opiate (drug dose, drug toxicity)
phencyclidine (adverse drug reaction, drug toxicity)
psychedelic agent (adverse drug reaction, drug toxicity)
sedative agent (drug toxicity)
tetrahydrocannabinol (drug toxicity)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol withdrawal syndrome (drug therapy, diagnosis, disease management,
drug therapy, prevention)
drug dependence (drug therapy, diagnosis, disease management, drug therapy)
emergency health service
opiate addiction (drug therapy, diagnosis, disease management, drug therapy)
substance abuse
EMTREE MEDICAL INDEX TERMS
alcoholism (diagnosis, drug therapy)
clinical assessment
clinical decision making
clinical evaluation
clinical trial
detoxification
drug abuse
drug blood level
drug dependence treatment
drug dose reduction
drug excretion
drug half life
drug intoxication (disease management)
drug megadose
emergency ward
food and drug administration
hallucination (side effect)
hospital discharge
human
Mini Mental State Examination
nystagmus (side effect)
patient care
physician
practice guideline
psychiatrist
respiration depression (side effect)
review
rhabdomyolysis (side effect)
symptom
treatment duration
Wernicke encephalopathy (drug therapy, prevention)
withdrawal syndrome (disease management)
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
alprazolam (28981-97-7)
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
lorazepam (846-49-1)
lysergide (50-37-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phencyclidine (77-10-1, 956-90-1)
tetrahydrocannabinol (1972-08-3)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Psychiatry (32)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2010077516
PUI
L358208583
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 880
TITLE
Poisoning and toxicological emergencies - Current trends and practice
AUTHOR NAMES
Banhan-Hall E.
Mallinson R.
Trepte N.
AUTHOR ADDRESSES
(Banhan-Hall E., e.banham-hall@doctors.org.uk; Mallinson R.; Trepte N.)
Ipswich Hospital NHS Trust, Heath Road, Ipswich IP4 5PD, United Kingdom.
CORRESPONDENCE ADDRESS
E. Banham-Hall, Ipswich Hospital NHS Trust, Heath Road, Ipswich IP4 5PD,
United Kingdom. Email: e.banham-hall@doctors.org.uk
SOURCE
Acute Medicine (2009) 8:1 (17-21). Date of Publication: 2009
ISSN
1747-4884
1747-4892 (electronic)
BOOK PUBLISHER
Rila Publications Ltd, 73 Newman Street, London, United Kingdom.
ABSTRACT
Poisoning is a common presentation to hospital acute medical units, and can
produce a variety of clinical scenarios. This review discusses the
epidemiology of poisoning, a framework for managing patients with drug
toxicity and considerations in the diagnosis of toxicity with unknown
substances. The commonest substances seen in toxicity in the UK -
paracetamol, antidepressants, sedatives and opioids are discussed in more
detail. © 2009 Rila Publications Ltd.
EMTREE DRUG INDEX TERMS
acetylcysteine (adverse drug reaction, drug concentration, drug therapy,
intravenous drug administration, oral drug administration)
analgesic agent (drug toxicity)
antidote (drug therapy)
benzodiazepine (drug toxicity)
bicarbonate (drug therapy)
charcoal (drug therapy)
flumazenil (drug therapy, intravenous drug administration, pharmacokinetics)
naloxone (adverse drug reaction, drug therapy)
opiate (drug toxicity)
paracetamol (drug concentration, drug toxicity)
salicylic acid (drug toxicity)
sedative agent (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, diagnosis, drug therapy, epidemiology,
therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
aggression
alcohol intoxication
alkalinization
angioneurotic edema (side effect)
arterial gas
artificial ventilation
bronchospasm (side effect)
carbon monoxide intoxication
cardiotoxicity (drug therapy)
drug blood level
drug eruption (side effect)
drug half life
drug overdose
drug safety
fluid resuscitation
flushing
human
intoxication (drug therapy)
liver toxicity (etiology)
lung toxicity (therapy)
neurotoxicity
pathophysiology
practice guideline
pruritus (side effect)
review
sex difference
side effect (side effect)
tachycardia (side effect)
treatment duration
vomiting (side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
charcoal (16291-96-6)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009373767
PUI
L354972162
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 881
TITLE
Factors associated with poor analgesia when using intravenous opioids for
acute pain
AUTHOR NAMES
Hwang U.
AUTHOR ADDRESSES
(Hwang U.)
SOURCE
Journal of Clinical Outcomes Management (2009) 16:8 (352-354). Date of
Publication: August 2009
ISSN
1079-6533
BOOK PUBLISHER
Turner White Communications Inc., 125 Strafford Avenue, Suite 220, Wayne,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
drug tolerance
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
cohort analysis
drug use
emergency ward
female
human
major clinical study
male
note
outcome assessment
pain assessment
prospective study
risk assessment
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009555183
PUI
L355481871
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 882
TITLE
Aetiological and demographical characteristics of acute poisoning in the
Celje region, Slovenia
AUTHOR NAMES
Poplas-Susic T.
Komericki-Grzinic M.
Klemenc-Ketis Z.
Tusek-Bunc K.
Zelko E.
Kersnik J.
AUTHOR ADDRESSES
(Poplas-Susic T.) Department of Family Medicine, University of Ljubljana,
Ljubljana, Slovenia.
(Komericki-Grzinic M.; Klemenc-Ketis Z.; Tusek-Bunc K.; Zelko E.; Kersnik
J., janko.kersnik@ozg-kranj.si) Department of Family Medicine, University of
Maribor, Ljubljana, Slovenia.
(Kersnik J., janko.kersnik@ozg-kranj.si) University of Maribor, Medical
School, Koroska ul, 13, 4280 Kranjska Gora, Slovenia.
CORRESPONDENCE ADDRESS
J. Kersnik, University of Maribor, Medical School, Koroska ul, 13, 4280
Kranjska Gora, Slovenia. Email: janko.kersnik@ozg-kranj.si
SOURCE
European Journal of Emergency Medicine (2009) 16:3 (127-130). Date of
Publication: June 2009
ISSN
0969-9546
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Background: Data on emergency treatment of poisonings are scarce. Objective:
To determine the annual rate of poisoning-related emergency medical services
(EMS) interventions and to determine the aetiology and demographic
characteristics of poisoning cases. Methods: A prospective observational
study included all poisoning-related intervention cases over 3 years
(1999-2001) in the Celje region, Slovenia, covering 125 000 inhabitants.
Data were recorded on an EMS form. Results: Two hundred and forty-four
poisoning-related EMS interventions were recorded among a total of 4486
interventions (5.4%) corresponding to an average annual rate of 0.56
poisonings per 1000 inhabitants per year. Psychoactive agents were detected
in 56.5% of the cases. Two-thirds of the poisonings took place outside
patients' home. In 30% of the cases, the administration of poison was
because of suicidal intentions. The most common substance ingested was
alcohol alone or in combination with prescription or illegal drugs in 42.6%
of cases, followed by drugs alone or in combination with alcohol in 39.2%
cases. More than one-fifth of the poisonings were because of the use of
illegal drugs. At the time of the arrival of EMS 23.5% of the patients were
in coma. EMS applied antidote in 23.2% of the patients. After emergency
care, 9.3% of the patients were still in coma, 15.6% were comatose, 26.6%
were somnolent, 18.6% were disoriented and 30% had complete consciousness.
Of these, 84.4% of the patients were admitted to hospital or specialized
care and 15.6% were sent back home. Conclusion: The pattern of poisoning is
contrasted with that in other countries. The EMS proved to be a valuable
resource for treatment of acute poisoning. © 2009 Wolters Kluwer Health |
Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS
alcohol
antidote (drug therapy)
charcoal (drug therapy)
flumazenil (drug therapy)
illicit drug
infusion fluid
naloxone (drug therapy)
poison
psychotropic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, drug therapy, epidemiology, therapy)
self poisoning (drug therapy, drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
alcohol consumption
alcoholism (etiology)
article
child
coma
comatose patient
consciousness
cross-sectional study
demography
disorientation
drug abuse
drug dependence (etiology)
emergency care
emergency health service
female
fluid therapy
home care
hospital admission
human
ingestion
intervention study
intubation
major clinical study
male
observational study
oxygen therapy
prescription
priority journal
prospective study
retrospective study
school child
Slovenia
somnolence
stomach lavage
substance abuse
suicide (etiology)
CAS REGISTRY NUMBERS
alcohol (64-17-5)
charcoal (16291-96-6)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009424164
MEDLINE PMID
19425244 (http://www.ncbi.nlm.nih.gov/pubmed/19425244)
PUI
L355083613
DOI
10.1097/MEJ.0b013e32831cc1d0
FULL TEXT LINK
http://dx.doi.org/10.1097/MEJ.0b013e32831cc1d0
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 883
TITLE
Outcomes after intravenous opioids in emergency patients: A prospective
cohort analysis
AUTHOR NAMES
O'Connor A.B.
Zwemer F.L.
Hays D.P.
Feng C.
AUTHOR ADDRESSES
(O'Connor A.B., alec_oconnor@urmc.rochester.edu) Department of Internal
Medicine, University of Rochester, School of Medicine and Dentistry,
Rochester, NY, United States.
(Zwemer F.L.; Hays D.P.) Department of Emergency Medicine, University of
Rochester, School of Medicine and Dentistry, Rochester, NY, United States.
(Hays D.P.) Department of Pharmacy, University of Rochester, School of
Medicine and Dentistry, Rochester, NY, United States.
(Feng C.) Department of Biostatistics and Computational Biology, University
of Rochester, School of Medicine and Dentistry, Rochester, NY, United
States.
(Zwemer F.L.) Department of Emergency Medicine, McGuire VA Medical Center,
Richmond, VA, United States.
(Hays D.P.) Departments of Pharmacy and Emergency Medicine, University of
Arizona, Tucson, AZ, United States.
CORRESPONDENCE ADDRESS
A. B. O'Connor, Department of Internal Medicine, University of Rochester,
School of Medicine and Dentistry, Rochester, NY, United States. Email:
alec_oconnor@urmc.rochester.edu
SOURCE
Academic Emergency Medicine (2009) 16:6 (477-487). Date of Publication: June
2009
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: Pain management continues to be suboptimal in emergency
departments (EDs). Several studies have documented failures in the processes
of care, such as whether opioid analgesics were given. The objectives of
this study were to measure the outcomes following administration of
intravenous (IV) opioids and to identify clinical factors that may predict
poor analgesic outcomes in these patients. Methods: In this prospective
cohort study, emergency patients were enrolled if they were prescribed IV
morphine or hydromorphone (the most commonly used IV opioids in the study
hospital) as their initial analgesic. Patients were surveyed at the time of
opioid administration and 1 to 2 hours after the initial opioid dosage. They
scored their pain using a verbal 0-10 pain scale. The following binary
analgesic variables were primarily used to identify patients with poor
analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a
postanalgesic pain score of 7 or greater (using the 0-10 numeric rating
scale), and 3) the development of opioid-related side effects. Logistic
regression analyses were used to study the effects of demographic, clinical,
and treatment covariates on the outcome variables. Results: A total of 2,414
were approached for enrollment, of whom 1,312 were ineligible (658 were
identified more than 2 hours after IV opioid was administered and 341
received another analgesic before or with the IV opioid) and 369 declined to
consent. A total of 691 patients with a median baseline pain score of 9 were
included in the final analyses. Following treatment, 57% of the cohort
failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or
greater, 48% wanted additional analgesics, and 23% developed opioid-related
side effects. In the logistic regression analyses, the factors associated
with poor analgesia (both <50% pain score reduction and postanalgesic pain
score of ≥7) were the use of longacting opioids at home, administration of
additional analgesics, provider concern for drug-seeking behavior, and older
age. An initial pain score of 10 was also strongly associated with a
postanalgesic pain score of ≥7. African American patients who were not
taking opioids at home were less likely to achieve a 50% pain score
reduction than other patients, despite receiving similar initial and total
equianalgesic dosages. None of the variables we assessed were significantly
associated with the development of opioid-related side effects. Conclusions:
Poor analgesic outcomes were common in this cohort of ED patients prescribed
IV opioids. Patients taking long-acting opioids, those thought to be
drug-seeking, older patients, those with an initial pain score of 10, and
possibly African American patients are at especially high risk of poor
analgesia following IV opioid administration. © 2009 by the Society for
Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy, intravenous drug administration)
morphine (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
antiemetic agent (drug combination)
fentanyl (transdermal drug administration)
ketorolac (drug therapy, intravenous drug administration)
oxycodone
EMTREE MEDICAL INDEX TERMS
adult
age distribution
analgesia
article
confusion (side effect)
controlled study
dizziness (side effect)
drug efficacy
emergency patient
female
home care
human
hypotension (side effect)
major clinical study
male
nausea (side effect)
opiate addiction
pain (drug therapy)
pain assessment
prescription
priority journal
rating scale
refusal to participate
sedation
side effect (side effect)
treatment outcome
vomiting (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009292956
MEDLINE PMID
19426295 (http://www.ncbi.nlm.nih.gov/pubmed/19426295)
PUI
L354733279
DOI
10.1111/j.1553-2712.2009.00405.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1553-2712.2009.00405.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 884
TITLE
Prescriptions for schedule II opioids and benzodiazepines increase after the
introduction of computer-generated prescriptions
AUTHOR NAMES
McGerald G.
Dvorkin R.
Levy D.
Lovell-Rose S.
Sharma A.
AUTHOR ADDRESSES
(McGerald G., genmcger2000@yahoo.com; Dvorkin R.; Levy D.; Lovell-Rose S.;
Sharma A.) Department of Emergency Medicine, Good Samaritan Hospital Medical
Center, West Islip, NY, United States.
CORRESPONDENCE ADDRESS
G. McGerald, Department of Emergency Medicine, Good Samaritan Hospital
Medical Center, West Islip, NY, United States. Email: genmcger2000@yahoo.com
SOURCE
Academic Emergency Medicine (2009) 16:6 (508-512). Date of Publication: June
2009
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Background: Prescriptions for controlled substances decrease when regulatory
barriers are put in place. The converse has not been studied. Objectives:
The objective was to determine whether a less complicated prescription
writing process is associated with a change in the prescribing patterns of
controlled substances in the emergency department (ED). Methods: The authors
conducted a retrospective nonconcurrent cohort study of all patients seen in
an adult ED between April 19, 2005, and April 18, 2007, who were discharged
with a prescription. Prior to April 19, 2006, a specialized prescription
form stored in a locked cabinet was obtained from the nursing staff to write
a prescription for benzodiazepines or Schedule II opioids. After April 19,
2006, New York State mandated that all prescriptions, regardless of schedule
classification, be generated on a specialized bar-coded prescription form.
The main outcome of the study was to compare the proportion of Schedule
III-V opioids to Schedule II opioids and benzodiazepines prescribed in the
ED before and after the introduction of a less cumbersome prescription
writing process. Results: Of the 26,638 charts reviewed, 2.1% of the total
number of prescriptions generated were for a Schedule II controlled opioid
before the new system was implemented compared to 13.6% after (odds ratio
[OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding
percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95%
CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI =
2.4 to 3.4). Conclusions: Patients were more likely to receive a
prescription for a Schedule II opioid or a benzodiazepine after a more
streamlined computer-generated prescription writing process was introduced
in this ED. © 2009 by the Society for Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative
narcotic analgesic agent
EMTREE DRUG INDEX TERMS
hydrocodone
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
computer generated prescription system
medical information system
prescription
EMTREE MEDICAL INDEX TERMS
adult
article
classification
controlled study
emergency nurse practitioner
emergency ward
female
human
intermethod comparison
major clinical study
male
medical record review
priority journal
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009292960
MEDLINE PMID
19388914 (http://www.ncbi.nlm.nih.gov/pubmed/19388914)
PUI
L354733283
DOI
10.1111/j.1553-2712.2009.00398.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1553-2712.2009.00398.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 885
TITLE
Cardiopulmonary resuscitation in children
AUTHOR NAMES
Topjian A.A.
Nadkarni V.M.
Berg R.A.
AUTHOR ADDRESSES
(Topjian A.A., topjian@email.chop.edu; Nadkarni V.M.; Berg R.A.) University
of Pennsylvania School of Medicine, Department of Anesthesia and Critical
Care Medicine, Children's Hospital of Philadelphia, 34th Street and Civic
Center Boulevard, Philadelphia, PA 19104, United States.
CORRESPONDENCE ADDRESS
A. A. Topjian, University of Pennsylvania School of Medicine, Department of
Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia,
34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United
States. Email: topjian@email.chop.edu
SOURCE
Current Opinion in Critical Care (2009) 15:3 (203-208). Date of Publication:
June 2009
ISSN
1070-5295
1531-7072 (electronic)
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
PURPOSE OF REVIEW: To summarize recent advances in pediatric cardiopulmonary
arrest prevention, resuscitation and postresuscitation management. RECENT
FINDINGS: Pediatric cardiac arrest has traditionally been considered a
futile medical condition with dismal outcomes. Data in the 21st century
indicate that more than 25% of children treated for in-hospital cardiac
arrests survive to hospital discharge and more than 10% of children older
than 1 year treated for out-of-hospital cardiac arrests survive to hospital
discharge. These data establish that children are more likely to survive to
hospital discharge than adults after both in-hospital and out-of-hospital
cardiac arrests. Before arrest, exciting new studies demonstrate that the
implementation of in-hospital pediatric medical emergency teams is
associated with significant decreases in cardiac arrest incidence and
overall pediatric hospital mortality. During arrest, ventricular
fibrillation or ventricular tachycardia, once thought to be rare in
children, occurs during 25% of in-hospital pediatric cardiac arrests and at
least 7% of out-of-hospital pediatric cardiac arrests. Survival to hospital
discharge is much more likely after arrests with a first documented rhythm
of ventricular fibrillation or ventricular tachycardia than after pulseless
electric activity and asystole. However, ventricular fibrillation or
ventricular tachycardia is not always a favorable rhythm, as survival to
discharge is much less likely when ventricular fibrillation or ventricular
tachycardia occurs during resuscitation from an arrest with the first
documented rhythm of pulseless electric activity or asystole. Further,
extracorporeal membrane oxygenation cardiopulmonary resuscitation appears
promising under special resuscitation circumstances to improve outcome from
highly selected in-hospital pediatric cardiac arrest victims. Further,
postresuscitation interventions such as goal-directed therapies and
therapeutic hypothermia have been demonstrated in adults and infants to
improve outcome for selected cardiac arrest victims and are promising
candidate targets for study in children. SUMMARY: Pediatric cardiac arrest
is not a futile condition; many children are successfully resuscitated each
year. The implementation of new prearrest, intraarrest and postresuscitative
therapies has the potential to further improve survival rates following
pediatric cardiac arrest. © 2009 Lippincott Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
vasopressin (drug therapy)
EMTREE DRUG INDEX TERMS
adenosine (drug therapy)
amiodarone (drug therapy, intravenous drug administration)
atropine (drug therapy, intravenous drug administration)
bicarbonate (drug therapy, intravenous drug administration)
calcium chloride (drug therapy, intravenous drug administration)
epinephrine (drug therapy, intravenous drug administration)
glucose (drug therapy, intravenous drug administration)
lidocaine (drug therapy, intravenous drug administration)
magnesium sulfate (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
procainamide (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
resuscitation
EMTREE MEDICAL INDEX TERMS
cardiopulmonary arrest (epidemiology, therapy)
continuous infusion
electric activity
emergency health service
extracorporeal oxygenation
heart arrest
heart arrest (drug therapy, epidemiology, therapy)
heart rhythm
heart ventricle fibrillation (epidemiology, therapy)
heart ventricle tachycardia
hospital discharge
human
incidence
induced hypothermia
mortality
pediatric cardiology
pediatric hospital
prognosis
review
survival
survival rate
victim
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
procainamide (51-06-9, 614-39-1)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009402219
MEDLINE PMID
19469022 (http://www.ncbi.nlm.nih.gov/pubmed/19469022)
PUI
L355030296
DOI
10.1097/MCC.0b013e32832931e1
FULL TEXT LINK
http://dx.doi.org/10.1097/MCC.0b013e32832931e1
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 886
TITLE
Case 15-2009: A 25-year-old man with coma after cardiac arrest
AUTHOR NAMES
Kotton C.N.
Elias N.
Delmonico F.L.
Kradin R.L.
AUTHOR ADDRESSES
(Kotton C.N.) Infectious Disease Unit, Massachusetts General Hospital,
Boston, MA, United States.
(Elias N.) Department of Transplant Surgery, Massachusetts General Hospital,
Boston, MA, United States.
(Kradin R.L.) Department of Pathology, Massachusetts General Hospital,
Boston, MA, United States.
(Delmonico F.L.) England Organ Bank, Newton, MA, United States.
(Kotton C.N.) Department of Medicine, Harvard Medical School, Boston, MA,
United States.
(Elias N.; Delmonico F.L.) Department of Surgery, Harvard Medical School,
Boston, MA, United States.
CORRESPONDENCE ADDRESS
C. N. Kotton, Infectious Disease Unit, Massachusetts General Hospital,
Boston, MA, United States.
SOURCE
New England Journal of Medicine (2009) 360:20 (2118-2125). Date of
Publication: 14 May 2009
ISSN
0028-4793
1533-4406 (electronic)
BOOK PUBLISHER
Massachussetts Medical Society, 860 Winter Street, Waltham, United States.
EMTREE DRUG INDEX TERMS
antibiotic agent (intravenous drug administration)
atropine (drug therapy)
bicarbonate (drug therapy)
epinephrine (drug therapy)
glucose (endogenous compound)
lidocaine (drug therapy)
lorazepam (drug therapy)
mannitol
naloxone (drug therapy)
omeprazole
protein (endogenous compound)
urobilinogen (endogenous compound)
vecuronium (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (complication, diagnosis)
heart arrest (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
article
blood pressure monitoring
case report
colitis
computer assisted tomography
continuous infusion
crystalloid
defibrillation
diagnostic procedure
differential diagnosis
electrocardiogram
emergency health service
endotracheal intubation
erythrocyte count
glucose blood level
heart rhythm
heart ventricle fibrillation (drug therapy, therapy)
hospital admission
human
hypotension (complication)
intestine schistosomiasis (diagnosis, etiology)
laboratory test
leukocyte count
male
nuclear magnetic resonance imaging
organ donor
pH measurement
physical examination
priority journal
protein blood level
resuscitation
schistosomiasis (diagnosis, etiology)
sinus tachycardia (diagnosis, drug therapy)
thorax radiography
ulcerative colitis (diagnosis, etiology)
urinalysis
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
omeprazole (73590-58-6, 95510-70-6)
protein (67254-75-5)
urobilinogen (11000-27-4)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009263175
MEDLINE PMID
19439747 (http://www.ncbi.nlm.nih.gov/pubmed/19439747)
PUI
L354663249
DOI
10.1056/NEJMcpc0806982
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMcpc0806982
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 887
TITLE
Evaluating the Use and Timing of Opioids for the Treatment of Migraine
Headaches in the Emergency Department
AUTHOR NAMES
Tornabene S.V.
Deutsch R.
Davis D.P.
Chan T.C.
Vilke G.M.
AUTHOR ADDRESSES
(Tornabene S.V.) Department of Otolaryngology-Head and Neck Surgery, Kaiser
Permanente Oakland, Oakland, CA, United States.
(Deutsch R.) Department of Family and Preventive Medicine, University of
California San Diego Medical Center, San Diego, CA, United States.
(Davis D.P.; Chan T.C.; Vilke G.M.) Department of Emergency Medicine,
University of California San Diego Medical Center, San Diego, CA, United
States.
CORRESPONDENCE ADDRESS
G.M. Vilke, Department of Emergency Medicine, University of California San
Diego Medical Center, San Diego, CA, United States.
SOURCE
Journal of Emergency Medicine (2009) 36:4 (333-337). Date of Publication:
May 2009
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
The objective of this study was to evaluate the throughput times of patients
administered opioids for the treatment of migraine headaches in the frequent
emergency department (ED) visitor. A retrospective review of ED patient
records was conducted. Repeat patients were significantly more likely to
receive opioids as a treatment, receive multiple doses of opioids, and
receive opioids as the initial pharmacological treatment compared to
non-repeaters. Patients administered opioids, regardless of repeater status,
had significantly longer ED stays; 142 min (95% confidence interval [CI]
124-160) vs. 111 min (95% CI 93-129), respectively, p = 0.015. Patients
given multiple doses of opioids had significantly longer ED stays than
patients given a single dose of an opioid; 191 min (95% CI 156-225) vs. 125
min (95% CI 101-149), respectively, p = 0.003. Delayed administration of
opioids did not result in longer ED stays in those patients eventually
treated with opioids. Administration of opioids for migraine headache may
result in longer ED stays when compared with non-opioid migraine treatments.
Judicious use of opioids as a treatment for migraine headaches is
recommended. © 2009 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
anticonvulsive agent (drug comparison, drug therapy)
antiemetic agent (drug comparison, drug therapy)
anxiolytic agent (drug comparison, drug therapy)
butalbital plus caffeine plus paracetamol (drug therapy)
codeine (drug therapy)
diazepam (drug therapy)
dihydroergotamine (drug therapy)
fentanyl (drug therapy)
hydrocodone bitartrate plus paracetamol (drug therapy)
hydromorphone (drug therapy)
hydroxyzine (drug therapy)
ketorolac (drug therapy)
lorazepam (drug therapy)
metoclopramide (drug therapy)
morphine (drug therapy)
ondansetron (drug therapy)
oxycodone (drug therapy)
paracetamol (drug therapy)
pethidine (drug therapy)
prednisolone (drug therapy)
prochlorperazine maleate (drug therapy)
promethazine (drug therapy)
steroid (drug comparison, drug therapy)
triptan derivative (drug therapy)
valproic acid (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
emergency ward
headache (drug therapy, drug therapy)
migraine (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
evaluation study
female
hospitalization
human
length of stay
major clinical study
male
medical record
pharmaceutical care
priority journal
retrospective study
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
codeine (76-57-3)
diazepam (439-14-5)
dihydroergotamine (511-12-6)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ketorolac (74103-06-3)
lorazepam (846-49-1)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
prednisolone (50-24-8)
prochlorperazine maleate (84-02-6)
promethazine (58-33-3, 60-87-7)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009189888
MEDLINE PMID
18280084 (http://www.ncbi.nlm.nih.gov/pubmed/18280084)
PUI
L50065244
DOI
10.1016/j.jemermed.2007.07.068
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2007.07.068
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 888
TITLE
Opioid-induced constipation negatively impacts pain management,
productivity, and health-related quality of life: Findings from the National
Health and Wellness Survey
AUTHOR NAMES
Bell T.
Annunziata K.
Leslie J.B.
AUTHOR ADDRESSES
(Bell T.) GlaxoSmithKline, Research Triangle Park, NC, United States.
(Annunziata K.) Consumer Health Sciences, Princeton, NJ, United States.
(Leslie J.B.) Mayo Clinic College of Medicine, Scottsdale, AZ, United
States.
CORRESPONDENCE ADDRESS
T. Bell, GlaxoSmithKline, Research Triangle Park, NC, United States.
SOURCE
Journal of Opioid Management (2009) 5:3 (137-144). Date of Publication:
May/June 2009
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Objective: To characterize the impact of opioid-induced constipation (OIC)
on healthcare resource use, work productivity, and health-related quality of
life (HRQOL) in patients receiving chronic opioid therapy. Design: Data were
collected via Internet questionnaires during the international National
Health and Wellness Survey (NHWS) 2004 from individuals aged ≥18 years who
reported taking opioids for ≥6 months. Healthcare resource utilization, Work
Productivity, and Activity Impairment, and Short-Form 8 (SF-8) questionnaire
responses were compared between those who did or did not report OIC.
Results: Data were available from 2,430 individuals receiving opioids, of
whom 359 reported OIC. Participants with OIC reported significantly more
physician visits (mean difference 3-84 visits; p < 0.05) and alternative
care provider visits (mean difference 1.73 visits; p < 0.05) over the
previous 6 months than those without OIC; however, no significant
differences in emergency room visits or number of days of hospitalization
were observed. Respondents with OIC also reported significantly greater time
missed from work, impairment while working, overall work impairment, and
activity impairment (p < 0.05 for all comparisons). HRQOL scores were
significantly lower in the OIC group than those without OIC on both the
physical and mental components of the SF-8 questionnaire (p < 0.05 for both
comparisons). Conclusions: The survey results refect a negative impact of
OIC on individuals' HRQOL and on society in terms of healthcare resource use
and work productivity beyond that imposed by patients' pain conditions.
These findings indicate a need for effective treatment for opioid-induced
constipation in patients receiving chronic opioid therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
laxative
EMTREE MEDICAL INDEX TERMS
abdominal discomfort (side effect)
abdominal pain (side effect)
adult
bloating (side effect)
chronic pain (drug therapy)
comorbidity
constipation (side effect)
controlled study
dizziness (side effect)
emergency ward
female
health care personnel
health care utilization
human
job performance
major clinical study
male
mood change
nausea (side effect)
pain (drug therapy)
quality of life
review
scoring system
Short Form 8
side effect (side effect)
somnolence (side effect)
thought disorder (side effect)
treatment duration
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009417365
MEDLINE PMID
19662923 (http://www.ncbi.nlm.nih.gov/pubmed/19662923)
PUI
L355067812
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 889
TITLE
An oral opioid alternative for acute pain
AUTHOR NAMES
Hwang U.
AUTHOR ADDRESSES
(Hwang U.)
SOURCE
Journal of Clinical Outcomes Management (2009) 16:4 (163-164). Date of
Publication: April 2009
ISSN
1079-6533
BOOK PUBLISHER
Turner White Communications Inc., 125 Strafford Avenue, Suite 220, Wayne,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (adverse drug reaction, clinical trial, drug comparison,
drug therapy, intravenous drug administration)
oxycodone (adverse drug reaction, clinical trial, drug comparison, drug
therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
musculoskeletal pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
adolescent
adult
aged
analgesia
analgesic activity
child
clinical trial
controlled clinical trial
controlled study
emergency ward
human
major clinical study
note
pain assessment
prospective study
randomization
randomized controlled trial
school child
treatment duration
treatment failure
urban area
visual analog scale
CAS REGISTRY NUMBERS
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009256630
PUI
L354651819
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 890
TITLE
Pediatric ziprasidone overdose.
AUTHOR NAMES
Fasano C.J.
O'Malley G.F.
Lares C.
Rowden A.K.
AUTHOR ADDRESSES
(Fasano C.J.; O'Malley G.F.; Lares C.; Rowden A.K.) Department of Emergency
Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
CORRESPONDENCE ADDRESS
C.J. Fasano, Department of Emergency Medicine, Albert Einstein Medical
Center, Philadelphia, PA 19141, USA. Email: pasanoc@einstein.edu
SOURCE
Pediatric emergency care (2009) 25:4 (258-259). Date of Publication: Apr
2009
ISSN
1535-1815 (electronic)
ABSTRACT
We describe the first ziprasidone overdose with quantitative serum levels of
a pediatric patient in coma and with pinpoint pupils. This case is an
important contribution to the pediatric ziprasidone literature because it
illustrates that ingestion of just 1 pill may result to profound mental
status and respiratory depression in a child. H.C., a 30-month-old girl,
presented to the emergency department approximately 30 minutes after an
accidental ingestion of an adult family member's medication. The child was
found on the floor surrounded by numerous pills and was witnessed to have
ingested at least 1 tablet by a caregiver. After finding the child with the
pills, the family observed the child for a brief period but transported her
to the hospital after she became lethargic and unresponsive. The child
received 2 doses of 0.4 mg of intravenous naloxone without change in her
neurologic status. The child then underwent a rapid sequence intubation for
airway protection and subsequently received gastrointestinal decontamination
with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an
atypical antipsychotic drug that was approved by the Food and Drug
Administration in February 2001 for the general treatment of schizophrenia
in adults. Previously reported pediatric ziprasidone overdoses describe a
syndrome of sedation, tachycardia, hypotonia, and coma consistent with that
of the patient described in this paper. In pediatric ziprasidone overdose,
QTc prolongation and hypotension have also been illustrated, but seizures
have not been reported. An interesting aspect of this case is the
development of pinpoint pupils unresponsive to naloxone. This phenomenon has
been reported before with overdose of olanzapine, a similar atypical
antipsychotic. The mechanism of miosis associated with overdose of atypical
antipsychotics is unclear but is likely related to interference with central
innervation of the pupil. Pupil size is maintained by a balance between
sympathetic and parasympathetic neurohumeral tones. We propose that an
overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results
in unopposed parasympathetic stimulation resulting in miosis.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
neuroleptic agent (drug administration, drug toxicity, pharmacokinetics)
piperazine derivative (drug administration, drug toxicity, pharmacokinetics)
thiazole derivative (drug administration, drug toxicity, pharmacokinetics)
EMTREE DRUG INDEX TERMS
alpha 1 adrenergic receptor
antidote (drug therapy)
charcoal (drug therapy)
naloxone (drug therapy)
ziprasidone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
EMTREE MEDICAL INDEX TERMS
article
case report
chemically induced disorder
drug antagonism
drug resistance
emergency
endotracheal intubation
female
human
miosis
orthostatic hypotension
pathophysiology
preschool child
tachycardia
CAS REGISTRY NUMBERS
charcoal (16291-96-6)
naloxone (357-08-4, 465-65-6)
ziprasidone (118289-78-4, 122883-93-6, 138982-67-9, 199191-69-0)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
19369840 (http://www.ncbi.nlm.nih.gov/pubmed/19369840)
PUI
L354891600
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 891
TITLE
Procedural sedation and analgesia in children by non-anesthesiologists in an
Emergency Department
AUTHOR NAMES
Leroy P.L.J.M.
Gorzeman M.P.
Sury M.R.J.
AUTHOR ADDRESSES
(Leroy P.L.J.M., p.leroy@mumc.nl) Division of Pediatric Intensive Care,
Department of Pediatrics, Univetsity Hospital Maastricht, Netherlands.
(Leroy P.L.J.M., p.leroy@mumc.nl; Gorzeman M.P.) Dutch Guideline Working
Group on Paediatric Procedural Sedation and Analgesia, Dutch Institute for
Health Care Improvement CBO, Utrecht, Netherlands.
(Gorzeman M.P.) Department of Emergency Medicine, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands.
(Sury M.R.J.) Department of Anesthesia, Great Ormond Street Hospital for
Children, NHS Trust, London, United Kingdom.
(Sury M.R.J.) Portex Unit of Anesthesia, Institute of Child Health,
University College London, London, United Kingdom.
(Leroy P.L.J.M., p.leroy@mumc.nl) Department of Pediatrics, University
Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, Netherlands.
CORRESPONDENCE ADDRESS
P. L. J. M. Leroy, Department of Pediatrics, University Hospital Maastricht,
P.O. Box 5800, 6202 AZ Maastricht, Netherlands. Email: p.leroy@mumc.nl
SOURCE
Minerva Pediatrica (2009) 61:2 (193-215). Date of Publication: Aprile 2009
ISSN
0026-4946
BOOK PUBLISHER
Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Turin, Italy.
ABSTRACT
Procedural sedation and analgesia (PSA) is a standard of care for the
management of acute procedural pain and anxiety in the emergency department
(ED). However, there is evidence that PSA practice is still ineffective and
potentially unsafe in many pediatric settings. PSA has to be regarded as a
separate medical act that should be provided only by well-trained and
credentialized professionals, within a context of transparency, registration
and ongoing quality control. Only by maintaining strict criteria regarding
professional competences, safety precautions, monitoring, recovery and
rescue facilities an optimal patient safety can be guaranteed. Besides, ED
professionals have a duty to deliver effective PSA, not only from a
procedural point of view (i.e. guaranteeing predictable procedural success
and timing) but also from a patient's perspective (i.e. achieving optimal
procedural comfort). An effective PSA program on a pediatric ED means that a
professional is easily available at all times who is trained in the safe use
of highly controllable drugs that match the sedation need and guarantee an
optimal level of comfort - without the need for forced immobilization or
restraint. A high-quality PSA service includes the adequate use of local or
topical anesthesia, the systematic application of non-pharmacologic
techniques, the availability of effective PSA drugs and the possibility of
rescue anesthesia in case PSA is unsuccessful or is expected to be
ineffective or unsafe in a given patient. PSA for children, including deep
sedation, should be formally incorporated in the training program for
emergency physicians.
EMTREE DRUG INDEX TERMS
anesthetic agent (topical drug administration)
anxiolytic agent (drug therapy)
atropine
benzodiazepine derivative
chloral hydrate (drug comparison, oral drug administration, rectal drug
administration)
cocaine (topical drug administration)
dexmedetomidine (drug comparison)
diazepam (drug combination)
epinephrine (topical drug administration)
fentanyl (adverse drug reaction, drug combination, drug comparison, drug
dose, intravenous drug administration)
flumazenil (drug therapy)
ketamine (adverse drug reaction, drug combination, drug comparison, drug
dose, intramuscular drug administration, intravenous drug administration)
lidocaine (topical drug administration)
lidocaine plus prilocaine
local anesthetic agent (drug combination)
midazolam (adverse drug reaction, drug combination, drug comparison, drug
dose, intranasal drug administration, intravenous drug administration, oral
drug administration, rectal drug administration, sublingual drug
administration)
morphine (drug combination)
naloxone
nitrous oxide (drug comparison, inhalational drug administration)
ondansetron (drug therapy, intravenous drug administration)
pentobarbital (intramuscular drug administration, intravenous drug
administration)
pethidine (drug combination, intramuscular drug administration)
propofol (adverse drug reaction, drug combination, drug comparison)
remifentanil (adverse drug reaction, drug combination, pharmacokinetics)
tetracaine (topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pediatric anesthesia
procedural sedation and analgesia
sedation
EMTREE MEDICAL INDEX TERMS
agitation
anxiety
anxiety disorder (drug therapy)
apnea (side effect)
child
diplopia (side effect)
drug choice
drug dose titration
drug safety
drug use
emergence reaction (side effect)
emergence reaction (side effect)
emergency care
emergency physician
emergency ward
erythema (side effect)
excitement
hallucination (side effect)
hiccup (side effect)
horizontal nystagmus (side effect)
horizontal nystagmus (side effect)
human
hypersalivation (side effect)
hypotension (drug therapy, side effect)
hypoxia (side effect)
informed consent
injection pain (side effect)
local anesthesia
low drug dose
myoclonus (side effect)
neurologic disease (drug therapy)
nystagmus (side effect)
pain
paradoxical excitement (drug therapy, side effect)
paradoxical excitement (drug therapy, side effect)
patient monitoring
patient safety
patient selection
pediatric advanced life support
professional competence
psychosis (side effect)
respiration depression (drug therapy, side effect)
review
risk assessment
side effect (side effect)
standard
topical anesthesia
vomiting (drug therapy, side effect)
DRUG TRADE NAMES
ametop
CAS REGISTRY NUMBERS
EMLA (101362-25-8)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
chloral hydrate (302-17-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dexmedetomidine (113775-47-6)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
remifentanil (132539-07-2)
tetracaine (136-47-0, 94-24-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
2009320139
MEDLINE PMID
19322124 (http://www.ncbi.nlm.nih.gov/pubmed/19322124)
PUI
L354818279
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 892
TITLE
Delayed Emergence and Acute Renal Failure After Pneumonectomy: Tumor Emboli
Complicating Postoperative Course
AUTHOR NAMES
Karzai W.
Schmidt J.
Jung A.
Kröger R.
Clausner G.
Presselt N.
AUTHOR ADDRESSES
(Karzai W., w.karzai.ana@zentralklinik-bad-berka.de; Schmidt J.; Jung A.)
Department of Anesthesia and Intensive Care Medicine, Zentralklinik Bad
Berka, Bad Berka, Germany.
(Kröger R.) Department of Radiology, Zentralklinik Bad Berka, Bad Berka,
Germany.
(Clausner G.; Presselt N.) Department of Thoracic and Vascular Surgery,
Zentralklinik Bad Berka, Bad Berka, Germany.
CORRESPONDENCE ADDRESS
W. Karzai, Department of Anesthesia and Intensive Care Medicine,
Zentralklinik Bad Berka, Bad Berka, Germany. Email:
w.karzai.ana@zentralklinik-bad-berka.de
SOURCE
Journal of Cardiothoracic and Vascular Anesthesia (2009) 23:2 (219-222).
Date of Publication: April 2009
ISSN
1053-0770
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS
antibiotic agent (drug therapy)
antineoplastic agent (drug therapy)
bupivacaine (epidural drug administration)
diuretic agent (drug therapy, intravenous drug administration)
fentanyl (epidural drug administration)
midazolam (oral drug administration)
naloxone
physostigmine (drug dose, drug therapy)
propofol
rocuronium
sevoflurane
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute kidney failure (complication)
lung resection
squamous cell lung carcinoma (drug therapy, diagnosis, drug therapy,
radiotherapy, surgery)
tumor embolism (diagnosis)
EMTREE MEDICAL INDEX TERMS
aged
anticholinergic syndrome (drug therapy)
article
brain infarction (diagnosis)
cancer chemotherapy
cancer radiotherapy
case report
computer assisted tomography
endotracheal intubation
histology
human
human tissue
kidney infarction (diagnosis, surgery)
lymph node metastasis (complication, diagnosis)
male
oliguria (drug therapy)
pneumonia (drug therapy)
postoperative period
priority journal
single drug dose
transesophageal echocardiography
CAS REGISTRY NUMBERS
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
fentanyl (437-38-7)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
propofol (2078-54-8)
rocuronium (119302-91-9)
sevoflurane (28523-86-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Urology and Nephrology (28)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009135062
MEDLINE PMID
18834843 (http://www.ncbi.nlm.nih.gov/pubmed/18834843)
PUI
L50179498
DOI
10.1053/j.jvca.2008.04.001
FULL TEXT LINK
http://dx.doi.org/10.1053/j.jvca.2008.04.001
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 893
TITLE
The emergency care of cocaine intoxications
AUTHOR NAMES
Vroegop M.P.
Franssen E.J.
van der Voort P.H.J.
van den Berg T.N.A.
Langeweg R.J.
Kramers C.
AUTHOR ADDRESSES
(Vroegop M.P.) Emergency Department, Radboud University Medical Centre,
Nijmegen, Netherlands.
(Franssen E.J.) Department of Pharmacology, Onze Lieve Vrouw Gasthuis,
Amsterdam, Netherlands.
(van der Voort P.H.J.) Department of Intensive Care, Onze Lieve Vrouw
Gasthuis, Amsterdam, Netherlands.
(van den Berg T.N.A.; Langeweg R.J.) Department of Medicine, Onze Lieve
Vrouw Gasthuis, Amsterdam, Netherlands.
(Kramers C., c.kramers@pharmtox.umcm.nl) Department of
Pharmacology-Toxicology (233), Radboud University Medical Centre, Nijmegen,
Netherlands.
CORRESPONDENCE ADDRESS
C. Kramers, Department of Pharmacology-Toxicology (233), Radboud University
Medical Centre, Nijmegen, Netherlands. Email: c.kramers@pharmtox.umcm.nl
SOURCE
Netherlands Journal of Medicine (2009) 67:4 (122-126). Date of Publication:
April 2009
ISSN
0300-2977
BOOK PUBLISHER
Van Zuiden Communications BV, Postbus 2122, Alphen aan de Rijn, Netherlands.
ABSTRACT
Cocaine is frequently used, especially among adolescents and by men between
the age of 25 and 44. Many of them are able to use cocaine in normal
day-to-day life, without any problems.(I) Reduced prices of cocaine and
other recreational drugs such as MDMA (ecstasy) and gamma hydroxybutyrate
(GHB) has led to an increased incidence of intoxications with these
drugs.(2) Since the production of cocaine is illegal, it may be impure and
mixtures with other drugs such as atropine may occur. The treatment of
patients with an acute cocaine intoxication can be complicated. Combination
of cocaine with other drugs results in clinical pictures which are difficult
to discriminate and that may have important consequences for treatment. ©
2009 Van Zuiden Communications B.V. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
alcohol
diamorphine
diazepam
epinephrine (drug therapy)
flumazenil (drug therapy)
glyceryl trinitrate
hemoglobin (endogenous compound)
labetalol
levomepromazine
loperamide
metoprolol (drug therapy)
mirtazapine
naloxone (drug therapy)
naltrexone
oxazepam
pantoprazole
recreational drug
troponin I (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cocaine intoxication (diagnosis, therapy)
emergency care
intoxication (drug therapy, diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
agitation
alcohol abuse
angina pectoris
brain damage
brain hypoxia
case report
coma
duodenum ulcer (drug therapy)
heart left ventricle hypertrophy (diagnosis)
heart rate
hemoglobin blood level
human
hypertension
hyperthermia
laboratory test
male
mydriasis
oxygen therapy
respiratory acidosis
review
sinus rhythm
sinus tachycardia (drug therapy)
sore throat
ST segment depression
unconsciousness
urinalysis
wheezing
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
flumazenil (78755-81-4)
glyceryl trinitrate (55-63-0)
hemoglobin (9008-02-0)
labetalol (32780-64-6, 36894-69-6)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
loperamide (34552-83-5, 53179-11-6)
metoprolol (37350-58-6)
mirtazapine (61337-67-5)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
oxazepam (604-75-1)
pantoprazole (102625-70-7)
troponin I (77108-40-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009202035
MEDLINE PMID
19581655 (http://www.ncbi.nlm.nih.gov/pubmed/19581655)
PUI
L354529136
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 894
TITLE
A case series of abuse of a new opioid combination, Norjizak
AUTHOR NAMES
Siavash M.
Janghorbani M.
Gheshlaghi F.
Adeli S.H.
Saljoughi M.
Moradi F.
Majidinezhad M.
AUTHOR ADDRESSES
(Siavash M.) Isfahan Endocrine and Metabolism Research Center, Isfahan,
Iran.
(Janghorbani M., janghorbani@yahoo.com) Department of Epidemiology and
Biostatistics, School of Public Health, Isfahan University of Medical
Sciences, Isfahan, Iran.
(Gheshlaghi F.; Moradi F.) Poisoning Emergency Department, Khorshid
Hospital, Isfahan, Iran.
(Saljoughi M.; Majidinezhad M.) Department of Internal Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran.
(Adeli S.H.) Department of Internal Medicine, Qom University of Medical
Sciences, Iran.
CORRESPONDENCE ADDRESS
M. Janghorbani, Department of Epidemiology and Biostatistics, School of
Public Health, Isfahan University of Medical Sciences, Isfahan, Iran. Email:
janghorbani@yahoo.com
SOURCE
Journal of Addictive Diseases (2009) 28:2 (180-185). Date of Publication:
April 2009
ISSN
1055-0887
1545-0848 (electronic)
BOOK PUBLISHER
Routledge, 325 Chestnut Street, Philadelphia, United States.
ABSTRACT
Cushing's syndrome results from lengthy and inappropriate exposure to
excessive concentrations of either endogenous or exogenous glucocorticoids.
This study described 30 patients with a novel type of severe exogenous
Cushing's syndrome in a group of intravenous drug users due to illicit use
and dependence on a new opioid combination, Norjizak. Thirty consecutive
patients (2 women and 28 men) who presented with a novel type of severe
exogenous Cushing's syndrome and other complications were admitted to the
emergency departments of Qom and Isfahan University of Medical Sciences,
Isfahan, Iran, between September 2005 and September 2007 were enrolled. All
participating patients were intravenous drug users who used a narcotic drug
called Norjizak, a combination of different opioids with dexamethason or
benzodiazepines. Patients were first evaluated and managed based on the
current illness, and then entered into a detoxification program by a medical
team. Clinical data were collected by an open interview and the patient's
files using a standard form. High-performance liquid chromatography was used
to determined glucocorticoid existence in the brand. The major complaints
and clinical findings were withdrawal symptoms, severe edema, osteoporotic
fracture, impairment in glucose tolerance, decreased libido, and sepsis
(including necrotizing pneumonia, cutaneous infection, multivalvular
endocarditis, osteomyelitis, and urogenital infection). Most patients had
started with 2 or 3 vials per day and then increased the dose compulsively
to maximum of approximately 15 to 20 vials per day. The concentration of
Dexamethhasone disodium phosphate in each 2 mL vial was 0.4 to 1 mg/mL.
Heroin was also found in them. We are witnessing a special exogenous Cushing
syndrome due to the mixing of opiates and dexamethasone. Norjizak syndrome
is the clinical condition of poisoning with a second material when it is
combined with opiates due to compulsive dose increment and long duration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
illicit drug
norjizak
opiate
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
dexamethasone
dexamethasone sodium phosphate
diamorphine
glucocorticoid
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
clinical article
Cushing syndrome (etiology)
drug analysis
drug dependence treatment
drug determination
drug detoxification
edema
emergency ward
endocarditis
female
fragility fracture
glucose tolerance
high performance liquid chromatography
hospital admission
human
interview
intoxication
Iran
libido
male
necrosis
norjizak syndrome
osteomyelitis
osteoporosis
pneumonia
sepsis
skin infection
urogenital tract infection
withdrawal syndrome
CAS REGISTRY NUMBERS
dexamethasone (50-02-2)
dexamethasone sodium phosphate (2392-39-4, 312-93-6)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009596563
MEDLINE PMID
19340681 (http://www.ncbi.nlm.nih.gov/pubmed/19340681)
PUI
L355647286
DOI
10.1080/10550880902772928
FULL TEXT LINK
http://dx.doi.org/10.1080/10550880902772928
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 895
TITLE
A toxicological emergency case: Gone wrong
ORIGINAL (NON-ENGLISH) TITLE
Dumm gelaufen
AUTHOR NAMES
Martens F.
AUTHOR ADDRESSES
(Martens F., frank.martens@charite.de) Charité, Campus Virchow Klinikum,
Klinik für Nephrologie und Internistische Intensivmedizin, Augustenburger
Platz 1, 13353 Berlin, Germany.
CORRESPONDENCE ADDRESS
F. Martens, Charité, Campus Virchow Klinikum, Klinik für Nephrologie und
Internistische Intensivmedizin, Augustenburger Platz 1, 13353 Berlin,
Germany. Email: frank.martens@charite.de
SOURCE
Notarzt (2009) 25:2 (59-60). Date of Publication: April 2009
ISSN
0177-2309
1438-8693 (electronic)
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
barbituric acid derivative
benzodiazepine
diclofenac
fenetylline
morphine
naloxone
naltrexone (oral drug administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug toxicity
EMTREE MEDICAL INDEX TERMS
blood sampling
clinical examination
clinical feature
continuous infusion
drug blood level
drug effect
drug half life
human
pulse oximetry
short survey
sleep
urine volume
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
diclofenac (15307-79-6, 15307-86-5)
fenetylline (1892-80-4, 3736-08-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
2009335487
PUI
L354861814
DOI
10.1055/s-0028-1090104
FULL TEXT LINK
http://dx.doi.org/10.1055/s-0028-1090104
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 896
TITLE
Demographics of toxic exposures presenting to three public hospital
emergency departments in Singapore 2001-2003
AUTHOR NAMES
Ponampalam R.
Tan H.H.
Ng K.C.
Lee W.Y.
Tan S.C.
AUTHOR ADDRESSES
(Ponampalam R., gaerpo@sgh.com.sg; Tan S.C.) Department of Emergency
Medicine, Singapore General Hospital, Outram Road, Singapore 169608,
Singapore.
(Tan H.H.; Lee W.Y.) Department of Emergency Medicine, Changi General
Hospital, 2 Simei Street 3, Singapore 629889, Singapore.
(Ng K.C.) Paediatric Emergency Department, Kandang Kerbau Hospital, 100
Bukit Timah Road, Singapore 229889, Singapore.
CORRESPONDENCE ADDRESS
R. Ponampalam, Department of Emergency Medicine, Singapore General Hospital,
Outram Road, Singapore 169608, Singapore. Email: gaerpo@sgh.com.sg
SOURCE
International Journal of Emergency Medicine (2009) 2:1 (25-31). Date of
Publication: April 2009
ISSN
1865-1372
1865-1380 (electronic)
BOOK PUBLISHER
Springer London Ltd, The Guildway, Old Portsmouth Road, Artington,
Guildford, United Kingdom.
ABSTRACT
Background: The demographics of poisoned patients and the circumstances of
toxic exposure have not been evaluated in Singapore for the last 10 years.
Aim: This study aims to give an estimate of the burden of poisoning in
Singapore from the emergency department's (ED) perspective. Method: A
retrospective study of toxic exposure was conducted over a period of 3 years
from 2001 to 2003 at the ED of three public hospitals, one being a
paediatric hospital. Results: There were 9,212 cases of toxic exposures
during the study period, which constituted 0.94% of total ED attendances.
The poison exposure rate was 1.7 per 1,000 population and the estimated case
fatality rate was 0.8 per 1,000 ED attendances for poisoning. The mean age
of patients was 29 years and the majority were male (63.3%). Non-accidental
injuries constituted 60% of the cohort. Alcohol was the commonest toxin
involved (26%), but paracetamol (acetaminophen) was the most common
pharmaceutical agent (33%). The mean time of exposure to ED presentation was
3.3 h. About one third of the patients were admitted of whom 157 patients
(4.7% of admitted cases) required intensive care management. Conclusion: The
patients were predominantly young adults. This may suggest a need for poison
prevention and chemical safety education to reduce the impact on this
high-risk group. Although poisoning accounts for only 1% of the total ED
attendance, a sizable proportion of them required inpatient care (36.1%)
with a significant proportion requiring intensive care management. However,
it was also noted that a third of those who were admitted stayed for less
than 24 h, and hence a short-stay ward in the ED might be a cost-effective
strategy to consider. © 2009 Springer-Verlag London Ltd.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug dose, drug therapy)
Anarex
antiasthmatic agent (drug toxicity)
anticoagulant agent (drug toxicity)
anticonvulsive agent (drug toxicity)
antidepressant agent (drug toxicity)
antiinfective agent (drug toxicity)
atropine (drug therapy)
benzatropine (drug therapy)
bicarbonate (drug therapy)
calcium (drug combination, drug therapy, intravenous drug administration)
cardiac agent (drug toxicity)
digoxin (drug therapy)
flumazenil (drug therapy)
gastrointestinal agent (drug toxicity)
glucagon (drug therapy)
gluconate calcium (drug combination, drug therapy, intravenous drug
administration)
glucose (drug therapy, intravenous drug administration)
hypochlorite sodium
ipecac (drug therapy)
ipratropium bromide
methionine (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
nonsteroid antiinflammatory agent (drug toxicity)
oral antidiabetic agent (drug toxicity, oral drug administration)
paracetamol (drug toxicity)
pralidoxime (drug therapy)
pyridoxine (drug therapy)
rofecoxib
sedative agent (drug toxicity)
unclassified drug
unindexed drug
vitamin (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
demography
emergency ward
intoxication (drug therapy, drug therapy)
public hospital
EMTREE MEDICAL INDEX TERMS
accident
adolescent
adult
age distribution
article
child
drug intoxication
fatality
female
food poisoning
hospital admission
human
injury
intensive care
major clinical study
male
population exposure
population research
preschool child
priority journal
race difference
retrospective study
school child
sex difference
Singapore
single drug dose
DRUG TRADE NAMES
Anarex
atrovent
clorox
vioxx
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
benzatropine (86-13-5)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
digoxin (20830-75-5, 57285-89-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
hypochlorite sodium (7681-52-9)
ipecac (8012-96-2)
ipratropium bromide (22254-24-6)
methionine (59-51-8, 63-68-3, 7005-18-7)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
rofecoxib (162011-90-7, 186912-82-3)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009410984
PUI
L50421160
DOI
10.1007/s12245-008-0080-9
FULL TEXT LINK
http://dx.doi.org/10.1007/s12245-008-0080-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 897
TITLE
Clinical pharmacology and use of morphin, ketamin and midazolam
ORIGINAL (NON-ENGLISH) TITLE
Klinische pharmakologie und anwendung von morphin, ketamin und midazolam
AUTHOR NAMES
Jantzen T.
AUTHOR ADDRESSES
(Jantzen T., rosolski@t-online.de) Intensivverlegungsdienst
Mecklenburg-Vorpommern Ggmbh, .
(Jantzen T., rosolski@t-online.de) Chefärztin, Intensivverlegungsdienst
Mecklenburg-Vorpommern Ggmbh, Moltkeplatz 3, 19370 Parchim.
CORRESPONDENCE ADDRESS
T. Jantzen, Chefärztin, Intensivverlegungsdienst Mecklenburg-Vorpommern
Ggmbh, Moltkeplatz 3, 19370 Parchim. Email: rosolski@t-online.de
SOURCE
Notarzt (2009) 25:1 (11-16). Date of Publication: 2009
ISSN
0177-2309
1438-8693 (electronic)
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
ABSTRACT
The pharmacological properties of three drugs commonly used in emergency
medical systems (EMS) - morphin, ketamine und midazolam - are described.
Morphin, a potent analgesic interacts with the opioid receptor. Side effects
include respiratory depression, hypotension and bradykardia. Morphin is
hepatically degraded to active metabolites, which are excreted renally. 7-10
mg are administered intravenously, clinical effects may be antagonized by
naloxone. Ketamine produces analgesia, sedation and anesthesia in a dose
dependent manner. Effects are mainly due to non-compatitive antagonism at
the NMDA-receptor. Side effects include respiratory depression,
psychotomimetic derangement, blurred vision and hypersalivation. Ketamine is
hepatically metabolized and renally excreted. Onset of action is rapid, due
to high lipophilicity. Ketamine is available as racemic mixture of S(+) and
R(-)- ketamine, or as pure S(+)-ketamine. S (+)-ketamine is given at dosages
of 0.125-0.25 mg/kg to achieve analgesia. When the effect is to be achieved
with the racemate, dosages must be more than doubled. Midazolam interacts
with the benzodiazepine subunit of the GABA-receptor. Main effects include
sedation, anxiolysis, anterograde amnesia and an increase of the seizure
threshold; a relevant side effect is respiratory depression. Onset is rapid
following intravenous administration. Midazolam is hepatically metabolized
and renally excreted. Attention must be paid to drug interactions. For
sedation, 1-2.5 mg / kg are given. Flumazenil is available as antagonist.
Morphin, ketamine and midazolam are powerful drugs, the use of which shall
be restricted to experienced physicians. In order to assess and balance
effects and risks of these drugs, thorough understanding of their clinical
pharmacology is mandatory. © Georg Thieme Verlag KG.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ketamine (adverse drug reaction, drug interaction, intravenous drug
administration, pharmacokinetics, pharmacology)
midazolam (adverse drug reaction, drug interaction, intravenous drug
administration, pharmacokinetics, pharmacology)
morphine (adverse drug reaction, drug interaction, intravenous drug
administration, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
atropine (drug interaction)
benzodiazepine (drug interaction, pharmacology)
flumazenil (pharmacology)
imidazole (parenteral drug administration, pharmacology)
morphine sulfate (pharmacology)
n methyl dextro aspartic acid receptor (drug interaction, pharmacology)
naloxone (drug interaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical pharmacology
emergency health service
EMTREE MEDICAL INDEX TERMS
amnesia
analgesia
anesthesia
antidiuresis
article
blurred vision (side effect)
bradycardia (side effect)
clinical assessment
derange (side effect)
derange (side effect)
dose response
drug antagonism
drug effect
drug elimination
drug excretion
drug half life
drug mechanism
drug metabolism
human
hypersalivation (side effect)
hypotension (side effect)
lipophilicity
metabolite
physician
racemic mixture
respiration depression (side effect)
sedation
seizure threshold
structure activity relation
tranquilizing activity
urinary excretion
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
imidazole (1467-16-9, 288-32-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2009129527
PUI
L354319639
DOI
10.1055/s-0028-1090100
FULL TEXT LINK
http://dx.doi.org/10.1055/s-0028-1090100
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 898
TITLE
Opiate-using patients: Intake in the emergency rooms. Patients interviews in
the Gironde's emergency rooms and drug rehabilitation facilities
ORIGINAL (NON-ENGLISH) TITLE
Patients usagers d'opiacés : accueil et prise en charge au sein des services
d'urgence. Audit en Gironde au sein des principaux services d'urgence et
auprès des entités spécialisées en addictologie
AUTHOR NAMES
Grelet-Doazan A.
Auriacombe M.
AUTHOR ADDRESSES
(Grelet-Doazan A., ann.grelet-doazan@laposte.net) Service d'accueil des
urgences, SMUR, centre hospitalier Pasteur, rue Langevin, BP 116, Langon,
33210, France.
(Grelet-Doazan A., ann.grelet-doazan@laposte.net; Auriacombe M.) JE2358,
Laboratoire de psychiatrie, Université Victor-Segalen, Bordeaux 2, Bordeaux,
France.
(Auriacombe M.) Département d'addictologie, CHU de Bordeaux et centre
hospitalier Charles-Perrens, Bordeaux, France.
CORRESPONDENCE ADDRESS
A. Grelet-Doazan, Service d'accueil des urgences, SMUR, centre hospitalier
Pasteur, rue Langevin, BP 116, Langon, 33210, France. Email:
ann.grelet-doazan@laposte.net
SOURCE
JEUR (2009) 22:1 (1-9). Date of Publication: March 2009
ISSN
0993-9857
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
Aim: To establish the current problems encountered, the questions raised and
proposed suggestions regarding the intake of opiate-addicted patients in
Gironde's emergency rooms. Methods: Expert interviews with all emergency
room directors of major hospitals in Bordeaux and its neighbourhood, as well
as directors of drug rehabilitation facilities in Gironde. Evaluation of
emergency management and analysis of present intake methods of
drug-dependent patients. All results were recorded in a comparative chart.
Discussion: To create a common protocol for the most frequent situations
regarding the intake of patients who arrive in emergency rooms and pose an
implicit or explicit problem related to opiate addictions. Conclusion:
Implementation of an evaluative study in the field regarding commonly
agreed-upon protocol such as Evidence-Based Medicine based on the
literature's findings. © 2009 Elsevier Masson SAS. All rights reserved.
EMTREE DRUG INDEX TERMS
buprenorphine
morphine
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug abuse
drug dependence treatment
emergency ward
human
priority journal
rehabilitation center
semi structured interview
DRUG TRADE NAMES
naloxone
skenan
subutex
temgesic
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French, English
EMBASE ACCESSION NUMBER
2009187766
PUI
L50435547
DOI
10.1016/j.jeur.2008.12.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jeur.2008.12.002
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 899
TITLE
Two milligrams IV hydromorphone is efficacious for treating pain but is
associated with oxygen desaturation
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Napolitano A.
Lupow J.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K.; Bijur P.E.; Napolitano A.; Lupow J.; Gallagher E.J.) Department
of Emergency Medicine, Albert Einstein College of Medicine, Montefiore
Medical Center, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY, United States.
SOURCE
Journal of Opioid Management (2009) 5:2 (75-80). Date of Publication:
March/April 2009
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Objective: To evaluate the safety and efficacy of a single dose of 2 mg IV
hydromorphone administered to emergency department patients in acute severe
pain. Design: Prospective interventional. Setting: Urban academic emergency
department. Patient, participants: Nonelderly adults (21-64 years old) witb
acute severepain and baseline oxygen saturation (SO(2)) ≥95 percent.
Interventions: Two milligrams IV hydromorphone administered over 2-3
minutes. Main outcome measures: The primary outcome was use of naloxone as a
reversal agent. Secondary outcomes included degree of pain relief as
measured on a numerical rating scale, frequency of oxygen desaturation
(SO(2) < 95 percent), and side effects. Results: Of the 269 patients, none
received IV naloxone. Median pain scoresfellfrom 10 (worst pain possible) at
baseline to 1 within 5 minutes and to 0 (no pain) at 30 minutes. SO(2) was
≥95 percent at all time points in 68 percent of patients (95 percent CI
62-73 percent), while 26 percent (95 percent CI 21-32 percent) had one or
more SO(2) levels between 90-94 percent, and 6 percent (95 percent CI 4-10
percent) had SO(2) values below 90 percent at one or more time points, Tbe
lowest SO(2) was 82 percent. The incidence of nausea and vomiting were 16
percent and 7 percent, respectively. Conclusions: Two milligrams IV
hydromorphone provides efficacious and rapid pain relief in nonelderly
adults presenting to the ED with acute severe pain. However, oxygen
desaturation below 95 percent occurred in about one third of patients.
Although no noticeable clinical signs of hypoxemia occurred, a conservative
interpretation of this finding suggests that 2 mg IV hydromorphone is too
much opioid to be given routinely to patients in pain as a single initial
dose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, clinical trial, drug dose, drug
therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
oxygen desaturation
oxygen saturation
pain (drug therapy, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
age
analgesia
article
bradycardia (side effect)
breathing rate
clinical trial
disease severity
dose response
drug efficacy
drug safety
emergency care
female
heart rate
human
hypotension (side effect)
hypoxemia
major clinical study
male
nausea (side effect)
prospective study
pruritus (side effect)
respiration depression (side effect)
side effect (side effect)
single drug dose
systolic blood pressure
treatment duration
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009234056
MEDLINE PMID
19507803 (http://www.ncbi.nlm.nih.gov/pubmed/19507803)
PUI
L354607076
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 900
TITLE
Out-of-hospital opioid therapy of palliative care patients with "acute
dyspnoea": A retrospective multicenter investigation
AUTHOR NAMES
Wiese C.H.R.
Bartels U.E.
Graf B.M.
Hanekop G.G.
AUTHOR ADDRESSES
(Wiese C.H.R.; Hanekop G.G.) Department of Anaesthesiology, Emergency and
Intensive Care Medicine, University Medical Centre, Goettingen, Germany.
(Bartels U.E.) Department of Anaesthesiology and Intensive Care Medicine,
University Medical Centre, Jena, Germany.
(Graf B.M.) Department of Anaesthesiology, University Medical Centre,
Regensburg, Germany.
CORRESPONDENCE ADDRESS
C.H.R. Wiese, Department of Anaesthesiology, Emergency and Intensive Care
Medicine, University Medical Centre, Goettingen, Germany.
SOURCE
Journal of Opioid Management (2009) 5:2 (115-122). Date of Publication:
March/April 2009
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Background: Prehospital emergency physicians (EP) are often confronted with
the acute care of palliative care patients. Dyspnoea is a frequent acute
symptom and its causes often differ from the generally known emergency
medical causes, Till now, there have been no relevant concepts for emergency
care of palliative care patients for their specific symptoms. Methods: Over
a 24-month period, the authors retrospectively investigated all
out-of-hospital emergency medical services for palliative care patients with
acute dyspnoea at four emergency physician support points. The evaluation of
these services was followed retrospectively on the basis of the therapy
carried out by the EP (Group 1: therapy with morphine and oxygen; Group 2:
therapy with morphine, bronchodilator effective drugs and oxygen; Group 3:
therapy with bronchodilator effective drugs and oxygen; Group 4: therapy
with oxygen; Group 5: no medical treatment. Moreover, EPs were interviewed
about their actions and their uncertainties in the treatment of palliative
care patients. Results: The diagnosis of acute dyspnoea in palliative
arepatients occurred 121 times (116 patients were integrated in the present
investigation) within the defined period. In total, 116 patients were
included (Group 1: 21, Group 2: 29, Group 3: 31, Group 4: 28, and Group 5:
7). Dyspnoea was satisfactorily treated in 41 percent of the patients (Group
1: 67 percent, Group 2: 52 percent, Group 3: 22 percent, Group 4: 18
percent, and Group 5: 71 percent). Most EPs (70 percent) revealed
uncertainties in emergency medical therapy for patients at the end of life.
Conclusions: The current investigation showed a significant relief of acute
dyspnoea when using opioids, in contrast with the established
out-of-hospital emergency medical therapy for acute dyspnoea. Therefore,
opioids should be recommended for emergency medical therapy of dyspnoea in
palliative care patients. Clinical studies that recommend the use of
effective opioids for the treatment of dyspnoea in palliative care patients
are supported by the current retrospective study. Most EPs felt uncertain in
the treatment of palliative care patients. Therefore, advanced training in
palliative care medicine and end-of-life care should be integrated into
emergency medical training.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bronchodilating agent (drug combination, drug comparison, drug therapy,
inhalational drug administration, intravenous drug administration)
morphine (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy, intravenous drug administration)
oxygen (drug combination, drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
benzodiazepine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute dyspnea (drug therapy, drug therapy)
dyspnea (drug therapy, drug therapy)
palliative therapy
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
adult
aged
article
breathing rate
controlled study
dose response
drug dose titration
drug efficacy
emergency care
female
human
major clinical study
male
oxygen saturation
oxygen therapy
retrospective study
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
morphine (52-26-6, 57-27-2)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009234061
MEDLINE PMID
19507808 (http://www.ncbi.nlm.nih.gov/pubmed/19507808)
PUI
L354607081
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 901
TITLE
Enhancing safe medication use for pediatric patients in the emergency
department
AUTHOR NAMES
Greenall J.
Santora P.
Koczmara C.
Hyland S.
AUTHOR ADDRESSES
(Greenall J.; Koczmara C.) Institute for Safe Medication Practices Canada,
Toronto, ON, Canada.
(Santora P.) Emergency Program, William Osler Health Centre, Brampton, ON,
Canada.
(Hyland S.) ISMP Canada, Toronto, ON, Canada.
CORRESPONDENCE ADDRESS
J. Greenall, Institute for Safe Medication Practices Canada, Toronto, ON,
Canada.
SOURCE
Canadian Journal of Hospital Pharmacy (2009) 62:2 (150-153). Date of
Publication: March/April 2009
ISSN
0008-4123
BOOK PUBLISHER
Canadian Society of Hospital Pharmacists, 30 Concourse Gate, Unit 3, Ottawa,
Canada.
EMTREE DRUG INDEX TERMS
activated carbon (intragastric drug administration)
hydromorphone (oral drug administration)
naloxone (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
medication error
patient safety
pediatrics
EMTREE MEDICAL INDEX TERMS
article
case report
clinical feature
community hospital
ear disease
fever
human
infant
medical practice
patient care
pharmaceutical care
pharmacist
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
hydromorphone (466-99-9, 71-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2009220754
PUI
L354574243
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 902
TITLE
Opiate intoxication in elderly emergency patients. A rare emergency
situation?
ORIGINAL (NON-ENGLISH) TITLE
Opiatintoxikation beim älteren notfallpatienten. Ein seltener notfall?
AUTHOR NAMES
Kleber C.
Kleber A.J.
AUTHOR ADDRESSES
(Kleber C., christian.kleber@charite.de) Klinik für Unfall- und
Wiederherstellungschirurgie, Operative Intensiv- und Notfallmedizin, Centrum
für Muskuloskeletale Chirurgie, Charité, Berlin, Germany.
(Kleber A.J.) Werner Forßmann Krankenhaus, Medizinische Klinik I, Klinikum
Barnim GmbH, Eberswalde, Germany.
(Kleber C., christian.kleber@charite.de) Klinik für Unfall- und
Wiederherstellungschirurgie, Operative Intensiv- und Notfallmedizin, Centrum
für Muskuloskeletale Chirurgie, Charité, Augustenburger Platz 1, Berlin
13353, Germany.
CORRESPONDENCE ADDRESS
C. Kleber, Klinik für Unfall- und Wiederherstellungschirurgie, Operative
Intensiv- und Notfallmedizin, Centrum für Muskuloskeletale Chirurgie,
Charité, Augustenburger Platz 1, Berlin 13353, Germany. Email:
christian.kleber@charite.de
SOURCE
Notfall und Rettungsmedizin (2009) 12:1 (40-44). Date of Publication:
February 2009
ISSN
1434-6222
1436-0578 (electronic)
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
Acute opiate intoxication in aged people is an atypical emergency case. The
challenge is to keep pre-hospital opiate intoxication as a potential cause
of emergency in mind. The prescription of opiate patches for out-patient
pain therapy has increased. Therefore, in aged patients with several chronic
diseases and permanent medication, there is the danger of pharmacological
and pharmacokinetic interactions with extension of the opiate effect leading
to acute opiate intoxication. The pre-hospital diagnosis and therapy of
acute opiate intoxication in aged emergency patients poses a challenge.
Important preclinical factors are to check the pupils, the breathing
frequency and the complete medical history. In this article two cases of
preclinical management of acute opiate intoxication are demonstrated.
Naloxone is the antidote of choice in acute opiate intoxication. The
side-effects, pharmacologic interactions and the danger of the rebound
effect are described below. Antidote therapy, airway maintenance and
assurance of adequate ventilation and oxygenation have priority and must not
be neglected. In the age of out-patient pain therapy, the acute opiate
intoxication is no longer a "drug emergency". © 2009 Springer Medizin
Verlag.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, drug toxicity, intradermal drug administration)
EMTREE DRUG INDEX TERMS
fentanyl
naloxone (drug therapy, intravenous drug administration)
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
elderly care
emergency care
EMTREE MEDICAL INDEX TERMS
aged
anamnesis
article
breathing rate
case report
chronic disease
emergency patient
human
outpatient care
pain (drug therapy)
pupil
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2009075770
PUI
L354177058
DOI
10.1007/s10049-008-1119-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s10049-008-1119-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 903
TITLE
Unrecognized valproic acid intoxication
AUTHOR NAMES
Hurdle A.C.
Moss R.D.
AUTHOR ADDRESSES
(Hurdle A.C., achurdle@bellsouth.net; Moss R.D.) Department of Pharmacy,
Methodist University Hospital, Memphis, TN 38104, United States.
(Hurdle A.C., achurdle@bellsouth.net; Moss R.D.) Department of Clinical
Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38104,
United States.
CORRESPONDENCE ADDRESS
A.C. Hurdle, Department of Pharmacy, Methodist University Hospital, Memphis,
TN 38104, United States. Email: achurdle@bellsouth.net
SOURCE
American Journal of Emergency Medicine (2009) 27:2 (250.e1-250.e2). Date of
Publication: February 2009
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
We report the case of a patient with schizophrenia who presented to the
emergency department (ED) with a mental status change. He was initially
treated for nonconvulsive seizures until a valproic acid (VPA) serum
concentration test was performed and indicated acute intoxication. To report
a case of acute intoxication with VPA that was unrecognized and treated as
nonconvulsive seizure. A 28-year old man presented to the ED after being
assaulted. A computed tomography scan of his head showed no intracranial
injury. While still in the ED, the patient became increasingly difficult to
arouse. Because nonconvulsive seizures were suspected, an
electroencephalogram was performed, which indicated mild encephalopathy but
no epileptogenic activity. Despite these results, the patient was given VPA
1000 mg intravenously. A VPA level was obtained before the dose was given,
but the results were not available at the time the dose was ordered and
administered. It was later determined to be greater than 300 μg/mL and
increased to 423 μg/mL. The patient was admitted to the hospital and later
reported that he had attempted to commit suicide by taking an unknown amount
of VPA, which was prescribed for a history of schizophrenia. Emergency
physicians should be aware that anticonvulsant medications are used for a
variety of medical conditions in addition to the treatment of seizure
disorders. Especially when anticonvulsant medications are used for
psychiatric conditions, acute intoxication should be a differential
diagnosis in any patient presenting with mental status changes. © 2009
Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
valproic acid (drug concentration, drug therapy, drug toxicity, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
benzatropine (drug therapy)
carbamazepine (drug therapy)
fluoxetine (drug therapy)
lamotrigine (drug therapy)
naloxone (intravenous drug administration)
ziprasidone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
article
bedtime dosage
brain disease
case report
consciousness disorder
drug blood level
electroencephalogram
emergency ward
human
male
orbit fracture (diagnosis)
paranoid schizophrenia (drug therapy)
priority journal
schizophrenia (drug therapy)
seizure (drug therapy)
suicide attempt
CAS REGISTRY NUMBERS
benzatropine (86-13-5)
carbamazepine (298-46-4, 8047-84-5)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
lamotrigine (84057-84-1)
naloxone (357-08-4, 465-65-6)
valproic acid (1069-66-5, 99-66-1)
ziprasidone (118289-78-4, 122883-93-6, 138982-67-9, 199191-69-0)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009203056
MEDLINE PMID
19371546 (http://www.ncbi.nlm.nih.gov/pubmed/19371546)
PUI
L354530760
DOI
10.1016/j.ajem.2008.05.028
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2008.05.028
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 904
TITLE
Association between access block and time to parenteral opioid analgesia in
renal colic: A pilot study
AUTHOR NAMES
Chu K.
Brown A.
AUTHOR ADDRESSES
(Chu K., kevin_chu@health.qld.gov.au; Brown A.) Department of Emergency
Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
(Chu K., kevin_chu@health.qld.gov.au; Brown A.) School of Medicine,
University of Queensland, Australia.
(Chu K., kevin_chu@health.qld.gov.au) Department of Emergency Medicine,
Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia.
CORRESPONDENCE ADDRESS
K. Chu, Department of Emergency Medicine, Royal Brisbane and Women's
Hospital, Brisbane, QLD 4029, Australia. Email: kevin_chu@health.qld.gov.au
SOURCE
EMA - Emergency Medicine Australasia (2009) 21:1 (38-42). Date of
Publication: February 2009
ISSN
1742-6731
1742-6723 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
Objective: To seek an association between access block and time to
parenteral opioid analgesia (POA) in ED patients presenting with renal
colic. Methods: Renal colic patients given POA were retrospectively
identified over 3 months. Time of administration of POA was abstracted from
patients' charts. Access block data, time of arrival and demographics were
retrieved electronically. A logistic regression was used to seek an
association between time to POA (dichotomized into <1 h and >1 h of arrival)
with daily access block (proportion of patients requiring hospital admission
in a 24 h period who have a total ED time >8 h, dichotomized at its median),
time of administration of POA (00.00-07.59 hours [T1], 08.00-15.59 hours
[T2], 16.00-23.59 hours [T3]), age and sex. Results: Of 69 patients, 42
(60.1%, 95% CI 51-70%) received POA within 1 h. Access block occurred daily
(median 28.8%, range 6.8-53.1%). Mean hourly ED attendance rates for all
patients during T1, T2 and T3 were 4.0, 11.7 and 7.8 patients/h
respectively. As predictors of time to POA (>1 h vs ≤1 h), the adjusted OR
for access block (≥29% vs <29%) was 1.0 (95% CI 0.4-2.9), T3 versus T2 was
5.0 (95% CI 1.4-17.7), T1 versus T2 was 1.0 (95% CI 0.3-23.8), age (≥47
years vs <47 years) was 0.8 (95% CI 0.3-2.3) and for sex (female vs male)
was 0.4 (95% CI 0.1-1.6). Conclusion: Time to POA was related to time of
administration, but not to access block. Access block might be too crude a
measure to quantify ED overcrowding, and so its influence on time to POA may
not be exhibited. © 2009 Australasian College for Emergency Medicine and
Australasian Society for Emergency Medicine.or Emergency Medicine.
EMTREE DRUG INDEX TERMS
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
kidney colic (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
controlled study
demography
electronic medical record
emergency ward
female
hospital admission
human
major clinical study
male
priority journal
sex difference
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009088558
MEDLINE PMID
19254311 (http://www.ncbi.nlm.nih.gov/pubmed/19254311)
PUI
L354207136
DOI
10.1111/j.1742-6723.2008.01146.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1742-6723.2008.01146.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 905
TITLE
Coma and impaired consciousness in the emergency room: Characteristics of
poisoning versus other causes
AUTHOR NAMES
Forsberg S.
Höjer J.
Enander C.
Ludwigs U.
AUTHOR ADDRESSES
(Forsberg S., sune.forsberg@sodersjukhuset.se) Medical Intensive Care Unit,
South Hospital, Stockholm, Sweden.
(Höjer J.) Swedish Poisons Information Centre, Stockholm, Sweden.
(Enander C.) Neurological Intensive Care Unit, Department of Neurosurgery,
Karolinska University Hospital, Solna, Stockholm, Sweden.
(Ludwigs U.) Department of Emergency Medicine, Karolinska University
Hospital, Solna, Stockholm, Sweden.
(Forsberg S., sune.forsberg@sodersjukhuset.se; Höjer J.; Ludwigs U.)
Karolinska Institute, Stockholm, Sweden.
(Forsberg S., sune.forsberg@sodersjukhuset.se) Medicinska
Intensivvårdsavdelningen, MIVA, Södersjukhuset, 11883 Stockholm, Sweden.
CORRESPONDENCE ADDRESS
S. Forsberg, Medicinska Intensivvårdsavdelningen, MIVA, Södersjukhuset,
11883 Stockholm, Sweden. Email: sune.forsberg@sodersjukhuset.se
SOURCE
Emergency Medicine Journal (2009) 26:2 (100-102). Date of Publication:
February 2009
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Objectives: Unconscious patients represent a diagnostic challenge in the
emergency room (ER), but studies on their characteristics are limited. The
aim of this study was to investigate the frequency, characteristics and
prognosis of different coma aetiologies with special focus on poisoning.
Design: An observational study of consecutive adults admitted to the
non-surgical ER, with a Glasgow coma scale (GCS) score of 10 or below. The
GCS score on admission was prospectively entered into a study protocol,
which was complemented with data from the medical record within one month.
Results: 938 patients were enrolled. Poisoning caused unconsciousness in 352
cases (38%). In the remaining 586 cases (non-poisoning group) the underlying
cause was a focal neurological lesion in 24%, a metabolic or diffuse
cerebral disturbance in 21%, epileptogenic in 12%, psychogenic in 1% and was
still not clarified at hospital discharge in 4%. Among patients below the
age of 40 years, the coma was caused by poisoning in 80%, but among those
over 60 years, poisoning was the cause in only 11%. The median GCS score on
admission was identical in the two study groups. Hospital mortality rates
were 2.8% and 39% in the two groups, respectively. Conclusion: Poisoning was
the most common cause of coma and young age was a strong predictor of this
condition. The prognosis was favourable among poisoned patients but poor in
the rest of the study population as a group.
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
alcohol (drug toxicity)
diamorphine (drug toxicity)
flumazenil (drug therapy)
hypnotic sedative agent (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (etiology)
consciousness disorder (etiology)
intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age distribution
aged
article
brain damage (epidemiology)
cerebrovascular disease
emergency ward
female
Glasgow coma scale
hospital admission
hospital discharge
human
male
medical record
metabolic disorder (epidemiology)
mortality
neurologic disease (epidemiology)
observational study
population research
predictor variable
priority journal
prognosis
respiratory failure (complication)
seizure (complication)
stomach lavage
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
diamorphine (1502-95-0, 561-27-3)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009113413
MEDLINE PMID
19164617 (http://www.ncbi.nlm.nih.gov/pubmed/19164617)
PUI
L354270571
DOI
10.1136/emj.2007.054536
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2007.054536
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 906
TITLE
Case 2-2009: A 25-year-old man with pain and swelling of the right hand and
hypotension
AUTHOR NAMES
Filbin M.R.
Ring D.C.
Wessels M.R.
Avery L.L.
Kradin R.L.
AUTHOR ADDRESSES
(Filbin M.R.) Department of Emergency Services, Massachusetts General
Hospital, Boston, MA, United States.
(Ring D.C.) Department of Orthopaedics, Massachusetts General Hospital,
Boston, MA, United States.
(Avery L.L.) Department of Radiology, Massachusetts General Hospital,
Boston, MA, United States.
(Kradin R.L.) Department of Pathology, Massachusetts General Hospital,
Boston, MA, United States.
(Kradin R.L.) Department of Medicine, Massachusetts General Hospital,
Boston, MA, United States.
(Wessels M.R.) Division of Infectious Diseases, Children's Hospital, Boston,
MA, United States.
(Filbin M.R.) Department of Surgery, Harvard Medical School, Boston, MA,
United States.
(Ring D.C.) Department of Orthopaedic Surgery, Harvard Medical School,
Boston, MA, United States.
(Wessels M.R.) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States.
(Avery L.L.) Department of Radiology, Harvard Medical School, Boston, MA,
United States.
(Kradin R.L.) Department of Pathology, Harvard Medical School, Boston, MA,
United States.
(Kradin R.L.) Department of Medicine, Harvard Medical School, Boston, MA,
United States.
CORRESPONDENCE ADDRESS
M. R. Filbin, Department of Emergency Services, Massachusetts General
Hospital, Boston, MA, United States.
SOURCE
New England Journal of Medicine (2009) 360:3 (281-290). Date of Publication:
15 Jan 2009
ISSN
0028-4793
1533-4406 (electronic)
BOOK PUBLISHER
Massachussetts Medical Society, 860 Winter Street, Waltham, United States.
ABSTRACT
A 25-year-old man was transferred to the emergency department of this
hospital because of pain and swelling of the right hand and hypotension. His
hand was mottled and swollen, with a black eschar on the dorsum, and
soft-tissue swelling extended up the proximal forearm. Vigorous fluid
resuscitation and norepinephrine were required for hemodynamic support.
Copyright © 2009 Massachusetts Medical Society.
EMTREE DRUG INDEX TERMS
ceftriaxone
cetirizine
clindamycin (intravenous drug administration)
diphenhydramine
magnesium sulfate
methylprednisolone
morphine
naloxone
noradrenalin
pantoprazole
paracetamol
piperacillin
potassium chloride
prednisone (drug therapy)
tazobactam
tetanus toxoid
vancomycin (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hand edema
hypotension
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
case report
clinical feature
computer assisted tomography
coughing (drug therapy)
electrocardiography
human
laboratory test
male
medical examination
pain
priority journal
sinus tachycardia (diagnosis)
CAS REGISTRY NUMBERS
ceftriaxone (73384-59-5, 74578-69-1)
cetirizine (83881-51-0, 83881-52-1)
clindamycin (18323-44-9)
diphenhydramine (147-24-0, 58-73-1)
magnesium sulfate (7487-88-9)
methylprednisolone (6923-42-8, 83-43-2)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
pantoprazole (102625-70-7)
paracetamol (103-90-2)
piperacillin (59703-84-3, 61477-96-1)
potassium chloride (7447-40-7)
prednisone (53-03-2)
tazobactam (93528-38-2)
tetanus toxoid (57425-69-1, 93384-51-1)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009032211
MEDLINE PMID
19144944 (http://www.ncbi.nlm.nih.gov/pubmed/19144944)
PUI
L354081606
DOI
10.1056/NEJMcpc0807489
FULL TEXT LINK
http://dx.doi.org/10.1056/NEJMcpc0807489
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 907
TITLE
Hospitalizations for opioid poisoning: A nation-wide population-based study
in Denmark, 1998-2004
AUTHOR NAMES
Bjørn A.-M.B.
Jepsen P.
Larsson H.J.
Thomsen H.F.
Kieler H.
Ehrenstein V.
Christensen S.
AUTHOR ADDRESSES
(Bjørn A.-M.B., abb@dce.au.dk) Department of Clinical Epidemiology, Aarhus
University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
(Bjørn A.-M.B., abb@dce.au.dk; Jepsen P.; Larsson H.J.; Thomsen H.F.;
Ehrenstein V.; Christensen S.) Department of Clinical Epidemiology, Aarhus
University Hospital, Denmark.
(Kieler H.) Center for Pharmacoepidemiology, Department of Medicine,
Karolinska Institute, Stockholm, Sweden.
CORRESPONDENCE ADDRESS
A.-M. B. Bjørn, Department of Clinical Epidemiology, Aarhus University
Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. Email:
abb@dce.au.dk
SOURCE
Addiction (2009) 104:1 (104-108). Date of Publication: January 2009
ISSN
0965-2140
1360-0443 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Aims: To assess hospitalization rates (HR) for poisoning with heroin,
methadone or strong analgesics and relate them to quantities of prescribed
methadone and strong analgesics in Denmark between 1998 and 2004. Design:
Population-based ecological study. Settings: We extracted data on all
emergency department visits and hospital admissions registered in the Danish
National Patient Registry with a diagnosis of poisoning with heroin (n =
1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale
of prescribed medications we used data from the Danish Medicines Agency.
Measurements: Age- and gender-standardized HR and defined daily doses (DDD)
per 1000 people per day. Findings: HR for heroin poisoning was 4.4 [95%
confidence interval (CI): 3.8-4.9] per 100 000 person-years (p-y) in 1998
and 4.6 (CI: 4.0-5.2) per 100 000 p-y in 2004. HR for methadone poisoning
increased from 0.1 (CI: 0.0-0.2) per 100 000 p-y in 1998 to 1.1 (CI:
0.8-1.4) per 100 000 p-y in 2004. HR for poisoning with strong analgesics
increased from 0.6 (CI: 0.4-0.9) per 100 000 p-y in 1998 to 2.1 (CI:
1.8-2.6) per 100 000 p-y in 2004. The sale of prescribed strong analgesics
(5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone
(3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased
slightly between 1998 and 2004. Conclusion: Increasing sale of prescribed
methadone and strong analgesics coincided with increasing HRs of poisoning
with these drugs, whereas HR of heroin poisoning varied. Further
longitudinal studies are important for the guidance of future policy making.
© 2009 The Authors.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
analgesic agent (drug toxicity)
diamorphine (drug toxicity)
methadone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
article
Denmark
emergency ward
female
hospitalization
human
male
population research
prescription
register
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008597404
MEDLINE PMID
19133894 (http://www.ncbi.nlm.nih.gov/pubmed/19133894)
PUI
L352829326
DOI
10.1111/j.1360-0443.2008.02420.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.2008.02420.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 908
TITLE
Chronic lumbar and sciatic pain. Are we using opioids correctly? Spinal
surgery vs morphine in the elderly
ORIGINAL (NON-ENGLISH) TITLE
Lumbalgia y ciática crónicas. ¿usamos adecuadamente los opiáceos? ¿cirugía
de raquis o morfina en el paciente mayor
AUTHOR NAMES
Robaina Padrón F.J.
AUTHOR ADDRESSES
(Robaina Padrón F.J., frobpad@gobiernodecanarias.org) Unidad Del Dolor
Crónico y Neurocirugía Funcional, Hospital Universitario de Gran Canaria,
Las Palmas de Gran Canaria, Spain.
CORRESPONDENCE ADDRESS
F. J. Robaina Padrón, Unidad Del Dolor Crónico y Neurocirugía Funcional,
Hospital Universitario de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Email: frobpad@gobiernodecanarias.org
SOURCE
Revista de la Sociedad Espanola del Dolor (2009) 16:1 (46-56). Date of
Publication: January 2009
ISSN
1134-8046
1134-8046 (electronic)
BOOK PUBLISHER
Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain.
ABSTRACT
The specialist literature is sending out alarm signals spread by different
organizations related to the study and treatment of noncancer pain and,
specifically, the long-term pharmacological management of low back pain. The
present article aims to draw attention to the problems resulting from the
long-term use of potent opiates to control persistent pain due to
degenerative lumbar disease, as well as to study the relationship between
opiate medication and surgery in this type of disorder. To date, the units
responsible for performing this type of surgery in the elderly generally
seem not to accept, or to be reluctant to use, minimally-invasive techniques
for spinal surgery, thus obliging many patients to undergo protracted
treatment with potent opiates. Recent publications have alerted us to the
risk of addiction resulting from prolonged opiate treatment, the frequency
of addiction varying between 5 and 24%. Clearly, there is a risk to
patients, society in general and physicians. Visits to the hospital
emergency departments due to fentanyl abuse increased 50-fold between 1994
and 2002. Not all healthcare professionals keep their knowledge up-to-date
and develop the skills required to provide effective treatment (guilty of
ignorance). Opiates can activate neurophysiological pronociceptor
mechanisms, creating a situation of increased pain sensitivity, which has
been described as opiate-induced hypersensitivity (OIH). The longterm
decrease in analgesic efficacy is most probably related to OIH; between 18%
and 41% of patients may abuse these medications. Between 1999 and 2002, the
number of deaths associated with opiate intoxication increased by 91.2% in
the USA. There is a need for more in-depth studies on the relationship
between cerebral structural changes and the neuro-physiological /
neuro-chemical mechanisms of nociceptor transmission in relation to chronic
opiate use. There is talk of "medicine flying blind" in the prescription of
opiates for the long-term management of lumbar pain of musculoskeletal
origin. Recently, in the field of surgical instrumentation, as well as in
the market of analgesic medication, there has been a certain distrust of the
results of published studies. There are sufficient scientific reasons, both
basic and clinical, to seriously question the long-term use of potent
opiates for the control of noncancer low back pain. The guidelines and
protocols developed by primary and specialist care professionals (management
by processes) encourages better management and control of this type of pain.
There is no need to continue with the current situation of opting out of
spinal surgery in the old or very old merely because of age and of
introducing the patient to an environment of morphine-on-demand. Purely
economic reasons are inadmissible and the clinical reasons are unappealing.
© 2009 Asociación España del Dolor. Published by Elsevier España, S.L. All
rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug therapy, pharmacoeconomics)
opiate (adverse drug reaction, drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
fentanyl (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ischialgia (drug therapy, disease management, drug therapy, surgery)
low back pain (drug therapy, disease management, drug therapy, surgery)
spine surgery
EMTREE MEDICAL INDEX TERMS
analgesic activity
bioethics
drug abuse
drug intoxication
drug use
human
hyperalgesia (side effect)
hypersensitivity (side effect)
intoxication (side effect)
long term care
medical education
minimally invasive surgery
nausea (side effect)
nociception
opiate addiction (complication, side effect)
practice guideline
prescription
primary medical care
review
side effect (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Orthopedic Surgery (33)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2009416455
PUI
L355065352
DOI
10.1016/S1134-8046(09)70805-5
FULL TEXT LINK
http://dx.doi.org/10.1016/S1134-8046(09)70805-5
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 909
TITLE
'Nother one for Narcan.
AUTHOR NAMES
Tabano C.
AUTHOR ADDRESSES
(Tabano C.)
CORRESPONDENCE ADDRESS
C. Tabano,
SOURCE
JEMS : a journal of emergency medical services (2009) 34:1 (20). Date of
Publication: Jan 2009
ISSN
0197-2510
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE DRUG INDEX TERMS
valproic acid
EMTREE MEDICAL INDEX TERMS
emergency health service
human
note
suicide attempt
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
valproic acid (1069-66-5, 99-66-1)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
19245950 (http://www.ncbi.nlm.nih.gov/pubmed/19245950)
PUI
L354394107
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 910
TITLE
Psychological comorbidities predicting prescription opioid abuse among
patients in chronic pain presenting to the emergency department
AUTHOR NAMES
Wilsey B.L.
Fishman S.M.
Tsodikov A.
Ogden C.
Symreng I.
Ernst A.
AUTHOR ADDRESSES
(Wilsey B.L., blwilsey@ucdavis.edu) Department of Anesthesiology and Pain
Medicine, VA Northern California Health Care System, University of
California, Davis, CA, United States.
(Fishman S.M.) Department of Anesthesiology and Pain Medicine, University of
California, Davis, CA, United States.
(Tsodikov A.) Division of Biostatistics, Department of Public Health
Sciences, University of California, Davis, CA, United States.
(Ogden C.; Symreng I.) Department of Anesthesiology and Pain Medicine,
University of California, Davis, CA, United States.
(Ernst A.) Department of Emergency Medicine, University of California,
Davis, CA, United States.
(Wilsey B.L., blwilsey@ucdavis.edu) Pain Academic Offfice, UC Davis Medical
Center, 3020 Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA
95817, United States.
(Tsodikov A.) Department of Biostatistics, School of Public Health,
University of Michigan, Ann Arbor, MI, United States.
(Ernst A.) Department of Emergency Medicine, University of New Mexico,
School of Medicine, Albuguergue, NM, United States.
CORRESPONDENCE ADDRESS
B.L. Wilsey, Pain Academic Office, UC Davis Medical Center, 3020 Ellison
Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817, United States.
Email: blwilsey@ucdavis.edu
SOURCE
Pain Medicine (2008) 9:8 (1107-1117). Date of Publication: 2008
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Objective. We attempted to identify psychological comorbidities that are
associated with the propensity for prescription opioid abuse. Interventions.
Patients presenting to an emergency department seeking opioid refills for
chronic pain were evaluated with five validated self-report instruments and
structured clinical interviews. The potential for prescription opioid abuse
was modeled with multiple regression analysis using depression, anxiety
disorders, personality disorder, and addiction as independent variables.
Results. Of the 113 patients studied, 91 (81%) showed a propensity for
prescription opioid abuse as determined by scores on the Screener and Opioid
Assessment for Patients with Pain instrument. Depression, anxiety, and a
history of substance were common and panic attacks, posttraumatic stress
disorder, and personality disorders were also found, albeit less frequently.
Panic attacks, trait anxiety, and the presence of a personality disorder
accounted for 38% of the variance in the potential for prescription opioid
abuse. Conclusions. Patients in chronic pain should be assessed for
psychological and addiction disorders because they are at increased risk for
abusing opioids. They should also be referred for psychosocial treatment as
part of their care, where appropriate. © 2008 by American Academy of Pain
Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy)
emergency ward
mental disease
opiate addiction (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
aged
anxiety disorder
article
Beck Depression Inventory
clinical assessment tool
comorbidity
depression
female
human
major clinical study
male
multiple regression
panic
Personality Diagnostic Questionnaire 4th edition
personality disorder
posttraumatic stress disorder
prescription
questionnaire
scoring system
Screener and Opioid Assessment for Patients with Pain instrument
self report
Structured Clinical Interview for DSM Disorders
structured interview
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008564033
MEDLINE PMID
18266809 (http://www.ncbi.nlm.nih.gov/pubmed/18266809)
PUI
L352749181
DOI
10.1111/j.1526-4637.2007.00401.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1526-4637.2007.00401.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 911
TITLE
Paediatric emergency transport - Organization and current perspective
ORIGINAL (NON-ENGLISH) TITLE
Transporte neonatal e pediátrico organização e perspectivas actuais
AUTHOR NAMES
Abecasis F.
AUTHOR ADDRESSES
(Abecasis F.) Unidade de Cuidados Intensivos Pediátricos, Hospital de Santa
Maria, Portugal.
CORRESPONDENCE ADDRESS
F. Abecasis, Unidade de Cuidados Intensivos Pediátricos, Hospital de Santa
Maria, Portugal.
SOURCE
Nascer e Crescer (2008) 17:3 (162-165). Date of Publication: 2008
ISSN
0872-0754
BOOK PUBLISHER
Hospital de Criancas Maria Pia, Rua da Boavista 827, Porto, Portugal.
ABSTRACT
Programmes of neonatal and paediatric transport allow tertiary hospitals to
extend their action into the community so that patients benefit from
specialized care that is usually only available after arrival at these
centres. The retrieval of a patient is associated with risks and limitations
that can be partly compensated if it is done by qualified personnel with
specialized equipments adapted to the transport environment. In this paper
the national and international context of interfacility transport of
paediatric critically ill patients will be analysed. We will discuss the
advantages and disadvantages of a specialized transport system, present
different models of organization and suggest the development of an organized
interfacility paediatric transport in the South of Portugal.
EMTREE DRUG INDEX TERMS
adenosine
amiodarone
antiasthmatic agent
antibiotic agent
anticonvulsive agent
antivirus agent
atropine
bicarbonate
diuretic agent
dobutamine
dopamine
epinephrine
fentanyl
gluconate calcium
infusion fluid
inotropic agent
ketamine
lidocaine
magnesium sulfate
mannitol
midazolam
milrinone
naloxone
noradrenalin
propofol
prostaglandin
rocuronium
thiopental
unindexed drug
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
patient transport
EMTREE MEDICAL INDEX TERMS
article
critically ill patient
hospital management
hospital organization
human
intensive care
interhospital cooperation
Portugal
tertiary health care
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
fentanyl (437-38-7)
gluconate calcium (299-28-5)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
mannitol (69-65-8, 87-78-5)
midazolam (59467-70-8)
milrinone (78415-72-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
propofol (2078-54-8)
rocuronium (119302-91-9)
thiopental (71-73-8, 76-75-5)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Portuguese
LANGUAGE OF SUMMARY
Portuguese, English
EMBASE ACCESSION NUMBER
2008565625
PUI
L352752057
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 912
TITLE
Oral versus intravenous opioid dosing for the initial treatment of acute
musculoskeletal pain in the emergency department
AUTHOR NAMES
Miner J.R.
Moore J.
Gray R.O.
Skinner L.
Biros M.H.
AUTHOR ADDRESSES
(Miner J.R., jimminer@hotmail.com; Moore J.; Gray R.O.; Skinner L.; Biros
M.H.) Department of Emergency Medicine, Hennepin County Medical Center,
Minneapolis, MN, United States.
CORRESPONDENCE ADDRESS
J. R. Miner, Department of Emergency Medicine, Hennepin County Medical
Center, Minneapolis, MN, United States. Email: jimminer@hotmail.com
SOURCE
Academic Emergency Medicine (2008) 15:12 (1234-1240). Date of Publication:
December 2008
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: The objective was to compare the time to medication
administration, the side effects, and the analgesic effect at sequential
time points after medication administration of an oral treatment strategy
using oxycodone solution with an intravenous (IV) treatment strategy using
morphine sulfate for the initial treatment of musculoskeletal pain in
emergency department (ED) patients. Methods: This was a prospective
randomized clinical trial of patients >6 years old who were going to receive
IV morphine sulfate for the treatment of musculoskeletal pain but did not
yet have an IV. Consenting patients were randomized to have the treating
physician order either 0.1 mg?kg morphine sulfate IV or 0.125 mg?kg
oxycodone orally in a 5 mg?5 mL suspension as their initial treatment for
pain. The time from the placement of the order to the administration of the
medication was recorded. Pain was measured using a 100-mm visual analog
scale (VAS) and recorded at 0, 10, 20, 30 and 40 minutes after drug
administration. Results: A total of 405 eligible patients were identified
during the study period; 328 (81.0%) patients consented to be in the study.
A total of 158 patients were randomized to the IV morphine sulfate treatment
group, and 162 were randomized to the oral oxycodone treatment group. Of the
patients who were randomized to IV therapy, 34 were withdrawn from the study
prior to drug administration; leaving 125 patients in the IV group for
analysis. Of the patients who randomized to oral therapy, 22 were withdrawn
from the study prior to drug administration, leaving 140 patients for
analysis. No serious adverse events were detected. There was a 12-minute
difference between the median time of the order and the administration of
oral oxycodone (8.5 minutes) and IV morphine (20.5 minutes). The mean
percent change in VAS score was larger for patients in the IV therapy group
than those in the oral therapy group at 10 and 20 minutes. At 30 and 40
minutes, the authors could no longer detect a difference. The satisfaction
scale score was higher after treatment for the morphine group (median = 4;
interquartile range [IQR] = 4 to 5) than for the oxycodone group (median =
4; IQR = 2 to 5; p = 0.008). Conclusions: The oral loading strategy was
associated with delayed onset of analgesia and decreased patient
satisfaction, but a shorter time to administration. The oral loading
strategy using an oxycodone solution provided similar pain relief to the IV
strategy using morphine 30 minutes after administration of the drug. Oral
0.125 mg?kg oxycodone represents a feasible alternative to 0.1 mg? kg IV
morphine in the treatment of severe acute musculoskeletal pain when
difficult or delayed IV placement greater than 30 minutes presents a barrier
to treatment. © 2008 by the Society for Academic Emergency Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (adverse drug reaction, clinical trial, drug comparison,
drug dose, intravenous drug administration)
oxycodone (adverse drug reaction, clinical trial, drug comparison, drug
dose, oral drug administration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
naloxone
opiate (clinical trial, drug combination, drug dose, drug therapy, oral drug
administration)
oxycodone plus paracetamol (drug combination)
paracetamol (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
musculoskeletal pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
analgesia
article
clinical trial
dose response
drug absorption
drug bioavailability
drug dose regimen
drug dose titration
female
human
informed consent
major clinical study
male
patient satisfaction
priority journal
prospective study
scoring system
unspecified side effect (side effect)
visual analog scale
CAS REGISTRY NUMBERS
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008586727
MEDLINE PMID
18945240 (http://www.ncbi.nlm.nih.gov/pubmed/18945240)
PUI
L352802796
DOI
10.1111/j.1553-2712.2008.00266.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1553-2712.2008.00266.x
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 913
TITLE
Orthopaedic anesthesia: Part 1. Commonly used anesthetic agents in
orthopaedics
AUTHOR NAMES
Latifzai K.
Sites B.D.
Koval K.J.
AUTHOR ADDRESSES
(Latifzai K.; Koval K.J., kjkmd@yahoo.com) Department of Orthopaedics,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
(Sites B.D.) Department of Anesthesia, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States.
(Koval K.J., kjkmd@yahoo.com) Dartmouth Hitchcock Medical Center, 1 Medical
Center Drive, Lebanon, NH 03766, United States.
CORRESPONDENCE ADDRESS
K. J. Koval, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03766, United States. Email: kjkmd@yahoo.com
SOURCE
Bulletin of the NYU Hospital for Joint Diseases (2008) 66:4 (297-305). Date
of Publication: 2008
ISSN
1936-9719
1936-9727 (electronic)
BOOK PUBLISHER
J. Michael Ryan Publishing Inc., 24 Crescent Drive North, Andover, United
States.
ABSTRACT
Anesthesia is a broad discipline; for orthopaedic applications, the type and
location of the planned orthopaedic procedure is important in the selection
of the most appropriate anesthetic agent and technique. The purpose of this
overiew is to: 1. highlight the role of several anesthetic agents commonly
used in an orthopaedic setting and 2. to familiarize the orthopaedist with
those techniques of regional anesthesia that have implications for emergency
rooms and other ambulatory settings. Because the subject matter is expansive
in scope, it is necessary to address each of the above objectives
separately, in two different articles. Part 1 describes anesthetic agents,
whereas Part 2 encompases techniques of adminsistering regional anesthesia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent (pharmacology)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (drug combination, pharmacology)
bupivacaine (drug combination, pharmacology)
desflurane (adverse drug reaction, drug comparison, inhalational drug
administration, pharmacology)
diazepam (pharmacology)
drug additive
epinephrine (drug combination, pharmacology)
fentanyl (pharmacology)
flumazenil (intravenous drug administration, pharmacokinetics, pharmacology)
isoflurane (adverse drug reaction, drug comparison, inhalational drug
administration, pharmacology)
ketamine (adverse drug reaction, drug combination, intramuscular drug
administration, intravenous drug administration)
lidocaine (drug combination, intravenous drug administration, pharmacology)
lorazepam (pharmacology)
midazolam (adverse drug reaction)
morphine (intravenous drug administration, pharmacology)
naloxone (intravenous drug administration, pharmacology)
nitrous oxide (drug combination, inhalational drug administration,
pharmacology)
norpethidine (pharmacokinetics, pharmacology)
opiate (adverse drug reaction, pharmacology)
pethidine (intramuscular drug administration, intravenous drug
administration, oral drug administration, pharmacology, subcutaneous drug
administration)
propofol (adverse drug reaction, drug comparison)
sedative agent (pharmacology)
sevoflurane (drug combination, drug comparison, inhalational drug
administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
orthopedics
EMTREE MEDICAL INDEX TERMS
analgesia
anatomy
bradycardia (side effect)
breathing
drug mechanism
emergency ward
hallucination (side effect)
human
hypotension (side effect)
injection site pain (side effect)
lipid solubility
local anesthesia
nausea (side effect)
nausea and vomiting (side effect)
pain
practice guideline
protein binding
regional anesthesia
review
sedation
side effect (side effect)
surgical technique
vomiting (side effect)
DRUG TRADE NAMES
demerol
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
desflurane (57041-67-5)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
isoflurane (26675-46-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
norpethidine (77-17-8)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
sevoflurane (28523-86-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009013329
MEDLINE PMID
19093907 (http://www.ncbi.nlm.nih.gov/pubmed/19093907)
PUI
L354039954
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 914
TITLE
Altered Mental Status
AUTHOR NAMES
Wong J.
Traub S.J.
Macnow L.
Kulchycki L.K.
AUTHOR ADDRESSES
(Wong J.) Department of Emergency Medicine, Jefferson Regional Medical
Center, Pittsburgh, PA, United States.
(Traub S.J.; Macnow L.; Kulchycki L.K.) Department of Emergency Medicine,
Beth Israel Deaconess Medical Center, Boston, MA, United States.
(Traub S.J.; Macnow L.; Kulchycki L.K.) Division of Emergency Medicine,
Harvard Medical School, Boston, MA, United States.
CORRESPONDENCE ADDRESS
L.K. Kulchycki, Department of Emergency Medicine, Beth Israel Deaconess
Medical Center, Boston, MA, United States.
SOURCE
Journal of Emergency Medicine (2008) 35:4 (445-448). Date of Publication:
November 2008
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
EMTREE DRUG INDEX TERMS
benzocaine (adverse drug reaction)
bicarbonate (intravenous drug administration)
dapsone (adverse drug reaction)
etomidate
flutamide (adverse drug reaction)
glyceryl trinitrate (adverse drug reaction)
methylene blue (drug therapy, intravenous drug administration)
metoclopramide (adverse drug reaction)
monolinuron (adverse drug reaction)
naloxone
nitroprusside sodium (adverse drug reaction)
paracetamol (adverse drug reaction)
paraquat (adverse drug reaction)
phenacetin (adverse drug reaction)
phenazopyridine (adverse drug reaction)
prilocaine (adverse drug reaction)
primaquine (adverse drug reaction)
sulfonamide (adverse drug reaction)
suxamethonium
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mental instability
EMTREE MEDICAL INDEX TERMS
alcohol consumption
arterial gas
article
clinical feature
deterioration
emergency ward
human
hypotension
intubation
mental health
methemoglobinemia (diagnosis, drug therapy, side effect)
priority journal
CAS REGISTRY NUMBERS
benzocaine (1333-08-0, 94-09-7)
bicarbonate (144-55-8, 71-52-3)
dapsone (80-08-0)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
flutamide (13311-84-7)
glyceryl trinitrate (55-63-0)
methylene blue (61-73-4)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
monolinuron (1746-81-2)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
phenacetin (62-44-2)
phenazopyridine (136-40-3, 94-78-0)
prilocaine (1786-81-8, 721-50-6)
primaquine (90-34-6)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Hematology (25)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008527417
MEDLINE PMID
18835511 (http://www.ncbi.nlm.nih.gov/pubmed/18835511)
PUI
L50290406
DOI
10.1016/j.jemermed.2008.08.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2008.08.006
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 915
TITLE
Substance-abuse related emergencies - Illegal drugs, part I
ORIGINAL (NON-ENGLISH) TITLE
Psychosozialer notfall: Substanzinduzierte störungen durch illegale drogen -
teil 1
AUTHOR NAMES
Kinn M.
Holzbach R.
Pajonk F.-G.B.
AUTHOR ADDRESSES
(Kinn M., mkinn@bgu-ludwigshafen.de) Abteilung für Anästhesie,
Intensivmedizin und Schmerztherapie, Berufsgenossenschaftlichen Unfallklinik
Ludwigshafen, .
(Holzbach R., R.Holzbach@wkp-lwl.org) Abteilung Suchtmedizin, Westfälischen
Kliniken Warstein und Lippstadt, .
(Pajonk F.-G.B., pajonk@klinik-dr-fontheim.de) Privat-Nerven-Klinik Dr. Kurt
Fontheim, Liebenburg.
CORRESPONDENCE ADDRESS
M. Kinn, Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie,
Berufsgenossenschaftlichen Unfallklinik Ludwigshafen, . Email:
mkinn@bgu-ludwigshafen.de
SOURCE
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (2008)
43:11-12 (746-753). Date of Publication: November/December 2008
ISSN
0939-2661
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
EMTREE DRUG INDEX TERMS
buprenorphine
cannabis
clonidine (intravenous drug administration)
cocaine
diamorphine
diazepam (intravenous drug administration)
furosemide (intravenous drug administration)
haloperidol (intravenous drug administration)
illicit drug
methylprednisolone (intravenous drug administration)
naloxone
opiate
propranolol derivative (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
substance abuse
EMTREE MEDICAL INDEX TERMS
aggression
article
clinical feature
drug dependence treatment
drug intoxication
dyskinesia
heart arrhythmia
human
satisfaction
DRUG TRADE NAMES
narcanti
subutex
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
cannabis (8001-45-4, 8063-14-7)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
furosemide (54-31-9)
haloperidol (52-86-8)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
German
EMBASE ACCESSION NUMBER
2008599147
MEDLINE PMID
19016385 (http://www.ncbi.nlm.nih.gov/pubmed/19016385)
PUI
L352833106
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 916
TITLE
A prospective study of non-fatal heroin overdose
AUTHOR NAMES
Fatovich D.M.
Bartu A.
Daly F.F.S.
AUTHOR ADDRESSES
(Fatovich D.M.; Daly F.F.S.) Department of Emergency Medicine, University of
Western Australia, Crawley, WA, Australia.
(Bartu A.) School of Nursing and Midwifery, Curtin University of Technology,
Bentley, WA, Australia.
CORRESPONDENCE ADDRESS
D.M. Fatovich, Department of Emergency Medicine, University of Western
Australia, Crawley, WA, Australia.
SOURCE
Journal of Substance Use (2008) 13:5 (299-307). Date of Publication: 2008
ISSN
1465-9891
1475-9942 (electronic)
BOOK PUBLISHER
Taylor and Francis Ltd., 4 Park Square, Milton Park, Abingdon, Oxfordshire,
United Kingdom.
ABSTRACT
Aims: We aimed to study the prevalence, characteristics and outcomes of
patients presenting with non-fatal heroin overdose. Design: Prospective
observational study. Setting: Emergency Department (ED). Participants:
Patients attending with non-fatal heroin overdose. Intervention: Nil.
Measurement: Descriptive and epidemiological data. Findings:
Two-hundred-and-forty-nine overdoses in 224 patients (61.2% male, range
15-49 years). Mean reported age of first heroin use was 18.8 years (range
10-42). Forty-two per cent reported a previous heroin overdose requiring
hospital intervention. Co-ingestants included benzodiazepines (61, 27.2%),
alcohol (35, 15.6%), cannabis (25, 11.1%), amphetamines (13, 5.8%) and
hallucinogens (3, 1.3%). Most patients experienced a benign course; 81 of
115 ambulance presentations (70.4%) received prehospital naloxone and 23
(9.2%) received naloxone in the ED; 67.9% had no investigations and
complications were uncommon (two aspiration, one hypoxic brain injury).
Median length of stay was 180 min (15 min to 48 h). Only 29 (11.6%)
presentations required admission. There were 15 individuals (6.7%) who had
40 (16.1% of the total) repeat presentations. Conclusions: Heroin overdose
tends to occur in experienced users who commonly co-ingest other drugs.
There is a trend of overdose occurring with increasing frequency in teenage
females. Repeat overdosing is common. However, while morbidity is low, these
patients require considerable resources.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
amphetamine derivative
benzodiazepine
cannabis
naloxone (drug therapy)
psychedelic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
ambulance
article
brain hypoxia
controlled study
disease course
emergency care
emergency ward
epidemiological data
female
hospital admission
human
length of stay
major clinical study
male
morbidity
observational study
outcome assessment
prevalence
priority journal
prospective study
pulmonary aspiration
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
cannabis (8001-45-4, 8063-14-7)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008467151
PUI
L352462818
DOI
10.1080/14659890802040773
FULL TEXT LINK
http://dx.doi.org/10.1080/14659890802040773
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 917
TITLE
Estimated drug overdose deaths averted by North America's first
medically-supervised safer injection facility
AUTHOR NAMES
Milloy M.-J.S.
Kerr T.
Tyndall M.
Montaner J.
Wood E.
AUTHOR ADDRESSES
(Milloy M.-J.S.; Kerr T.; Tyndall M.; Montaner J.; Wood E.,
uhri-ew@cfenet.ubc.ca) British Columbia Centre for Excellence in HIV/AIDS,
St. Paul's Hospital, Vancouver, BC, Canada.
(Milloy M.-J.S.) School of Population and Public Health, University of
British Columbia, Vancouver, BC, Canada.
(Kerr T.; Tyndall M.; Montaner J.; Wood E., uhri-ew@cfenet.ubc.ca)
Department of Medicine, University of British Columbia, Vancouver, BC,
Canada.
CORRESPONDENCE ADDRESS
M.-J.S. Milloy, British Columbia Centre for Excellence in HIV/AIDS, St.
Paul's Hospital, Vancouver, BC, Canada.
SOURCE
PLoS ONE (2008) 3:10 Article Number: e3351. Date of Publication: 7 Oct 2008
ISSN
1932-6203 (electronic)
BOOK PUBLISHER
Public Library of Science, 185 Berry Street, Suite 1300, San Francisco,
United States.
ABSTRACT
Background: Illicit drug overdose remains a leading cause of premature
mortality in urban settings worldwide. We sought to estimate the number of
deaths potentially averted by the implementation of a medically supervised
safer injection facility (SIF) in Vancouver, Canada. Methodology/Principal
Findings: The number of potentially averted deaths was calculated using an
estimate of the local ratio of non-fatal to fatal overdoses. Inputs were
derived from counts of overdose deaths by the British Columbia Vital
Statistics Agency and non-fatal overdose rates from published estimates.
Potentially-fatal overdoses were defined as events within the SIF that
required the provision of naloxone, a 911 call or an ambulance. Point
estimates and 95% Confidence Intervals (95% CI) were calculated using a
Monte Carlo simulation. Between March 1, 2004 and July 1, 2008 there were
1004 overdose events in the SIF of which 453 events matched our definition
of potentially fatal. In 2004, 2005 and 2006 there were 32, 37 and 38
drug-induced deaths in the SIF's neighbourhood. Owing to the wide range of
non-fatal overdose rates reported in the literature (between 5% and 30% per
year) we performed sensitivity analyses using non-fatal overdose rates of
50, 200 and 300 per 1,000 person years. Using these model inputs, the number
of averted deaths were, respectively: 50.9 (95% CI: 23.6-78.1); 12.6 (95%
CI: 9.6-15.7); 8.4 (95% CI: 6.5-10.4) during the study period, equal to 1.9
to 11.7 averted deaths per annum. Conclusions/Significance: Based on a
conservative estimate of the local ratio of non-fatal to fatal overdoses,
the potentially fatal overdoses in the SIF during the study period could
have resulted in between 8 and 51 deaths had they occurred outside the
facility, or from 6% to 37% of the total overdose mortality burden in the
neighborhood during the study period. These data should inform the ongoing
debates over the future of the pilot project. © 2008 Milloy et al.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
illicit drug (drug toxicity)
EMTREE DRUG INDEX TERMS
cocaine (drug toxicity)
diamorphine (drug toxicity)
hydromorphone (drug toxicity)
methadone (drug toxicity)
methylphenidate (drug toxicity)
morphine (drug toxicity)
naloxone (drug toxicity)
pentazocine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
mortality
EMTREE MEDICAL INDEX TERMS
ambulance
article
Canada
controlled study
emergency health service
health statistics
human
major clinical study
Monte Carlo method
North America
sensitivity analysis
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methylphenidate (113-45-1, 298-59-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008496663
MEDLINE PMID
18839040 (http://www.ncbi.nlm.nih.gov/pubmed/18839040)
PUI
L352543818
DOI
10.1371/journal.pone.0003351
FULL TEXT LINK
http://dx.doi.org/10.1371/journal.pone.0003351
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 918
TITLE
Training and prescription of naloxone for personal use in overdose for
opiate addicts
AUTHOR ADDRESSES
SOURCE
Emergency Medicine Journal (2008) 25:10 (688-689). Date of Publication:
October 2008
ISSN
1472-0205
1472-0213 (electronic)
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate
EMTREE DRUG INDEX TERMS
diamorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
opiate addiction (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug use
emergency ward
evidence based medicine
follow up
Glasgow coma scale
human
Medline
mortality
prescription
priority journal
short survey
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008517493
MEDLINE PMID
18843073 (http://www.ncbi.nlm.nih.gov/pubmed/18843073)
PUI
L352605934
DOI
10.1136/emj.2008.065698
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2008.065698
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 919
TITLE
[Commentary] case for peer naloxone further strengthened
AUTHOR NAMES
Lenton S.
AUTHOR ADDRESSES
(Lenton S., s.lenton@curtin.edu.au) National Drug Research Institute, Curtin
University of Technology, Perth, WA, Australia.
CORRESPONDENCE ADDRESS
S. Lenton, National Drug Research Institute, Curtin University of
Technology, Perth, WA, Australia. Email: s.lenton@curtin.edu.au
SOURCE
Addiction (2008) 103:10 (1658-1659). Date of Publication: October 2008
ISSN
0965-2140
1360-0443 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, prevention)
heroin dependence (drug therapy)
EMTREE MEDICAL INDEX TERMS
emergency treatment
human
note
patient education
peer group
policy
risk reduction
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008423469
MEDLINE PMID
18821876 (http://www.ncbi.nlm.nih.gov/pubmed/18821876)
PUI
L352298672
DOI
10.1111/j.1360-0443.2008.02346.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.2008.02346.x
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 920
TITLE
A pilot randomised clinical trial of 3-in-1 femoral nerve block and
intravenous morphine as primary analgesia for patients presenting to the
emergency department with fractured hip
AUTHOR NAMES
Graham C.A.
Baird K.
McGuffie A.C.
AUTHOR ADDRESSES
(Graham C.A., cagraham@cuhk.edu.hk) Crosshouse Hospital, Emergency
Department, Kilmarnock KA2 0BE, United Kingdom.
(McGuffie A.C.) Crosshouse Hospital, Orthopaedic Department, Kilmarnock KA2
0BE, United Kingdom.
(Baird K.) Accident and Emergency Medicine Academic Unit, Chinese University
of Hong Kong, Trauma and Emergency Centre, Shatin, N.T., Hong Kong.
CORRESPONDENCE ADDRESS
C.A. Graham, Crosshouse Hospital, Emergency Department, Kilmarnock KA2 0BE,
United Kingdom. Email: cagraham@cuhk.edu.hk
SOURCE
Hong Kong Journal of Emergency Medicine (2008) 15:4 (205-211). Date of
Publication: October 2008
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, Room 808, Two Chinachem Exchange Square, 338 King's Road,
North Point, Hong Kong.
ABSTRACT
Background: Fractured neck of femur (NOT) is a leading cause of morbidity
and mortality in the elderly. Published clinical guidelines suggest early
adequate analgesia as a key management aim. The femoral nerve '3-in-1 block'
has previously been shown to provide effective analgesia for these patients
in the peri- and post-operative phase of care. The aim of this study was to
examine the use of the '3-in-1' femoral nerve block as primary analgesia for
patients with a fractured NOT presenting to the emergency department.
Methods: This was a single centre pragmatic randomised controlled open-label
trial comparing femoral nerve block (using a '3-in-1' technique) with
intravenous (IV) morphine. A convenience sample of patients presenting to
the emergency department of a district general hospital with a clinically or
radiologically suspected fractured NOT were recruited. They were randomised
to receive either 0.1 mg/kg IV bolus of morphine or a '3-in-1' femoral nerve
block with 30 mi of 0.5% plain bupivacaine. Visual analogue pain scores were
noted prior to treatment and at 30 minutes, 2 hours, 6 hours and 12 hours
after treatment. Immediate complications such as vascular puncture or the
requirement for naloxone were noted. Results: Forty patients were recruited,
22 patients were randomised to IV morphine and 18 patients were randomised
to '3-in-1' femoral nerve block. Complete data were available for 33
patients. There was no significant difference in initial median pain score
(p=0.45). Analysis using the Wilcoxon test showed a significant decrease in
pain score for the morphine group (p=0.01) and the nerve block group
(p<0.01) at 30 minutes compared with baseline. Analysis using the
Mann-Whitney U test between median pain scores at each time point showed a
significant lower pain score in the nerve block group at 30 minutes
(p=0.046). There were no immediate complications in either group.
Conclusion: Our results suggest that a '3-in-1' femoral nerve block is at
least as effective as IV morphine when used as primary analgesia for
patients with fractured NOF Our results suggest that the femoral nerve block
may provide better analgesia at 30 minutes. Further larger scale randomised
trials are warranted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, clinical trial, drug combination, drug
dose, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
bupivacaine (clinical trial, drug combination, drug therapy)
diclofenac (clinical trial, drug dose, drug therapy)
dihydrocodeine (clinical trial, drug dose, drug therapy, oral drug
administration)
naloxone
opiate derivative (drug therapy, intravenous drug administration)
paracetamol (clinical trial, drug dose, drug therapy, oral drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
femoral neck fracture (diagnosis)
femoral nerve
nerve block
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
aged
article
blood vessel injury
bolus injection
clinical article
clinical trial
controlled clinical trial
controlled study
drug efficacy
emergency ward
female
general hospital
hip fracture (diagnosis)
hip radiography
human
male
open study
outcome assessment
randomized controlled trial
scoring system
visual analog scale
CAS REGISTRY NUMBERS
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
diclofenac (15307-79-6, 15307-86-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Gerontology and Geriatrics (20)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2008542025
PUI
L352685410
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 921
TITLE
Hong Kong Poison Information Centre: Annual Report 2006
AUTHOR NAMES
Chan Y.C.
Tse M.L.
Lau F.L.
AUTHOR ADDRESSES
(Chan Y.C., chanyc3@ha.org.hk) Hong Kong Poison Information Centre, K3A,
United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.
(Tse M.L.; Lau F.L.)
CORRESPONDENCE ADDRESS
Y.C. Chan, Hong Kong Poison Information Centre, K3A, United Christian
Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong. Email:
chanyc3@ha.org.hk
SOURCE
Hong Kong Journal of Emergency Medicine (2008) 15:4 (240-253). Date of
Publication: October 2008
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, Room 808, Two Chinachem Exchange Square, 338 King's Road,
North Point, Hong Kong.
ABSTRACT
Objective: To report the poisoning data of Hong Kong Poison Information
Centre (HKPIC) in 2006. Methods: From 1st January 2006 to 31st December
2006, all poisoning cases received by HKPIC were retrieved from its database
(DATOX) for analysis. Results: A total of 2555 poisoned cases were analysed.
There were 1051 male and 1466 female patients and nearly 60% of the cases
were between 20 and 49 years old. Common causes of exposure were suicidal
attempts and accidents. Paracetamol, sedative-hypnotic and household
products were common sources of poison exposure. The majority of the
patients were managed conservatively, with 18.8% and 10.5% treated by
decontamination and antidotes respectively. Most cases had uneventful
recovery; less than 1% of the poison exposure resulted in death and about 5%
of the exposure had major outcomes. Nearly half of the cases were managed in
the accident & emergency department without hospitalisation. Conclusions:
This annual report provides updated epidemiological information on poisoning
in Hong Kong. Subsequent annual reports would provide important information
on the trend of poisoning pattern and may guide further strategies in poison
control and prevention in Hong Kong.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug dose, drug therapy, oral drug administration)
antidote (drug therapy)
antitoxin (drug toxicity)
atropine (drug therapy)
benzodiazepine derivative (drug therapy)
bicarbonate (drug therapy)
calcium (drug therapy)
carbon monoxide (drug toxicity)
domestic chemical (drug toxicity)
flumazenil (drug therapy)
glucagon (drug therapy)
glucose (drug therapy)
hypnotic agent (drug toxicity)
insecticide (drug toxicity)
insulin (drug therapy)
ketamine (drug toxicity)
laxative (drug therapy)
methylene blue (drug therapy)
naloxone (drug therapy)
opiate (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy)
pralidoxime (drug therapy)
sedative agent (drug toxicity)
thiamine (drug therapy)
unindexed drug
venom antiserum (drug therapy)
vitamin K group (drug therapy)
warfarin (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, prevention)
medical information system
poison center
toxicology
EMTREE MEDICAL INDEX TERMS
accident
adolescent
adult
aged
article
child
conservative treatment
disease severity
drug intoxication (drug therapy, prevention)
emergency ward
fatality
female
Hong Kong
hospitalization
human
infant
information retrieval
major clinical study
male
medical literature
outcome assessment
preventive health service
single drug dose
stomach lavage
suicide attempt
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
carbon monoxide (630-08-0)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
thiamine (59-43-8, 67-03-8)
vitamin K group (12001-79-5)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2008542030
PUI
L352685415
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 922
TITLE
Barriers to Propofol Use in Emergency Medicine
AUTHOR NAMES
Green S.M.
Krauss B.
AUTHOR ADDRESSES
(Green S.M., stevegreen@tarascon.com) Department of Emergency Medicine, Loma
Linda University Medical Center, Children's Hospital, Loma Linda, CA, United
States.
(Krauss B.) The Division of Emergency Medicine, Children's Hospital, Harvard
Medical School, Boston, MA, United States.
CORRESPONDENCE ADDRESS
S.M. Green, Department of Emergency Medicine, Loma Linda University Medical
Center, Children's Hospital, Loma Linda, CA, United States. Email:
stevegreen@tarascon.com
SOURCE
Annals of Emergency Medicine (2008) 52:4 (392-398). Date of Publication:
October 2008
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Propofol is rapidly becoming one of the most popular procedural sedation and
analgesia agents in emergency medicine. However, in many hospitals emergency
physicians lack access to this potent sedative. This article details the
evidence and politics underlying this area of controversy, the nature and
authority of hospital-wide sedation policies, and discussion of the most
common criticisms of emergency department use of propofol. © 2008 American
College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
propofol (adverse drug reaction)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
flumazenil
naloxone
opiate derivative
EMTREE MEDICAL INDEX TERMS
analgesia
article
drug use
emergency medicine
emergency ward
hospital policy
human
medical society
practice guideline
priority journal
sedation
side effect (side effect)
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008443007
MEDLINE PMID
18295374 (http://www.ncbi.nlm.nih.gov/pubmed/18295374)
PUI
L50071905
DOI
10.1016/j.annemergmed.2007.12.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2007.12.002
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 923
TITLE
2007 update of the 3rd Consensus Conference in Emergency Medicine (Créteil,
April 1993): Medicinal treatment of pain in adults in the emergency setting
ORIGINAL (NON-ENGLISH) TITLE
Actualisation 2007 de la III(e) Conférence de consensus en médecine
d'urgence (Créteil, avril 1993) : le traitement médicamenteux de la douleur
de l'adulte dans le cadre de l'urgence
AUTHOR NAMES
Trinh-Duc A.
Santin A.
Sureau C.
Bagou G.
Charpentier S.
Couvreur J.
Fougeras O.
Miranda J.
Philippe J.-M.
Perrier C.
Raphaël V.
Le Gall C.
AUTHOR ADDRESSES
(Trinh-Duc A., albert.trinh-duc@wanadoo.fr; Santin A.; Sureau C.; Bagou G.;
Charpentier S.; Couvreur J.; Fougeras O.; Miranda J.; Philippe J.-M.;
Perrier C.; Raphaël V.; Le Gall C.) Service d'accueil des urgences, centre
hospitalier, route de Villeneuve-sur-Lot, 47923 Agen cedex 9, France.
CORRESPONDENCE ADDRESS
A. Trinh-Duc, Service d'accueil des urgences, centre hospitalier, route de
Villeneuve-sur-Lot, 47923 Agen cedex 9, France. Email:
albert.trinh-duc@wanadoo.fr
SOURCE
Douleurs (2008) 9:5 (248-278). Date of Publication: October 2008
ISSN
1624-5687
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
A questionnaire was posted on the SFMU website from February 15 through
April 15 2007 in order to assess the impact of the 1993 Consensus
Conference. Four hundred and seventy-three questionnaires were available for
study. Among the main findings, it was noted that most of the emergency
physicians had a mixed activity, with a predominance of the adult
population. Numeric and analogue scales were widely used. Dolopus and the
Edin scale were not employed. Sixty-two percent of persons interrogated used
the unit protocol. Seventy-two percent of the interrogated persons had an
initial dose of morphine then titration with repeated boluses. Management of
adults with pain thus appears to be in compliance with the guidelines. An
analysis of the literature, using Medline, Cochrane and ScienceDirect(®) was
based on decreasing level of proof. As for the preceding updates, the
articles were classified as follows: randomized controlled studies,
practical guidelines, meta-analysis, review articles. Data concerning
medication used in the emergency setting for pain relief were selected. ©
2008.
EMTREE DRUG INDEX TERMS
17 methylnaltrexone (drug therapy)
acktiskenan
adolor
alfentanil (drug comparison, drug dose, drug therapy, pharmacokinetics,
pharmacology)
almivopan (drug therapy)
analgesic agent (drug therapy)
antiemetic agent (drug therapy)
antivitamin K (drug interaction)
buprenorphine (drug therapy)
codeine (drug therapy)
diclofenac (adverse drug reaction, drug comparison, drug therapy,
intramuscular drug administration, oral drug administration)
fenoprofen (adverse drug reaction, drug therapy, oral drug administration)
fentanyl (buccal drug administration, drug comparison, drug therapy,
pharmaceutics, pharmacokinetics, pharmacology)
fentanyl citrate
hydrocodone (drug comparison, drug therapy)
hydromorphone (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration, pharmacokinetics, pharmacology)
ibuprofen (adverse drug reaction, drug comparison, drug therapy, oral drug
administration, pharmacokinetics, pharmacology)
ketoprofen (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration, pharmacokinetics, pharmacology)
ketorolac (drug comparison, drug therapy)
morphine (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy, inhalational drug administration, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, pharmaceutics, pharmacokinetics, pharmacology, subcutaneous
drug administration)
morphine sulfate
morphine sulfate
nalbuphine (drug therapy)
naloxone (drug therapy)
naproxen (adverse drug reaction, drug therapy, oral drug administration)
opiate (drug comparison, drug therapy)
oxycodone (adverse drug reaction, drug combination, drug comparison, drug
therapy, pharmacokinetics, pharmacology)
oxytocin
paracetamol (adverse drug reaction, drug combination, drug comparison, drug
dose, drug interaction, drug therapy, intravenous drug administration, oral
drug administration, pharmaceutics, pharmacokinetics, pharmacology, rectal
drug administration)
pethidine (drug comparison, drug therapy, oral drug administration)
placebo
propacetamol (drug therapy, intravenous drug administration, oral drug
administration)
psychotropic agent (adverse drug reaction, drug therapy)
sirop
steroid (drug therapy, oral drug administration, pharmacokinetics,
pharmacology)
sufentanil (drug comparison, drug therapy, pharmacokinetics, pharmacology)
unclassified drug
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (drug therapy, diagnosis, disease management, drug therapy)
consensus development
emergency medicine
pain (drug therapy, diagnosis, disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (diagnosis, disease management, drug therapy)
adult
agitation
analgesia
anaphylaxis (side effect)
article
attitude
bad taste (side effect)
bad taste (side effect)
bleeding (side effect)
clinical assessment
clinical assessment tool
clinical evaluation
clinical protocol
clinical trial
constipation (side effect)
data base
drug absorption
drug capsule
drug contraindication
drug dose comparison
drug dose titration
drug efficacy
drug hypersensitivity (side effect)
drug mechanism
drug metabolism
drug safety
drug tolerance
drug withdrawal
dyspepsia (side effect)
dysuria (side effect)
embolism (side effect)
emergency physician
emergency ward
health care utilization
human
kidney failure (side effect)
liver failure (side effect)
liver toxicity (side effect)
loading drug dose
meta analysis
mucosa inflammation (side effect)
nasal discomfort (side effect)
nasal discomfort (side effect)
nausea (drug therapy, side effect)
necrotizing fasciitis (side effect)
nociception
nose obstruction (side effect)
obesity (side effect)
optimal drug dose
pain assessment
patient compliance
patient controlled analgesia
patient satisfaction
peptic ulcer (side effect)
pharynx discomfort (side effect)
practice guideline
pruritus (side effect)
questionnaire
repeated drug dose
respiration depression (side effect)
rhinorrhea (side effect)
sedation
stomach pain (side effect)
systematic review
tablet formulation
thrombocytopenia (side effect)
time to maximum plasma concentration
urine retention (side effect)
vomiting (side effect)
DRUG TRADE NAMES
acktiskenan
actiq
adolor
oxynorm
oxytocin
perfalgan
prodafalgan
rylomine
sevredol
sirop
sophidone
CAS REGISTRY NUMBERS
17 methylnaltrexone (83387-25-1)
alfentanil (69049-06-5, 71195-58-9)
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
diclofenac (15307-79-6, 15307-86-5)
fenoprofen (29679-58-1, 31879-05-7, 34691-31-1)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1)
ketoprofen (22071-15-4, 57495-14-4)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxytocin (50-56-6, 54577-94-5)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propacetamol (66532-85-2)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French, English
EMBASE ACCESSION NUMBER
2009483917
PUI
L355249403
DOI
10.1016/j.douler.2008.06.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.douler.2008.06.010
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 924
TITLE
Serotonin syndrome triggered by a single dose of suboxone
AUTHOR NAMES
Isenberg D.
Wong S.C.
Curtis J.A.
AUTHOR ADDRESSES
(Isenberg D., disenber@drexelmed.edu; Wong S.C.; Curtis J.A.) Department of
Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA
19102, United States.
CORRESPONDENCE ADDRESS
D. Isenberg, Department of Emergency Medicine, Drexel University College of
Medicine, Philadelphia, PA 19102, United States. Email:
disenber@drexelmed.edu
SOURCE
American Journal of Emergency Medicine (2008) 26:7 (840.e3-840.e5). Date of
Publication: September 2008
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Suboxone (buprenorphine/naloxone) is an oral medication used for the
treatment of opiate dependence. Because of its mixed properties at the
opiate receptors, buprenorphine has a ceiling on its euphoric effects. We
report the first case of serotonin syndrome caused by buprenorphine and
review other medications implicated in serotonin syndrome. A 54-year-old man
on tricyclic antidepressants took an unprescribed dose of
buprenorphine/naloxone. He presented to the emergency department with signs
and symptoms of severe serotonin syndrome including clonus, agitation, and
altered mental status. His agitation was not controlled with benzodiazepines
and was electively intubated. At the recommendation of the toxicology
service, cyproheptadine, a serotonin receptor antagonist, was administered
with improvement in the patient's symptoms. Emergency physicians should be
aware of the potential of buprenorphine/naloxone to trigger serotonin
syndrome. In 2002, the Federal Drug Administration approved suboxone
(buprenorphine/naloxone) for the treatment of opiate dependence [1].
Buprenorphine/naloxone is an oral medication that contains buprenorphine, an
opiate agonist/antagonist, and naloxone, an opiate antagonist. Because of
its mixed properties at the κ- and μ-opiate receptors, buprenorphine, in
contrast to pure opioid agonists such as heroin, has a ceiling on its
euphoric effects. Naloxone has poor oral bioavailability but will block any
euphoric effects if a patient attempts to crush and inject the medication
intravenously. The naloxone also discourages patients from using heroin or
other opiates while taking buprenorphine. The Federal Drug Administration
allows certified physicians to prescribe buprenorphine/naloxone from their
private offices unlike methadone where a patient must be enrolled in a
formal treatment program [2]. A 54-year-old man presented to a community
emergency department complaining of jaw spasm and the inability to open his
mouth for 1 hour. One and a half hours before arrival, he admitted to taking
a friend's buprenorphine/naloxone in an attempt to achieve a euphoric high.
The patient's medical history included hypertension, insulin-dependent
diabetes, diabetic peripheral neuropathy, seizure disorder, urinary
incontinence, insomnia, and chronic lower back pain. His medication list
included insulin, doxepin, ramipril, doxazosin, tolterodine, gabapentin,
metformin, amitriptyline, fluticasone, repaglinide, ibuprofen, and morphine.
His social history included 1/2 pack of cigarettes per day and had a history
of intravenous drug use. However, he denied alcohol use. The patient's vital
signs on arrival were temperature of 100.4°F rectally, heart rate of 130
beats per minute, respiratory rate of 30 breaths per minute, blood pressure
of 210/93 mm Hg, pulse oximetry of 98% on room air, and a bedside glucose of
243 g/d. The patient was extremely anxious but in no acute distress. He was
unable to sit still on the bed. He would respond to questions and follow
commands but had episodes during which he spoke nonsensically. On physical
examination, his head was atraumatic. Pupils were 4 to 2 mm equal, round,
and reactive. There was masseter spasm with accompanying trismus. The neck
was supple with full painless range of motion. The lungs were clear. Cardiac
examination revealed a regular, tachycardic rhythm without murmurs, rubs, or
gallops. The abdomen was obese but soft and nontender, without organomegaly.
Extremities were without cyanosis or edema. The patient was unable to
cooperate with a detailed neurological examination, but there were no
obvious cranial nerve deficits. He had 5/5 strength in all extremities;
reflexes were 3+ and symmetrical in the upper extremities, with clonus noted
in his lower extremities. The patient had spontaneous jerking movements of
his upper extremities as well. The patient remained agitated and confused.
He was hydrated with 2 L of normal saline. He was given a total of 8 mg of
lorazepam (2 mg in 4 separate doses) and 4 mg of midazolam. He was further
given diphenhydramine and benzotropin for a possible dystonic reaction. He
was given 2 mg of hydromorphone intravenously for possible acute narcotic
withdrawal. There was no change in the patient's condition with any of these
interventions. Because of the need to obtain a computed tomographic scan and
a lumbar puncture, the decision was made, after discussion with the family,
to electively intubate the patient. The patient was intubated using
etomidate and succinylcholine without difficulty. Furthermore, ceftriaxone 2
g and vancomycin 1 g were given intravenously for possible meningitis. The
patient's laboratory work showed complete blood count within normal limits
with a normal differential and normal coagulation studies. The patient's
chemistry was significant for a blood glucose of 243 mg/dL, calcium of 7.0
mg/dL, and creatine kinase of 1006 U/L, with a normal MB fraction.
Troponin-T and liver function tests were all within normal limits. A urine
drug screen was positive for methadone and tricyclic antidepressants. The
electrocardiogram showed a sinus tachycardia with nonspecific ST segment
changes. A chest radiograph and computed tomographic scan of the brain
showed no abnormalities. Cerebrospinal fluid gram stain and culture were
negative for organisms. The toxicology service was consulted and was
concerned about possible serotonin syndrome (SS) from the multiple tricyclic
antidepressant medications combined with buprenorphine/naloxone. The patient
was started on cyproheptadine 4 mg via nasogastric tube. The patient was
transferred to the intensive care unit in critical but stable condition. The
patient was continued on cyproheptadine in the intensive care unit with
improvement in his mental status. On hospital day 3, the patient
self-extubated and was found to be alert, oriented, and cooperative. He
complained of chest pain and was ruled out for acute coronary syndrome with
3 negative troponins. On hospital day 4, the patient was discharged home in
stable condition and at baseline mental status. At 6 months, the patient
complained of no sequela from this episode. We report a case of SS
precipitated by an acute ingestion of buprenorphine/naloxone. Serotonin
syndrome is a cluster of symptoms that results from an excess amount of
serotonin in the central nervous system (CNS). This is usually the result of
drug interactions including selective serotonin reuptake inhibitors (SSRIs),
monoamine oxidase inhibitors, and certain synthetic opiates. The effects of
serotonin range from mild agitation to death. As the number of prescriptions
for SSRIs increases, so does the incidence of SS. In 2005, the toxic
exposure surveillance system reported 48 279 exposures to SSRIs with 118
deaths [3]. The diagnosis of SS is based on clinical examination because
there is no confirmatory laboratory testing available. Although there is no
consensus on the diagnostic criteria for SS, a number of criteria have been
proposed [4,5]. Mild symptoms include tremor, diaphoresis, and restless.
More severe symptoms include altered mental status, autonomic nervous system
instability, and hyperreflexia (usually more significant in the lower
extremities) [6]. Previous reports have linked several synthetic opiates to
SS. Meperidine, methadone, and tramadol are well associated with SS [7-11].
Although opiate analogues do not inhibit serotonin reuptake like synthetic
opioids, there have been several case reports of morphine analogues
triggering SS [12]. Karunatilake and Buckley [13] report a case of SS
involving oxycodone and as does Rosebraugh et al [14]. Gnanadesigan and
colleagues [15] reports 3 cases of SS involving oxycodone at a long-term
care facility. The patients in these reports developed the classic triad of
autonomic instability, neuromuscular changes, and altered mental status.
Because morphine analogues do not inhibit serotonin reuptake like opioids,
other theories have been proposed to explain SS involving these drugs. There
are no definitive studies in humans that explain the effects of opiates on
the serotonergic system. All theories involving opiates and SS come from
animal models. Hiyami et al [16] showed that buprenorphine itself increased
serotonin metabolites in the midbrain of rats. In a 1998 study, placement of
morphine pellets into rat brains produced a 50% increase in circulating
serotonin levels [17]. After 12 hours, the level of circulating serotonin
returned to baseline. In addition, opiates inhibit GABAergic neurons in the
dorsal raphe nucleus and, as a result, disinhibit serotonin release in the
CNS [18]. Therefore, buprenorphine may increase serotonin in the CNS through
disinhibition or a yet undescribed mechanism. We considered the possibility
of opiate withdrawal in this patient precipitated by the naloxone component
of the buprenorphine/naloxone. The patient's urine drug screen was negative
for opiates but was positive for methadone. However, the temporal
relationship between the time the patient took the buprenorphine/naloxone
and the onset of symptoms suggests that this medication was the cause of the
SS. In addition, we treated the patient empirically with hydromorphone
without change in the patient's condition. We report the first case of SS
associated with the use of buprenorphine/naloxone. Emergency practitioners
and physicians prescribing buprenorphine/naloxone should be aware of the
possibility of this drug to trigger SS. © 2008 Elsevier Inc. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (adverse drug reaction, drug therapy, oral drug
administration)
cyproheptadine (drug therapy, intragastric drug administration)
EMTREE DRUG INDEX TERMS
amitriptyline
benzatropine
ceftriaxone (intravenous drug administration)
diphenhydramine
doxazosin
doxepin
etomidate
fluticasone
gabapentin
hydromorphone
ibuprofen
insulin
metformin
methadone
morphine
ramipril
repaglinide
tolterodine
vancomycin (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
serotonin syndrome (side effect, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
adult
agitation
article
case report
clonus (side effect)
drug indication
emergency ward
human
male
mental health
opiate addiction
priority journal
self medication
side effect (side effect)
single drug dose
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
benzatropine (86-13-5)
ceftriaxone (73384-59-5, 74578-69-1)
cyproheptadine (129-03-3, 969-33-5)
diphenhydramine (147-24-0, 58-73-1)
doxazosin (74191-85-8)
doxepin (1229-29-4, 1668-19-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fluticasone (90566-53-3)
gabapentin (60142-96-3)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1)
insulin (9004-10-8)
metformin (1115-70-4, 657-24-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
ramipril (87333-19-5)
repaglinide (135062-02-1)
tolterodine (124937-51-5)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008412312
MEDLINE PMID
18774063 (http://www.ncbi.nlm.nih.gov/pubmed/18774063)
PUI
L352250495
DOI
10.1016/j.ajem.2008.01.039
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2008.01.039
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 925
TITLE
Case files of the University of Massachusetts fellowship in medical
toxicology: lethal dose of opioids contained in an elastomeric capsule
labeled as vancomycin.
AUTHOR NAMES
Courtney J.
Boyer E.
AUTHOR ADDRESSES
(Courtney J.; Boyer E.) Department of Emergency Medicine, Division of
Medical Toxicology, University of Massachusetts Medical School, Worcester,
MA 01655, USA.
CORRESPONDENCE ADDRESS
J. Courtney, Department of Emergency Medicine, Division of Medical
Toxicology, University of Massachusetts Medical School, Worcester, MA 01655,
USA. Email: jcourtn@gmail.com
SOURCE
Journal of medical toxicology : official journal of the American College of
Medical Toxicology (2008) 4:3 (192-196). Date of Publication: Sep 2008
ISSN
1556-9039
ABSTRACT
A 67 year-old male presented to the emergency department with alteration in
mental status. On arrival he had vital signs: pulse 110, BP 173/83,
respiratory rate 4, oxygen saturation 57% and temperature 36.1 degrees
Celsius. His past medical history included hypertension, vitamin B12
deficiency, hyperlipidemia, and recurrent cellulitis treated with
vancomycin. The patient had no response to noxious stimuli, pinpoint pupils,
and agonal respirations. Secondary to his wife's vehement denial that he had
access to or history of using any narcotics, he was intubated after 2.2mg IV
naloxone failed to reverse respiratory depression. Thirty minutes before
presentation, however, he had received an intravenous infusion of vancomycin
administered by his wife at home. The vancomycin, obtained from a home
infusion medication supply company, was contained in one of five sealed
elastomeric capsules delivered earlier that day. A qualitative comprehensive
toxicology screen of urine for 1043 substances identified morphine, codeine,
naloxone, lidocaine and caffeine. The original elastomeric container was not
available for testing, but another container from the same delivery was
submitted for testing to the state forensic laboratory. This intact
container was labeled as Vancomycin 1g in 240mL of normal saline. The
forensic laboratory confirmed that the alkaloidal contents of the
elastomeric capsule were 10% codeine, 4.4% 6-monoacetyl morphine, and 84%
morphine. No vancomycin was identified in the infusion bottles. The case was
referred to the local police department and the state department of health
drug control board. The home infusion company was also immediately notified
to prevent similar occurrence. CONCLUSION: We are reporting the first known
case of opioid overdose from an adulterated elastomeric capsule that was
labeled as containing an antimicrobial agent.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antiinfective agent
narcotic analgesic agent (drug toxicity)
vancomycin
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug labeling
medication error
EMTREE MEDICAL INDEX TERMS
aged
article
case report
chemically induced disorder
chemistry
drug contamination
drug packaging
human
infusion
male
microcapsule
respiratory failure (therapy)
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
vancomycin (1404-90-6, 1404-93-9)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
18821494 (http://www.ncbi.nlm.nih.gov/pubmed/18821494)
PUI
L352597352
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 926
TITLE
Approach to a child with depressed level of consciousness and coma
AUTHOR NAMES
Sarnaik A.
Bhaya N.B.
Mahajan P.V.
AUTHOR ADDRESSES
(Sarnaik A., asarnaik@dmc.org; Bhaya N.B., nbhaya@dmc.org; Mahajan P.V.)
Division of Emergency Medicine, Carman and Ann Adams Department of
Pediatrics, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 4820,
United States.
CORRESPONDENCE ADDRESS
A. Sarnaik, Division of Emergency Medicine, Carman and Ann Adams Department
of Pediatrics, Wayne State University, 3901 Beaubien Blvd., Detroit, MI
4820, United States. Email: asarnaik@dmc.org
SOURCE
Therapy (2008) 5:4 (435-439). Date of Publication: 2008
ISSN
1475-0708
1744-831X (electronic)
BOOK PUBLISHER
Future Medicine Ltd., 2nd Albert Place, Finchley Central, London, United
Kingdom.
ABSTRACT
Altered mental status and coma can be considered as an acute neurological
emergency characterized by significant brain impairment, necessitating a
rapid, methodical approach to evaluation and treatment. There are several,
diverse causes of coma, which makes an exact diagnosis challenging.
Regardless of the etiology, coma is suggestive of a primary insult to the
brain, which, if left untreated, can rapidly progress to secondary injury,
and thus result in substantial morbidity and even mortality. It is
imperative to rapidly recognize this entity, institute appropriate
treatments and improve prognosis. In this article, we review the
pathophysiology of coma and its causes to get a basic understanding of this
entity. We also discuss the various diagnostic and management approaches for
timely recognition and treatment of this life-threatening emergency. In
addition, we present some prognostic indicators in a comatose child. © 2008
Future Medicine Ltd.
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
antibiotic agent (drug therapy)
antihistaminic agent (drug toxicity)
barbituric acid derivative (drug toxicity)
benzodiazepine derivative (drug therapy, drug toxicity)
cannabis (drug toxicity)
carbamazepine (drug toxicity)
carbon monoxide (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
cocaine (drug toxicity)
cyanide (drug toxicity)
flumazenil (drug therapy, intravenous drug administration)
furosemide (drug therapy)
glucose (drug therapy, intravenous drug administration)
heavy metal (drug toxicity)
lead (drug toxicity)
loop diuretic agent (drug therapy)
lysergide (drug toxicity)
mannitol (drug therapy)
naloxone (drug therapy, intramuscular drug administration, subcutaneous drug
administration)
narcotic agent (drug toxicity)
organophosphate (drug toxicity)
osmotic diuretic agent (drug therapy)
paracetamol (drug toxicity)
phenobarbital (drug therapy)
phenothiazine (drug toxicity)
phenytoin (drug therapy)
salicylic acid (drug toxicity)
steroid (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
coma (therapy)
consciousness disorder (therapy)
EMTREE MEDICAL INDEX TERMS
anamnesis
arousal
blood analysis
brain decompression
brain dysfunction
brain infection (drug therapy)
brain injury
catatonia
cerebrospinal fluid analysis
child
computer assisted tomography
conversion disorder
disease course
drug intoxication (drug therapy)
electroencephalography
emergency treatment
endotracheal intubation
epilepsy (drug therapy)
fluid resuscitation
Glasgow coma scale
human
hyperalimentation
hypoglycemia (drug therapy)
hypoxia
induced hypothermia
intracranial hypertension (drug therapy, surgery)
medical assessment
mental health
metabolic disorder
morbidity
mortality
neurologic examination
nuclear magnetic resonance imaging
outcome assessment
pathophysiology
patient care
physical examination
prognosis
review
unconsciousness
vascular disease
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
carbamazepine (298-46-4, 8047-84-5)
carbon monoxide (630-08-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
cyanide (57-12-5)
flumazenil (78755-81-4)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
lead (7439-92-1)
lysergide (50-37-3)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenothiazine (92-84-2)
phenytoin (57-41-0, 630-93-3)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008378711
PUI
L352123647
DOI
10.2217/14750708.5.4.435
FULL TEXT LINK
http://dx.doi.org/10.2217/14750708.5.4.435
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 927
TITLE
Meet Narcan. The amazing drug that helps save overdose patients.
AUTHOR NAMES
Barker K.
Hunjadi D.
AUTHOR ADDRESSES
(Barker K.; Hunjadi D.) Gateway Technical College, Burlington, WI, USA.
CORRESPONDENCE ADDRESS
K. Barker, Gateway Technical College, Burlington, WI, USA. Email:
barkerk@gtc.edu
SOURCE
JEMS : a journal of emergency medical services (2008) 33:8 (72-76). Date of
Publication: Aug 2008
ISSN
0197-2510
ABSTRACT
They wake the unconscious, cure the very ill and even rescue patients from
death's door. They're miracle drugs, and thousands of ambulance services
across the country carry them. For those onlookers and new EMS providers who
see a patient wake up from a deep, unconscious state, it's a captivating
experience. The most common of these drugs is dextrose. But there's
another--meet Narcan.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug therapy)
narcotic antagonist (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
narcotic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
emergency health service
human
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
18692733 (http://www.ncbi.nlm.nih.gov/pubmed/18692733)
PUI
L352518269
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 928
TITLE
Poisoning necessitating pediatric ICU admissions: Size of pupils does matter
AUTHOR NAMES
Hon K.-L.E.
Ho J.K.-Y.
Hung E.C.-W.
Cheung K.-L.
Ng P.-C.
AUTHOR ADDRESSES
(Hon K.-L.E., ehon@cuhk.edu.hk; Ho J.K.-Y.; Cheung K.-L.; Ng P.-C.)
Department of Pediatrics, Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong.
(Hung E.C.-W.) Department of Chemical Pathology, Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, Hong Kong.
(Hon K.-L.E., ehon@cuhk.edu.hk) Department of Paediatrics, Chinese
University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
CORRESPONDENCE ADDRESS
K.-L. E. Hon, Department of Paediatrics, Chinese University of Hong Kong,
Prince of Wales Hospital, Shatin, Hong Kong. Email: ehon@cuhk.edu.hk
SOURCE
Journal of the National Medical Association (2008) 100:8 (952-956). Date of
Publication: August 2008
ISSN
0027-9684
BOOK PUBLISHER
National Medical Association, 1012 Tenth Street NW, Washington, United
States.
ABSTRACT
Introduction: Childhood poisonings are common, but usually trivial, and
infrequently necessitate intensive care unit (ICU) admissions. Methods: A
retrospective record review was conducted to analyze the pattern of severe
poisoning-associated ICU admissions at a teaching hospital between May 2002
and December 2007. Results: Six cases (4 boys and 2 girls, aged 2 months to
11 years) of drug poisoning-associated ICU admissions were identified.
Methadone was the culprit in 3 boys and 1 girl, resulting in respiratory
failure, depressed conscious state and pinpoint pupils. As relevant exposure
history was not immediately apparent, diagnosis at the emergency department
was only made correctly in 2 patients. Phenobarbitone overdose occurred in 1
girl with past history of phenobarbitone overdose as a clue. She was also
considered to have pinpoint pupils that were unresponsive to naloxone.
Features consistent with cholinergic toxidrome, including small pupils, and
increased secretion occurred in an infant fed with milk prepared with an
herbal broth suspected to have been adulterated with a pesticide. Atropine
as an antidote was used when the child was in the pediatric ICU. All
children made an uneventful recovery following their short ICU stay.
Conclusions: Life-threatening poisonings requiring ICU support can pose
diagnostic difficulties and challenges to frontline medical officers at the
emergency department. Children from all age groups can be affected. Prompt
diagnosis is based on relevant history, careful clinical examination and a
high index of suspicion in patients known to be at risk. The pupillary size
and its reaction following treatment serves as an important diagnostic clue.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cholinergic receptor stimulating agent (drug toxicity)
methadone (drug toxicity)
pesticide (drug toxicity)
phenobarbital (drug toxicity)
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
midazolam (drug therapy)
naloxone (drug dose, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
hospital admission
intensive care
pupil
EMTREE MEDICAL INDEX TERMS
article
child
clinical article
clinical examination
consciousness disorder
convalescence
drug dose increase
emergency ward
female
groups by age
history
hospitalization
human
infant
infant feeding
life
male
medical personnel
medical record review
milk
priority journal
respiratory failure
retrospective study
risk
teaching hospital
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Ophthalmology (12)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008401204
MEDLINE PMID
18717147 (http://www.ncbi.nlm.nih.gov/pubmed/18717147)
PUI
L352209137
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 929
TITLE
Valproic acid poisoning: An evidence-based consensus guideline for
out-of-hospital management
AUTHOR NAMES
Manoguerra A.S.
Erdman A.R.
Woolf A.D.
Chyka P.A.
Martin Caravati E.
Scharman E.J.
Booze L.L.
Christianson G.
Nelson L.S.
Cobaugh D.J.
Troutman W.G.
AUTHOR ADDRESSES
(Manoguerra A.S.; Erdman A.R.; Woolf A.D.; Chyka P.A.; Martin Caravati E.;
Scharman E.J.; Booze L.L.; Christianson G.; Nelson L.S.; Cobaugh D.J.;
Troutman W.G.) American Association of Poison Control Centers, Washington,
DC, United States.
CORRESPONDENCE ADDRESS
A. S. Manoguerra, American Association of Poison Control Centers,
Washington, DC, United States.
SOURCE
Clinical Toxicology (2008) 46:7 (661-676). Date of Publication: August 2008
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
A review of US poison center data for 2004 showed over 9000 ingestions of
valproic acid. A guideline that determines the conditions for emergency
department referral and prehospital care could potentially optimize patient
outcome, avoid unnecessary emergency department visits, reduce health care
costs, and reduce life disruption for patients and caregivers. An
evidence-based expert consensus process was used to create the guideline.
Relevant articles were abstracted by a trained physician researcher. The
first draft of the guideline was created by the lead author. The entire
panel discussed and refined the guideline before distribution to secondary
reviewers for comment. The panel then made changes based on the secondary
review comments. The objective of this guideline is to assist poison center
personnel in the appropriate out-of-hospital triage and initial
out-of-hospital management of patients with a suspected ingestion of
valproic acid by 1) describing the process by which an ingestion of valproic
acid might be managed, 2) identifying the key decision elements in managing
cases of valproic acid ingestion, 3) providing clear and practical
recommendations that reflect the current state of knowledge, and 4)
identifying needs for research. This guideline applies to the acute
ingestion and acute-on-chronic ingestion of immediate-release and
extended-release dosage forms of valproic acid, divalproex, and valproate
sodium alone. Co-ingestion of additional substances could require different
referral and management recommendations depending on the combined toxicities
of the substances. This review focuses on the ingestion of more than a
single therapeutic dose and the effects of an overdose. Although therapeutic
doses of valproic acid can cause adverse effects in adults and children,
some idiosyncratic and some dose-dependent, these cases are not considered.
This guideline is based on an assessment of current scientific and clinical
information. The expert consensus panel recognizes that specific patient
care decisions might be at variance with this guideline and are the
prerogative of the patient and the health professionals providing care,
considering all of the circumstances involved. This guideline does not
substitute for clinical judgment. Recommendations are in chronological order
of likely clinical use. The grade of recommendation is in parentheses. 1)
All patients with suicidal intent, intentional abuse, or in whom a malicious
intent is suspected (e.g., child abuse or neglect) should be referred to an
emergency department (Grade D). 2) Patients who are symptomatic (more than
somnolence or exhibiting coma or seizures) after a valproic acid ingestion
should be referred to an emergency department (Grade C). 3) Asymptomatic
patients with an unintentional acute ingestion of 50 mg/kg or more or
asymptomatic patients who are taking the drug therapeutically and who take
an additional single acute ingestion of 50 mg/kg or more of any valproic
acid formulation should be referred to an emergency department for
evaluation (Grade C). 4) Patients with unintentional ingestions of
immediate-release valproic acid formulations, who are asymptomatic, and more
than 6 hours has elapsed since the time of ingestion, can be observed at
home (Grade C). 5) Patients with unintentional ingestions of delayed-release
or extended-release formulations of valproic acid who are asymptomatic, and
more than 12 hours has elapsed since the time of ingestion, can be observed
at home (Grade C). 6) Pregnant women who ingest below the dose for emergency
department referral and do not have other referral conditions should be
directed to their primary care obstetrical provider for evaluation of
potential maternal and fetal risk. Routine referral to an emergency
department for immediate care is not required (Grade D). 7) Do not induce
emesis (Grade C). 8) Activated charcoal can be administered to asymptomatic
patients who have ingested valproic acid within the preceding hour (Grade
C). Prehospital activated charcoal administration, if available, should only
be carried out by health professionals and only if no contraindications are
present. Poison centers should follow local protocols and experience with
its use. Do not delay transportation in order to administer activated
charcoal (Grades D). 9) In patients who have ingested valproic acid and who
are comatose, naloxone can be considered for prehospital administration in
the doses used for treatment of opioid overdose, particularly if the patient
has respiratory depression (Grade C). 10) A benzodiazepine can be
administered by EMS personnel if convulsions are present and if authorized
by EMS medical direction, expressed by written treatment protocol or policy,
or if there is direct medical oversight (Grade C). Copyright © American
Association of Poison Control Centers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
valproate semisodium (drug combination, drug toxicity, oral drug
administration, pharmaceutics)
valproic acid (adverse drug reaction, drug combination, drug concentration,
drug dose, drug therapy, drug toxicity, oral drug administration,
pharmaceutics, pharmacokinetics)
valpromide (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug combination, drug toxicity)
activated carbon (clinical trial, drug dose, drug therapy, intragastric drug
administration, oral drug administration)
alcohol (drug toxicity)
benzodiazepine (drug therapy)
carnitine (drug therapy)
chlorpheniramine (drug combination, drug toxicity)
clonazepam (drug combination, drug therapy)
ipecac (drug therapy)
naloxone (drug dose, drug therapy, intravenous drug administration)
opiate
paroxetine (drug combination, drug toxicity)
sodium bromide (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
consensus development
drug intoxication (disease management, drug therapy, etiology, therapy)
practice guideline
EMTREE MEDICAL INDEX TERMS
age distribution
brain edema (side effect)
caregiver
child abuse
child neglect
clinical feature
clinical protocol
clinical trial
coma
continuous infusion
controlled drug release
convulsion (drug therapy)
cost control
dose response
drug contraindication
drug dosage form
drug fatality (side effect)
drug formulation
drug overdose
emergency health service
emergency ward
fetus risk
health care cost
health care personnel
health care policy
human
liver failure (side effect)
liver toxicity (side effect)
maternal care
medical decision making
medical education
neurotoxicity (drug therapy)
outpatient care
patient care
patient referral
poison center
pregnancy
primary medical care
respiration depression
review
seizure (drug therapy)
somnolence
stomach lavage
suicide
United States
vomiting
DRUG TRADE NAMES
aspirin
depakene
depakote
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
benzodiazepine (12794-10-4)
carnitine (461-06-3, 541-15-1, 56-99-5)
chlorpheniramine (132-22-9)
clonazepam (1622-61-3)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paroxetine (61869-08-7)
sodium bromide (7647-15-6)
valproate semisodium (76584-70-8)
valproic acid (1069-66-5, 99-66-1)
valpromide (2430-27-5)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008368085
MEDLINE PMID
18608263 (http://www.ncbi.nlm.nih.gov/pubmed/18608263)
PUI
L352090452
DOI
10.1080/15563650802178136
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650802178136
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 930
TITLE
Cardiopulmonary resuscitation and pediatric advanced life support update for
the emergency physician
AUTHOR NAMES
Fuchs S.
AUTHOR ADDRESSES
(Fuchs S., s-fuchs@northwestern.edu) Division of Pediatric Emergency
Medicine, Children's Memorial Hospital, Chicago, IL.
(Fuchs S., s-fuchs@northwestern.edu) 2300 Childrens Plaza Box No. 62,
Chicago, IL 60614.
CORRESPONDENCE ADDRESS
S. Fuchs, 2300 Childrens Plaza Box No. 62, Chicago, IL 60614. Email:
s-fuchs@northwestern.edu
SOURCE
Pediatric Emergency Care (2008) 24:8 (561-565). Date of Publication: August
2008
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Although pediatric cardiopulmonary arrest is uncommon, out-of-hospital
survival is dismal. Through international consensus conferences, the
American Heart Association develops new treatment recommendations for
cardiopulmonary resuscitation every few years. The recent changes in
cardiopulmonary resuscitation and pediatric advanced life support, with some
background information about these changes, will be reviewed. Copyright ©
2008 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS
atropine (drug administration, intraosseous drug administration,
intratracheal drug administration, intravenous drug administration)
epinephrine (drug administration, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration)
lidocaine (drug administration, intraosseous drug administration,
intratracheal drug administration, intravenous drug administration)
naloxone (drug administration, intraosseous drug administration,
intratracheal drug administration, intravenous drug administration)
vasopressin (drug administration, intraosseous drug administration,
intratracheal drug administration, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary arrest (therapy)
pediatric advanced life support
resuscitation
EMTREE MEDICAL INDEX TERMS
assisted ventilation
clinical practice
compression
consensus development
drug megadose
drug overdose (drug therapy)
emergency care
emergency physician
endotracheal intubation
health care organization
heart arrest (drug therapy)
human
intraosseous drug administration
optimal drug dose
pulse rate
review
survival rate
vascular access
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009254570
MEDLINE PMID
18708904 (http://www.ncbi.nlm.nih.gov/pubmed/18708904)
PUI
L354648467
DOI
10.1097/PEC.0b013e3181823b34
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e3181823b34
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 931
TITLE
Children's mental health emergencies-part 2: Emergency department evaluation
and treatment of children with mental health disorders
AUTHOR NAMES
Baren J.M.
MacE S.E.
Hendry P.L.
Dietrich A.M.
Goldman R.D.
Warden C.R.
AUTHOR ADDRESSES
(Baren J.M.) Department of Emergency Medicine and Pediatrics, University of
Pennsylvania, School of Medicine, .
(Baren J.M.) Division of Emergency Medicine, Children's Hospital of
Philadelphia, Hospital of University of Pennsylvania, Philadelphia, PA.
(MacE S.E., maces@ccf.org) Department of Emergency Medicine, Ohio State
University, School of Medicine, .
(MacE S.E., maces@ccf.org) Pediatric Education/Quality Improvement,
Cleveland Clinic, Cleveland, OH.
(Hendry P.L.) Department of Emergency Medicine and Pediatrics, University of
Florida-Jacksonville, Jacksonville, FL.
(Dietrich A.M.) Ohio State University, College of Medicine and Public
Health, Columbus, OH.
(Goldman R.D.) Department of Pediatrics, University of Toronto, Hospital for
Sick Children, Toronto, Canada.
(Warden C.R.) Department of Emergency Medicine and Pediatrics, University of
Oregon Health Sciences, Portland, OR.
(MacE S.E., maces@ccf.org) Cleveland Clinic, Department of Emergency
Medicine, E19, 9500 Euclid Ave, Cleveland, OH 44195.
CORRESPONDENCE ADDRESS
J. M. Baren, Division of Emergency Medicine, Children's Hospital of
Philadelphia, Hospital of University of Pennsylvania, Philadelphia, PA.
SOURCE
Pediatric Emergency Care (2008) 24:7 (485-498). Date of Publication: July
2008
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Objective: The emergency physician should be familiar with the wide spectrum
of pediatric mental health emergencies because they are commonly encountered
in emergency medical practice. Methods: A review of the literature was done
in order to develop an approach for dealing with children presenting with
mental health disorders in the emergency department (ED). Results: Children'
mental health emergencies have a wide spectrum from behavioral disturbances
to major depression. An approach to the issues involved in caring for these
patients is discussed which acknowledges the essential role of the emergency
physician and the importance of integrating ED care with multidisciplinary
services. Conclusions: The actions and directions taken in the ED are a
crucial part of the child's long-term care and treatment. The ED evaluation
and management of pediatric mental health emergencies may vary depending on
the complaint and includes differentiation from organic etiologies, medical
stabilization, and occasionally in depth psychosocial interview. Copyright ©
2008 by Lippincott Williams & Wilkins.
EMTREE DRUG INDEX TERMS
amitriptyline (adverse drug reaction, drug interaction, pharmacology)
antiarrhythmic agent (drug interaction)
antibiotic agent (drug interaction)
antidepressant agent (adverse drug reaction)
antifungal agent (drug interaction)
benzodiazepine
butyrophenone
carbamazepine (adverse drug reaction, drug interaction, pharmacology)
central depressant agent (drug interaction)
cholinergic receptor blocking agent
droperidol (adverse drug reaction, intramuscular drug administration,
intravenous drug administration)
flumazenil
fluoxetine (adverse drug reaction, drug interaction, pharmacology)
haloperidol (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, oral drug administration)
imipramine (adverse drug reaction, drug interaction, pharmacology)
ipecac (drug interaction)
lithium (adverse drug reaction, drug interaction)
lorazepam (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, oral drug administration)
midazolam (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, oral drug administration)
monoamine oxidase inhibitor (drug interaction)
naloxone
nonsteroid antiinflammatory agent (drug interaction)
paroxetine (adverse drug reaction, drug interaction, pharmacology)
phenelzine (adverse drug reaction, drug interaction, pharmacology)
phenobarbital (drug interaction)
phenytoin (drug interaction)
placebo
serotonin uptake inhibitor (drug interaction)
steroid (drug interaction)
valproic acid (adverse drug reaction, drug interaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
mental disease
mental health
EMTREE MEDICAL INDEX TERMS
abdominal cramp (side effect)
agranulocytosis (side effect)
airway obstruction (side effect)
anorexia nervosa
anxiety disorder
ataxia (side effect)
attention deficit disorder
behavior disorder
bipolar disorder
blurred vision (side effect)
bulimia
child health
clinical evaluation
conduct disorder
constipation (side effect)
diabetes insipidus (side effect)
diarrhea (side effect)
differential diagnosis
diplopia (side effect)
disruptive behavior
drug induced headache (side effect)
emergency health service
emergency physician
emergency ward
extrapyramidal symptom (side effect)
extrapyramidal syndrome (side effect)
flushing
heart muscle conduction disturbance (side effect)
heart palpitation (side effect)
human
hyponatremia (side effect)
hypotension (side effect)
insomnia (side effect)
laboratory
lethargy (side effect)
leukocytosis (side effect)
leukopenia (side effect)
liver failure (side effect)
long term care
major depression
medical assessment
medical practice
nausea (side effect)
neuroleptic malignant syndrome (side effect)
nystagmus (side effect)
orthostatic hypertension (side effect)
patient care
photophobia (side effect)
physician attitude
polydipsia (side effect)
polyuria (side effect)
psychosis
QT prolongation (side effect)
respiration depression (side effect)
restlessness (side effect)
review
sedation
seizure (side effect)
side effect (side effect)
somatoform disorder
Stevens Johnson syndrome (side effect)
substance abuse
suicidal ideation
suicide (side effect)
tachycardia (side effect)
thrombocytopenia (side effect)
torsade des pointes (side effect)
tremor (side effect)
urine retention (side effect)
vomiting (side effect)
xerostomia (side effect)
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
benzodiazepine (12794-10-4)
butyrophenone (495-40-9)
carbamazepine (298-46-4, 8047-84-5)
droperidol (548-73-2)
flumazenil (78755-81-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
haloperidol (52-86-8)
imipramine (113-52-0, 50-49-7)
ipecac (8012-96-2)
lithium (7439-93-2)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
paroxetine (61869-08-7)
phenelzine (156-51-4, 51-71-8)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009254494
MEDLINE PMID
18633314 (http://www.ncbi.nlm.nih.gov/pubmed/18633314)
PUI
L354648391
DOI
10.1097/PEC.0b13e31817de2bb
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b13e31817de2bb
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 932
TITLE
Prehospital Trauma Analgesia
AUTHOR NAMES
Thomas S.H.
Shewakramani S.
AUTHOR ADDRESSES
(Thomas S.H.; Shewakramani S.) Harvard Affiliated Emergency Medicine
Residency, Boston, MA, United States.
(Thomas S.H.) Boston MedFlight, Boston, MA, United States.
CORRESPONDENCE ADDRESS
S.H. Thomas, Harvard Affiliated Emergency Medicine Residency, Boston, MA,
United States.
SOURCE
Journal of Emergency Medicine (2008) 35:1 (47-57). Date of Publication: July
2008
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
This review aims to describe and evaluate current practices and
controversies surrounding provision of pain relief in the prehospital
setting. The review addresses analgesia indications and contraindications,
frequency with which analgesics are used, and factors associated with
improved prehospital analgesia care in Emergency Medical Services systems
with both physician and non-physician staffing. As part of its evaluation of
the state of the art in prehospital pharmacologic treatment of pain, the
review will summarize available evidence relevant to the major drugs.
Although some situations have been insufficiently studied to allow for
definitive data-driven analgesia recommendations, the review will, where
possible, include evidence-based recommendations concerning prehospital pain
medication. © 2008 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
alfentanil (drug therapy)
butorphanol (drug therapy, intranasal drug administration, intravenous drug
administration)
fentanyl (drug therapy, intranasal drug administration, intravenous drug
administration)
ketamine (adverse drug reaction, drug therapy, intravenous drug
administration)
ketorolac (drug therapy, intravenous drug administration)
morphine (drug therapy, intravenous drug administration)
nalbuphine (drug therapy, intravenous drug administration)
naloxone (drug therapy)
nitrous oxide (adverse drug reaction, drug therapy, inhalational drug
administration)
opiate (adverse drug reaction, drug therapy)
paracetamol (drug therapy, oral drug administration)
tramadol (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
EMTREE MEDICAL INDEX TERMS
apnea (side effect)
article
emergency health service
hemodynamics
human
medical education
medical practice
mental health
nerve block
pain (drug therapy)
physical examination
pneumothorax (side effect)
priority journal
respiration depression (drug therapy, side effect)
serotonin syndrome (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
butorphanol (42408-82-2)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008293764
MEDLINE PMID
17997072 (http://www.ncbi.nlm.nih.gov/pubmed/17997072)
PUI
L351842742
DOI
10.1016/j.jemermed.2007.05.041
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2007.05.041
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 933
TITLE
Comparison of Two Methods of Pediatric Resuscitation and Critical Care
Management
AUTHOR NAMES
Fineberg S.L.
Arendts G.
AUTHOR ADDRESSES
(Fineberg S.L., slfineberg@gmail.com) Department of Emergency Medicine,
George Hospital, The St, Kogarah, NSW, Australia.
(Fineberg S.L., slfineberg@gmail.com; Arendts G.) Department of Emergency
Medicine, The Wollongong Hospital, Wollongong, NSW, Australia.
CORRESPONDENCE ADDRESS
S.L. Fineberg, Department of Emergency Medicine, George Hospital, The St,
Kogarah, NSW, Australia. Email: slfineberg@gmail.com
SOURCE
Annals of Emergency Medicine (2008) 52:1 (35-40.e13). Date of Publication:
July 2008
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: We compare time to drug delivery and the incidence of
dosage error between 2 different systems of medication administration: The
Broselow Pediatric Emergency Tape and a standardized volume/weight-based
dose reformulation of resuscitation and critical care medications
(reformulated to 0.1 mL/kg). Methods: This was a randomized crossover trial,
in which volunteers (n=16) from emergency department (ED) pediatric
resuscitation teams from the ED of a large, urban, teaching hospital in
Australia were assigned to manage simulated (Advanced Pediatric Life Support
scenario) patients. The volunteers were each presented with 3 case scenarios
(brady-asystolic arrest, status epilepticus, and rapid sequence intubation
requiring administration of 4, 5, and 4 medications, respectively). The
order of presentation was randomized for the 2 methods. The volunteers were
then asked to manage 3 case scenarios using one and then the other method
(resulting in a total of 6 cases managed per participant). The dosage of
each medication ordered, as well as the time to the simulated administration
of that medication, was recorded for all scenarios. The expected dosages
were compared with the actual dosages delivered to determine which system
provided greater accuracy in medication administration. Statistical analysis
was undertaken using the Wilcoxon signed rank test and McNemars test for
paired proportions. Results: Compared with the Broselow tape, the
standardized volume/weight-based dose reformulation significantly reduced
median time to medication delivery for all clinical scenarios (147 versus 72
seconds; 197 versus 87 seconds; 146 versus 64 seconds; P<.001). The
proportion of dosing errors with Broselow tape across the 3 scenarios was
greater than with volume/weight-based dosing (0.08 versus 0, 0 versus 0, and
0.08 versus 0.02, respectively). Conclusion: Use of a standardized
volume/weight-based dose reformulation method is a simple, fast, and
accurate method of medication delivery for the pediatric patient that
eliminates the need for memorization and/or calculation. The standardized
volume/weight-based dose reformulation method performs better than the
Broselow tape in speed of delivery of medications used for pediatric
resuscitation and critical care without any reduction in dosing accuracy. ©
2008 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS
adenosine
amiodarone
atropine
calcium chloride
diazepam (drug therapy)
diphenhydramine (drug therapy)
diprovan
epinephrine
etomidate
fentanyl citrate
flumazenil
fosphenytoin sodium
glucagon
gluconate calcium
ketamine
lidocaine
lorazepam
methylprednisolone (drug therapy)
methylprednisolone sodium succinate
midazolam (drug therapy)
morphine sulfate
naloxone
pancuronium
pancuronium bromide
phenobarbital
phenytoin (drug therapy)
promethazine (drug therapy)
propofol
propofol (drug therapy)
rocuronium
suxamethonium (drug therapy)
thiopental
unindexed drug
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intensive care
pediatrics
resuscitation
EMTREE MEDICAL INDEX TERMS
anaphylaxis (drug therapy)
article
asthma (drug therapy)
clinical trial
comparative study
controlled clinical trial
controlled study
crossover procedure
drug delivery system
emergency ward
epileptic state (drug therapy)
human
incidence
McNemar test
medical error
priority journal
randomized controlled trial
statistical analysis
teaching hospital
Wilcoxon signed ranks test
DRUG TRADE NAMES
adenocard , JapanFujisawa
ativan , United StatesBaxter
benadryl International Medical Systems
cerebyx Parke Davis
cerebyx Pfizer
cordarone , FranceSanofi Synthelabo
dilantin Parke Davis
dilantin Pfizer
diprovan , United StatesAstra Zeneca
fresofol , AustraliaFresenius Kabi
narcan , United StatesDuPont
pavulon Organon
phenergan Baxter
romazicon , SwitzerlandHoffmann La Roche
solumedrol Pfizer
versed , United StatesHoffmann La Roche
zemuron Organon
DRUG MANUFACTURERS
(United States)American Regent
(United States)Astellas
(United States)Astra Zeneca
Astra
(United States)Baxter
(United States)Bedford
Bioniche
(United Kingdom)Celltech
(United States)DuPont
(United States)Elkins Sinn
(Australia)Fresenius Kabi
(Japan)Fujisawa
Glaxo Wellcome
(Switzerland)Hoffmann La Roche
(United States)Hoffmann La Roche
(United States)Hospira
(United States)International Medical Systems
Ohmeda
(India)olita
Organon
(United States)Parke Davis
Pfizer
(Canada)Sandoz
(France)Sanofi Synthelabo
(United States)Sicor
(United Kingdom)Wyeth
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
calcium chloride (10043-52-4)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
fosphenytoin sodium (92134-98-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
methylprednisolone sodium succinate (2375-03-3, 2921-57-5)
midazolam (59467-70-8)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
pancuronium bromide (15500-66-0)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
rocuronium (119302-91-9)
suxamethonium (306-40-1, 71-27-2)
thiopental (71-73-8, 76-75-5)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008284131
MEDLINE PMID
18407376 (http://www.ncbi.nlm.nih.gov/pubmed/18407376)
PUI
L50118415
DOI
10.1016/j.annemergmed.2007.10.021
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2007.10.021
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 934
TITLE
A 19 year old man with loss of consciousness
AUTHOR NAMES
Shamsvahdati S.
Moharamzadeh P.
AUTHOR ADDRESSES
(Shamsvahdati S.; Moharamzadeh P.) Department of Emergency Medicine, Logman
Hakim Hospital of Tehran, Tehran, Iran.
CORRESPONDENCE ADDRESS
S. Shamsvahdati, Department of Emergency Medicine, Logman Hakim Hospital of
Tehran, Tehran, Iran.
SOURCE
Rawal Medical Journal (2008) 33:2. Date of Publication: July/December 2008
ISSN
0303-5212
BOOK PUBLISHER
Pakistan Medical Association, Garden Road, Karachi - 3, Pakistan.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methanol (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug combination, drug therapy)
alcohol
folic acid (drug therapy)
glucose (endogenous compound)
naloxone (drug therapy, intravenous drug administration)
sorbitol (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain edema (diagnosis)
brain infarction (diagnosis)
methanol poisoning (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
arterial gas
article
artificial ventilation
basal ganglion
blood gas analysis
brain hemorrhage (diagnosis)
case report
computer assisted tomography
consciousness disorder (drug therapy, therapy)
cornea reflex
electrocardiogram
emergency ward
glucose blood level
hemodialysis
homelessness
human
hyperemia
laboratory test
lavage
male
mydriasis
ophthalmoscopy
papilledema
physical examination
stomach intubation
vital sign
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
folic acid (59-30-3, 6484-89-5)
glucose (50-99-7, 84778-64-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008531091
PUI
L352646193
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 935
TITLE
Fentanyl epidemic in Chicago, Illinois and surrounding Cook County
AUTHOR NAMES
Schumann H.
Erickson T.
Thompson T.M.
Zautcke J.L.
Denton J.S.
AUTHOR ADDRESSES
(Schumann H., heather.eyrich@gmail.com) University of Illinois at Chicago,
College of Pharmacy, Department of Pharmacy Practice, Chicago, IL, United
States.
(Erickson T.; Thompson T.M.; Zautcke J.L.) University of Illinois at
Chicago, Department of Emergency Medicine, Chicago, IL, United States.
(Denton J.S.) Cook County Medical Examiner's Office, Chicago, IL, United
States.
(Schumann H., heather.eyrich@gmail.com) University of Illinois at Chicago,
College of Pharmacy, Department of Pharmacy Practice, 833 S. Wood Street,
Chicago, IL 60612, United States.
CORRESPONDENCE ADDRESS
H. Schumann, University of Illinois at Chicago, College of Pharmacy,
Department of Pharmacy Practice, 833 S. Wood Street, Chicago, IL 60612,
United States. Email: heather.eyrich@gmail.com
SOURCE
Clinical Toxicology (2008) 46:6 (501-506). Date of Publication: July 2008
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
Introduction. Epidemics related to illicit fentanyl abuse have been reported
and the potential exists for a national epidemic associated with high
mortality. This report describes emergency department visits for opioid
toxicity and a recent outbreak of illicit fentanyl fatalities in Chicago,
Illinois and surrounding Cook County. Methods. Retrospective chart review of
opioid-related overdoses seen in our emergency department and a
retrospective review of data from the Cook County Medical Examiner's Office
Fentanyl Fatality Database from April 2005 through December 2006. Results.
Our emergency department treated 43 patients with a total of 55 emergency
department visits during this time. Paramedic transport was utilized for
83.6% of the emergency department visits and naloxone was administered
during 80.4% of transports. Naloxone was administered during 47.3% of
emergency department visits witwh total doses ranging from 0.4 mg to 12 mg.
Eighty percent of cases were treated and discharged from the emergency
department. During this same time frame, the Medical Examiner's office
identified 342 fentanyl-related fatalities. In 2006, illicit fentanyl
fatalities represented 6.9% of all Medical Examiner cases for that year.
Approximately 80% of deaths occurred in Chicago. A peak in fentanyl-related
deaths occurred in the spring of 2006 and again in the fall of 2006 while
the number of emergency department visits peaked during May of 2006.
Conclusion. Chicago and surrounding Cook County experienced an outbreak of
342 fentanyl-related deaths between April 2005 and December 2006. The
experience demonstrated a clear need for an interdisciplinary approach to
identifying, communicating, and managing an outbreak. Copyright © Informa
Healthcare USA, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity)
naloxone (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
benzodiazepine (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
methadone (drug toxicity)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
central nervous system depression
clinical article
controlled study
demography
drug abuse
drug intoxication
drug screening
emergency ward
epidemic
female
heart arrest
hospital discharge
human
male
mortality
respiration depression
toxicity testing
United States
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008315690
MEDLINE PMID
18584361 (http://www.ncbi.nlm.nih.gov/pubmed/18584361)
PUI
L351913758
DOI
10.1080/15563650701877374
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650701877374
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 936
TITLE
Alteration in prehospital drug concentration after thermal exposure
AUTHOR NAMES
Gammon D.L.
Su S.
Huckfeldt R.
Jordan J.
Patterson R.
Finley P.J.
Lowe C.
AUTHOR ADDRESSES
(Gammon D.L., dustin.gammon@mercy.net; Jordan J.; Patterson R.) St. John's
Emergency Medical Services, Springfield, MO 65804, United States.
(Gammon D.L., dustin.gammon@mercy.net; Su S.) Department of Chemistry,
Missouri State University, Springfield, MO 65897, United States.
(Huckfeldt R.; Finley P.J.; Lowe C.) St. John's Trauma Services, Research
Department, Springfield, MO 65804, United States.
CORRESPONDENCE ADDRESS
D.L. Gammon, St. John's Emergency Medical Services, Springfield, MO 65804,
United States. Email: dustin.gammon@mercy.net
SOURCE
American Journal of Emergency Medicine (2008) 26:5 (566-573). Date of
Publication: June 2008
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Objective: The aim of the study was to determine the remaining concentration
of 23 commonly carried emergency medical services medications used in the
United States after they have experienced thermal extremes that have been
documented in the prehospital environment for a period of 1 month. Methods:
Pharmaceuticals were thermally cycled (-6°C and 54°C) every 12 hours and
then assayed by high-performance liquid chromatography. Results: Eight (35%)
of 23 prehospital pharmaceuticals revealed ending concentrations of less
than 90% with strong correlation to thermal exposure time. These included
lidocaine, diltiazem, dopamine, nitroglycerin, ipratropium, succinylcholine,
haloperidol, and naloxone. Conclusion: A decrease in concentration was found
to be statistically significant in 8 (35%) of 23 commonly carried emergency
medical services pharmaceuticals. These results provide new information and
perspective regarding stability of emergency drugs in the prehospital
environment by evaluating a broad range of pharmaceuticals as well as by
using thermal exposure points that have been documented in the United
States. © 2008 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
adenosine (pharmaceutics)
amiodarone (pharmaceutics)
atropine (pharmaceutics)
diltiazem (pharmaceutics)
dopamine (pharmaceutics)
epinephrine (pharmaceutics)
etomidate (pharmaceutics)
glyceryl trinitrate (pharmaceutics)
haloperidol (pharmaceutics)
heparin (pharmaceutics)
hydralazine (pharmaceutics)
ipratropium bromide (pharmaceutics)
labetalol (pharmaceutics)
lidocaine (pharmaceutics)
naloxone (pharmaceutics)
ondansetron (pharmaceutics)
oxytocin (pharmaceutics)
procainamide (pharmaceutics)
salbutamol (pharmaceutics)
suxamethonium (pharmaceutics)
terbutaline (pharmaceutics)
thiamine (pharmaceutics)
vasopressin (pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
environmental temperature
EMTREE MEDICAL INDEX TERMS
article
concentration (parameters)
drug structure
emergency health service
exposure
high performance liquid chromatography
priority journal
statistical significance
storage temperature
United States
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
diltiazem (33286-22-5, 42399-41-7)
dopamine (51-61-6, 62-31-7)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydralazine (304-20-1, 86-54-4)
ipratropium bromide (22254-24-6)
labetalol (32780-64-6, 36894-69-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
oxytocin (50-56-6, 54577-94-5)
procainamide (51-06-9, 614-39-1)
salbutamol (18559-94-9)
suxamethonium (306-40-1, 71-27-2)
terbutaline (23031-25-6)
thiamine (59-43-8, 67-03-8)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008262071
MEDLINE PMID
18534286 (http://www.ncbi.nlm.nih.gov/pubmed/18534286)
PUI
L351755008
DOI
10.1016/j.ajem.2007.09.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2007.09.004
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 937
TITLE
Attitudes of Australian heroin users to peer distribution of naloxone for
heroin overdose: Perspectives on intranasal administration
AUTHOR NAMES
Kerr D.
Dietze P.
Kelly A.-M.
Jolley D.
AUTHOR ADDRESSES
(Kerr D., Debbie.Kerr@wh.org.au) Joseph Epstein Centre for Emergency
Medicine Research, Sunshine Hospital, 176 Furlong Rd, St Albans, VIC 3021,
Australia.
(Kelly A.-M.) University of Melbourne, Melbourne, VIC, Australia.
(Dietze P.) Burnet Institute, Melbourne, VIC, Australia.
(Dietze P.; Jolley D.) Monash Institute of Health Services Research,
Melbourne, VIC, Australia.
(Kerr D., Debbie.Kerr@wh.org.au; Kelly A.-M.) Joseph Epstein Centre for
Emergency Medicine Research, Sunshine Hospital, St. Albans, VIC, Australia.
CORRESPONDENCE ADDRESS
D. Kerr, Joseph Epstein Centre for Emergency Medicine Research, Sunshine
Hospital, 176 Furlong Rd, St Albans, VIC 3021, Australia. Email:
Debbie.Kerr@wh.org.au
SOURCE
Journal of Urban Health (2008) 85:3 (352-360). Date of Publication: May 2008
ISSN
1099-3460
1468-2869 (electronic)
BOOK PUBLISHER
Springer Science and Business Media Deutschland GmbH, Heidelberger Platz 3,
Berlin, Germany.
ABSTRACT
Naloxone distribution to injecting drug users (IDUs) for peer administration
is a suggested strategy to prevent fatal heroin overdose. The aim of this
study was to explore attitudes of IDUs to administration of naloxone to
others after heroin overdose, and preferences for method of administration.
A sample of 99 IDUs (median age 35 years, 72% male) recruited from needle
and syringe programs in Melbourne were administered a questionnaire. Data
collected included demographics, attitudes to naloxone distribution, and
preferences for method of administration. The primary study outcomes were
attitudes of IDUs to use of naloxone for peer administration (categorized on
a five-point scale ranging from "very good idea" to "very bad idea") and
preferred mode of administration (intravenous, intramuscular, and
intranasal). The majority of the sample reported positive attitudes toward
naloxone distribution (good to very good idea: 89%) and 92% said they were
willing to participate in a related training program. Some participants
raised concerns about peer administration including the competence of IDUs
to administer naloxone in an emergency, victim response on wakening and
legal implications. Most (74%) preferred intranasal administration in
comparison to other administration methods (21%). There was no association
with age, sex, or heroin practice. There appears to be strong support among
Australian IDU for naloxone distribution to peers. Intranasal spray is the
preferred route of administration. © 2008 The New York Academy of Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug administration, drug therapy, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
heroin dependence
EMTREE MEDICAL INDEX TERMS
adult
article
attitude
Australia
controlled study
demography
emergency treatment
female
human
legal aspect
major clinical study
male
outcome assessment
priority journal
questionnaire
sampling
treatment outcome
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008199563
MEDLINE PMID
18347990 (http://www.ncbi.nlm.nih.gov/pubmed/18347990)
PUI
L50095608
DOI
10.1007/s11524-008-9273-z
FULL TEXT LINK
http://dx.doi.org/10.1007/s11524-008-9273-z
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 938
TITLE
In a Delirium: patient in a post-excited state takes EMS by surprise.
AUTHOR NAMES
Maggiore W.A.
AUTHOR ADDRESSES
(Maggiore W.A.) University of New Mexico, USA.
CORRESPONDENCE ADDRESS
W.A. Maggiore, University of New Mexico, USA. Email:
desertrose1@wildblue.net
SOURCE
JEMS : a journal of emergency medical services (2008) 33:5 (44). Date of
Publication: May 2008
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
delirium (diagnosis)
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
article
case report
human
male
pathophysiology
periodicity
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
18482649 (http://www.ncbi.nlm.nih.gov/pubmed/18482649)
PUI
L351889421
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 939
TITLE
Iatrogenic delirium and coma: A "near miss"
AUTHOR NAMES
Dunn W.F.
Adams S.C.
Adams R.W.
AUTHOR ADDRESSES
(Dunn W.F., dunn.william@mayo.edu; Adams S.C.; Adams R.W.) Mayo Foundation,
Rochester, MN, United States.
(Dunn W.F., dunn.william@mayo.edu) Mayo Foundation, 200 First St SW,
Rochester, MN 55905, United States.
CORRESPONDENCE ADDRESS
W. F. Dunn, Mayo Foundation, 200 First St SW, Rochester, MN 55905, United
States. Email: dunn.william@mayo.edu
SOURCE
Chest (2008) 133:5 (1217-1220). Date of Publication: May 2008
ISSN
0012-3692
BOOK PUBLISHER
American College of Chest Physicians, 3300 Dundee Road, Northbrook, United
States.
ABSTRACT
A 66-year-old woman was cared for at two referral institutions following a
witnessed cardiac arrest in a local emergency department. Despite aggressive
initial care, she failed to regain consciousness during a 28-day course.
Based on an erroneous neurologic diagnosis of anoxic encephalopathy,
pessimism regarding likelihood of improvement existed, prompting clinical
consideration of withdrawal of care. The correct diagnosis of iatrogenic
drug-induced coma alternating with drug-induced delirium only became
apparent after the IV administration of repeated doses of a benzodiazepine
antagonist. The patient and husband (co-authors) provide insights often
unheard within care circles.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
lorazepam (adverse drug reaction, intravenous drug administration)
EMTREE DRUG INDEX TERMS
flumazenil (intravenous drug administration)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (side effect, diagnosis, side effect)
delirium (side effect, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
aged
article
brain hypoxia
case report
diagnostic error
female
heart arrest
human
iatrogenic disease
patient attitude
priority journal
sedation
spouse
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008239505
MEDLINE PMID
18460520 (http://www.ncbi.nlm.nih.gov/pubmed/18460520)
PUI
L351685529
DOI
10.1378/chest.08-0471
FULL TEXT LINK
http://dx.doi.org/10.1378/chest.08-0471
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 940
TITLE
Assessment of the delta opioid agonist DADLE in a rat model of lethal
hemorrhage treated by emergency preservation and resuscitation
AUTHOR NAMES
Drabek T.
Han F.
Garman R.H.
Stezoski J.
Tisherman S.A.
Stezoski S.W.
Morhard R.C.
Kochanek P.M.
AUTHOR ADDRESSES
(Drabek T., drabekt@anes.upmc.edu; Han F.; Stezoski J.; Tisherman S.A.;
Stezoski S.W.; Morhard R.C.; Kochanek P.M.) Safar Center for Resuscitation
Research, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States.
(Drabek T., drabekt@anes.upmc.edu; Han F.) Department of Anesthesiology,
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
(Stezoski J.; Tisherman S.A.; Stezoski S.W.; Kochanek P.M.) Department of
Critical Care Medicine, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States.
(Garman R.H.) Veterinary Pathology Inc., Murrysville, PA, United States.
(Tisherman S.A.) Department of Surgery, University of Pittsburgh School of
Medicine, Pittsburgh, PA, United States.
CORRESPONDENCE ADDRESS
T. Drabek, Safar Center for Resuscitation Research, University of Pittsburgh
School of Medicine, Pittsburgh, PA, United States. Email:
drabekt@anes.upmc.edu
SOURCE
Resuscitation (2008) 77:2 (220-228). Date of Publication: May 2008
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Emergency preservation and resuscitation (EPR) is a new approach for
resuscitation of exsanguination cardiac arrest (CA) victims. EPR uses a cold
aortic flush to induce deep hypothermic preservation during no-flow to buy
time for transport and damage control surgery, followed by resuscitation
with cardiopulmonary bypass (CPB). We reported previously that 20-60 min EPR
in rats was associated with intact outcome, while 75 min EPR resulted in
high mortality and neurological impairment in survivors. The delta opioid
agonist DADLE ([d-Ala(2),d-Leu(5)]-enkephalin) was shown previously to be
protective against ischemia-reperfusion injury in multiple organs, including
brain. We hypothesized that DADLE could augment neurological outcome after
EPR in rats. After rapid lethal hemorrhage, EPR was initiated by perfusion
with ice-cold crystalloid to induce hypothermia (15 °C). After 75 min EPR,
resuscitation was attempted with CPB. After randomization, three groups were
studied (n = 10 per group): DADLE 0 mg/kg (D0), 4 mg/kg (D4) or 10 mg/kg
(D10) added to the flush and during reperfusion. Survival, overall
performance category (OPC; 1 = normal, 5 = death), neurological deficit
score (NDS; 0-10% normal, 100% = max deficit), and histological damage score
(HDS) were assessed in survivors on day 3. In D0 group, 2/10 rats survived,
while in D4 and D10 groups, 4/10 and 5/10 rats survived, respectively (p =
NS). Survival time (h) was 26.7 ± 28.2 in D0, 36.3 ± 31.9 in D4 and 47.1 ±
30.3 in D10 groups, respectively (p = 0.3). OPC, NDS and HDS were not
significantly different between groups. In conclusion, DADLE failed to
confer benefit on functional or histological outcome in our model of
prolonged rat EPR. © 2007 Elsevier Ireland Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
enkephalin[2 dextro alanine 5 dextro leucine] (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest (therapy)
ischemia (drug therapy, prevention)
reperfusion injury (drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
animal experiment
animal model
article
bleeding
controlled study
histopathology
hypothermia
male
mortality
neurologic disease
nonhuman
outcome assessment
priority journal
rat
resuscitation
survival rate
survival time
CAS REGISTRY NUMBERS
enkephalin[2 dextro alanine 5 dextro leucine] (63631-40-3)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008155859
MEDLINE PMID
18207625 (http://www.ncbi.nlm.nih.gov/pubmed/18207625)
PUI
L50041164
DOI
10.1016/j.resuscitation.2007.11.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2007.11.020
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 941
TITLE
Demographic characteristics and opioid prescribing
AUTHOR NAMES
Maserejian N.N.
McKinlay J.B.
AUTHOR ADDRESSES
(Maserejian N.N., nmaserejian@neriscience.com; McKinlay J.B.) New England
Research Institutes, Watertown, MA, United States.
CORRESPONDENCE ADDRESS
N. N. Maserejian, New England Research Institutes, Watertown, MA, United
States. Email: nmaserejian@neriscience.com
SOURCE
JAMA - Journal of the American Medical Association (2008) 299:15 (1773).
Date of Publication: 16 Apr 2008
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical decision making
correlation analysis
demography
emergency ward
ethnicity
human
insurance
letter
observational study
prescription
priority journal
race difference
socioeconomics
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008189696
MEDLINE PMID
18413872 (http://www.ncbi.nlm.nih.gov/pubmed/18413872)
PUI
L351549983
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 942
TITLE
Demographic characteristics and opioid prescribing
AUTHOR NAMES
Berger J.T.
AUTHOR ADDRESSES
(Berger J.T., jberger@winthrop.org) Winthrop University Hospital, Mineola,
NY, United States.
CORRESPONDENCE ADDRESS
J. T. Berger, Winthrop University Hospital, Mineola, NY, United States.
Email: jberger@winthrop.org
SOURCE
JAMA - Journal of the American Medical Association (2008) 299:15
(1773-1774). Date of Publication: 16 Apr 2008
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
demography
doctor patient relation
emergency ward
ethnicity
human
letter
medical care
prescription
priority journal
race difference
sex difference
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008189697
MEDLINE PMID
18413871 (http://www.ncbi.nlm.nih.gov/pubmed/18413871)
PUI
L351549984
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 943
TITLE
Toxicity of buprenorphine overdoses in children
AUTHOR NAMES
Hayes B.D.
Klein-Schwartz W.
Doyon S.
AUTHOR ADDRESSES
(Hayes B.D., bryan-d-hayes@yahoo.com; Klein-Schwartz W.; Doyon S.) Maryland
Poison Center, University of Maryland, School of Pharmacy, Baltimore, MD.
(Hayes B.D., bryan-d-hayes@yahoo.com) Maryland Poison Center, University of
Maryland, School of Pharmacy, 220 Arch St., Baltimore, MD 21201.
CORRESPONDENCE ADDRESS
B. D. Hayes, Maryland Poison Center, University of Maryland, School of
Pharmacy, 220 Arch St., Baltimore, MD 21201. Email: bryan-d-hayes@yahoo.com
SOURCE
Pediatrics (2008) 121:4 (e782-e786). Date of Publication: April 2008
ISSN
0031-4005
1098-4275 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
OBJECTIVE. There are few reports in children of overdoses of buprenorphine,
a partial opioid agonist used in the treatment of opioid dependence and
pain. The purpose of this study was to analyze buprenorphine overdoses in
young children reported by US poison centers to the Researched Abuse,
Diversion, and Addiction-Related Surveillance System. METHODS. A
retrospective review of buprenorphine overdoses in children <6 years of age
reported to the Researched Abuse, Diversion, and Addiction-Related
Surveillance System from November 2002 through December 2005 was performed.
Patients lost to follow-up and those ingesting multiple substances were
excluded. RESULTS.Eighty-six cases met inclusion criteria. In the 54
children who developed toxicity, the clinical effects included drowsiness or
lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%),
agitation or irritability (5%), pallor (3%), and coma (2%). There were no
fatalities. The mean time to onset of effects was 64.2 minutes, with a range
of 20 minutes to 3 hours. Duration of clinical effects was under 2 hours in
11%, 2 to 8 hours in 59%, 8 to 24 hours in 26%, and >24 hours in 4%.
Children who ingested ≥2 mg of buprenorphine were more likely to experience
clinical effects, and all of the children who ingested >4 mg experienced
some effect. No child ingesting <4 mg experienced a severe effect. Of the 22
children administered naloxone, 67% had at least a partial response.
CONCLUSIONS. Buprenorphine overdoses are generally well tolerated in
children, with significant central nervous system and respiratory depression
occurring in only 7%. Any child ingesting >2 mg and children <2 years of age
ingesting more than a lick or taste should be referred to the emergency
department for a minimum of 6 hours of observation. Naloxone can be used to
reverse respiratory depression. Copyright © 2008 by the American Academy of
Pediatrics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug toxicity, oral drug administration)
buprenorphine plus naloxone (drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
emetic agent (drug therapy)
ipecac (drug therapy)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
agitation
article
ataxia
child
coma
continuous infusion
cyanosis
disease course
disease duration
drowsiness
drug effect
drug fatality
drug overdose_ddth respiration depression; (drug therapy)
drug overdose_ddth respiration depression; (drug therapy)
drug surveillance program
female
food intake
groups by age
human
hypotension
infant
irritability
lethargy
major clinical study
male
miosis
pallor
poison center
preschool child
priority journal
respiration depression
retrospective study
treatment response
United States
vomiting
DRUG TRADE NAMES
buprenex
suboxone
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
buprenorphine (52485-79-7, 53152-21-9)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009161546
MEDLINE PMID
18381506 (http://www.ncbi.nlm.nih.gov/pubmed/18381506)
PUI
L354416784
DOI
10.1542/peds.2007-1774
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2007-1774
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 944
TITLE
Etomidate and midazolam for procedural sedation in the emergency department
of Queen Elizabeth Hospital: A randomised controlled trial
AUTHOR NAMES
Chan K.K.L.
Ho H.F.
AUTHOR ADDRESSES
(Chan K.K.L., littokaren@yahoo.com) Queen Elizabeth Hospital, Accident and
Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong.
(Ho H.F.) Emergency Medicine, Kowloon, Hong Kong.
CORRESPONDENCE ADDRESS
K.K.L. Chan, Queen Elizabeth Hospital, Accident and Emergency Department, 30
Gascoigne Road, Kowloon, Hong Kong. Email: littokaren@yahoo.com
SOURCE
Hong Kong Journal of Emergency Medicine (2008) 15:2 (75-87). Date of
Publication: April 2008
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, Room 808, Two Chinachem Exchange Square, 338 King's Road,
North Point, Hong Kong.
ABSTRACT
Objective: The objective of the study was to compare the effectiveness and
safety of intravenous etomidate against midazolam in procedures which
required sedation and analgesia in our emergency department. Methods: The
study was conducted in the emergency department of Queen Elizabeth Hospital
from 1st November 2005 to 30th June 2006. Adult patients who required
procedural sedation and analgesia were recruited and randomised into two
groups, in which either etomidate or midazolam was used as the sedative
agent. Vital parameters and depth of sedation were closely monitored until
they regained full consciousness. Results: A total of 87 patients were
recruited and randomised into study and control groups, of which 78 patients
completed the study and were analysed - 36 patients were in the midazolam
group whereas 42 patients were in the etomidate group. There was no
statistical difference in mean age, mean weight and procedures between the
two groups. Mean time for onset of action was 1.8 minutes for the etomidate
group versus 3.4 minutes for the midazolam group (p=0.003). There were no
significant differences in total procedure time, total length of stay, pain
score, satisfaction score and adverse effects. Conclusion: Etomidate
achieved adequate depth of sedation for painful procedures in significantly
shorter time than midazolam. There were no differences in procedure, time,
length of stay, pain relief and patient's satisfaction between the two
drugs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
etomidate (adverse drug reaction, clinical trial, drug comparison,
intravenous drug administration)
midazolam (adverse drug reaction, clinical trial, drug comparison,
intravenous drug administration)
EMTREE DRUG INDEX TERMS
epinephrine
flumazenil
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
sedation
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
anesthesia level
article
clinical trial
consciousness
controlled clinical trial
controlled study
dose time effect relation
double blind procedure
drug efficacy
drug safety
emergency care
emergency ward
female
Hong Kong
human
hypotension (side effect)
injection site pain (side effect)
length of stay
major clinical study
male
nausea (side effect)
pain assessment
patient satisfaction
randomized controlled trial
unspecified side effect (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
flumazenil (78755-81-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2008247458
PUI
L351711947
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 945
TITLE
Somatic health among heroin addicts before and during opioid maintenance
treatment: A retrospective cohort study
AUTHOR NAMES
Skeie I.
Brekke M.
Lindbæk M.
Waal H.
AUTHOR ADDRESSES
(Skeie I., ivskeie@online.no; Waal H., helge.waal@medisin.uio.no) Aker
University Hospital, Oslo, Norway.
(Skeie I., ivskeie@online.no; Waal H., helge.waal@medisin.uio.no) University
of Oslo, Faculty of Medicine, Institute of Psychiatry, Oslo, Norway.
(Brekke M., mette.brekke@medisin.uio.no; Lindbæk M.,
morten.lindbak@medisin.uio.no) University of Oslo, Faculty of Medicine,
Institute of General Practice and Community Medicine, Oslo, Norway.
CORRESPONDENCE ADDRESS
I. Skeie, Aker University Hospital, Oslo, Norway. Email: ivskeie@online.no
SOURCE
BMC Public Health (2008) 8 Article Number: 43. Date of Publication: 2008
ISSN
1471-2458 (electronic)
BOOK PUBLISHER
BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom.
ABSTRACT
Background. The long-term impact of opioid maintenance treatment (OMT) on
morbidity and health care utilization among heroin addicts has been
insufficiently studied. The objective of this study was to investigate
whether health care utilization due to somatic disease decreased during OMT,
and if so, whether the reduction included all kinds of diseases and whether
a reduction was related to abstinence from drug use. Methods. Cohort study
with retrospective registration of somatic disease incidents (health
problems, acute or sub-acute, or acute problems related to chronic disease,
resulting in a health care contact). Medical record data were collected from
hospitals, Outpatients' Departments, emergency wards and from general
practitioners (GPs) and prospective data on substance use during OMT were
available from 2001 onwards. The observation period was five years before
and up to five years during OMT. The cohort consisted of 35 out of 40
patients who received OMT between April 1999 and January 2005 in a Norwegian
district town. Statistical significance concerning changes in number of
incidents and inpatient and outpatient days during OMT compared with the pre
OMT period was calculated according to Wilcoxon signed rank test.
Significance concerning pre/during OMT changes in disease incidents by
relation to the type of health service contacts, as well as the impact of
ongoing substance use during OMT on the volume of contacts, was calculated
according to Pearson chi-square and Fisher's exact tests. Results. 278
disease incidents were registered. There was a reduction in all incidents by
35% (p = 0.004), in substance-related incidents by 62% (p < 0.001) and in
injection-related incidents by 70% (p < 0.001). There was an insignificant
reduction in non-fatal overdose incidents by 44% (p = 0.127) and an
insignificant increase in non-substance-related incidents by 13% (p =
0.741). Inpatient and outpatient days were reduced by 76% (p = 0.003) and
46% (p = 0.060), respectively. The disease incidents were less often
drug-related during OMT (p < 0.001). Patients experienced a reduction in
substance-related disease incidents regardless of ongoing substance use,
however there was a trend towards greater reductions in those without
ongoing abuse. Conclusion. Although as few as 35 patients were included,
this study demonstrates a significant reduction in health care utilization
due to somatic disease incidents during OMT. The reduction was most
pronounced for incidents related to substance use and injection. Inpatient
and outpatient days were reduced. Most probably these findings reflect
somatic health improvement among heroin addicts during OMT. © 2008 Skeie et
al; licensee BioMed Central Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heroin dependence (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
chi square test
cohort analysis
controlled study
female
Fisher exact test
human
major clinical study
male
medical record
morbidity
substance abuse
Wilcoxon signed ranks test
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008101143
MEDLINE PMID
18237421 (http://www.ncbi.nlm.nih.gov/pubmed/18237421)
PUI
L351303211
DOI
10.1186/1471-2458-8-43
FULL TEXT LINK
http://dx.doi.org/10.1186/1471-2458-8-43
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 946
TITLE
Response to morphine in male and female patients: Analgesia and adverse
events
AUTHOR NAMES
Bijur P.E.
Esses D.
Birnbaum A.
Chang A.K.
Schechter C.
Gallagher E.J.
AUTHOR ADDRESSES
(Bijur P.E., Bijur@aecom.yu.edu; Esses D.; Birnbaum A.; Chang A.K.;
Gallagher E.J.) Department of Emergency Medicine, Albert Einstein College of
Medicine, Bronx, NY, United States.
(Schechter C.) Department of Family Medicine, Albert Einstein College of
Medicine, Bronx, NY, United States.
(Bijur P.E., Bijur@aecom.yu.edu) Albert Einstein College of Medicine, Rose
F. Kennedy Center, 1410 Pelham Parkway South, Bronx, NY 10461, United
States.
CORRESPONDENCE ADDRESS
P. E. Bijur, Albert Einstein College of Medicine, Rose F. Kennedy Center,
1410 Pelham Parkway South, Bronx, NY 10461, United States. Email:
Bijur@aecom.yu.edu
SOURCE
Clinical Journal of Pain (2008) 24:3 (192-198). Date of Publication:
March/April 2008
ISSN
0749-8047
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
BACKGROUND: There is little agreement about a differential response of men
and women to opioid analgesics. Some experimental and clinical studies have
shown that women have a better response to opioids, others have found no
difference, and still others have found opioids to be more effective
analgesics for men than women. OBJECTIVES: To assess sex differences in
analgesic response to morphine and incidence of adverse events in patients
receiving a dose of 0.1 mg intravenous morphine/kg. METHODS: Secondary
analysis of the control arms of 6 randomized clinical trials that compared
0.1 mg/kg intravenous morphine with other opioids or other doses of morphine
in patients aged 21 to 65 with acute pain. The setting was an academic
medical center Emergency Department serving primarily Latino and
African-American patients. Change in self-reported pain intensity from
baseline to 30 minutes postbaseline on a validated and reproducible 11-point
numerical rating scale and count of adverse events were the primary
outcomes. RESULTS: The sample consisted of 211 women and 144 men. The mean
change in pain from baseline to 30 minutes postbaseline was 3.7 in women,
3.6 men (difference=0.04; 95% confidence interval: -0.52, 0.60). In women
without nausea before administration of morphine, the incidence of adverse
events was 18.3% versus 10.7% in men without initial nausea
(difference=7.6%; 95% confidence interval: -2.0, 17.2). DISCUSSION: Men and
women presenting to the Emergency Department did not have a differential
response to a single weight-based dose of morphine for alleviation of acute
pain. Women without baseline nausea had more adverse events than men. © 2008
Lippincott Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug comparison, drug dose, drug therapy,
intravenous drug administration)
EMTREE DRUG INDEX TERMS
hydromorphone (drug comparison, drug therapy, intravenous drug
administration)
naloxone (drug comparison, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy)
sex difference
EMTREE MEDICAL INDEX TERMS
adult
African American
article
controlled study
drug efficacy
drug safety
female
Hispanic
human
major clinical study
male
nausea (side effect)
nausea and vomiting (side effect)
pain assessment
priority journal
rating scale
side effect (side effect)
systolic blood pressure
treatment outcome
university hospital
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008222568
MEDLINE PMID
18287823 (http://www.ncbi.nlm.nih.gov/pubmed/18287823)
PUI
L351640915
DOI
10.1097/AJP.0b013e31815d3619
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0b013e31815d3619
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 947
TITLE
Poisoning by liquid ecstasy (GHB) in hospital emergency departments of
Barcelona: A 2-years study
ORIGINAL (NON-ENGLISH) TITLE
Intoxicaciones por éxtasis líquido atendidas en servicios de urgencias
hospitalarios de la ciudad de Barcelona durante 2 años
AUTHOR NAMES
Galicia M.
Nogué S.
To-Figueras J.
Echarte J.-L.
Iglesias M.L.
Miró O.
AUTHOR ADDRESSES
(Galicia M., miguelgaliciap@hotmail.com; Nogué S.; Miró O.) Servicio de
Urgencias, Hospital Clínic, Barcelona, Spain.
(To-Figueras J.) Laboratorio de Toxicología, Hospital Clínic, Barcelona,
Spain.
(Echarte J.-L.) Servicio de Urgencias, Hospital del Mar, Barcelona, Spain.
(Iglesias M.L.) Servicio de Urgencias, Consorci Parc Taulí, Sabadell.
Barcelona, Spain.
(Galicia M., miguelgaliciap@hotmail.com) Servicio de Urgencias, Área de
Medicina, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain.
CORRESPONDENCE ADDRESS
M. Galicia, Servicio de Urgencias, Área de Medicina, Hospital Clínic,
Villarroel, 170, 08036 Barcelona, Spain. Email: miguelgaliciap@hotmail.com
SOURCE
Medicina Clinica (2008) 130:7 (254-258). Date of Publication: 1 Mar 2008
ISSN
0025-7753
1578-8989 (electronic)
BOOK PUBLISHER
Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain.
ABSTRACT
BACKGROUND AND OBJECTIVE: Liquid ecstasy (GHB) is a new cause of drug
overdose in our country. To describe the epidemiological profile and
clinical manifestations, we analyzed cases of poisoning by GHB attended by
the Emergency Departments (ED) of 2 hospitals of the city of Barcelona.
PATIENTS AND METHOD: During two years (2003-2004) all cases of poisoning or
overdose due to GHB attended in the ED of the Hospital del Mar and the
Hospital Clinic of Barcelona were collected. The diagnosis was clinical
and/or by means of toxicological analysis. Epidemiological, clinical,
laboratory and therapeutic variables as well as the evolution were
collected. RESULTS: A total of 339 patients (mean age 23.5 years, 62% male)
were identified. Most patients (89%) were admitted during the early morning
and during weekends (89%). Symptoms began in a public place in 97%. Reduced
consciousness was the most important clinical manifestation, since 72% of
patients had a Glasgow Coma Score of 12 or less. Seventy per cent stated
having consumed GHB with other drugs, mainly ethyl alcohol (53%) and cocaine
(16%). Some form of treatment was required in 32% of cases and 20 cases were
administered an antidote: naloxone (12 cases), flumazenil (8 cases) and
physostigmine (6 cases). Five patients needed orotracheal intubation and
ventilatory support. One patient needed advanced vital support. There were
no deaths. CONCLUSIONS: GHB intoxication leading to reduced consciousness is
a frequent motive for admission to the ED, mostly in young people and in the
early morning during the weekend. GHB intoxication should be discarded in
all cases of coma of unknown origin.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
cocaine
EMTREE DRUG INDEX TERMS
flumazenil (drug therapy)
naloxone (drug therapy)
physostigmine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
assisted ventilation
clinical examination
clinical feature
coma
consciousness
drug use
emergency ward
endotracheal intubation
evolution
female
Glasgow coma scale
hospital admission
hospital department
human
laboratory
liquid
major clinical study
male
outpatient department
Spain
symptom
toxicology
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2008180806
MEDLINE PMID
18355425 (http://www.ncbi.nlm.nih.gov/pubmed/18355425)
PUI
L351520648
DOI
10.1157/13116549
FULL TEXT LINK
http://dx.doi.org/10.1157/13116549
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 948
TITLE
Author's reply [6]
AUTHOR NAMES
Voronov P.
AUTHOR ADDRESSES
(Voronov P., pvoronov@childrensmemorial.org) Department of Pediatric
Anesthesia, Children's Memorial Hospital, Chicago, IL, United States.
CORRESPONDENCE ADDRESS
P. Voronov, Department of Pediatric Anesthesia, Children's Memorial
Hospital, Chicago, IL, United States. Email: pvoronov@childrensmemorial.org
SOURCE
Paediatric Anaesthesia (2008) 18:3 (275-276). Date of Publication: March
2008
ISSN
1155-5645
1460-9592 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS
allele
analgesia
DNA polymorphism
drug metabolism
drug safety
emergency ward
genetic polymorphism
genotype
human
letter
phenotype
priority journal
surgical technique
treatment response
CAS REGISTRY NUMBERS
codeine (76-57-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Human Genetics (22)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008047613
PUI
L351159919
DOI
10.1111/j.1460-9592.2008.02422.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1460-9592.2008.02422.x
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 949
TITLE
Avoiding caesarean section in maternal hypothermia associated with marked
fetal distress
AUTHOR NAMES
Usman S.B.
Menon V.
AUTHOR ADDRESSES
(Usman S.B.; Menon V., Vijay.Menon@uhns.nhs.uk) University Hospital of North
Staffordshire, Newcastle Road, Stoke on Trent ST4 6QG, United Kingdom.
CORRESPONDENCE ADDRESS
V. Menon, University Hospital of North Staffordshire, Women and Children's
Division, Newcastle Road, Stoke on Trent ST4 6QG, United Kingdom. Email:
Vijay.Menon@uhns.nhs.uk
SOURCE
Emergency Medicine Journal (2008) 25:3 (177). Date of Publication: March
2008
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
A 37-weeks pregnant woman was admitted to the accident and emergency
department with hypothermia following possible drug misuse. Although her
pulse and blood pressure were normal, her fetus was found to have marked
bradycardia. This caused anxiety and quick transfer of the unconscious and
still hypothermic woman to the maternity unit. The baby was, however, not
immediately delivered by caesarean section. Instead, rewarming of the mother
was undertaken, which produced a rise in fetal heart rate as the maternal
temperature rose. A healthy baby was eventually born after spontaneous
labour. This report discusses the effects of hypothermia on the body and
fetus. It also discusses the rationale for delaying delivery of baby until
hypothermia is corrected.
EMTREE DRUG INDEX TERMS
naloxone
paracetamol
salicylic acid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cesarean section
fetus distress (complication)
hypothermia (therapy)
EMTREE MEDICAL INDEX TERMS
accident
adult
anxiety disorder (complication, diagnosis)
Apgar score
article
body fluid
case report
disease association
drug misuse
female
fetus heart rate
heart auscultation
human
intensive care
priority journal
vaporization
warming
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Developmental Biology and Teratology (21)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008119051
MEDLINE PMID
18299376 (http://www.ncbi.nlm.nih.gov/pubmed/18299376)
PUI
L351351118
DOI
10.1136/emj.2007.053264
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2007.053264
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 950
TITLE
Therapeutic opioids: A ten-year perspective on the complexities and
complications of the escalating use, abuse, and nonmedical use of opioids
AUTHOR NAMES
Manchikanti L.
Singh A.
AUTHOR ADDRESSES
(Manchikanti L., drlm@thepainmd.com) Pain Management Center of Paducah,
Paducah, KY, United States.
(Manchikanti L., drlm@thepainmd.com) Department of Anesthesiology and
Perioperative Medicine, University of Louisville, Louisville, KY, United
States.
(Singh A.) Pain Diagnostic Associates, Niagara, WI, United States.
(Manchikanti L., drlm@thepainmd.com) 2831 Lone Oak Road, Paducah, KY 42003,
United States.
CORRESPONDENCE ADDRESS
L. Manchikanti, 2831 Lone Oak Road, Paducah, KY 42003, United States. Email:
drlm@thepainmd.com
SOURCE
Pain Physician (2008) 11:SPEC. ISS. 2 (S63-S88). Date of Publication:
March/April 2008
Opioids, Book Series Title:
ISSN
1533-3159
BOOK PUBLISHER
American Society of Interventional Pain Physicians, Pain Physicians, 81
Lakeview Drive, Paducah, United States.
ABSTRACT
Therapeutic opioid use and abuse coupled with the nonmedical use of other
psychotherapeutic drugs has shown an explosive growth in recent years and
has been a topic of great concern and controversy. Americans, constituting
only 4.6% of the world's population, have been consuming 80% of the global
opioid supply, and 99% of the global hydrocodone supply, as well as
two-thirds of the world's illegal drugs. With the increasing therapeutic use
of opioids, the supply and retail sales of opioids are mirrored by
increasing abuse in patients receiving opioids, nonmedical use of other
psychotherapeutic drugs (in this article the category of psychotherapeutics
includes pain relievers, tranquilizers, stimulants, and sedatives, but does
not include over-the-counter drugs), emergency department visits for
prescription controlled drugs, exploding costs, increasing incidence of side
effects, and unintentional deaths. However, all these ills of illicit drug
use and opioid use, abuse, and non-medical use do not stop with adults. It
has been shown that 80% of America's high school students, or 11 million
teens, and 44% of middle school students, or 5 million teens, have
personally witnessed, on the grounds of their schools, illegal drug use,
illegal drug dealing, illegal drug possession, and other activities related
to drug abuse. The results of the 2006 National Survey on Drug Use and
Health showed that 7.0 million or 2.8% of all persons aged 12 or older had
used prescription type psychotherapeutic drugs nonmedically in the past
month, 16.387 million, or 6.6% of the population, had used in the past year,
and 20.3%, or almost 49.8 million, had used prescription psychotherapeutic
drugs nonmedically during their lifetime. Sadly, the initiates of
psychotherapeutic drugs used for nonmedical purposes were highest for
opioids. Therapeutic opioid use has increased substantially, specifically of
Schedule II drugs. Apart from lack of effectiveness (except for short-term,
acute pain) there are multiple adverse consequences including hormonal and
immune system effects, abuse and addiction, tolerance, and hyperalgesia.
Patients on long-term opioid use have been shown to increase the overall
cost of healthcare, disability, rates of surgery, and late opioid use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, clinical trial, drug
therapy, drug toxicity, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
alprazolam
analgesic agent (drug therapy, pharmacoeconomics)
anxiolytic agent
benzodiazepine derivative
cannabis (drug toxicity)
central stimulant agent
cocaine (drug toxicity)
codeine (drug therapy)
dextropropoxyphene (drug therapy)
diamorphine (drug toxicity)
fentanyl (drug therapy)
hydrocodone (drug therapy)
hydromorphone (drug therapy)
hypnotic sedative agent
illicit drug
lysergide (drug toxicity)
methadone (adverse drug reaction, drug therapy, drug toxicity)
methamphetamine
morphine (drug therapy)
non prescription drug
opiate (drug toxicity)
oxycodone (drug therapy)
pethidine (drug therapy)
psychedelic agent
psychotropic agent
sedative agent
tranquilizer
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic pain (disease management, drug therapy)
opiate addiction (disease management)
EMTREE MEDICAL INDEX TERMS
age distribution
ambulatory care
cancer pain (complication, drug therapy)
child parent relation
clinical trial
constipation (side effect)
cost benefit analysis
distress syndrome
driving ability
drug abuse
drug control
drug cost
drug efficacy
drug fatality (side effect)
drug intoxication
drug marketing
drug misuse
drug monitoring
drug safety
drug tolerance
dysphoria (side effect)
emergency ward
employment status
endocrine disease (side effect)
euphoria
evidence based medicine
forensic medicine
geographic distribution
health care cost
health statistics
health survey
high risk population
high school student
human
hyperalgesia (side effect)
immunopathology (side effect)
long term care
low back pain (disease management, drug therapy)
major depression
middle school student
mortality
musculoskeletal pain (drug therapy)
narcotic dependence
nausea (side effect)
parental attitude
patient attitude
patient compliance
patient education
physical disability
pregnant woman
prescription
pruritus (side effect)
review
risk assessment
sedation
sex difference
side effect (side effect)
DRUG TRADE NAMES
oxycontin
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
lysergide (50-37-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008238629
MEDLINE PMID
18443641 (http://www.ncbi.nlm.nih.gov/pubmed/18443641)
PUI
L351682079
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 951
TITLE
The epidemiologic association between opioid prescribing, non-medical use,
and emergency department visits
AUTHOR NAMES
Wisniewski A.M.
Purdy C.H.
Blondell R.D.
AUTHOR ADDRESSES
(Wisniewski A.M., amw25@buffalo.edu; Purdy C.H.; Blondell R.D.) Department
of Family Medicine, School of Medicine and Biomedical Sciences, University
at Buffalo, 462 Grider Street, Buffalo, NY 14215, United States.
CORRESPONDENCE ADDRESS
A. M. Wisniewski, Department of Family Medicine, School of Medicine and
Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY
14215, United States. Email: amw25@buffalo.edu
SOURCE
Journal of Addictive Diseases (2008) 27:1 (1-11). Date of Publication: 27
Feb 2008
ISSN
1055-0887
1545-0848 (electronic)
BOOK PUBLISHER
Routledge, 325 Chestnut Street, Philadelphia, United States.
ABSTRACT
Introduction: Since the 1990s prescriptions for and the non-medical use of
opioids have increased. This study examines associations between opioid
prescribing, non-medical use, and emergency department (ED) visits. Methods:
Data were abstracted from four federally sponsored, nationally
representative, annual surveys (National Hospital Ambulatory Medical Care
Survey, National Ambulatory Medical Care Survey, National Survey on Drug Use
and Health, and Drug Abuse Warning Network). Results: For hydrocodone and
oxycodone, associations between prescribing and non-medical use, and
prescribing and ED visits were statistically significant (p-values 0.04) and
strongly associated (correlation coefficient range 0.73 to 0.87). Male
gender, White race, and age 35 were all statistically significant (p-values
0.0001) predictors of receiving a hydrocodone or oxycodone-containing
prescription. Conclusion: The increased number of prescriptions written for
hydrocodone and oxycodone between 1995 and 2004 was associated with similar
increases in non-medical use and the number of ED visits during this time
period.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydrocodone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
prescription
EMTREE MEDICAL INDEX TERMS
adult
African American
age distribution
article
controlled study
drug use
European American
exploratory research
female
health survey
Hispanic
human
major clinical study
male
prediction
race difference
sex difference
CAS REGISTRY NUMBERS
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
morphine (52-26-6, 57-27-2)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2009596485
MEDLINE PMID
18551883 (http://www.ncbi.nlm.nih.gov/pubmed/18551883)
PUI
L355647051
DOI
10.1300/J069v27n01_01
FULL TEXT LINK
http://dx.doi.org/10.1300/J069v27n01_01
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 952
TITLE
Trends in opioid prescribing by race/ethnicity for patients seeking care in
US emergency departments
AUTHOR NAMES
Pletcher M.J.
Kertesz S.G.
Kohn M.A.
Gonzales R.
AUTHOR ADDRESSES
(Pletcher M.J., mpletcher@epi.ucsf.edu; Kohn M.A.) Department of
Epidemiology and Biostatistics, Division of General Internal Medicine,
University of California, San Francisco, CA, United States.
(Pletcher M.J., mpletcher@epi.ucsf.edu; Gonzales R.) Department of Medicine,
University of California, San Francisco, CA, United States.
(Kertesz S.G.) Division of Preventive Medicine, University of Alabama,
Birmingham, AL, United States.
(Kertesz S.G.) Deep South Center on Effectiveness, Veterans Affairs Medical
Center, Birmingham, AL, United States.
(Kohn M.A.) Emergency Department, Mills-Peninsula Medical Center,
Burlingame, CA, United States.
(Pletcher M.J., mpletcher@epi.ucsf.edu) Department of Epidemiology and
Biostatistics, University of California, San Francisco, 185 Berry St, Ste
5700, San Francisco, CA 94107, United States.
CORRESPONDENCE ADDRESS
M.J. Pletcher, Department of Epidemiology and Biostatistics, University of
California, San Francisco, 185 Berry St, Ste 5700, San Francisco, CA 94107,
United States. Email: mpletcher@epi.ucsf.edu
SOURCE
JAMA - Journal of the American Medical Association (2008) 299:1 (70-78).
Date of Publication: 2 Jan 2008
ISSN
0098-7484
1538-3598 (electronic)
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Context: National quality improvement initiatives implemented in the late
1990s were followed by substantial increases in opioid prescribing in the
United States, but it is unknown whether opioid prescribing for treatment of
pain in the emergency department has increased and whether differences in
opioid prescribing by race/ethnicity have decreased. Objectives: To
determine whether opioid prescribing in emergency departments has increased,
whether non-Hispanic white patients are more likely to receive an opioid
than other racial/ethnic groups, and whether differential prescribing by
race/ethnicity has diminished since 2000. Design and Setting: Pain-related
visits to US emergency departments were identified using reason-for-visit
and physician diagnosis codes from 13 years (1993-2005) of the National
Hospital Ambulatory Medical Care Survey. Main Outcome Measure: Prescription
of an opioid analgesic. Results: Pain-related visits accounted for 156 729
of 374 891 (42%) emergency department visits. Opioid prescribing for
pain-related visits increased from 23% (95% confidence interval [CI],
21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P<.001 for trend), and
this trend was more pronounced in 2001-2005 (P=.02). Over all years, white
patients with pain were more likely to receive an opioid (31%) than black
(23%), Hispanic (24%), or Asian/other patients (28%) (P<.001 for trend), and
differences did not diminish over time (P=.44), with opioid prescribing
rates of 40% for white patients and 32% for all other patients in 2005.
Differential prescribing by race/ethnicity was evident for all types of pain
visits, was more pronounced with increasing pain severity, and was
detectable for long-bone fracture and nephrolithiasis as well as among
children. Statistical adjustment for pain severity and other factors did not
substantially attenuate these differences, with white patients remaining
significantly more likely to receive an opioid prescription than black
patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients
(0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI,
0.67-0.93). Conclusion: Opioid prescribing for patients making a
pain-related visit to the emergency department increased after national
quality improvement initiatives in the late 1990s, but differences in opioid
prescribing by race/ethnicity have not diminished. ©2008 American Medical
Association. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate derivative (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
African American
article
Asian
Caucasian
disease severity
emergency ward
ethnicity
fracture
Hispanic
human
nephrolithiasis
prescription
priority journal
race difference
trend study
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Urology and Nephrology (28)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008019136
MEDLINE PMID
18167408 (http://www.ncbi.nlm.nih.gov/pubmed/18167408)
PUI
L351053448
DOI
10.1001/jama.2007.64
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.2007.64
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 953
TITLE
Predictors for opioid analgesia administration in children with abdominal
pain presenting to the emergency department
AUTHOR NAMES
Goldman R.D.
Narula N.
Klein-Kremer A.
Finkelstein Y.
Rogovik A.L.
AUTHOR ADDRESSES
(Goldman R.D., rgoldman@cw.bc.ca) Department of Pediatrics, BC Children's
Hospital, University of British Columbia, Vancouver, BC, Canada.
(Narula N.; Klein-Kremer A.; Finkelstein Y.; Rogovik A.L.) Department of
Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada.
(Goldman R.D., rgoldman@cw.bc.ca) Division of Pediatric Emergency Medicine,
BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
CORRESPONDENCE ADDRESS
R.D. Goldman, Division of Pediatric Emergency Medicine, BC Children's
Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada. Email:
rgoldman@cw.bc.ca
SOURCE
Clinical Journal of Pain (2008) 24:1 (11-15). Date of Publication: January
2008
ISSN
0749-8047
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
OBJECTIVES: Abdominal pain is one of the most common symptoms in children.
The aim of this study was to determine the rate of opioid analgesia in
children with abdominal pain presenting to the pediatric Emergency
Department (ED) and to identify factors associated with administration of
opioids. METHODS: We retrospectively reviewed all charts of patients with
abdominal pain <7 days presenting to the ED of a tertiary pediatric hospital
over a 3-month period. Demographic and illness-related variables were
recorded, and the primary outcome variable was whether opioid analgesia was
used to relieve abdominal pain. We analyzed the data with a univariate
analysis and a multivariate stepwise regression analysis to determine
independent influences on the rate of opioid prescribing. RESULTS: Of 582
children included in the analysis, 53 (9%) received opioid analgesia. Pain
in the right lower quadrant on examination, documentation of a pain score in
triage, and the level of acuity as determined by the triage nurse were
predictors of administration of opioids by the physician. Thirty-four (77%)
of the opioids given were below the recommended dose for the child.
CONCLUSIONS: Few pediatric patients with abdominal pain are treated with
pain medications. The decision to use opioid analgesia for acute abdominal
pain in the pediatric ED is influenced by acuity level, pain score
documentation in triage, and location of abdominal pain. Efforts should be
made to educate physicians on the appropriate administration and dose of
opioids in children with abdominal pain in the ED. © 2008 Lippincott
Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (drug therapy)
hydromorphone (drug therapy)
morphine (drug therapy)
opiate (drug dose, drug therapy)
pethidine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (drug therapy)
acute abdomen
emergency treatment
EMTREE MEDICAL INDEX TERMS
adolescent
analgesia
article
Canada Triage and Acuity Scale
child
child health care
controlled study
drug indication
drug overdose
emergency health service
emergency physician
emergency ward
female
human
major clinical study
male
medical decision making
multivariate analysis
nurse
pain assessment
prediction
priority journal
rating scale
recommended drug dose
regression analysis
retrospective study
scoring system
software
univariate analysis
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008018756
MEDLINE PMID
18180630 (http://www.ncbi.nlm.nih.gov/pubmed/18180630)
PUI
L351053056
DOI
10.1097/AJP.0b013e318156d921
FULL TEXT LINK
http://dx.doi.org/10.1097/AJP.0b013e318156d921
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 954
TITLE
The clinical applications of intranasal opioids
AUTHOR NAMES
Shelley K.
Paech M.J.
AUTHOR ADDRESSES
(Shelley K.; Paech M.J., Michael.Paech@health.wa.gov.au) Department of
Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women,
Perth, WA, Australia.
(Paech M.J., Michael.Paech@health.wa.gov.au) Pharmacology and
Anaesthesiology Unit, School of Medicine and Pharmacology, University of
Western Australia, .
CORRESPONDENCE ADDRESS
M.J. Paech, Department of Anaesthesia and Pain Medicine, King Edward
Memorial Hospital for Women, Perth, WA, Australia. Email:
Michael.Paech@health.wa.gov.au
SOURCE
Current Drug Delivery (2008) 5:1 (55-58). Date of Publication: January 2008
ISSN
1567-2018
BOOK PUBLISHER
Bentham Science Publishers B.V., P.O. Box 294, Bussum, Netherlands.
ABSTRACT
Opioids are widely used in all fields of pain management and may be
delivered by a number of routes of administration. The intranasal
administration of opioid is a convenient route of transmucosal drug delivery
that has received limited attention. Potential advantages compared with
parenteral or oral administration include avoidance of painful injection,
avoidance of risks associated with intravenous access, rapid onset and
titration to effect, good bioavailability, and high levels of acceptability
and familiarity to patients. These features also lend themselves to the
benefits of patient-controlled delivery systems and commercially available
devices are described. In this paper we briefly consider the relevant
pharmacology of intranasal drug delivery; opioid drugs and formulations; and
delivery devices used clinically for intranasal administration. We review
the clinical applications of intranasal opioid analgesia. These have
included use for in-hospital pain management in adult and paediatric
populations, in the emergency department, perioperatively and in burns
units. Out-of-hospital use has included palliative care and paramedic use
during retrieval and transfer to hospital. Many small trials suggest that
intranasal opioids play a useful role in pain management, but large clinical
trials are needed to better define advantages, safety and acceptability. ©
2008 Bentham Science Publishers Ltd.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (intranasal drug administration, oral drug administration, parenteral
drug administration, pharmaceutics, pharmacokinetics)
EMTREE DRUG INDEX TERMS
fentanyl
morphine (adverse drug reaction, drug therapy)
pethidine (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
bitter taste
burn
drug absorption
drug bioavailability
drug delivery system
drug formulation
drug safety
health service
human
nasal irritation (side effect)
nasal irritation (side effect)
nose disease (side effect)
palliative therapy
postoperative pain
priority journal
risk factor
side effect (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008072848
MEDLINE PMID
18220551 (http://www.ncbi.nlm.nih.gov/pubmed/18220551)
PUI
L351225634
DOI
10.2174/156720108783330989
FULL TEXT LINK
http://dx.doi.org/10.2174/156720108783330989
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 955
TITLE
Impact of home care on place of death, access to emergency departments and
opioid therapy in 350 terminal cancer patients
AUTHOR NAMES
Saugo M.
Pellizzari M.
Marcon L.
Benetollo P.
Toffanin R.
Gallina P.
Cecchetto G.
Miccinesi G.
Rigon S.
Cancian M.
Sichetti D.
AUTHOR ADDRESSES
(Saugo M., mario.saugo@ulss4.veneto.it; Pellizzari M.; Rigon S.) Servizio
Epidemiologico, ULSS 4, Italy.
(Marcon L.) Servizio Farmaceutico, ULSS 4, Italy.
(Benetollo P.) Direzione Sanitaria, ULSS 4, Italy.
(Toffanin R.; Gallina P.) Distretto Sanitario 7, ULSS 16, Italy.
(Cecchetto G.) UO Lungodegenza, ULSS 8, Italy.
(Miccinesi G.) CSPO Firenze, Italy.
(Cancian M.) MMG Conegliano Veneto, Italy.
(Sichetti D.) Laboratoho di Farmacoepidemiologia, Consorzio Mario Negri Sud,
Santa Maria Imbaro (Chieti), Italy.
(Saugo M., mario.saugo@ulss4.veneto.it) Servizio Epidemiologico, ULSS 4, Via
Rasa 9, 36016 Thiene (VI), Italy.
CORRESPONDENCE ADDRESS
M. Saugo, Servizio Epidemiologico, ULSS 4, Via Rasa 9, 36016 Thiene (VI),
Italy. Email: mario.saugo@ulss4.veneto.it
SOURCE
Tumori (2008) 94:1 (87-95). Date of Publication: January/February 2008
ISSN
0300-8916
BOOK PUBLISHER
Il Pensiero Scientifico Editore s.r.l., Via Bradano 3/C, Roma, Italy.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer patient
emergency ward
home care
terminal disease (disease management)
EMTREE MEDICAL INDEX TERMS
article
clinical assessment
community care
death
general practitioner
health care
health care access
health care quality
health service
hospital service
organization
primary medical care
social care
social work
EMBASE CLASSIFICATIONS
Cancer (16)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2008166595
MEDLINE PMID
18468342 (http://www.ncbi.nlm.nih.gov/pubmed/18468342)
PUI
L351487192
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 956
TITLE
Characteristics of patients transported by an aeromedical service for acute
toxicologic emergencies: A 5-year experience
AUTHOR NAMES
Maloney Jr. G.E.
Pakiela J.A.
AUTHOR ADDRESSES
(Maloney Jr. G.E., gmaloney@metrohealth.org; Pakiela J.A.) Department of
Emergency Medicine, MetroHealth Medical Center, Cleveland, OH, United
States.
CORRESPONDENCE ADDRESS
G.E. Maloney Jr., Department of Emergency Medicine, MetroHealth Medical
Center, Cleveland, OH, United States. Email: gmaloney@metrohealth.org
SOURCE
Air Medical Journal (2008) 27:1 (48-50). Date of Publication: January
2008/February 2008
ISSN
1067-991X
1532-6497 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Introduction: Aeromedical services are used routinely in the prehospital and
interhospital transfer of patients with trauma, neurosurgical, cardiac, and
other conditions requiring specialized care. The use of aeromedical
transport in patients with acute toxicologic emergencies is not well
described. We sought to investigate and describe the characteristics of
patients transported by our aeromedical service. Setting: The study was
performed at an urban critical care transport service operating both ground
and aeromedical units and transporting an average of 3,362 patients per year
during the study period. Methods: Charts from the 5-year period of 2000 to
2004 for which a toxicologic emergency was coded as the primary diagnosis
were identified and reviewed by the authors. Data abstracted included age,
sex, toxin(s) involved, treatment rendered at the scene/bedside and en route
by the transport team, and additional data (electrocardiogram [ECG]
findings, serum levels) when appropriate. Results: One hundred thirty-three
patients were transported (for a total of 135 transports). Most (82%) were
transported by air. Carbon monoxide was the most common toxic exposure,
accounting for 16% of all transports. Fifty-seven percent of the patients
were intubated, with 11% intubated by the flight crew. Antidotes were
administered in 40 patients, with naloxone and bicarbonate being the most
common. Conclusion: Acute toxicologic emergencies accounted for a small
percentage of total transports. The most common additional intervention by
flight crews was endotracheal intubation. Identification of common
poisonings encountered by flight crews may assist services in developing
education and quality assurance programs. © 2008 Air Medical Journal
Associates.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
antidote (drug therapy)
bicarbonate (drug therapy)
calcium chloride (drug therapy)
carbon monoxide
dopamine (drug therapy)
flumazenil (drug therapy)
hypertensive agent (drug therapy)
naloxone (drug therapy)
noradrenalin (drug therapy)
oxygen
pralidoxime (drug therapy)
toxin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute toxicity (drug therapy, therapy)
air medical transport
emergency health service
EMTREE MEDICAL INDEX TERMS
article
blood level
controlled study
education
electrocardiogram
endotracheal intubation
female
human
intensive care
major clinical study
male
medical record review
priority journal
quality control
toxicology
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
carbon monoxide (630-08-0)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
oxygen (7782-44-7)
pralidoxime (6735-59-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008013269
MEDLINE PMID
18191089 (http://www.ncbi.nlm.nih.gov/pubmed/18191089)
PUI
L351036180
DOI
10.1016/j.amj.2007.07.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2007.07.002
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 957
TITLE
Crystal methamphetamine use associated with non-fatal overdose among a
cohort of injection drug users in Vancouver
AUTHOR NAMES
Fairbairn N.
Wood E.
Stoltz J.-a.
Li K.
Montaner J.
Kerr T.
AUTHOR ADDRESSES
(Fairbairn N.; Wood E.; Stoltz J.-a.; Li K.; Montaner J.; Kerr T.,
tkerr@cfenet.ubc.ca) British Columbia Centre for Excellence in HIV, AIDS,
St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 146, Canada.
(Wood E.; Montaner J.; Kerr T., tkerr@cfenet.ubc.ca) Department of Medecine,
University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z
146, Canada.
CORRESPONDENCE ADDRESS
T. Kerr, British Columbia Centre for Excellence in HIV, AIDS, St. Paul's
Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 146, Canada. Email:
tkerr@cfenet.ubc.ca
SOURCE
Public Health (2008) 122:1 (70-78). Date of Publication: January 2008
ISSN
0033-3506
BOOK PUBLISHER
Elsevier, P.O. Box 211, Amsterdam, Netherlands.
ABSTRACT
Objectives: To evaluate the prevalence and correlates of non-fatal overdose
among a polysubstance-using cohort of injection drug users (IDU) in
Vancouver. Study design/methods: We evaluated factors associated with
non-fatal overdose among participants enrolled in the Vancouver Injection
Drug Users Study (VIDUS) using univariate statistics. Self-reports of the
awareness of drugs taken and drug potency, polysubstance use, and assistance
received at the time of non-fatal overdose were also recorded. Results: From
1 December 2003 to 1 June 2005, 551 participants who were active injectors
were followed. In total, 37 (6.7%) individuals reported experiencing a
non-fatal overdose in the previous 6 months. Factors positively associated
with non-fatal overdose included public injecting (odds ratio (OR)=4.74, 95%
confidence interval (CI) 2.35-9.37, P<0.001), crystal methamphetamine use
(OR=4.11) and injection (OR=3.63), morphine injection (OR=3.55),
non-injection opiate use (OR=3.30), frequent heroin injection (OR=2.28) and
sex trade work (OR=2.12). Factors negatively associated with non-fatal
overdose included participation in methadone maintenance therapy (OR=0.31)
and injecting alone (OR=0.36). Sixty-two percent of individuals were unaware
of drug potency, 64.9% of IDU were taking other drugs at the time of
overdosing, with crack being the main drug (37.0%). Fifty-four percent were
assisted by ambulance personnel, 56.8% were taken to accident and emergency
or hospital, 38.1% left accident and emergency or hospital before being
released, and 35.1% were given Naloxone. Conclusion: Structural
interventions are needed that seek to modify the social and contextual risks
for overdose, increased access to treatment programmes, and trials of novel
interventions for crystal methamphetamine users. © 2007.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methamphetamine (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
benzodiazepine (drug toxicity)
methadone (drug therapy)
morphine (drug toxicity)
naloxone (drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
intravenous drug abuse
EMTREE MEDICAL INDEX TERMS
adult
alcohol abuse
article
awareness
Canada
cohort analysis
confidence interval
controlled study
correlation analysis
drug dependence (drug therapy, epidemiology, etiology)
drug potency
emergency ward
female
human
major clinical study
male
methadone treatment
morphine addiction (drug therapy, epidemiology, etiology)
opiate addiction (drug therapy, epidemiology, etiology)
prevalence
risk assessment
self report
statistics
substance abuse
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007604042
MEDLINE PMID
17645904 (http://www.ncbi.nlm.nih.gov/pubmed/17645904)
PUI
L350246233
DOI
10.1016/j.puhe.2007.02.016
FULL TEXT LINK
http://dx.doi.org/10.1016/j.puhe.2007.02.016
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 958
TITLE
Emergency Department Based Sedation Services
AUTHOR NAMES
Pershad J.
Kost S.
AUTHOR ADDRESSES
(Pershad J., pers2260@bellsouth.net) Division of Emergency Services, Le
Bonheur Children's Medical Center, Memphis, TN, United States.
(Kost S.) Division of Emergency Services, A.I.Dupont Hospital for Children,
Wilmington, DE, United States.
CORRESPONDENCE ADDRESS
J. Pershad, Division of Emergency Services, Le Bonheur Children's Medical
Center, Memphis, TN, United States. Email: pers2260@bellsouth.net
SOURCE
Clinical Pediatric Emergency Medicine (2007) 8:4 (253-261). Date of
Publication: December 2007
ISSN
1522-8401
BOOK PUBLISHER
W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Increased demand for procedural sedation in areas of the hospital outside
the traditional emergency department and operating room settings has led to
a growing trend of these services being rendered by pediatric emergency
physicians. We will review the pros and cons of establishing an emergency
department-based sedation service, discuss the scope of the service, review
practical considerations in successfully implementing and administering this
service, and highlight challenges and opportunities for reimbursement. ©
2007 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
chloral hydrate (drug dose, oral drug administration)
diazepam (drug dose, intravenous drug administration)
etomidate (adverse drug reaction, drug dose, intravenous drug
administration)
fentanyl (drug dose)
flumazenil (drug dose, intravenous drug administration)
ketamine (drug dose, intramuscular drug administration, intravenous drug
administration)
methohexital (drug dose)
midazolam (drug dose, intramuscular drug administration, intranasal drug
administration, intravenous drug administration, oral drug administration,
rectal drug administration)
morphine (drug dose, intravenous drug administration)
naloxone (drug dose, intramuscular drug administration, intravenous drug
administration)
nitrous oxide (inhalational drug administration)
pentobarbital (drug dose, intramuscular drug administration, oral drug
administration, rectal drug administration)
propofol (adverse drug reaction, drug dose, intravenous drug administration)
thiopental (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child health care
emergency ward
sedation
EMTREE MEDICAL INDEX TERMS
accreditation
analgesia
article
child
clinical practice
cooperation
drug dose titration
emergency health service
health care delivery
health care personnel
hospital care
hospital department
human
hypotension (side effect)
interpersonal communication
medical documentation
myoclonus (side effect)
nausea (side effect)
operating room
patient referral
patient scheduling
quality control
reimbursement
respiration depression (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007573609
PUI
L350163031
DOI
10.1016/j.cpem.2007.08.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2007.08.005
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 959
TITLE
Towards evidence based emergency medicine: best BETs from the Manchester
Royal Infirmary. Epidural analgesia/anaesthesia versus systemic intravenous
opioid analgesia in the management of blunt thoracic trauma.
AUTHOR NAMES
Parris R.
AUTHOR ADDRESSES
(Parris R.) Royal Bolton Hospital, UK.
CORRESPONDENCE ADDRESS
R. Parris, Royal Bolton Hospital, UK.
SOURCE
Emergency medicine journal : EMJ (2007) 24:12 (848-849). Date of
Publication: Dec 2007
ISSN
1472-0213 (electronic)
ABSTRACT
A short cut review was carried out to establish whether an epidural infusion
provided any advantage over intravenous analgesia in the management of blunt
thoracic trauma. Only four papers presented evidence to answer the clinical
question. The author, date and country of publication, patient group
studied, study type, relevant outcomes, results and study weaknesses of this
paper are presented in table 2. The clinical bottom line is that epidural
analgesia may provide better pain relief, but may not alter clinical
outcomes.
EMTREE DRUG INDEX TERMS
narcotic analgesic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blunt trauma (complication)
epidural anesthesia
thorax injury (complication)
EMTREE MEDICAL INDEX TERMS
aged
evidence based medicine
human
male
review
rib fracture (complication)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
18029522 (http://www.ncbi.nlm.nih.gov/pubmed/18029522)
PUI
L350340177
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 960
TITLE
Local anaesthetic-opioid mixture for emergency Caesarean section [12]
AUTHOR NAMES
Benhamou D.
AUTHOR ADDRESSES
(Benhamou D., dan.benhamou@bct.aphp.fr) Hôpital de Bicetre, 94275 Le Kremlin
Bicetre, Cedex, France.
CORRESPONDENCE ADDRESS
D. Benhamou, Hôpital de Bicetre, 94275 Le Kremlin Bicetre, Cedex, France.
Email: dan.benhamou@bct.aphp.fr
SOURCE
Anaesthesia (2007) 62:12 (1298). Date of Publication: December 2007
ISSN
0003-2409
1365-2044 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bupivacaine (drug combination)
fentanyl
levobupivacaine
lidocaine (drug combination)
sufentanil (drug combination, epidural drug administration)
EMTREE DRUG INDEX TERMS
anesthetic agent
epinephrine (drug combination)
opiate derivative
EMTREE MEDICAL INDEX TERMS
cesarean section
emergency ward
human
letter
local anesthesia
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
fentanyl (437-38-7)
levobupivacaine (27262-47-1, 27262-48-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007541210
MEDLINE PMID
17991279 (http://www.ncbi.nlm.nih.gov/pubmed/17991279)
PUI
L350060539
DOI
10.1111/j.1365-2044.2007.05362_1.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1365-2044.2007.05362_1.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 961
TITLE
Case files of the Drexel University Medical Toxicology Fellowship:
methadone-induced QTc prolongation.
AUTHOR NAMES
Wong S.C.
Roberts J.R.
AUTHOR ADDRESSES
(Wong S.C.; Roberts J.R.) Department of Emergency Medicine, Division of
Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA,
USA.
CORRESPONDENCE ADDRESS
S.C. Wong, Department of Emergency Medicine, Division of Medical Toxicology,
Drexel University College of Medicine, Philadelphia, PA, USA. Email:
scw101@gmail.com
SOURCE
Journal of medical toxicology : official journal of the American College of
Medical Toxicology (2007) 3:4 (190-194). Date of Publication: Dec 2007
ISSN
1556-9039
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (adverse drug reaction)
narcotic agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
long QT syndrome
torsade des pointes
EMTREE MEDICAL INDEX TERMS
adult
article
case report
chemically induced disorder
electrocardiography
emergency health service
human
intoxication (drug therapy)
male
pathophysiology
treatment outcome
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
18072176 (http://www.ncbi.nlm.nih.gov/pubmed/18072176)
PUI
L350337085
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 962
TITLE
Accidental intoxication with unlabeled, generic transdermal fentanyl patches
caused by insufficient instruction
ORIGINAL (NON-ENGLISH) TITLE
Akzidentelle intoxikation durch unbeschriftete, generische transdermale
fentanylpflaster nach unzureichender aufklärung
AUTHOR NAMES
Tank S.
Stork K.
Skibba W.
Zittel S.
Andresen H.
Goetz A.E.
Beck H.
AUTHOR ADDRESSES
(Tank S., sascha.tank@gmx.de; Skibba W.; Goetz A.E.; Beck H.) Klinik für
Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
(Stork K.) Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg, Germany.
(Zittel S.) Klinik und Poliklinik für Neurologie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg, Germany.
(Andresen H.) Institut für Rechtsmedizin, Universitätsklinikum
Hamburg-Eppendorf, Hamburg, Germany.
(Tank S., sascha.tank@gmx.de) Klinik für Anästhesiologie,
Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg,
Germany.
CORRESPONDENCE ADDRESS
S. Tank, Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf,
Martinistraße 52, 20246 Hamburg, Germany. Email: sascha.tank@gmx.de
SOURCE
Anaesthesist (2007) 56:11 (1137-1141). Date of Publication: November 2007
ISSN
0003-2417
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
A somnolent 78-year-old male patient was brought to our emergency room by an
ambulance with the presumptive diagnosis of stroke. Cranial computed
tomography provided no evidence. On the intensive care unit of the
neurosurgical department the patient was completely undressed. Covered by a
sock and underwear the ICU staff found five unlabeled, transparent patches.
Under the presumptive diagnosis of an opioid intoxication by a transdermal
therapeutic system naloxone was infused over 3 days. The patient reported
after rapidly awaking that fentanyl patches had been prescribed by his
family practitioner the day before. The patient recovered without any
sequelae. © 2007 Springer Medizin Verlag.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity, transdermal drug administration)
naloxone (drug toxicity, transdermal drug administration)
EMTREE DRUG INDEX TERMS
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
aged
article
blood gas analysis
case report
cerebrovascular accident
computer assisted tomography
drug information
electrocardiogram
emergency ward
general practitioner
Glasgow coma scale
human
intensive care
male
neurosurgery
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2007562965
MEDLINE PMID
17846727 (http://www.ncbi.nlm.nih.gov/pubmed/17846727)
PUI
L350132100
DOI
10.1007/s00101-007-1240-7
FULL TEXT LINK
http://dx.doi.org/10.1007/s00101-007-1240-7
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 963
TITLE
The evaluation and management of acute poisoning emergencies
AUTHOR NAMES
Lawrence D.T.
Bechtel L.
Walsh J.P.
Holstege C.P.
AUTHOR ADDRESSES
(Lawrence D.T.; Bechtel L.; Holstege C.P., ch2xf@virginia.edu) Division of
Medical Toxicology, Department of Emergency Medicine, University of Virginia
School of Medicine, Charlottesville, VA, United States.
(Walsh J.P.) Critical Incident Analysis Group, Department of Psychiatry,
University of Virginia School of Medicine, Charlottesville, VA, United
States.
(Holstege C.P., ch2xf@virginia.edu) University of Virginia, P.O. Box 800774,
Charlottesville, VA 22908-0774, United States.
CORRESPONDENCE ADDRESS
C.P. Holstege, University of Virginia, P.O. Box 800774, Charlottesville, VA
22908-0774, United States. Email: ch2xf@virginia.edu
SOURCE
Minerva Medica (2007) 98:5 (543-568). Date of Publication: October 2007
ISSN
0026-4806
BOOK PUBLISHER
Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Turin, Italy.
ABSTRACT
Emergency physicians will regularly be called upon to care for poisoned
patients. The purpose of this article is to review the general approach to
the poisoned patient. Specific signs and symptoms will be identified that
may clue the clinician into a specific toxin class as a diagnosis. Necessary
testing in poisonings will be highlighted. This article will also introduce
the basics of gastrointestinal decontamination and antidotes against select
poisons.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (adverse drug reaction, drug dose, drug therapy, oral drug
administration)
laxative (drug therapy)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug concentration, drug dose, drug therapy)
acetylcysteine (drug dose, drug therapy, intravenous drug administration,
oral drug administration, parenteral drug administration, pharmacology)
adrenergic receptor stimulating agent (drug toxicity)
anion (drug toxicity)
atropine (intramuscular drug administration, intravenous drug
administration, pharmacology)
benzodiazepine (drug therapy, pharmacology)
carbon monoxide (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
cholinergic receptor stimulating agent (drug toxicity)
deferoxamine (intravenous drug administration)
digitab
digoxin antibody F(ab) fragment (adverse drug reaction, pharmacology)
flumazenil (drug therapy, intravenous drug administration)
hydroxocobalamin (drug therapy)
hypnotic sedative agent (drug toxicity)
macrogol (pharmacokinetics, pharmacology)
magnesium citrate (adverse drug reaction, drug therapy)
methylene blue (drug therapy)
naloxone (inhalational drug administration, intramuscular drug
administration, intranasal drug administration, intraosseous drug
administration, intravenous drug administration)
octreotide (drug therapy)
opiate (drug toxicity)
paracetamol (drug toxicity)
pralidoxime (adverse drug reaction, drug dose, drug therapy,
pharmacokinetics, pharmacology)
pralidoxime chloride
pyridoxine (drug therapy, intravenous drug administration, pharmacology)
salicylic acid (drug toxicity)
sodium sulfate (drug therapy)
sorbitol (adverse drug reaction, drug therapy)
unclassified drug
unindexed drug
venom antiserum (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
intoxication (therapy)
EMTREE MEDICAL INDEX TERMS
abdominal cramp (side effect)
anion gap
blurred vision (side effect)
brain toxicity (prevention)
clinical evaluation
colon lavage
constipation (side effect)
continuous infusion
diaphoresis
diarrhea (side effect)
drug absorption
drug overdose
drug screening
drug urine level
electrocardiogram
enzyme multiplied immunoassay technique
epigastric discomfort (side effect)
eye lavage
headache (side effect)
human
hypermagnesemia (side effect)
hypersensitivity (side effect)
hypertension (side effect)
hypotension (side effect)
larynx spasm (side effect)
loading drug dose
lung aspiration
muscle rigidity (side effect)
nausea (side effect)
patient care
physical disease by body function
potassium blood level
radiography
recommended drug dose
respiration impairment (side effect)
respiration impairment (side effect)
review
seizure (drug therapy)
side effect (side effect)
single drug dose
skin decontamination
stomach lavage
tachydysrhythmia (side effect)
tachydysrhythmia (side effect)
vomiting (side effect)
DRUG TRADE NAMES
2 pam
digibind
digitab
mucomyst
narcan
protopam chloride
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
carbon monoxide (630-08-0)
deferoxamine (70-51-9)
flumazenil (78755-81-4)
hydroxocobalamin (13422-51-0, 13422-52-1)
macrogol (25322-68-3)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
pralidoxime chloride (51-15-0)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
salicylic acid (63-36-5, 69-72-7)
sodium sulfate (7757-82-6)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
2007603680
MEDLINE PMID
18043563 (http://www.ncbi.nlm.nih.gov/pubmed/18043563)
PUI
L350245310
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 964
TITLE
Coma blisters
AUTHOR NAMES
Waring W.S.
Sandilands E.A.
AUTHOR ADDRESSES
(Waring W.S., s.waring@ed.ac.uk; Sandilands E.A.) Scottish Poisons
Information Bureau, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
(Waring W.S., s.waring@ed.ac.uk) Scottish Poisons Information Bureau, Royal
Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA,
United Kingdom.
CORRESPONDENCE ADDRESS
W.S. Waring, Scottish Poisons Information Bureau, Royal Infirmary of
Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom.
Email: s.waring@ed.ac.uk
SOURCE
Clinical Toxicology (2007) 45:7 (808-809). Date of Publication: October 2007
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
codeine
opiate (drug toxicity)
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma blister (complication)
vesicular rash (complication)
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
case report
consciousness level
dyspnea
emergency ward
erythema
female
human
miosis
respiratory failure (diagnosis, drug therapy, therapy)
CAS REGISTRY NUMBERS
codeine (76-57-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007590639
MEDLINE PMID
17952753 (http://www.ncbi.nlm.nih.gov/pubmed/17952753)
PUI
L350208865
DOI
10.1080/15563650701709189
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650701709189
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 965
TITLE
Acute poisoning in the emergency department of a level III universitary
hospital: Changes produced in the last 10 years
ORIGINAL (NON-ENGLISH) TITLE
Intoxicaciones agudas en el servicio de urgencias de un hospital
universitario de nivel III: Cambios producidos en los últimos 10 años
AUTHOR NAMES
Pastó Cardona L.
Martorell Puigserver C.
Mercadal Orfila G.
Machí Ribes J.J.
Jódar Massanès R.
AUTHOR ADDRESSES
(Pastó Cardona L., lpasto@csub.scs.es; Martorell Puigserver C.; Mercadal
Orfila G.; Machí Ribes J.J.; Jódar Massanès R.) Servicio de Farmacia,
Hospital Universitari de Bellvitge, Feixa Llarga, s/n, 08907 l'Hospitalet de
Llobregat.
CORRESPONDENCE ADDRESS
L. Pastó Cardona, Servicio de Farmacia, Hospital Universitari de Bellvitge,
Feixa Llarga, s/n, 08907 l'Hospitalet de Llobregat. Email:
lpasto@csub.scs.es
SOURCE
Revista de Toxicologia (2007) 24:1 (36-41). Date of Publication: 2007
ISSN
0212-7113
BOOK PUBLISHER
Asociacion Espanola de Toxicologia, C/Serrano, 115 dpdo., Madrid, Spain.
ABSTRACT
The aim was to evaluate the epidemiological changes in the acute poisonings
(AP) between 1994 and 2004. For this purpose, all the cases attended at the
Emergency Service with the diagnosis of acute poisoning were studied, by
means of a transverse descriptive analytical study developed in two periods
of one month separated for 10 years, and comparing the results. The
demographic, clinical and toxicological data were recorded. The acute
poisoning's prevalence in the Emergency Service increased significantly
(0,83 vs. 1,25%) whereas the hospitalization for this reason decreased from
30,5% to 6,34%. The average age of our series were unchanged, (between 32-33
years) as well as the relation man / woman, that it ranged about 1. No
deaths were recorded. Drugs were the most frequent poisoning agent (51,3%
and 62,7% respectively) with an increase due principally to the
benzodiazepines. Likewise, the alcohol increased its presence in multiple
poisonings, diminishing as the only agent. The admissions for drugs of abuse
experienced a setback, from 26 to 19%. The patients who received any type of
treatment diminished but not in a significant form, from 52,8 to 44,4% and,
in spite of the benzodiazepines increase, the utilization of flumazenil
changed from 7% to 8,5% of the cases. The utilization of naloxone diminished
to the half. The attempts of suicide increased 25%, which supposed 65% of
the whole of the IA in the second studied period. The hospitalization, on
the contrary, descended from 45% to 6% in these patients. Drugs, and among
them the psychotropes, were the most frequent poisoning agent, implied in
62% and 78% of the suicide attempts. The association drug and alcohol
increased in a significant way (10% vs. 22%). The patients' record with
psychiatric precedents was increased from 29% to 75%. In the age interval
from 21 to 30, the percentage of women is twice than that of men in both
periods. The prevalencia of the IA experienced a significant increase,
parallel to the attempts of autolisis; nevertheless the admission in
hospitalization units, diminished both in the global of the IA and in the
suicide attempts. Drugs, and among them the benzodiacepines were the toxic
agent most frequently involved.
EMTREE DRUG INDEX TERMS
benzodiazepin 2 one derivative (drug therapy)
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
emergency ward
female
human
major clinical study
male
prevalence
suicide attempt
university hospital
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2007448375
PUI
L47400444
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 966
TITLE
Attributes and behaviors associated with opioid seeking in the emergency
department
AUTHOR NAMES
Chan L.
Winegard B.
AUTHOR ADDRESSES
(Chan L.; Winegard B.) Department of Emergency Medicine, University of
Arizona, Tucson, AZ, United States.
CORRESPONDENCE ADDRESS
L. Chan, Department of Emergency Medicine, University of Arizona, Tucson,
AZ, United States.
SOURCE
Journal of Opioid Management (2007) 3:5 (244-248). Date of Publication:
September/October 2007
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
Objective: Determine if the attributes and behaviors anecdotally thought to
be indicative of drug seeking have statistical association with opioid
seeking. Methods: Data on variables thought to be indicative of drug seeking
were retrospectively extracted and compared between two patient groups seen
in the Emergency Department between July 1, 2006 and December 31, 2006.
Group 1 was considered to have true physical pain, and Group 2 was thought
to be seeking opioids. Results: Seven variables were found to have
statistical associations with opioid seeking. There was no chart
documentation on absence or presence of six variables. Conclusions:
Significant associations were found between several variables and opioid
seeking. A prospective study should be performed so that all variables of
interest can be thoroughly studied and a predictive model can be developed
to differentiate patients with real pain from drug seekers.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
help seeking behavior
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
drug misuse
emergency ward
female
human
major clinical study
male
malingering
medical record review
pain
prescription
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007611743
MEDLINE PMID
18181378 (http://www.ncbi.nlm.nih.gov/pubmed/18181378)
PUI
L350268067
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 967
TITLE
Using the medical emergency team to supplement an existing adverse drug
event reporting framework
AUTHOR NAMES
Van De Vreede M.
Leong T.
AUTHOR ADDRESSES
(Van De Vreede M., M.VandeVreede@alfred.org.au) Master Health Services
Management, .
(Leong T.) Department of General ICU and Quality, The Alfred, Melbourne,
Vic., Australia.
(Van De Vreede M., M.VandeVreede@alfred.org.au) Pharmacy Department, The
Alfred, Melbourne, Vic. 3004, Australia.
CORRESPONDENCE ADDRESS
M. Van De Vreede, Pharmacy Department, The Alfred, Melbourne, Vic. 3004,
Australia. Email: M.VandeVreede@alfred.org.au
SOURCE
Journal of Pharmacy Practice and Research (2007) 37:3 (197-199). Date of
Publication: September 2007
ISSN
1445-937X
BOOK PUBLISHER
Society of Hospital Pharmacists of Australia, P.O.Box 1774, Collingwood,
Australia.
ABSTRACT
Background: The medical emergency team (MET) provides early intervention
when a patient deteriorates. The cause of the deterioration is subsequently
documented. There is no specific documentation if the cause is related to a
medication error. Aim: To introduce a process to ensure medication errors
identified via MET calls are notified to the quality use of medicines (QUM)
manager so they can be included in the continuous quality improvement
program. Method: A retrospective medical record review of MET calls over one
month was undertaken to detect calls related to medication errors. The MET
data management process was then modified to include medication as a
contributing factor for reporting such events. Reports of MET calls due to
medication errors were sent monthly to the QUM manager and these patients'
medical records were reviewed to confirm if a medication error occurred. If
so, the details of this error and whether it has been reported on the
hospital reporting system were determined. Results: The baseline review in
July 2005 identified 108 confirmed MET calls, 4 of which were definitely and
5 possibly related to medication errors. 2 of the confirmed medication
errors were precipitated by omitted doses. In March 2006, the improved
system started and in the first 4 months, review of the 12 calls notified by
the MET identified that 4 were due to medication errors. 2 of these had not
been reported on Riskman. The medical record review also identified one
adverse drug reaction which had not been reported and a near-miss involving
IV potassium chloride that would otherwise not have been detected.
Conclusion: The introduced process identified MET calls due to medication
errors that would otherwise have been missed.
EMTREE DRUG INDEX TERMS
chlorpromazine (adverse drug reaction)
clonazepam (adverse drug reaction)
diazepam (adverse drug reaction, intravenous drug administration)
digoxin (adverse drug reaction)
dopamine (adverse drug reaction)
flumazenil (drug therapy, intravenous drug administration)
haloperidol (adverse drug reaction, intravenous drug administration)
irbesartan (adverse drug reaction)
lamotrigine (adverse drug reaction)
lithium (adverse drug reaction)
metoprolol (adverse drug reaction)
morphine (adverse drug reaction)
naloxone (drug therapy)
oxycodone (adverse drug reaction, subcutaneous drug administration)
phenytoin (adverse drug reaction)
potassium chloride (adverse drug reaction, intravenous drug administration)
salbutamol (adverse drug reaction)
topiramate (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
health care quality
medication error
EMTREE MEDICAL INDEX TERMS
adult
aged
arousal
article
blood pressure
bradycardia (side effect)
chest tightness (drug therapy, side effect)
controlled study
data analysis
drug safety
dystonia (side effect)
early intervention
health care management
health program
human
hypertension (side effect)
major clinical study
medical record
mental disease (drug therapy)
oxygen saturation
retrospective study
seizure (side effect)
side effect (side effect)
tachycardia (side effect)
thorax pain (drug therapy, side effect)
unspecified side effect (side effect)
CAS REGISTRY NUMBERS
chlorpromazine (50-53-3, 69-09-0)
clonazepam (1622-61-3)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
haloperidol (52-86-8)
irbesartan (138402-11-6)
lamotrigine (84057-84-1)
lithium (7439-93-2)
metoprolol (37350-58-6)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
phenytoin (57-41-0, 630-93-3)
potassium chloride (7447-40-7)
salbutamol (18559-94-9)
topiramate (97240-79-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007507706
PUI
L47597535
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 968
TITLE
Why won't he wake up? Altered LOC, decreased respirations & pinpoint pupils
provide clues to a medication mishap.
AUTHOR NAMES
Augustine J.J.
AUTHOR ADDRESSES
(Augustine J.J.) Department of Emergency Medicine, Emory University,
Atlanta, GA, USA.
CORRESPONDENCE ADDRESS
J.J. Augustine, Department of Emergency Medicine, Emory University, Atlanta,
GA, USA. Email: jaugustine@emp.com
SOURCE
Emergency medical services (2007) 36:9 (25, 27). Date of Publication: Sep
2007
ISSN
0094-6575
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
medication error (adverse drug reaction)
unconsciousness (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
drug antagonism
emergency health service
human
male
pathophysiology
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17910238 (http://www.ncbi.nlm.nih.gov/pubmed/17910238)
PUI
L350038360
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 969
TITLE
Dextromethorphan poisoning: An evidence-based consensus guideline for
out-of-hospital management
AUTHOR NAMES
Chyka P.A.
Erdman A.R.
Manoguerra A.S.
Christianson G.
Booze L.L.
Nelson L.S.
Woolf A.D.
Cobaugh D.J.
Caravati E.M.
Scharman E.J.
Troutman W.G.
AUTHOR ADDRESSES
(Chyka P.A.; Erdman A.R.; Manoguerra A.S.; Christianson G.; Booze L.L.;
Nelson L.S.; Woolf A.D.; Cobaugh D.J.; Caravati E.M.; Scharman E.J.;
Troutman W.G.) American Association of Poison Control Centers, Washington,
DC, United States.
CORRESPONDENCE ADDRESS
P.A. Chyka, American Association of Poison Control Centers, Washington, DC,
United States. Email: info@aapcc.org
SOURCE
Clinical Toxicology (2007) 45:6 (662-677). Date of Publication: September
2007
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
ABSTRACT
The objective of this guideline is to assist poison center personnel in the
appropriate out-of-hospital triage and initial out-of-hospital management of
patients with a suspected ingestion of dextromethorphan by 1) describing the
process by which an ingestion of dextromethorphan might be managed, 2)
identifying the key decision elements in managing cases of dextromethorphan
ingestion, 3) providing clear and practical recommendations that reflect the
current state of knowledge, and 4) identifying needs for research. This
guideline applies to the ingestion of dextromethorphan alone. Co-ingestion
of additional substances could require different referral and management
recommendations depending on the combined toxicities of the substances. This
guideline is based on an assessment of current scientific and clinical
information. The expert consensus panel recognizes that specific patient
care decisions might be at variance with this guideline and are the
prerogative of the patient and the health professionals providing care,
considering all of the circumstances involved. This guideline does not
substitute for clinical judgment. The grade of recommendation is in
parentheses. 1) All patients with suicidal intent, intentional abuse, or in
cases in which a malicious intent is suspected (e.g., child abuse or
neglect) should be referred to an emergency department (Grade D). 2)
Patients who exhibit more than mild effects (e.g., infrequent vomiting or
somnolence [lightly sedated and arousable with speaking voice or light
touch]) after an acute dextromethorphan ingestion should be referred to an
emergency department (Grade C). 3) Patients who have ingested 5-7.5 mg/kg
should receive poison center-initiated follow-up approximately every 2 hours
for up to 4 hours after ingestion. Refer to an emergency department if more
than mild symptoms develop (Grade D). 4) Patients who have ingested more
than 7.5 mg/kg should be referred to an emergency department for evaluation
(Grade C). 5) If the patient is taking other medications likely to interact
with dextromethorphan and cause serotonin syndrome, such as monoamine
oxidase inhibitors or selective serotonin reuptake inhibitors, poison
center-initiated follow-up every 2 hours for 8 hours is recommended (Grade
D). 6) Patients who are asymptomatic and more than 4 hours have elapsed
since the time of ingestion can be observed at home (Grade C). 7) Do not
induce emesis (Grade D). 8) Do not use activated charcoal at home. Activated
charcoal can be administered to asymptomatic patients who have ingested
overdoses of dextromethorphan within the preceding hour. Its administration,
if available, should only be carried out by health professionals and only if
no contraindications are present. Do not delay transportation in order to
administer activated charcoal (Grade D). 9) For patients who have ingested
dextromethorphan and are sedated or comatose, naloxone, in the usual doses
for treatment of opioid overdose, can be considered for prehospital
administration, particularly if the patient has respiratory depression
(Grade C). 10) Use intravenous benzodiazepines for seizures and
benzodiazepines and external cooling measures for hyperthermia (>104°F,
>40°C) for serotonin syndrome. This should be done in consultation with and
authorized by EMS medical direction, by a written treatment protocol or
policy, or with direct medical oversight (Grade C). 11) Carefully ascertain
by history whether other drugs, such as acetaminophen, were involved in the
incident and assess the risk for toxicity or for a drug interaction.
Copyright © American Association of Poison Control Centers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dextromethorphan (adverse drug reaction, drug concentration, drug
interaction, drug toxicity, oral drug administration, pharmaceutics,
pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
anticonvulsive agent (drug therapy)
antidepressant agent (drug therapy)
barbituric acid derivative (drug therapy)
benzodiazepine (drug therapy, intravenous drug administration)
coricidin
diphenhydramine (drug therapy)
diuretic agent (drug therapy)
doxylamine
fluoxetine (drug interaction)
guaifenesin
isocarboxazid (drug interaction)
linezolid (drug interaction)
naloxone (drug therapy)
nyquil
paracetamol
paroxetine (drug interaction)
pertussin cs
phenelzine (drug interaction)
steroid (drug therapy)
theophylline (drug therapy)
trocal
trocal dm
unclassified drug
vicks 44
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
agitation
apnea (side effect)
article
ataxia (side effect)
atelectasis (side effect)
behavior disorder (side effect)
blood pressure
coma (side effect)
confusion (side effect)
cyanosis (side effect)
dehydration (side effect)
dizziness (side effect)
drug blood level
drug efficacy
drug elimination
drug fatality (side effect)
drug formulation
drug half life
drug mechanism
drug metabolism
dystonia (side effect)
fever (side effect)
follow up
hallucination (side effect)
headache (side effect)
hospital management
human
hyperactivity (side effect)
insomnia (side effect)
irritability
lethargy (side effect)
liver toxicity (side effect)
loose feces (side effect)
medical decision making
medical literature
miosis (side effect)
muscle disease (side effect)
muscle hypertonia (side effect)
muscle hypotonia (side effect)
mydriasis (side effect)
nausea (side effect)
nervousness
nystagmus (side effect)
opisthotonus (side effect)
paranoia (side effect)
patient care
poison center
practice guideline
psychosis (side effect)
respiratory tract disease (side effect)
restlessness (side effect)
seizure (side effect)
side effect (side effect)
slurred speech (side effect)
stomach pain (side effect)
tachycardia (side effect)
tachypnea (side effect)
temperature
urticaria (side effect)
vomiting (side effect)
wheezing (side effect)
xerostomia (side effect)
DRUG TRADE NAMES
benylin
coricidin
delsym
nyquil
pertussin cs
robitussin
trocal dm
trocal
tylenol
vicks 44
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
benzodiazepine (12794-10-4)
dextromethorphan (125-69-9, 125-71-3)
diphenhydramine (147-24-0, 58-73-1)
doxylamine (469-21-6, 562-10-7, 7047-26-9)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
guaifenesin (93-14-1)
isocarboxazid (59-63-2)
linezolid (165800-03-3)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
paroxetine (61869-08-7)
phenelzine (156-51-4, 51-71-8)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007446753
MEDLINE PMID
17849242 (http://www.ncbi.nlm.nih.gov/pubmed/17849242)
PUI
L47394415
DOI
10.1080/15563650701606443
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650701606443
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 970
TITLE
Acute opiate overdose in Tehran: The forgotten role of opium
AUTHOR NAMES
Karbakhsh M.
Salehian Zandi N.
AUTHOR ADDRESSES
(Karbakhsh M., mkarbakh@sina.tums.ac.ir; Salehian Zandi N.) Sina Trauma and
Surgery Research Center, Tehran University of Medical Sciences, Tehran,
Iran.
CORRESPONDENCE ADDRESS
M. Karbakhsh, Sina Trauma and Surgery Research Center, Tehran University of
Medical Sciences, Tehran, Iran. Email: mkarbakh@sina.tums.ac.ir
SOURCE
Addictive Behaviors (2007) 32:9 (1835-1842). Date of Publication: September
2007
ISSN
0306-4603
BOOK PUBLISHER
Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom.
ABSTRACT
Introduction: The global epidemic of opiate use continues to spread and is
an increasing burden especially in developing countries. Acute opiate
overdose (AOO) is one of the most dramatic complications of drug abuse. The
purpose of this study is to examine the epidemiology of acute opiate
overdose in a poisoning center in Tehran. Methods: In this cross-sectional
survey, patients who attended the emergency room of Loghman-Hakim hospital -
the only poisoning center in Tehran - and diagnosed with acute opiate
overdose over a six month period were included. Results: Overdose was more
common among men (91.2%). The mean and standard deviation of age was 36.9 ±
15. The most frequent opiate agent was opium (56.5%) followed by heroin.
Opium was most commonly used by regular users, as a single agent and through
ingestion. Benzodiazepines, antidepressants and alcohol were the most common
agents consumed accompanied with opiates. The mortality rate was 8.8% which
was not significantly different between cases of heroin and opium overdose.
Conclusion: Opium was the major cause of overdose in our study. This result
suggests that opium is not a harmless form of addiction although it is
regarded as a thing of the past in many countries. © 2006 Elsevier Ltd. All
rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
antidepressant agent
benzodiazepine derivative
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute opiate overdose (complication, epidemiology)
drug overdose (complication, epidemiology)
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
cross-sectional study
emergency ward
female
human
ingestion
Iran
major clinical study
male
mortality
poison center
sex difference
CAS REGISTRY NUMBERS
alcohol (64-17-5)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007327160
MEDLINE PMID
17229529 (http://www.ncbi.nlm.nih.gov/pubmed/17229529)
PUI
L47031484
DOI
10.1016/j.addbeh.2006.12.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.addbeh.2006.12.014
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 971
TITLE
Suboxone (buprenorphine/naloxone) toxicity in pediatric patients: A case
report
AUTHOR NAMES
Schwarz K.A.
Cantrell F.L.
Vohra R.B.
Clark R.F.
AUTHOR ADDRESSES
(Schwarz K.A., kschwarz@calpoison.org; Cantrell F.L.; Clark R.F.) San Diego
Division, University of California, San Diego Medical Center, San Diego, CA,
United States.
(Schwarz K.A., kschwarz@calpoison.org; Cantrell F.L.) University of
California, San Francisco School of Pharmacy, San Francisco, CA, United
States.
(Schwarz K.A., kschwarz@calpoison.org; Cantrell F.L.) University of
California, San Diego Skaggs School of Pharmacy, .
(Vohra R.B.; Clark R.F.) Division of Medical Toxicology, University of
California, School of Medicine, San Diego, CA, United States.
(Vohra R.B.; Clark R.F.) Department of Emergency Medicine, University of
California, School of Medicine, San Diego, CA, United States.
(Schwarz K.A., kschwarz@calpoison.org) San Diego Division, C/o University of
California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA
92103, United States.
CORRESPONDENCE ADDRESS
K.A. Schwarz, San Diego Division, C/o University of California, San Diego
Medical Center, 200 West Arbor Drive, San Diego, CA 92103, United States.
Email: kschwarz@calpoison.org
SOURCE
Pediatric Emergency Care (2007) 23:9 (651-652). Date of Publication:
September 2007
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
BACKGROUND: Suboxone, a combination of buprenorphine and naloxone in
sublingual tablet form, was recently approved in the United States for
management of opioid dependence. Little information exists regarding the
potential for opioid toxicity after Suboxone exposure in the pediatric
population. We report a case of opioid toxicity after exposure to Suboxone
in a pediatric patient and a review of other cases of pediatric Suboxone
ingestion in the literature. CASE: A previously healthy 2-year-old boy was
found with 1 tablet of Suboxone (8 mg buprenorphine/2 mg naloxone) in his
mouth. Remnants of the partly dissolved tablet were immediately removed from
the child's oropharynx. The child experienced 1 episode of spontaneous
emesis and became drowsy en route to the emergency department 30 minutes
after the exposure. The patient was observed in the emergency department; no
interventions were necessary, and the child was discharged asymptomatic and
stable 6 hours post ingestion. CONCLUSION: Suboxone, a combination of
buprenorphine and naloxone, may produce opioid toxicity via sublingual
absorption or ingestion by children. We present the case of a child with
mild central nervous system depression after exposure to Suboxone. Pediatric
case reports that demonstrate more significant central nervous system and
respiratory depressant effects from Suboxone ingestion are emerging. © 2007
Lippincott Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
article
case report
central nervous system depression
drowsiness
drug absorption
drug exposure
emergency ward
hospital discharge
human
male
medical literature
oropharynx
physical examination
preschool child
tablet
vomiting
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007457056
MEDLINE PMID
17876257 (http://www.ncbi.nlm.nih.gov/pubmed/17876257)
PUI
L47429063
DOI
10.1097/PEC.0b013e31814a6aac
FULL TEXT LINK
http://dx.doi.org/10.1097/PEC.0b013e31814a6aac
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 972
TITLE
Chronic valproic acid intoxication: Reversal by naloxone
AUTHOR NAMES
Thanacoody H.K.R.
AUTHOR ADDRESSES
(Thanacoody H.K.R., ruben.thanacoody@luht.scot.nhs.uk) Scottish Poisons
Information Bureau, Royal Infirmary Edinburgh, 51 Little France Crescent,
Edinburgh, United Kingdom.
CORRESPONDENCE ADDRESS
H.K.R. Thanacoody, Scottish Poisons Information Bureau, Royal Infirmary
Edinburgh, 51 Little France Crescent, Edinburgh, United Kingdom. Email:
ruben.thanacoody@luht.scot.nhs.uk
SOURCE
Emergency Medicine Journal (2007) 24:9 (677-678). Date of Publication:
September 2007
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
76-year-old woman being treated with sodium valproate for bipolar depression
presented with a 4 day history of acute confusion and tremulousness. She had
apnoeic episodes, reduced conscious level and generalised myoclonic
movements. Her plasma valproate concentration was 848 μmol/l (normal 300-600
μmol/l). Administration of naloxone 0.8 mg led to rapid clinical
improvement. Naloxone may be useful in reversing the features of chronic
valproate toxicity.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intravenous drug administration)
valproic acid (drug concentration, drug therapy, drug toxicity)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
ciprofloxacin (drug therapy)
furosemide
olanzapine
ramipril
simvastatin
urea (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
aged
anamnesis
apnea
article
artificial heart pacemaker
bacterium culture
bipolar depression (drug therapy)
case report
clinical examination
complete heart block (surgery)
confusion
consciousness disorder
convalescence
disease duration
drug blood level
drug dose increase
emergency ward
Escherichia coli
female
Glasgow coma scale
hemodialysis
human
intensive care unit
ischemic heart disease
malaise
myoclonus
non insulin dependent diabetes mellitus
patient monitoring
platelet count
priority journal
treatment outcome
tremor
urinary tract infection (diagnosis, drug therapy, etiology)
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
ciprofloxacin (85721-33-1)
furosemide (54-31-9)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
ramipril (87333-19-5)
simvastatin (79902-63-9)
urea (57-13-6)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Urology and Nephrology (28)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007428319
MEDLINE PMID
17711961 (http://www.ncbi.nlm.nih.gov/pubmed/17711961)
PUI
L47343068
DOI
10.1136/emj.2007.049791
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2007.049791
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 973
TITLE
Acute respiratory distress syndrome induced by oral methadone managed with
non-invasive ventilation
AUTHOR NAMES
Ridgway Z.A.
Pountney A.J.
AUTHOR ADDRESSES
(Ridgway Z.A., zoe.tom@ntlworld.com) Department of Anaesthesia, Leeds
General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
(Pountney A.J.) Emergency Department, St James's University Hospital, Leeds,
United Kingdom.
CORRESPONDENCE ADDRESS
Z.A. Ridgway, Department of Anaesthesia, Leeds General Infirmary, Great
George Street, Leeds LS1 3EX, United Kingdom. Email: zoe.tom@ntlworld.com
SOURCE
Emergency Medicine Journal (2007) 24:9 (681). Date of Publication: September
2007
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Non-cardiogenic pulmonary oedema is an uncommon complication of both
methadone and heroin overdose, often requiring a period of invasive
ventilation due to its severity. We report the successful, early use of
non-invasive ventilation in the management of non-cardiogenic pulmonary
oedema secondary to a non-fatal overdose of oral methadone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
furosemide (drug therapy, intravenous drug administration)
glyceryl trinitrate (drug therapy)
naloxone (drug therapy, intravenous drug administration)
oxygen (drug therapy, inhalational drug administration)
salbutamol (drug therapy, inhalational drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adult respiratory distress syndrome (drug therapy, therapy)
artificial ventilation
EMTREE MEDICAL INDEX TERMS
adult
article
case report
coronary care unit
disease severity
drug dose titration
drug overdose
dyspnea (drug therapy)
emergency ward
Glasgow coma scale
human
lung edema (therapy)
male
positive end expiratory pressure
priority journal
respiratory failure (complication, drug therapy, therapy)
thorax radiography
treatment outcome
DEVICE MANUFACTURERS
Respironics
CAS REGISTRY NUMBERS
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007428322
MEDLINE PMID
17711964 (http://www.ncbi.nlm.nih.gov/pubmed/17711964)
PUI
L47343071
DOI
10.1136/emj.2007.048991
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2007.048991
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 974
TITLE
Domestic abuse of the European rave drug prolintane
AUTHOR NAMES
Kyle P.B.
Daley W.P.
AUTHOR ADDRESSES
(Kyle P.B., pkyle@pathology.umsmed.edu; Daley W.P.) Department of Pathology,
University of Mississippi Medical Center, Jackson, MS 39216, United States.
(Kyle P.B., pkyle@pathology.umsmed.edu) Department of Pathology, University
of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216,
United States.
CORRESPONDENCE ADDRESS
P.B. Kyle, Department of Pathology, University of Mississippi Medical
Center, 2500 North State Street, Jackson, MS 39216, United States. Email:
pkyle@pathology.umsmed.edu
SOURCE
Journal of Analytical Toxicology (2007) 31:7 (415-418). Date of Publication:
September 2007
ISSN
0146-4760
0146-4760 (electronic)
BOOK PUBLISHER
Preston Publications, 6600 W. Touhy Avenue, Niles, United States.
ABSTRACT
Prolintane is a sympathomimetic amine with pharmacologic properties similar
to d-amphetamine. Side effects include insomnia, nervousness, and
irritability. Overdoses of prolintane may cause hallucinations, psychosis,
and death. The drug is commonly prescribed in Africa, Australia, and Europe
but is not available in the United States. This manuscript reports the first
medically documented cases of prolintane abuse in the United States. In the
first, a 34-year-old male presented to the emergency department confused,
agitated, and unable to follow commands. Initial drug and alcohol screens
were negative, but analysis by gas chromatography-mass spectrometry (GC-MS)
indicated the presence of amitriptyline, nortriptyline, nicotine, and
prolintane. The second patient, a healthy 26-year-old female, presented to
the emergency department after intrauterine fetal death and spontaneous
delivery. GC-MS revealed the presence of multiple drugs, including
cannabinoids, cocaine, nicotine, hydrocodone, and prolintane. The medical
and scientific communities should be aware of the potential for prolintane
abuse because it may cause symptoms similar to those of the amphetamines but
is not likely to be detected by a routine urine drug screen.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
prolintane (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
amitriptyline (drug toxicity)
amphetamine (drug toxicity)
cannabinoid (drug toxicity)
ceftriaxone (drug therapy)
cocaine (drug toxicity)
hydrocodone (drug toxicity)
lorazepam (drug therapy)
methamphetamine (drug toxicity)
naloxone (drug therapy)
nicotine (drug toxicity)
nortriptyline (drug toxicity)
sodium chloride (drug therapy, intravenous drug administration)
sorbitol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
case report
clinical feature
drug abuse
drug screening
drug urine level
electrocardiogram
emergency ward
female
fetus death
gas chromatography
human
male
mass spectrometry
physical examination
urinalysis
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
ceftriaxone (73384-59-5, 74578-69-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
lorazepam (846-49-1)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
nortriptyline (72-69-5, 894-71-3)
prolintane (1211-28-5, 493-92-5)
sodium chloride (7647-14-5)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007464485
MEDLINE PMID
17725890 (http://www.ncbi.nlm.nih.gov/pubmed/17725890)
PUI
L47451070
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 975
TITLE
Be prepared! Drugs and equipment for 'Good Samaritan' acts
AUTHOR NAMES
Whiticar R.A.
Potts D.J.
Smith S.
Thirumamanivannan G.
AUTHOR ADDRESSES
(Whiticar R.A.; Potts D.J.; Smith S., simon.smith@buckshosp.nhs.uk;
Thirumamanivannan G.) A and E Department, Wycombe Hospital, Queen Alexandra
Road, High Wycombe, United Kingdom.
(Smith S., simon.smith@buckshosp.nhs.uk) A and E Department, Wycombe
Hospital, Queen Alexandra Road, High Wycombe, HP11 2TT, United Kingdom.
CORRESPONDENCE ADDRESS
S. Smith, A and E Department, Wycombe Hospital, Queen Alexandra Road, High
Wycombe, HP11 2TT, United Kingdom. Email: simon.smith@buckshosp.nhs.uk
SOURCE
European Journal of Emergency Medicine (2007) 14:4 (236-238). Date of
Publication: August 2007
ISSN
0969-9546
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Little evidence or advice exists in the medical literature on 'medical kit'
that could be usefully carried by physicians to prepare them for unexpected
emergencies. The aim of this study was to establish what, in the opinion of
Emergency Physicians, is an appropriate medical kit for doctors to carry to
prepare them for 'Good Samaritan' acts. A telephone survey, using a
proforma, of United Kingdom Emergency Physicians was conducted. Of the
responders to the survey, 10% routinely undertook prehospital work.
Seventy-two percent thought it appropriate to carry equipment, but only 43%
thought it appropriate to carry medications. Over 80% considered basic
airway equipment useful to carry, whereas other items of medical kit were
considered appropriate much less commonly. A large proportion of emergency
physicians consider it appropriate to carry some medical kit for 'Good
Samaritan' acts and, in general, the consensus of opinion as to what medical
kit should be carried agreed with the evidence-base for prehospital
interventions. © 2007 Lippincott Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
analgesic agent
antibiotic agent
antihistaminic agent
atropine
benzodiazepine derivative
epinephrine
flumazenil
glucose
glyceryl trinitrate
infusion fluid
naloxone
oxygen
salbutamol
steroid
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
emergency physician
EMTREE MEDICAL INDEX TERMS
airway
article
blood sampling
cannula
consensus
container
defibrillator
devices
emergency care
emergency medicine
evidence based medicine
glove
human
laryngoscope
mask
priority journal
stethoscope
suture
telephone
United Kingdom
wound dressing
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9, 35763-26-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007337187
MEDLINE PMID
17620921 (http://www.ncbi.nlm.nih.gov/pubmed/17620921)
PUI
L47051945
DOI
10.1097/MEJ.0b013e3281260021
FULL TEXT LINK
http://dx.doi.org/10.1097/MEJ.0b013e3281260021
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 976
TITLE
The impact of an emergency department toxicology team in the management of
acute intoxication
AUTHOR NAMES
Chung A.H.Y.
Tsui S.H.
Tong H.K.
AUTHOR ADDRESSES
(Chung A.H.Y., andrewschunghy@yahoo.com.hk) Queen Mary Hospital, Accident
and Emergency Department, Pokfulam Road, Hong Kong, Hong Kong.
(Tsui S.H.; Tong H.K.)
CORRESPONDENCE ADDRESS
A.H.Y. Chung, Queen Mary Hospital, Accident and Emergency Department,
Pokfulam Road, Hong Kong, Hong Kong. Email: andrewschunghy@yahoo.com.hk
SOURCE
Hong Kong Journal of Emergency Medicine (2007) 14:3 (134-143). Date of
Publication: July 2007
ISSN
1024-9079
BOOK PUBLISHER
Medcom Limited, Room 808, Two Chinachem Exchange Square, 338 King's Road,
North Point, Hong Kong.
ABSTRACT
Objective: To evaluate the impact of the recently established Emergency
Department (ED) Toxicology Team of Queen Mary Hospital (QMH) in the
management of acute intoxication. Method: A descriptive comparative study
with retrospective data collection from all intoxicated and suspected
intoxicated patients over two separate half-year periods in 2001 and 2006,
before and after the establishment of the ED Toxicology Team in July 2005.
Data on reasons of intoxication, drugs and substances involved, ED
treatments, patient disposition, length of stay in ED, length of stay in
hospital, patient outcome, and 30-day ED re-attendance and hospital
re-admission were collected and examined. Results: A total of 333
intoxicated patients were included in the study, 171 in 2001 and 162 in
2006. The basic epidemiological data were similar in both groups. There was
a marked reduction in hospital admissions from 89.5% to 40.7% (P<0.01) and
significant decline in average length of hospital stay from 46.8 hours to
29.2 hours (P<0.05). There was no statistically significant difference in
patient outcome, 30-day ED re-attendance and hospital re-admission.
Conclusion: Our findings showed that the establishment of the ED Toxicology
Team in QMH achieved significant reductions in hospital admissions and the
length of stay in hospital in the management of patients with acute
intoxication without jeopardising patient outcome. The results illustrate
that the new model has a beneficial role in reducing cost and alleviating
stress on hospital bed availability, therefore it can be recognised as a
cost-effective means of management of acute intoxication.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
analgesic agent (drug toxicity)
anticonvulsive agent (drug toxicity)
antidepressant agent (drug toxicity)
antidote (drug therapy)
atropine (drug therapy)
bicarbonate (drug therapy)
carbon monoxide (drug toxicity)
cardiovascular agent (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
domestic chemical (drug toxicity)
flumazenil (drug therapy)
herbaceous agent (drug toxicity)
hypnotic agent (drug toxicity)
industrial chemical (drug toxicity)
ipecac (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
opiate (drug toxicity)
oxygen (drug therapy)
paracetamol (drug toxicity)
psychedelic agent (drug toxicity)
psychostimulant agent (drug toxicity)
sedative agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
intoxication (drug therapy, therapy)
toxicology
EMTREE MEDICAL INDEX TERMS
accidental injury
adolescent
adult
aged
article
child
comparative study
controlled study
cost effectiveness analysis
drug abuse
emergency ward
epidemiological data
female
hospital bed utilization
hospitalization
human
intensive care unit
major clinical study
male
outcomes research
resuscitation
retrospective study
statistical significance
suicide attempt
ward
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
carbon monoxide (630-08-0)
flumazenil (78755-81-4)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2007441239
PUI
L47377121
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 977
TITLE
Preparation for emergencies in the offices of pediatricians and pediatric
primary care providers
AUTHOR NAMES
Krug S.
Bojko T.
Dolan M.A.
Frush K.
O'Malley P.
Sapien R.
Shaw K.N.
Shook J.
Sirbaugh P.
Yamamoto L.
Ball J.
Role S.E.
Brown K.
Bullock K.
Kavanaugh D.
Turgel T.
Mace S.E.
Tuggle D.W.
Tellez S.
AUTHOR ADDRESSES
(Ball J.; Role S.E.) EMSC National Resource Center, .
(Brown K.) National Association of EMS Physicians, .
(Bullock K.) American Academy of Family Physicians, .
(Kavanaugh D.; Turgel T.) Maternal and Child Health Bureau, .
(Mace S.E.) American College of Emergency Physicians, .
(Tuggle D.W.) American College of Surgeons, .
(Krug S.; Bojko T.; Dolan M.A.; Frush K.; O'Malley P.; Sapien R.; Shaw K.N.;
Shook J.; Sirbaugh P.; Yamamoto L.; Tellez S.)
CORRESPONDENCE ADDRESS
EMSC National Resource Center, .
SOURCE
Pediatrics (2007) 120:1 (200-212). Date of Publication: July 2007
ISSN
0031-4005
0210-5721 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
High-quality pediatric emergency care can be provided only through the
collaborative efforts of many health care professionals and child advocates
working together throughout a continuum of care that extends from prevention
and the medical home to prehospital care, to emergency department
stabilization, to critical care and rehabilitation, and finally to a return
to care in the medical home. At times, the office of the pediatric primary
care provider will serve as the entry site into the emergency care system,
which comprises out-of-hospital emergency medical services personnel,
emergency department nurses and physicians, and other emergency and critical
care providers. Recognizing the important role of pediatric primary care
providers in the emergency care system for children and understanding the
capabilities and limitations of that system are essential if pediatric
primary care providers are to offer the best chance at intact survival for
every child who is brought to the office with an emergency. Optimizing
pediatric primary care provider office readiness for emergencies requires
consideration of the unique aspects of each office practice, the types of
patients and emergencies that might be seen, the resources on site, and the
resources of the larger emergency care system of which the pediatric primary
care provider's office is a part. Parent education regarding prevention,
recognition, and response to emergencies, patient triage, early recognition
and stabilization of pediatric emergencies in the office, and timely
transfer to an appropriate facility for definitive care are important
responsibilities of every pediatric primary care provider. In addition,
pediatric primary care providers can collaborate with out-of-hospital and
hospital-based providers and advocate for the best-quality emergency care
for their patients. Copyright © 2007 by the American Academy of Pediatrics.
EMTREE DRUG INDEX TERMS
activated carbon
antibiotic agent
atropine
bicarbonate
corticosteroid derivative (oral drug administration, parenteral drug
administration)
diazepam
diphenhydramine (parenteral drug administration)
epinephrine
glucose
lorazepam
naloxone
oxygen
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child health care
emergency health service
medical practice
EMTREE MEDICAL INDEX TERMS
clinical competence
documentation
emergency care
emergency ward
health care personnel
health care quality
health care system
home care
hospital equipment
patient education
pediatric advanced life support
pediatrician
primary health care
priority journal
quality control
resuscitation
review
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007328907
MEDLINE PMID
17606580 (http://www.ncbi.nlm.nih.gov/pubmed/17606580)
PUI
L47036261
DOI
10.1542/peds.2007-1109
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2007-1109
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 978
TITLE
Rates of adverse events of long-acting opioids in a state medicaid program
AUTHOR NAMES
Hartung D.M.
Middleton L.
Haxby D.G.
Koder M.
Ketchum K.L.
Chou R.
AUTHOR ADDRESSES
(Hartung D.M., hartungd@ohsu.edu) College of Pharmacy, Oregon State
University, Oregon Health and Science University Campus, Portland, OR,
United States.
(Middleton L.; Haxby D.G.; Koder M.) College of Pharmacy, Oregon State
University, Oregon Health and Science University Campus, United States.
(Ketchum K.L.) Medicaid-Related Programs, Oregon State University, Oregon
Health and Science University Campus, United States.
(Chou R.) Department of Medicine and Medical Informatics and Clinical
Epidemiology, Oregon Health and Science University, Oregon Evidence-Based
Practice Center, Portland, OR, United States.
(Hartung D.M., hartungd@ohsu.edu) College of Pharmacy, Oregon State
University, Oregon Health and Science University Campus, 3303 SW Bond Ave.,
Portland, OR 97239, United States.
CORRESPONDENCE ADDRESS
D.M. Hartung, College of Pharmacy, Oregon State University, Oregon Health
and Science University Campus, 3303 SW Bond Ave., Portland, OR 97239, United
States. Email: hartungd@ohsu.edu
SOURCE
Annals of Pharmacotherapy (2007) 41:6 (921-928). Date of Publication: June
2007
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
BACKGROUND: Despite widespread use and emerging safety concerns, data on the
comparative safety and effectiveness of long-acting opioid (LAO) analgesics
are weak. OBJECTIVE: To compare rates of adverse events among patients newly
prescribed an LAO. METHODS: A retrospective observational cohort study using
Medicaid administrative claims data was conducted examining time until first
adverse outcome among patients with new prescriptions for methadone,
extended-release (ER) oxycodone, ER morphine, or transdermal fentanyl.
Adverse outcomes included emergency department (ED) encounters or
hospitalizations for opioid-related adverse events, all-cause ED encounters
or hospitalizations, death, and diagnoses for opioid-related adverse
effects. Cox proportional hazards models were used to adjust for a variety
of measured covariates overall and within subgroups of patients with and
without cancer. RESULTS: This study included 5684 subjects. Patients
prescribed ER oxycodone were 35% less likely (adjusted hazard ratio [HR]
0.45; 95% CI 0.26 to 0.77) to experience an ED or hospitalization involving
an opioid-related adverse event, 23% lower risk of hospitalization (adjusted
HR 0.77; 95% CI 0.66 to 0.91), 41% lower risk of constipation (adjusted HR
0.59; 95% CI 0.35 to 1.00), and a 29% lower risk of death (adjusted HR 0.71;
95% CI 0.54 to 0.94) compared with those prescribed ER morphine. Among
subjects with noncancer pain, fentanyl was associated with a higher risk of
ED encounters (adjusted HR 1.27; 95% Cl 1.02 to 1.59) and methadone was
associated with a greater risk of overdose symptoms (adjusted HR 1.57; 95%
Cl 1.03 to 2.40) compared with ER morphine. CONCLUSIONS: Our results support
a modest safety advantage with ER oxycodone compared with ER morphine. Among
subjects with noncancer pain, fentanyl and methadone were associated with an
increased risk of an adverse event compared with ER morphine. Additional
studies are needed to confirm our findings and further clarify risks
associated with different LAOs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
barbituric acid derivative (drug interaction)
benzodiazepine derivative (drug interaction)
carisoprodol (drug interaction)
cyclobenzaprine (drug interaction)
fentanyl (adverse drug reaction, drug therapy, drug toxicity,
pharmacoeconomics, transdermal drug administration)
hydrocodone (drug interaction)
hypnotic sedative agent (drug interaction)
methadone (adverse drug reaction, drug therapy, drug toxicity,
pharmacoeconomics)
morphine (adverse drug reaction, drug comparison, drug therapy, drug
toxicity, pharmacoeconomics)
morphine sulfate (drug therapy, oral drug administration)
muscle relaxant agent (drug interaction)
oxycodone (adverse drug reaction, drug comparison, drug interaction, drug
therapy, drug toxicity, pharmacoeconomics)
zolpidem (drug interaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medicaid
EMTREE MEDICAL INDEX TERMS
adult
aged
article
backache (drug therapy)
cancer pain (drug therapy)
cohort analysis
consciousness
constipation (side effect)
death
drug efficacy
drug safety
emergency ward
fatigue (side effect)
female
fibromyalgia (drug therapy)
high risk patient
hospitalization
human
lethargy (side effect)
major clinical study
malaise (side effect)
male
neuropathy (drug therapy)
osteoarthritis (drug therapy)
outcome assessment
prescription
priority journal
respiratory failure (side effect)
retrospective study
risk assessment
side effect (side effect)
symptomatology
DRUG TRADE NAMES
avinza
dolophine
duragesic
kadian
ms contin
oramorph
oxycontin
CAS REGISTRY NUMBERS
carisoprodol (78-44-4)
cyclobenzaprine (303-53-7, 6202-23-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
muscle relaxant agent (9008-44-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
zolpidem (82626-48-0)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
2007289843
MEDLINE PMID
17504834 (http://www.ncbi.nlm.nih.gov/pubmed/17504834)
PUI
L46917617
DOI
10.1345/aph.1K066
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.1K066
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 979
TITLE
Venous access in the critically ill child: When the peripheral intravenous
fails!
AUTHOR NAMES
De Caen A.
AUTHOR ADDRESSES
(De Caen A., allandecaen@cha.ab.ca) Stollery Children's Hospital, Department
of Pediatrics, University of Alberta, Edmonton, Alta., Canada.
(De Caen A., allandecaen@cha.ab.ca) 3A3.06 Walter C Mackenzie Centre,
8440-112 St, Edmonton, Alta. T6G2B7, Canada.
CORRESPONDENCE ADDRESS
A. De Caen, 3A3.06 Walter C Mackenzie Centre, 8440-112 St, Edmonton, Alta.
T6G2B7, Canada. Email: allandecaen@cha.ab.ca
SOURCE
Pediatric Emergency Care (2007) 23:6 (422-424). Date of Publication: June
2007
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Emergent venous access is now achievable by intraosseous needle in patients
of all ages and sizes. The review outlines the limitations of other more
"traditional" forms of emergent venous access in children (when the
peripheral intravenous fails) and briefly discusses the intraosseous devices
that have been recently marketed that allow for rapid and effective
intraosseous access in older children and adults. © 2007 Lippincott Williams
& Wilkins, Inc.
EMTREE DRUG INDEX TERMS
atropine
epinephrine (adverse drug reaction, intravenous drug administration)
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
critically ill patient
vascular access
EMTREE MEDICAL INDEX TERMS
catheter
central venous catheter
child
diastolic blood pressure
drug absorption
drug delivery system
drug release
emergency ward
heart work
human
hypertension (side effect)
needle
pediatric advanced life support
review
vasodilatation
DEVICE MANUFACTURERS
(Canada)pyng medical
(United States)Vidacare
(Israel)wasimed
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007301128
MEDLINE PMID
17572532 (http://www.ncbi.nlm.nih.gov/pubmed/17572532)
PUI
L46956177
DOI
10.1097/01.pec.0000278404.30074.ad
FULL TEXT LINK
http://dx.doi.org/10.1097/01.pec.0000278404.30074.ad
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 980
TITLE
A Sticky Situation: Toxicity of Clonidine and Fentanyl Transdermal Patches
in Pediatrics
AUTHOR NAMES
Behrman A.
Goertemoeller S.
AUTHOR ADDRESSES
(Behrman A., Alysha.Behrman@cchmc.org; Goertemoeller S.)
CORRESPONDENCE ADDRESS
A. Behrman, Cincinnati, OH, United States. Email: Alysha.Behrman@cchmc.org
SOURCE
Journal of Emergency Nursing (2007) 33:3 (290-293). Date of Publication:
June 2007
ISSN
0099-1767
1527-2966 (electronic)
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antihypertensive agent (drug toxicity)
clonidine (drug toxicity)
fentanyl (drug toxicity)
narcotic analgesic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS
accident
article
case report
chemically induced disorder
coma (therapy)
drug self administration (adverse drug reaction)
emergency treatment
human
infant
intoxication
intradermal drug administration
methodology
patient education
seizure (therapy)
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17517283 (http://www.ncbi.nlm.nih.gov/pubmed/17517283)
PUI
L46760443
DOI
10.1016/j.jen.2007.02.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2007.02.004
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 981
TITLE
EGG changes in patients with acute ethanol intoxication
AUTHOR NAMES
Aasebø W.
Erikssen J.
Jonsbu J.
Stavem K.
AUTHOR ADDRESSES
(Aasebø W.; Erikssen J.; Jonsbu J.; Stavem K.) Medical Department, Akershus
University Hospital, Lørenskog, Norway.
(Stavem K.) Helse-Øst Health Services Research Center, Lørenskog, Norway.
(Aasebø W.; Erikssen J.; Jonsbu J.; Stavem K.) Section of Nephrology,
Medical Department, Rikshospitalet, NO-0027 Oslo, Norway.
CORRESPONDENCE ADDRESS
W. Aasebø, Section of Nephrology, Medical Department, Rikshospitalet,
NO-0027 Oslo, Norway.
SOURCE
Scandinavian Cardiovascular Journal (2007) 41:2 (79-84). Date of
Publication: 2007
ISSN
1401-7431
1651-2006 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
Objectives. To assess how ethanol in potential lethal serum concentrations
affects features of the ECG that may be associated with cardiac arrhythmias.
Design. We included 84 patients, who were hospitalised with assumed acute
ethanol intoxication. In the emergency room resting ECG was recorded and
blood was collected for serum osmolality measurement used as a proxy for
ethanol level. Thirty-two also had ECG recorded at discharge. Twenty-seven
hospitalised patients without known alcohol ingestion served as controls.
ECG segment durations were compared with controls and related to
intoxication level. Results. In subjects with moderately elevated to high
serum osmolality, the P wave and QTc intervals were prolonged compared with
sober subjects. P wave, PR, QRS and QTc intervals were longer when the
subjects had high blood ethanol levels (at admission) than at discharge
(p-values: 0.0001, 0.0002, 0.010 and ≤0.0001 for P wave, PR, QRS and QTc
intervals. n = 32). Conclusions. Ethanol at high to very high blood
concentration causes several changes in the ECG that might be associated
with increased risk of arrhythmias.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine
acetylsalicylic acid
antibiotic agent
benzodiazepine
carbamazepine
codeine
esomeprazole
flumazenil
haloperidol
ketobemidone
low molecular weight heparin
naloxone
neuroleptic agent
paracetamol
thioridazine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (diagnosis)
ECG abnormality (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
article
atrial fibrillation (complication)
blood sampling
comorbidity
controlled study
female
hangover
heart arrhythmia (complication)
heart disease
hospitalization
human
major clinical study
male
membrane steady potential
P wave
PR interval
priority journal
QRS complex
QT interval
QT prolongation
serum osmolality
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alcohol (64-17-5)
benzodiazepine (12794-10-4)
carbamazepine (298-46-4, 8047-84-5)
codeine (76-57-3)
esomeprazole (119141-88-7, 202742-32-3, 217087-09-7, 217087-10-0)
flumazenil (78755-81-4)
haloperidol (52-86-8)
ketobemidone (469-79-4)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
thioridazine (130-61-0, 50-52-2)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007189577
MEDLINE PMID
17454831 (http://www.ncbi.nlm.nih.gov/pubmed/17454831)
PUI
L46605381
DOI
10.1080/14017430601091698
FULL TEXT LINK
http://dx.doi.org/10.1080/14017430601091698
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 982
TITLE
"Crystal Dex:" Free-Base Dextromethorphan
AUTHOR NAMES
Hendrickson R.G.
Cloutier R.L.
AUTHOR ADDRESSES
(Hendrickson R.G.; Cloutier R.L.) Department of Emergency Medicine, Oregon
Health and Science University, Portland, OR, United States.
(Hendrickson R.G.) Oregon Poison Center, Portland, OR, United States.
(Hendrickson R.G.; Cloutier R.L.) Center for Policy and Research in
Emergency Medicine (CPR-EM), Portland, OR, United States.
CORRESPONDENCE ADDRESS
R.G. Hendrickson, Department of Emergency Medicine, Oregon Health and
Science University, Portland, OR, United States.
SOURCE
Journal of Emergency Medicine (2007) 32:4 (393-396). Date of Publication:
May 2007
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Dextromethorphan (DXM) is a common component of combination cold medications
that has become a popular drug of abuse for young adults. Abusers of DXM
have developed a simple acid-base extraction technique to "free-base," or
extract, the DXM from the unwanted guaifenesin, coloring agents, sweeteners,
and alcohol that are typically included in combination cold preparations. We
report a case of DXM overdose after ingestion of this purified "Crystal Dex"
and discuss the "Agent Lemon" and single-phase extraction techniques that
are used to free-base the dextromethorphan. © 2007 Elsevier Inc. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
charcoal (drug therapy, intragastric drug administration)
dextromethorphan (drug toxicity)
flumazenil (drug therapy, intravenous drug administration)
guaifenesin (drug toxicity)
naloxone (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
metoprolol (drug therapy)
midazolam (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
agitation
anamnesis
article
case report
clinical feature
crystal structure
disease course
drug isolation
emergency ward
endotracheal intubation
extraction
human
hypertension (complication, drug therapy)
male
neurologic examination
physical examination
priority journal
thorax radiography
unconsciousness
CAS REGISTRY NUMBERS
charcoal (16291-96-6)
dextromethorphan (125-69-9, 125-71-3)
flumazenil (78755-81-4)
guaifenesin (93-14-1)
metoprolol (37350-58-6)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007226642
MEDLINE PMID
17499693 (http://www.ncbi.nlm.nih.gov/pubmed/17499693)
PUI
L46710327
DOI
10.1016/j.jemermed.2007.03.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2007.03.010
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 983
TITLE
Managing acute heroin overdose.
AUTHOR NAMES
Dixon P.
AUTHOR ADDRESSES
(Dixon P.) Jersey General Hospital.
CORRESPONDENCE ADDRESS
P. Dixon, Jersey General Hospital.
SOURCE
Emergency nurse : the journal of the RCN Accident and Emergency Nursing
Association (2007) 15:2 (30-35). Date of Publication: May 2007
ISSN
1354-5752
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity, pharmacology)
EMTREE DRUG INDEX TERMS
naloxone (adverse drug reaction, pharmacology)
narcotic antagonist (drug administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
emergency health service
human
nursing
review
United Kingdom
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17542332 (http://www.ncbi.nlm.nih.gov/pubmed/17542332)
PUI
L47071046
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 984
TITLE
Infantile case of seizure induced by intoxication after accidental
consumption of eperisone hydrochloride, an antispastic agent
AUTHOR NAMES
Tanno K.
Narimatsu E.
Takeyama Y.
Asai Y.
AUTHOR ADDRESSES
(Tanno K.; Narimatsu E.; Takeyama Y.; Asai Y.) Department of Trauma and
Critical Care Medicine, Sapporo Medical University, Sapporo, 060-8543,
Japan.
CORRESPONDENCE ADDRESS
K. Tanno, Department of Trauma and Critical Care Medicine, Sapporo Medical
University, Sapporo, 060-8543, Japan.
SOURCE
American Journal of Emergency Medicine (2007) 25:4 (481-482). Date of
Publication: May 2007
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
glucose (endogenous compound)
lidocaine
midazolam
opiate
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cyanosis (diagnosis, prevention, therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
arterial gas
artificial ventilation
cancer patient
case report
clinical feature
computer assisted tomography
emergency care
emergency ward
endotracheal intubation
female
gas chromatography
glucose blood level
health care personnel
human
immunoassay
laboratory test
letter
mass spectrometry
morbidity
neurologic disease
oxygenation
preschool child
priority journal
radiodiagnosis
respiratory acidosis
tertiary health care
CAS REGISTRY NUMBERS
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007226606
MEDLINE PMID
17499672 (http://www.ncbi.nlm.nih.gov/pubmed/17499672)
PUI
L46710291
DOI
10.1016/j.ajem.2006.09.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2006.09.002
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 985
TITLE
The authors reply [15]
AUTHOR NAMES
Binswanger I.
Stern M.F.
Elmore J.G.
AUTHOR ADDRESSES
(Binswanger I., ingrid.binswanger@uchsc.edu) University of Colorado at
Denver, Denver, CO 80262, United States.
(Stern M.F.) Washington State Department of Corrections, Tumwater, WA 98504,
United States.
(Elmore J.G.) University of Washington, Seattle, WA 98104, United States.
CORRESPONDENCE ADDRESS
I. Binswanger, University of Colorado at Denver, Denver, CO 80262, United
States. Email: ingrid.binswanger@uchsc.edu
SOURCE
New England Journal of Medicine (2007) 356:17 (1786-1787). Date of
Publication: 26 Apr 2007
ISSN
0028-4793
1533-4406 (electronic)
BOOK PUBLISHER
Massachussetts Medical Society, 860 Winter Street, Waltham, United States.
EMTREE DRUG INDEX TERMS
cocaine
methamphetamine
naloxone
psychostimulant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mortality
prison
EMTREE MEDICAL INDEX TERMS
cause of death
cocaine dependence
drug overdose (prevention)
emergency health service
health care system
hepatitis C
human
Human immunodeficiency virus infection
letter
opiate addiction
priority journal
public health
risk assessment
United States
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007208025
PUI
L46658728
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 986
TITLE
A case report of opium body packer; review of the treatment protocols and
mechanisms of poisoning
AUTHOR NAMES
Shadnia S.
Faiaz-Noori M.-R.
Pajoumand A.
Talaie H.
Khoshkar A.
Vosough-Ghanbari S.
Abdollahi M.
AUTHOR ADDRESSES
(Shadnia S.; Faiaz-Noori M.-R.; Pajoumand A.; Talaie H.) Loghman-Hakim
Hospital, Faculty of Medicine, Shaheed Beheshti University of Medical
Sciences, Tehran, Iran.
(Khoshkar A.) Department of Surgery, Loghman-Hakim Hospital, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran.
(Vosough-Ghanbari S.; Abdollahi M., mohammad@tums.ac.ir) Department of
Toxicology and Pharmacology, Medical Sciences/University of Tehran, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran.
(Abdollahi M., mohammad@tums.ac.ir) Department of Toxicology and
Pharmacology, Pharmaceutical Sciences Research Center, Medical
Sciences/University of Tehran, P.O. Box: 14155-6451, Tehran, Iran.
CORRESPONDENCE ADDRESS
M. Abdollahi, Department of Toxicology and Pharmacology, Pharmaceutical
Sciences Research Center, Medical Sciences/University of Tehran, P.O. Box:
14155-6451, Tehran, Iran. Email: mohammad@tums.ac.ir
SOURCE
Toxicology Mechanisms and Methods (2007) 17:4 (205-214). Date of
Publication: April/May 2007
ISSN
1537-6524
1091-7667 (electronic)
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
ABSTRACT
Body packers are people who illegally carry drugs, mostly cocaine as well as
opium and/or heroin, concealed within their bodies. The packets are inserted
in the mouth, rectum, or vagina in order to get across borders without being
detected. In this presentation we report a case of an opium body packer and
review the available scientific literature by focusing on mechanisms of
toxicity and treatment approach. The patient was a 35-year-old man who had
lethargy, respiratory depression, tachycardia, normal blood pressure,
hyperthermia, and pinpoint pupils on presentation. No past medical history
was obtained and the only positive history was his travel from Afghanistan 2
days earlier, which he had given to emergency personnel before arriving at
our hospital. Complete blood cells and kidney and liver tests were all in
normal range. In the emergency department, the patient was treated with
oxygen, naloxone, and hypertonic glucose. One dose of activated charcoal (1
g/kg) was administered orally. After intravenous injection of naloxone (4
mg), the lethargy, respiratory depression, and miosis were resolved. The
patient was admitted to the intensive care unit and 90 min after admission,
the patient redeveloped respiratory distress and lost consciousness. He was
intubated and mechanically ventilated due to the suspicious of body packing.
Plain abdominal x-ray showed multiple packets throughout the
gastrointestinal tract; 81 packets were removed by surgery and three of them
were left due to leaking. After removing the packets, the patient was
treated conservatively. He suffered a pulmonary infection (aspiration
pneumonia) and he regained consciousness after 4 days. Upon recovery the
patient was seen by a psychiatrist prior to going to prison. Surgery is
recommended for body packers who have significant signs or symptoms.
Copyright © Informa Healthcare.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy, oral drug administration)
glucose
naloxonazine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
abdominal radiography
adult
artificial ventilation
aspiration pneumonia (complication)
blood cell count
case report
clinical protocol
conservative treatment
emergency treatment
human
hyperthermia
kidney function test
lethargy (drug therapy)
liver function test
male
miosis (drug therapy)
oxygen therapy
priority journal
respiration depression (drug therapy)
review
tachycardia
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
glucose (50-99-7, 84778-64-3)
naloxonazine (82824-01-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007301707
PUI
L46956935
DOI
10.1080/15376510600992574
FULL TEXT LINK
http://dx.doi.org/10.1080/15376510600992574
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 987
TITLE
Thanks for the high.
AUTHOR NAMES
Donoghue J.
AUTHOR ADDRESSES
(Donoghue J.)
CORRESPONDENCE ADDRESS
J. Donoghue,
SOURCE
JEMS : a journal of emergency medical services (2007) 32:4 (16). Date of
Publication: Apr 2007
ISSN
0197-2510
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (drug therapy)
EMTREE MEDICAL INDEX TERMS
emergency health service
human
letter
United States
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17407734 (http://www.ncbi.nlm.nih.gov/pubmed/17407734)
PUI
L46821852
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 988
TITLE
Analgosedation in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
Analgosedierung in der notfallmedizin
AUTHOR NAMES
Meyer O.
Wanzek R.
Soukup J.
AUTHOR ADDRESSES
(Meyer O., oliver.meyer@medizin.uni-halle.de; Wanzek R.; Soukup J.) Klinik
für Anästhesiologie und Operative Intensivmedizin, Klinikum der
Martin-Luther-Universität Halle-Wittenberg, Halle/Saale.
(Meyer O., oliver.meyer@medizin.uni-halle.de) Klinik für Anästhesiologie und
Operative Intensivmedizin, Klinikum der Martin-Luther-Universität
Halle-Wittenberg, Ernst-Grube-Straße 40, D-06120 Halle/Saale.
CORRESPONDENCE ADDRESS
O. Meyer, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum
der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40,
D-06120 Halle/Saale. Email: oliver.meyer@medizin.uni-halle.de
SOURCE
Intensiv- und Notfallbehandlung (2007) 32:1 (4-19). Date of Publication:
First Quarter 2007
ISSN
0947-5362
BOOK PUBLISHER
Dustri-Verlag Dr. Karl Feistle, P.O. Box 1351, Deisenhofen/Munchen, Germany.
ABSTRACT
Analgosedation in preclinical emergency medicine may be indicated for
different reasons. Indications as acute coronary syndrome, external pacing
or trapped patient with multiple injuries require different pharmacological
strategies. There are only a few steps from an analgosedation with a
sufficient, spontaneous breathing to preclinical anesthesia with intubation.
In difference to clinical medicine, only limited possibilities for
monitoring and therapy are available in preclinical emergency medicine. Thus
analgosedation or anesthesia in emergency medicine requires expertise with
the drugs used and airway management abilities, e.g. in case of an
accidental overdose. © 2007 Dustri-Verlag Dr. Karl Feistle.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent (pharmacology)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (pharmacology)
alfentanil
analgesic agent (pharmacology)
benzodiazepine (drug combination, pharmacology)
clonazepam (pharmacology)
diazepam (pharmacology)
dihydrobenzoperidol (drug combination, pharmacology)
dipyrone (pharmacology)
etomidate (pharmacology)
fentanyl (drug combination, pharmacology)
flumazenil (pharmacology)
haloperidol (pharmacology)
ketamine (pharmacology)
ketamine (pharmacology)
lipuro
lorazepam (pharmacology)
midazolam (drug combination, pharmacology)
midazolam maleate (pharmacology)
naloxone (pharmacology)
neuroleptic agent (pharmacology)
paracetamol (pharmacology)
promethazine (pharmacology)
propofol (pharmacology)
remifentanil
rocuronium (pharmacology)
scopolamine butyl bromide
thiopental (pharmacology)
tramadol (pharmacology)
triflupromazine (pharmacology)
unclassified drug
vecuronium (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia induction
sedation
EMTREE MEDICAL INDEX TERMS
acute coronary syndrome
anesthesia
breathing
drug activity
drug inhibition
drug mechanism
emergency medicine
heart pacing
human
intubation
multiple trauma
off label drug use
rebound
review
DRUG TRADE NAMES
anexate
aspisol
atosil
buscopan
disoprivan
dormicum
esmeron
haldol
hypnomidate
ketanest
lipuro
narcanti
norcuron
perfalgan
psyquil
rapifen
rivotril
tavor
tramal
trapanal
ultiva
valium
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alfentanil (69049-06-5, 71195-58-9)
benzodiazepine (12794-10-4)
clonazepam (1622-61-3)
diazepam (439-14-5)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
haloperidol (52-86-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
midazolam (59467-70-8)
midazolam maleate (59467-94-6, 65506-68-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
remifentanil (132539-07-2)
rocuronium (119302-91-9)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
thiopental (71-73-8, 76-75-5)
tramadol (27203-92-5, 36282-47-0)
triflupromazine (1098-60-8, 146-54-3)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2007167170
PUI
L46536282
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 989
TITLE
Physostigmine for gamma-hydroxybutyrate coma: Inefficacy, adverse events,
and review
AUTHOR NAMES
Zvosec D.L.
Smith S.W.
Litonjua R.
Westfal R.E.J.
AUTHOR ADDRESSES
(Zvosec D.L., dzvosec@hotmail.com) Department of Emergency Medicine,
Hennepin County Medical Center/Minneapolis, Medical Research Foundation,
Minneapolis, MN, United States.
(Smith S.W.) Department of Emergency Medicine, Hennepin County Medical
Center, Minneapolis, MN, United States.
(Smith S.W.) Minneapolis Medical Research Foundation, Minneapolis, MN,
United States.
(Litonjua R.) St. John Hospital and Medical Center, Detroit, MI, United
States.
(Westfal R.E.J.) St. Vincent's Catholic Medical Center, New York, NY, United
States.
(Zvosec D.L., dzvosec@hotmail.com) Department of Emergency Medicine,
Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN 55415, United
States.
CORRESPONDENCE ADDRESS
D.L. Zvosec, Department of Emergency Medicine, Hennepin County Medical
Center, 701 Park Ave, Minneapolis, MN 55415, United States. Email:
dzvosec@hotmail.com
SOURCE
Clinical Toxicology (2007) 45:3 (261-265). Date of Publication: March/April
2007
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
ABSTRACT
Physostigmine has been proposed as an antidote for gamma hydroxybutyrate
(GHB) intoxication, based on associated awakenings in 1) patients
anesthetized with GHB and 2) five of six patients administered physostigmine
for GHB intoxication. However, there are neither well-supported mechanisms
for physostigmine reversal of GHB effects, supportive animal studies, nor
randomized, placebo-controlled trials demonstrating safety, efficacy, or
improved outcomes. We sought to determine the outcomes of patients with
GHB-induced coma after a physostigmine treatment protocol was instituted in
an urban Emergency Department and ambulance service. Our search of medical
records located five cases of GHB toxicity, all with co-intoxicants, who
received physostigmine. None demonstrated response and, further, there were
associated adverse events, including atrial fibrillation (2), pulmonary
infiltrates (1) and significant bradycardia (1), and hypotension (1). We
also reviewed 18 published GHB toxicity case series for incidence of adverse
effects, stimulant co-intoxicants (which may heighten risk of
physostigmine), complications, and outcomes of supportive care for GHB
toxicity. We conclude that physostigmine is not indicated for reversal of
GHB-induced alteration of consciousness; it is not efficacious, it may be
unsafe, particularly in the setting of recreational polydrug use; and
supportive care results in universally good outcomes. Copyright © Informa
Healthcare.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 hydroxybutyric acid (drug toxicity)
physostigmine (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration)
EMTREE DRUG INDEX TERMS
atropine (intravenous drug administration)
diltiazem
glucose
lorazepam (intravenous drug administration)
metoprolol
midazolam
naloxone (drug therapy, intravenous drug administration)
pyrazinamide (drug therapy, intravenous drug administration)
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (complication, drug therapy)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
ambulance
article
atrial fibrillation (side effect)
bradycardia (side effect)
case report
clinical feature
clinical protocol
drug efficacy
echocardiography
emergency ward
human
hypotension (side effect)
lung infiltrate (side effect)
male
medical record
physical examination
treatment outcome
treatment response
urinalysis
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
atropine (51-55-8, 55-48-1)
diltiazem (33286-22-5, 42399-41-7)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
metoprolol (37350-58-6)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
pyrazinamide (98-96-4)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007164652
MEDLINE PMID
17453877 (http://www.ncbi.nlm.nih.gov/pubmed/17453877)
PUI
L46525186
DOI
10.1080/15563650601072159
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650601072159
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 990
TITLE
Analgesia and oncological emergencies
ORIGINAL (NON-ENGLISH) TITLE
Analgésie et urgences oncologiques
AUTHOR NAMES
Voisin-Saltiel S.
AUTHOR ADDRESSES
(Voisin-Saltiel S.) Centre de traitement de la douleur et de soins
palliatifs de l'adulte et de l'enfant, institut Gustave-Roussy, Villejuif,
France.
CORRESPONDENCE ADDRESS
S. Voisin-Saltiel, Centre de traitement de la douleur et de soins palliatifs
de l'adulte et de l'enfant, institut Gustave-Roussy, Villejuif, France.
SOURCE
JEUR (2007) 20:1 (32-36). Date of Publication: March 2007
ISSN
0993-9857
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
anticonvulsive agent (drug therapy)
antidepressant agent (drug therapy)
EMTREE DRUG INDEX TERMS
amitriptyline
bisphosphonic acid derivative (drug therapy)
clomipramine
clonazepam
codeine (drug therapy)
dextropropoxyphene (drug therapy, oral drug administration)
dextropropoxyphene plus paracetamol
dihydrocodeine (drug therapy, oral drug administration)
fentanyl (drug therapy, intravenous drug administration, transdermal drug
administration)
fentanyl citrate (drug therapy)
gabapentin
haloperidol
hydromorphone (drug therapy)
imipramine
methylprednisolone (oral drug administration)
methylprednisolone sodium succinate
morphine (drug therapy, intravenous drug administration, parenteral drug
administration, subcutaneous drug administration)
morphine sulfate
morphine sulfate (drug therapy)
naloxone (intravenous drug administration, subcutaneous drug administration)
oxycodone (drug therapy)
oxycodone
paracetamol (drug therapy, oral drug administration)
paracetamol plus tramadol
paracetamol plus tramadol (drug therapy)
prednisolone 3 sulfobenzoate
prednisone acetate
pregabalin (drug dose)
propofan
tramadol (drug therapy, intravenous drug administration)
unclassified drug
unindexed drug
valproic acid (intravenous drug administration, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
cancer pain (drug therapy)
emergency care
EMTREE MEDICAL INDEX TERMS
article
cancer palliative therapy
disease classification
drug dose reduction
human
pain assessment
priority journal
treatment outcome
DRUG TRADE NAMES
actiq
actiskenan
anafranil
cortancyl
dafalgan
depakine
diantalvic
durogesic
efferalgan
haldol
ixprim
kapanol
laroxyl
lyrica
medrol
moscontin
neurontin
oramorph
oxycontin
oxynorm
propofan
rivotril
sevredol
skenan
solumedrol
solupred
sophidone
tofranil
topalgic
zaldiar
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
clomipramine (17321-77-6, 303-49-1)
clonazepam (1622-61-3)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
dextropropoxyphene plus paracetamol (39400-85-6)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
gabapentin (60142-96-3)
haloperidol (52-86-8)
hydromorphone (466-99-9, 71-68-1)
imipramine (113-52-0, 50-49-7)
methylprednisolone (6923-42-8, 83-43-2)
methylprednisolone sodium succinate (2375-03-3, 2921-57-5)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
prednisolone 3 sulfobenzoate (3694-41-5, 39175-74-1)
prednisone acetate (125-10-0)
pregabalin (148553-50-8)
tramadol (27203-92-5, 36282-47-0)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cancer (16)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2007479530
PUI
L47500227
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 991
TITLE
Prescription Naloxone: A Novel Approach to Heroin Overdose Prevention
AUTHOR NAMES
Sporer K.A.
Kral A.H.
AUTHOR ADDRESSES
(Sporer K.A., ksporer@sfghed.ucsf.edu) University of California, San
Francisco, Department of Medicine, Section of Emergency Medicine, San
Francisco, CA, United States.
(Kral A.H.) Department of Family and Community Medicine, San Francisco, CA,
United States.
CORRESPONDENCE ADDRESS
K.A. Sporer, University of California, San Francisco, Department of
Medicine, Section of Emergency Medicine, San Francisco, CA, United States.
Email: ksporer@sfghed.ucsf.edu
SOURCE
Annals of Emergency Medicine (2007) 49:2 (172-177). Date of Publication:
February 2007
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
The mortality and morbidity from heroin overdose have increased in the
United States and internationally in the last decade. The lipid solubility
allows the rapid deposition of heroin and its metabolites into the central
nervous system and accounts for the "rush" experienced by users and for the
toxicity. Risk factors for fatal and nonfatal heroin overdoses such as
recent abstinence, decreased opiate tolerance, and polydrug use have been
identified. Opiate substitution treatment such as methadone or buprenorphine
is the only proven method of heroin overdose prevention. Death from a heroin
overdose most commonly occurs 1 to 3 hours after injection at home in the
company of other people. Numerous communities have taken advantage of this
opportunity for treatment by implementing overdose prevention education to
active heroin users, as well as prescribing naloxone for home use. Naloxone
is a specific opiate antagonist without agonist properties or potential for
abuse. It is inexpensive and nonscheduled and readily reverses the
respiratory depression and sedation caused by heroin, as well as causing
transient withdrawal symptoms. Program implementation considerations, legal
ramifications, and research needs for prescription naloxone are discussed. ©
2007 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (adverse drug reaction, drug therapy, intramuscular drug
administration, intranasal drug administration, pharmacokinetics,
subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
methadone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence (drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
agitation
article
emergency health service
health practitioner
heart arrhythmia (side effect)
human
legal aspect
lung edema (side effect)
morbidity
mortality
outcome assessment
prescription
priority journal
risk factor
seizure (side effect)
side effect (side effect)
vomiting (side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007043243
MEDLINE PMID
17141138 (http://www.ncbi.nlm.nih.gov/pubmed/17141138)
PUI
L46127584
DOI
10.1016/j.annemergmed.2006.05.025
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2006.05.025
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 992
TITLE
Posaconazole as salvage therapy in a patient with disseminated zygomycosis:
Case report and review of the literature
AUTHOR NAMES
Page II R.L.
Schwiesow J.
Hilts A.
AUTHOR ADDRESSES
(Page II R.L., robert.page@uchsc.edu; Hilts A.) Schools of Pharmacy and
Medicine, University of Colorado Health Sciences Center, Denver, CO, United
States.
(Schwiesow J.) Department of Pharmacy, National Jewish Medical and Research
Center, Denver, CO, United States.
(Page II R.L., robert.page@uchsc.edu; Hilts A.) Department of Pharmacy,
University of Colorado Hospital, Denver, CO, United States.
(Page II R.L., robert.page@uchsc.edu) University of Colorado Health Sciences
Center, Schools of Pharmacy and Medicine, Box C238, 4200 East Ninth Avenue,
Denver, CO 80262, United States.
CORRESPONDENCE ADDRESS
R.L. Page II, University of Colorado Health Sciences Center, Schools of
Pharmacy and Medicine, Box C238, 4200 East Ninth Avenue, Denver, CO 80262,
United States. Email: robert.page@uchsc.edu
SOURCE
Pharmacotherapy (2007) 27:2 (290-298). Date of Publication: February 2007
ISSN
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc., 750 Washington Street, Boston, United
States.
ABSTRACT
Zygomycosis refers to any fungal infection originating from the class
Zygomycetes and the order Mucorales. In immunocompromised patients, these
fungi produce a relatively rapid, violently destructive, and highly fatal
infection. Treatment approaches include both aggressive antifungal
pharmacotherapy and surgical intervention. Unfortunately, even with optimal
therapy, morbidity and mortality rates remain relatively high. As failure
rates are elevated with commercial antifungals, new treatment options are
needed. Posaconazole is an orally available, extended-spectrum triazole
antifungal being investigated in phase III clinical trials for the treatment
and prevention of invasive fungal infections, including zygomycosis. We
report the case of a 26-year-old Vietnamese man with a medical history of
acute lymphocytic leukemia who had undergone consolidation chemotherapy and
had neutropenic fever when he came to the emergency department. The patient
was admitted to the hospital and treated with broad-spectrum antibiotics and
caspofungin. Two weeks into his admission, however, abscesses in the pelvis,
prostate, and musculature surrounding the hip were detected
radiographically; these abscesses eventually cultured for Mucor sp.
Disseminated zygomycosis was diagnosed. Caspofungin was immediately
discontinued, and high-dose liposomal amphotericin B 10 mg/kg/day was begun.
Over the next month, infection spread to the right lung, left kidney, middle
thoracic spine, and epidural space. As a result, oral posaconazole 200 mg 4
times/day was added to the liposomal amphotericin B. Significant clinical,
hematologic, mycologic, and radiologic improvements were demonstrated as
early as 10 days after start of posaconazole therapy and continued through
41 days of inpatient treatment. Liposomal amphotericin B was discontinued
after 3 weeks of posaconazole, and the patient was discharged on hospital
day 92 receiving oral posaconazole, with no major adverse events reported.
Five months after discharge, the patient had no evidence of fungal disease
recurrence or progression. Posaconazole appears to be a well-tolerated and
effective salvage treatment for zygomycosis, including disseminated disease.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
posaconazole (adverse drug reaction, drug combination, drug therapy, oral
drug administration, pharmacology)
EMTREE DRUG INDEX TERMS
aciclovir (drug combination)
amphotericin B lipid complex (drug combination, drug therapy)
antineoplastic agent (adverse drug reaction, drug therapy)
caspofungin (drug combination, drug therapy)
cefepime (drug combination, drug therapy, intravenous drug administration)
dextropropoxyphene napsilate (drug combination, drug therapy)
docusate sodium (drug combination)
fluconazole (drug combination)
meropenem (drug combination, drug therapy, intravenous drug administration)
methotrexate (adverse drug reaction)
naloxone (drug combination, drug therapy, intravenous drug administration)
narcotic agent (drug therapy, oral drug administration)
paracetamol (drug combination, drug therapy)
paroxetine (drug combination, oral drug administration)
recombinant granulocyte colony stimulating factor (drug combination, drug
therapy, subcutaneous drug administration)
salsalate (drug combination)
Senna extract (drug combination)
vancomycin (drug combination, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mucormycosis (complication, diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
acute lymphoblastic leukemia (drug therapy)
adult
article
case report
drug efficacy
drug megadose
febrile neutropenia (drug therapy, etiology, side effect)
human
loading drug dose
male
Mucor
pain (drug therapy)
pelvis abscess (complication, diagnosis, drug therapy)
rash (side effect)
recommended drug dose
salvage therapy
single drug dose
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
caspofungin (189768-38-5)
cefepime (88040-23-7)
dextropropoxyphene napsilate (17140-78-2)
docusate sodium (577-11-7)
fluconazole (86386-73-4)
meropenem (96036-03-2)
methotrexate (15475-56-6, 59-05-2, 7413-34-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
paroxetine (61869-08-7)
posaconazole (171228-49-2)
recombinant granulocyte colony stimulating factor (121181-53-1)
salsalate (552-94-3)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Cancer (16)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007075386
MEDLINE PMID
17253919 (http://www.ncbi.nlm.nih.gov/pubmed/17253919)
PUI
L46214589
DOI
10.1592/phco.27.2.290
FULL TEXT LINK
http://dx.doi.org/10.1592/phco.27.2.290
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 993
TITLE
Active surveillance of abused and misused prescription opioids using poison
center data: A pilot study and descriptive comparison
AUTHOR NAMES
Hughes A.A.
Bogdan G.M.
Dart R.C.
AUTHOR ADDRESSES
(Hughes A.A., Alice.Hughes@RMPDC.org; Bogdan G.M.; Dart R.C.) Rocky Mountain
Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO,
United States.
(Bogdan G.M.) Univeristy of Colorado Health Sciences Center, Denver, CO,
United States.
(Hughes A.A., Alice.Hughes@RMPDC.org) Researched Abuse Diversion and
Addiction-Related Surveillance (RADARS), System Poison Center Group, Denver,
CO, United States.
(Hughes A.A., Alice.Hughes@RMPDC.org) Rocky Mountain Poison and Drug Center,
MC 0180, 777 Bannock St, Denver, CO 80204, United States.
CORRESPONDENCE ADDRESS
A.A. Hughes, Rocky Mountain Poison and Drug Center, MC 0180, 777 Bannock St,
Denver, CO 80204, United States. Email: Alice.Hughes@RMPDC.org
SOURCE
Clinical Toxicology (2007) 45:2 (144-151). Date of Publication: February
2007
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Background. Prescription opioids are abused throughout the United States.
Several monitoring programs are in existence, however, none of these systems
provide up-to-date information on prescription opioid abuse. This article
describes the use of poison centers as a real-time, geographically specific,
surveillance system for prescription opioid abuse and compares our system
with an existing prescription drug abuse monitoring program, the Drug Abuse
Warning Network (DAWN). Methods. Data were collected from eight
geographically dispersed poison centers for a period of twelve months. Any
call involving buprenorphine, fentanyl, hydrocodone, hydromorphone,
methadone, morphine, and oxycodone was considered a case. Any case coded as
intentional exposure (abuse, intentional misuse, suicide, or intentional
unknown) was regarded as misuse and abuse. Comparative data were obtained
from DAWN. Results. Poison center rates of abuse and misuse were highest for
hydrocodone at 3.75 per 100,000 population, followed by oxycodone at 1.81
per 100,000 population. DAWN emergency department (ED) data illustrate a
similar pattern of abuse with most mentions involving hydrocodone and
oxycodone. Poison center data indicate that people aged 18 to 25 had the
highest rates of abuse. DAWN reported the majority of ED mentions among 35
to 44-year-olds. Geographically, Kentucky had the uppermost rates of abuse
and misuse for all opioids combined at 20.69 per 100,000 population.
Conclusions. Comparing poison center data to DAWN yielded mostly comparable
results, including hydrocodone as the most commonly mentioned drug. Our
results suggest poison center data can be used as an indicator for
prescription opioid abuse and misuse and can provide timely, geographically
specific information on prescription drug abuse. Copyright © Informa
Healthcare.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
buprenorphine
fentanyl
hydrocodone
hydromorphone
methadone
morphine
oxycodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug surveillance program
poison center
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
comparative study
controlled study
drug misuse
emergency ward
female
human
major clinical study
male
prescription
suicide
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007096799
MEDLINE PMID
17364631 (http://www.ncbi.nlm.nih.gov/pubmed/17364631)
PUI
L46280021
DOI
10.1080/15563650600981137
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650600981137
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 994
TITLE
Letter to the editor: "Severe neurotoxicity following oral meperidine
(pethidine) overdose" [4]
AUTHOR NAMES
Karunatilake H.
Buckley N.A.
AUTHOR ADDRESSES
(Karunatilake H.; Buckley N.A., nick.buckley@act.gov.au) Department of
Clinical Pharmacology and Toxicology, Canberra Hospital, PO Box 11, Woden,
ACT 2606, Australia.
CORRESPONDENCE ADDRESS
N.A. Buckley, Department of Clinical Pharmacology and Toxicology, Canberra
Hospital, PO Box 11, Woden, ACT 2606, Australia. Email:
nick.buckley@act.gov.au
SOURCE
Clinical Toxicology (2007) 45:2 (200-201). Date of Publication: February
2007
ISSN
1556-3650
1556-9519 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
pethidine (oral drug administration)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neurotoxicity (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
case report
disease severity
drug overdose
emergency ward
female
Glasgow coma scale
grand mal epilepsy
human
intensive care unit
letter
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007096810
MEDLINE PMID
17364646 (http://www.ncbi.nlm.nih.gov/pubmed/17364646)
PUI
L46280032
DOI
10.1080/15563650600981194
FULL TEXT LINK
http://dx.doi.org/10.1080/15563650600981194
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 995
TITLE
Evaluation of the use of buprenorphine for opioid withdrawal in an emergency
department
AUTHOR NAMES
Berg M.L.
Idrees U.
Ding R.
Nesbit S.A.
Liang H.K.
McCarthy M.L.
AUTHOR ADDRESSES
(Berg M.L.) University of Illinois-Chicago, Edward Hospital, Department of
Pharmacy, 801 S. Washington Street, Naperville, IL 60540, United States.
(Idrees U., uidrees1@jhmi.edu; Nesbit S.A.) The Johns Hopkins Hospital,
Department of Pharmacy, 600 North Wolfe Street, Carnegie 180, Baltimore, MD
21287-6180, United States.
(Ding R.; McCarthy M.L.) The Johns Hopkins University, Department of
Emergency Medicine, Davis Building, 5801 Smith Avenue, Baltimore, MD 21209,
United States.
(Liang H.K.) The Johns Hopkins University, Department of Emergency Medicine,
600 North Wolfe Street, Baltimore, MD 21287, United States.
CORRESPONDENCE ADDRESS
U. Idrees, The Johns Hopkins Hospital, Department of Pharmacy, 600 North
Wolfe Street, Carnegie 180, Baltimore, MD 21287-6180, United States. Email:
uidrees1@jhmi.edu
SOURCE
Drug and Alcohol Dependence (2007) 86:2-3 (239-244). Date of Publication: 12
Jan 2007
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Objectives: To examine the use of buprenorphine for the treatment of opioid
withdrawal (OW) in an emergency department (ED) setting. Methods: The
medical records of all adult patients who presented to the study ED during a
10 week period for OW were abstracted. Subjects were categorized as
receiving buprenorphine, symptomatic treatment or no pharmacologic treatment
for their OW. The three groups were compared by patient and service
characteristics, withdrawal symptoms and outcomes. Results: Of the 11,019
patients who presented to the ED during the 10 week study period, 158 (1.4%)
were eligible. Subjects were more likely to receive buprenorphine (56%)
compared to symptomatic treatment only (26%) or no pharmacologic treatment
(18%). Subjects who received buprenorphine were more likely to have a
history of suicide ideation (34% versus 12% p < 0.05) compared to subjects
who received symptomatic treatment(s) and were less likely to present with a
gastrointestinal complaint (9% versus 25% p < 0.05). Subjects who received
buprenorphine were less likely to return to the same ED within 30 days for a
drug-related visit (8%) compared to those who received symptomatic treatment
(17%) (p < 0.05). Conclusions: Buprenorphine was a common treatment for OW
in this ED without any documented adverse outcomes. Given that it did not
result in an increase in drug-related return ED visits and its proven
efficacy in other settings, a prospective evaluation of its potential value
to ED patients who present with OW is warranted. © 2006 Elsevier Ireland
Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (adverse drug reaction, drug administration, drug dose, drug
therapy, intramuscular drug administration, intravenous drug administration)
opiate
EMTREE DRUG INDEX TERMS
antiemetic agent (drug therapy)
benzodiazepine derivative
clonidine
dicycloverine (drug therapy)
dolasetron mesilate (drug therapy)
metoclopramide (drug therapy)
promethazine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy)
withdrawal syndrome (drug therapy)
EMTREE MEDICAL INDEX TERMS
absence of side effects (side effect)
adult
article
controlled study
emergency ward
female
gastrointestinal symptom
human
major clinical study
male
medical record
palliative therapy
priority journal
suicidal ideation
treatment outcome
vomiting (drug therapy)
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
dicycloverine (50815-09-3, 67-92-5, 77-19-0)
dolasetron mesilate (115956-13-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006582589
MEDLINE PMID
16930865 (http://www.ncbi.nlm.nih.gov/pubmed/16930865)
PUI
L44822646
DOI
10.1016/j.drugalcdep.2006.06.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2006.06.014
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 996
TITLE
Opioid administration for acute abdominal pain in the pediatric emergency
department
AUTHOR NAMES
Klein-Kremer A.
Goldman R.D.
AUTHOR ADDRESSES
(Klein-Kremer A.) Pediatric Research in Emergency Therapeutics (PRETx)
Program, Division of Pediatric Emergency Medicine, The Hospital for Sick
Children, Toronto, ON, Canada.
(Goldman R.D.) Department of Pediatrics, University of Toronto, Toronto, ON,
Canada.
CORRESPONDENCE ADDRESS
A. Klein-Kremer, Pediatric Research in Emergency Therapeutics (PRETx)
Program, Division of Pediatric Emergency Medicine, The Hospital for Sick
Children, Toronto, ON, Canada.
SOURCE
Journal of Opioid Management (2007) 3:1 (11-14). Date of Publication:
January/February 2007
ISSN
1551-7489
BOOK PUBLISHER
Weston Medical Publishing, 470 Boston Post Road, Weston, United States.
ABSTRACT
The use of opioid analgesia for acute abdominal pain of unclear etiology has
traditionally been thought to mask symptoms, alter physical exam findings,
delay diagnosis, and increase morbidity and mortality. However, studies in
children and adults have demonstrated that administering intravenous opioids
to patients with acute abdominal pain induces analgesia but does not delay
diagnosis or adversely affect diagnostic accuracy. This review discusses the
effects of opioid administration on pain relief and diagnostic accuracy in
children with moderate to severe acute abdominal pain who have been
evaluated in the emergency department. We hold that current evidence
supports the administration of opioids to children with acute abdominal
pain, and future trials will help determine safe and effective timing and
dosing related to opioid administration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
antipyretic agent (drug therapy)
ibuprofen (drug therapy)
morphine (adverse drug reaction, drug comparison, drug therapy, intravenous
drug administration, oral drug administration, parenteral drug
administration, pharmacoeconomics, pharmacology)
narcotic analgesic agent (drug therapy)
oxycodone (adverse drug reaction, buccal drug administration, clinical
trial, drug comparison, drug therapy, pharmacology)
papaverine (clinical trial, drug therapy)
paracetamol (drug therapy, oral drug administration, rectal drug
administration)
placebo
tramadol (adverse drug reaction, clinical trial, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (diagnosis, disease management, drug therapy, prevention)
childhood disease (diagnosis, disease management, drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
analgesia
appendectomy
appendicitis (surgery)
clinical trial
diagnostic accuracy
drug cost
drug mechanism
drug safety
emergency ward
human
nausea and vomiting (side effect)
neurologic disease (side effect)
opiate addiction (side effect)
pain assessment
postoperative pain (complication, drug therapy, prevention)
review
sedation
side effect (side effect)
treatment response
unspecified side effect (side effect)
visual analog scale
CAS REGISTRY NUMBERS
ibuprofen (15687-27-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
papaverine (58-74-2, 61-25-6)
paracetamol (103-90-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007587360
MEDLINE PMID
17367089 (http://www.ncbi.nlm.nih.gov/pubmed/17367089)
PUI
L350199788
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 997
TITLE
Physicians' knowledge of and willingness to prescribe naloxone to reverse
accidental opiate overdose: Challenges and opportunities
AUTHOR NAMES
Beletsky L.
Ruthazer R.
Macalino G.E.
Rich J.D.
Tan L.
Burris S.
AUTHOR ADDRESSES
(Beletsky L., leob@temple.edu; Burris S.) Temple University, Beasley School
of Law, Philadelphia, PA, United States.
(Ruthazer R.) Biostatistics Research Center, Institute for Clinical Research
and Health Policy Studies, Tufts-New England Medical Center, Boston, MA,
United States.
(Macalino G.E.) Tufts University School of Medicine, Institute for Clinical
Research and Health Policy Studies, Tufts New England Medical Center,
Boston, MA, United States.
(Rich J.D.) Brown University, Miriam Hospital, Providence, RI, United
States.
(Tan L.) American Medical Association, Chicago, IL, United States.
(Beletsky L., leob@temple.edu) Temple University, Beasley School of Law,
1719 N. Broad St., Philadelphia, PA 19122, United States.
CORRESPONDENCE ADDRESS
L. Beletsky, Temple University, Beasley School of Law, 1719 N. Broad St.,
Philadelphia, PA 19122, United States. Email: leob@temple.edu
SOURCE
Journal of Urban Health (2007) 84:1 (126-136). Date of Publication: January
2007
ISSN
1099-3460
1468-2869 (electronic)
BOOK PUBLISHER
Springer Science and Business Media Deutschland GmbH, Heidelberger Platz 3,
Berlin, Germany.
ABSTRACT
Naloxone, the standard treatment for heroin overdose, is a safe and
effective prescription drug commonly administered by emergency room
physicians or first responders acting under standing orders of physicians.
High rates of overdose deaths and widely accepted evidence that witnesses of
heroin overdose are often unwilling or unable to call 9-1-1 has led to
interventions in several US cities and abroad in which drug users are
instructed in overdose rescue techniques and provided a "take-home" dose of
naloxone. Under current Food and Drug Administration (FDA) regulations, such
interventions require physician involvement. As part of a larger study to
evaluate the knowledge and attitudes of doctors towards providing drug
treatment and harm reduction services to injection drug users (IDUs), we
investigated physician knowledge and willingness to prescribe naloxone. Less
than one in four of the respondents in our sample reported having heard of
naloxone prescription as an intervention to prevent opiate overdose, and the
majority reported that they would never consider prescribing the agent and
explaining its application to a patient. Factors predicting a favorable
attitude towards prescribing naloxone included fewer negative perceptions of
IDUs, assigning less importance to peer and community pressure not to treat
IDUs, and increased confidence in ability to provide meaningful treatment to
IDUs. Our data suggest that steps to promote naloxone distribution programs
should include physician education about evidence-based harm minimization
schemes, broader support for such initiatives by professional organizations,
and policy reform to alleviate medicolegal concerns associated with naloxone
prescription. FDA re-classification of naloxone for over-the-counter sales
and promotion of nasal-delivery mechanism for this agent should be explored.
© 2006 The New York Academy of Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
controlled study
data analysis
drug abuse
evidence based medicine
female
food and drug administration
harm reduction
health care organization
health care personnel
health care policy
health service
human
male
medicolegal aspect
peer group
physician
prescription
priority journal
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007050766
MEDLINE PMID
17146712 (http://www.ncbi.nlm.nih.gov/pubmed/17146712)
PUI
L46147376
DOI
10.1007/s11524-006-9120-z
FULL TEXT LINK
http://dx.doi.org/10.1007/s11524-006-9120-z
COPYRIGHT
Copyright 2008 Elsevier B.V., All rights reserved.
RECORD 998
TITLE
Succinylcholine-induced masseter muscle rigidity associated with rapid
sequence intubation
AUTHOR NAMES
Roman C.S.
Rosin A.
AUTHOR ADDRESSES
(Roman C.S.; Rosin A.) Department of Emergency Medicine, Carl R. Darnall
Army Medical Center, Fort Hood, TX 76544, United States.
CORRESPONDENCE ADDRESS
C.S. Roman, Department of Emergency Medicine, Carl R. Darnall Army Medical
Center, Fort Hood, TX 76544, United States.
SOURCE
American Journal of Emergency Medicine (2007) 25:1 (102-104). Date of
Publication: January 2007
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
suxamethonium (adverse drug reaction)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
clonidine
etomidate (intravenous drug administration)
naloxone
oxygen
paracetamol
vecuronium (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intubation
masseter muscle
muscle rigidity (drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
adult
article
blood pressure
breathing rate
case report
clinical feature
emergency health service
endotracheal tube
face mask
Glasgow coma scale
human
intravenous catheter
male
oxygen saturation
priority journal
DRUG TRADE NAMES
aspirin
narcan
tylenol
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
paracetamol (103-90-2)
suxamethonium (306-40-1, 71-27-2)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006592397
MEDLINE PMID
17157700 (http://www.ncbi.nlm.nih.gov/pubmed/17157700)
PUI
L44854389
DOI
10.1016/j.ajem.2006.05.032
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2006.05.032
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 999
TITLE
Management of alcohol intoxication and aggressive behaviour: A tale of two
cities
AUTHOR NAMES
Sellaturay S.
Arya M.
Makepeace J.
Sellaturay P.
Henry J.A.
AUTHOR ADDRESSES
(Sellaturay S.; Sellaturay P.) University College London, United Kingdom.
(Arya M.) Hoyal Free Hospital, London, United Kingdom.
(Makepeace J.) Department of Anaesthetics, Lewisham Hospital, London, United
Kingdom.
(Henry J.A., j.a.henry@imperial.ac.uk) Academic Department of Accident and
Emergency Medicine, Imperial College, St. Mary's Hospital, London, United
Kingdom.
(Henry J.A., j.a.henry@imperial.ac.uk) Academic Department of Accident and
Emergency Medicine, Imperial College, St. Mary's Hospital, London W2 1NY,
United Kingdom.
CORRESPONDENCE ADDRESS
J.A. Henry, Academic Department of Accident and Emergency Medicine, Imperial
College, St. Mary's Hospital, London W2 1NY, United Kingdom. Email:
j.a.henry@imperial.ac.uk
SOURCE
Current Medical Research and Opinion (2007) 23:1 (77-83). Date of
Publication: January 2007
ISSN
0300-7995
BOOK PUBLISHER
Informa Healthcare, Telephone House, 69 - 77 Paul Street, United Kingdom.
ABSTRACT
Background: Violence and aggressive behaviour are a growing problem in
emergency departments on both sides of the Atlantic, and alcohol
intoxication is often involved. A wide range of management options is
available, and policies vary considerably. Methods: We compared the
management of alcohol intoxication and aggressive behaviour in four New York
and four London emergency departments, using a semi-structured interview
which covered 15 issues. Results: Differences were apparent between New York
and London emergency departments in the method used for diagnosis of alcohol
intoxication, the investigations carried out and discharge criteria.
Chemical and physical restraints were readily and frequently used in New
York in order to prevent intoxicated patients leaving the department, while
in London disruptive patients tended to be ejected. Conclusions: The marked
transatlantic differences, while partly due to cultural and historic
reasons, are largely due to the pressures to limit the risk of litigation in
the United States and the constraints of a cost-limited health service in
Britain. The management of violent and intoxicated patients deserves further
refinement. © 2007 Librapharm Limited. All rights reserved: reproduction in
whole or part not permitted.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
thiamine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aggression
alcohol intoxication (diagnosis, drug therapy, prevention)
violence
EMTREE MEDICAL INDEX TERMS
anamnesis
article
clinical feature
clinical practice
controlled study
detoxification
diagnostic procedure
emergency ward
health care organization
health care personnel
hospital discharge
human
medical assessment
medical staff
prophylaxis
questionnaire
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2007066825
MEDLINE PMID
17257468 (http://www.ncbi.nlm.nih.gov/pubmed/17257468)
PUI
L46191672
DOI
10.1185/030079906X159470
FULL TEXT LINK
http://dx.doi.org/10.1185/030079906X159470
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1000
TITLE
Naloxone use in a tiered-response emergency medical services system
AUTHOR NAMES
Belz D.
Lieb J.
Rea T.
Eisenberg M.S.
AUTHOR ADDRESSES
(Belz D.; Lieb J.) Department of Medicine, School of Medicine, University of
Washington, Seattle, WA, United States.
(Rea T.; Eisenberg M.S., gingy@u.washington.edu) Emergency Medical Services
Division, Public Health Seattle and King County, Seattle, WA, United States.
(Eisenberg M.S., gingy@u.washington.edu) Emergency Medical Services
Division, Public Health Seattle and King County, 999 Third Avenue, Seattle,
WA 98104, United States.
CORRESPONDENCE ADDRESS
M.S. Eisenberg, Emergency Medical Services Division, Public Health Seattle
and King County, 999 Third Avenue, Seattle, WA 98104, United States. Email:
gingy@u.washington.edu
SOURCE
Prehospital Emergency Care (2006) 10:4 (468-471). Date of Publication: 1 Dec
2006
ISSN
1090-3127
1545-0066 (electronic)
BOOK PUBLISHER
Informa Healthcare, 69-77 Paul Street, London, United Kingdom.
ABSTRACT
Objective. To examine the delivery and effect of naloxone for opioid
overdose in a tiered-response emergency medical services (EMS) system and to
ascertain how much time could be saved if the first arriving emergency
medical technicians (EMTs) could have administered intranasal naloxone.
Methods. This was case series of all EMS-treated overdose patients who
received naloxone by paramedics in a two-tiered EMS system during 2004. The
system dispatches basic life support-trained fire fighter-EMTs and/or
advanced life support-trained paramedics depending on the severity of cases.
Main outcomes were geographic distribution of naloxone-treated overdose,
severity of cases, response to naloxone, and time interval between arrival
of EMTs and arrival of paramedics at the scene. Results. There were 164
patients who received naloxone for suspected overdose. There were 75
patients (46%) initially unresponsive to painful stimulus. Respiratory rate
was <10 breaths/min in 79 (48%). Death occurred in 36 (22%) at the scene or
during transport. A full or partial response to naloxone occurred in 119
(73%). Recognized adverse reactions were limited to agitation/combativeness
in 25 (15%) and emesis in six (4%). Average EMT arrival time was 5.9
minutes. Average paramedic arrival time was 11.6 minutes in most cases and
16.1 minutes in 46 cases (28%) in which paramedics were requested by EMTs at
the scene. Conclusions. There is potential for significantly earlier
delivery of naloxone to patients in opioid overdose if EMTs could deliver
intranasal naloxone. A pilot study training and authorizing EMTs to
administer intranasal naloxone in suspected opioid overdose is warranted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug administration, drug dose, drug
therapy, intramuscular drug administration, intranasal drug administration,
intravenous drug administration)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
opiate addiction (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
agitation
article
breathing rate
death
disease severity
drug effect
drug overdose
female
geographic distribution
health care availability
health care delivery
health care personnel
human
major clinical study
male
pain
rescue personnel
side effect (side effect)
stimulus response
treatment response
violence
vomiting (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006472145
MEDLINE PMID
16997776 (http://www.ncbi.nlm.nih.gov/pubmed/16997776)
PUI
L44451598
DOI
10.1080/10903120600885134
FULL TEXT LINK
http://dx.doi.org/10.1080/10903120600885134
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1001
TITLE
Impact of Outside Regulatory Investigation on Opiate Administration in the
Emergency Department
AUTHOR NAMES
McErlean M.
Triner W.
Young A.
AUTHOR ADDRESSES
(McErlean M.; Triner W., trinerw@mail.amc.edu; Young A.) Department of
Emergency Medicine, Albany Medical College, Albany, NY, United States.
CORRESPONDENCE ADDRESS
W. Triner, Department of Emergency Medicine, Albany Medical College, Albany,
NY, United States. Email: trinerw@mail.amc.edu
SOURCE
Journal of Pain (2006) 7:12 (947-950). Date of Publication: December 2006
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
This study was conducted to determine whether outside regulatory
investigation related to opiate prescription diversion changes the
prescribing frequency of opiates in an emergency department (ED). The
presence of ED administration of opiates and prescriptions for opiates on
discharge were compared across a baseline period 90 days before arrest of a
physician for opiate diversion, a period immediately surrounding the arrest,
and a follow-up period 90 days later. At no time was there investigation of
excessive opiate prescribing for patients in the ED. The likelihood of
receiving opiate analgesia either in the ED or on discharge was not
significantly different for patients reporting mild pain or severe pain
across all three periods. Patients with moderate pain (self-reported pain
scores of 4 to 6 out of 10) were less likely to receive opiates in the ED
immediately after the arrest compared with the baseline period (likelihood
ratio, 0.4; confidence interval, 0.2 to 0.7). Patients with moderate pain
were also less likely to receive prescriptions for opiates on discharge from
the ED immediately after the arrest (likelihood ratio, 0.5; confidence
interval, 0.3 to 0.9). These effects had diminished by 90 days. Perspective:
This study indicates that factors outside of the provider-patient
relationship influence the likelihood of receiving opiates during an ED
visit. Awareness of this phenomenon might serve to reduce oligoanalgesia. ©
2006 American Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug administration, drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug administration, drug therapy)
hydromorphone (drug administration, drug therapy)
oxycodone (drug administration, drug therapy)
pethidine (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
prescription
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
confidence interval
controlled study
emergency ward
female
follow up
hospital discharge
human
major clinical study
male
pain (drug therapy)
physician
self report
statistical model
CAS REGISTRY NUMBERS
codeine (76-57-3)
hydromorphone (466-99-9, 71-68-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006592537
MEDLINE PMID
17157781 (http://www.ncbi.nlm.nih.gov/pubmed/17157781)
PUI
L44854742
DOI
10.1016/j.jpain.2006.05.012
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2006.05.012
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1002
TITLE
Incorrect labelling of naloxone [22]
AUTHOR NAMES
Windsor J.S.
Middleton P.M.
AUTHOR ADDRESSES
(Windsor J.S., jswindsor@doctors.org.uk; Middleton P.M.) Prince of Wales
Hospital, Sydney, NSW 2031, Australia.
CORRESPONDENCE ADDRESS
J.S. Windsor, Prince of Wales Hospital, Sydney, NSW 2031, Australia. Email:
jswindsor@doctors.org.uk
SOURCE
Anaesthesia (2006) 61:12 (1230). Date of Publication: December 2006
ISSN
0003-2409
1365-2044 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug labeling
EMTREE MEDICAL INDEX TERMS
drug delivery system
drug safety
emergency treatment
letter
syringe
DRUG MANUFACTURERS
(Australia)CSL
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006544198
MEDLINE PMID
17090269 (http://www.ncbi.nlm.nih.gov/pubmed/17090269)
PUI
L44697886
DOI
10.1111/j.1365-2044.2006.04890_1.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1365-2044.2006.04890_1.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1003
TITLE
Linking opioid-dependent hospital patients to drug treatment: Health care
use and costs 6 months after randomization
AUTHOR NAMES
Barnett P.G.
Masson C.L.
Sorensen J.L.
Wong W.
Hall S.
AUTHOR ADDRESSES
(Barnett P.G., paul.barnett@va.gov; Wong W.; Hall S.) Department of
Psychiatry, University of California, San Francisco, CA, United States.
(Barnett P.G., paul.barnett@va.gov) Veterans Affairs Palo Alto Health Care
System, Stanford University, Menlo Park, CA, United States.
(Masson C.L.; Sorensen J.L.) Department of Psychiatry, University of
California, San Francisco, San Francisco General Hospital, San Francisco,
CA, United States.
(Barnett P.G., paul.barnett@va.gov) Veterans Affairs Health Economics
Resource Center, 795 Willow Road 152, Menlo Park, CA 94025, United States.
CORRESPONDENCE ADDRESS
P.G. Barnett, Veterans Affairs Health Economics Resource Center, 795 Willow
Road 152, Menlo Park, CA 94025, United States. Email: paul.barnett@va.gov
SOURCE
Addiction (2006) 101:12 (1797-1804). Date of Publication: December 2006
ISSN
0965-2140
1360-0443 (electronic)
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Aims: To conduct an economic evaluation of the first 6 months' trial of
treatment vouchers and case management for opioid-dependent hospital
patients. Design: Randomized clinical trial and evaluation of administrative
data. Setting: Emergency department, wound clinic, in-patient units and
methadone clinic in a large urban public hospital. Participants: The study
randomized 126 opioid-dependent drug users seeking medical care.
Interventions: Participants were randomized among four groups. These
received vouchers for 6 months of methadone treatment, 6 months of case
management, both these interventions, or usual care. Findings: During the
first 6 months of this study, 90% of those randomized to vouchers alone
enrolled in methadone maintenance, significantly more than the 44%
enrollment in those randomized to case management without vouchers (P <
0.001). The direct costs of substance abuse treatment, including case
management, was $4040 for those who received vouchers, $4177 for those
assigned to case management and $5277 for those who received the combination
of both interventions. After 3 months, the vouchers alone group used less
heroin than the case management alone group. The difference was not
significant at 6 months. There were no significant differences in other
health care costs in the 6 months following randomization. Conclusion:
Vouchers were slightly more effective but no more costly than case
management during the initial 6 months of the study. Vouchers were as
effective and less costly than the combination of case management and
vouchers. The finding that vouchers dominate is tempered by the possibility
that case management may lower medical care costs. © 2006 Society for the
Study of Addiction.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug therapy, pharmacoeconomics)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
case management
clinical trial
controlled clinical trial
controlled study
disease severity
drug abuse
drug detoxification
drug use
economic evaluation
health care cost
health care utilization
hospital patient
human
major clinical study
methadone treatment
outcome assessment
randomized controlled trial
substance abuse
treatment duration
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006606382
MEDLINE PMID
17156179 (http://www.ncbi.nlm.nih.gov/pubmed/17156179)
PUI
L44899702
DOI
10.1111/j.1360-0443.2006.01636.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.2006.01636.x
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1004
TITLE
Intranasal diamorphine integrated care pathway for paediatric analgesia in
the accident and emergency department [2]
AUTHOR NAMES
Gahir K.K.
Ransom P.A.
AUTHOR ADDRESSES
(Gahir K.K., Kalvinder.Gahir@esht.nhs.uk; Ransom P.A.) A and E Department,
Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX,
United Kingdom.
(Gahir K.K., Kalvinder.Gahir@esht.nhs.uk) East Sussex Hospitals NHS Trust,
Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD,
United Kingdom.
CORRESPONDENCE ADDRESS
K.K. Gahir, East Sussex Hospitals NHS Trust, Eastbourne District General
Hospital, Kings Drive, Eastbourne BN21 2UD, United Kingdom. Email:
Kalvinder.Gahir@esht.nhs.uk
SOURCE
Emergency Medicine Journal (2006) 23:12 (959). Date of Publication: December
2006
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (clinical trial, drug comparison, intranasal drug
administration)
EMTREE DRUG INDEX TERMS
morphine (clinical trial, drug comparison)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
limb fracture
pediatric anesthesia
EMTREE MEDICAL INDEX TERMS
analgesia
clinical audit
clinical observation
clinical pathway
clinical trial
drug efficacy
drug tolerability
emergency ward
evidence based medicine
human
informed consent
letter
pain assessment
patient safety
practice guideline
priority journal
systematic review
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006601920
MEDLINE PMID
17130615 (http://www.ncbi.nlm.nih.gov/pubmed/17130615)
PUI
L44883633
DOI
10.1136/emj.2006.034637
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2006.034637
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1005
TITLE
Medication Errors in Children
AUTHOR NAMES
Kozer E.
Berkovitch M.
Koren G.
AUTHOR ADDRESSES
(Kozer E.) Pediatric Emergency Services, Assaf Harofeh Medical Center,
Zerifin, 70300, Israel.
(Kozer E.; Berkovitch M.) Pediatrics, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, 70300, Israel.
(Berkovitch M.) Clinical Pharmacology and Toxicology Unit, Assaf Harofeh
Medical Center, Zerifin, Israel.
(Koren G., gkoren@sickkids.ca) The Motherisk Program, Division of Clinical
Pharmacology, The Hospital for Sick Children, 555 University Avenue,
Toronto, Ont. M5G 1X8, Canada.
(Koren G., gkoren@sickkids.ca) The University of Toronto, 555 University
Avenue, Toronto, Ont. M5G 1X8, Canada.
CORRESPONDENCE ADDRESS
G. Koren, The Motherisk Program, Division of Clinical Pharmacology, The
Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8,
Canada. Email: gkoren@sickkids.ca
SOURCE
Pediatric Clinics of North America (2006) 53:6 (1155-1168). Date of
Publication: December 2006
Patient Safety, Book Series Title:
ISSN
0031-3955
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Medication errors account for significant morbidity and mortality and are
very common in pediatric practice. Errors are more common among the sickest
and more vulnerable patients. Applying the "system approach" to medication
errors enables hospitals and health organizations to detect and treat the
source of preventable errors before they harm patients. Professionals and
health organizations should adopt strategies that have been shown to reduce
errors, such as CPOE, preprinted order forms, and color-coded systems.
Systems for detecting and reporting medication errors should be implemented
at all levels of the medical system. Further studies are needed for better
understanding of this epidemic and development of effective preventive
measures. © 2006 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
codeine (adverse drug reaction, drug therapy)
naloxone (drug therapy, intravenous drug administration)
penicillin G (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medication error
EMTREE MEDICAL INDEX TERMS
allergic reaction (side effect)
ambulatory care
apnea (drug therapy, side effect)
emergency ward
fatigue
health care
health practitioner
human
iatrogenic disease
intensive care unit
patient safety
pharmacy
physician
prescription
review
risk assessment
software
teamwork
CAS REGISTRY NUMBERS
codeine (76-57-3)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006570495
MEDLINE PMID
17126688 (http://www.ncbi.nlm.nih.gov/pubmed/17126688)
PUI
L44779681
DOI
10.1016/j.pcl.2006.09.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.pcl.2006.09.005
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1006
TITLE
Anaesthesia for obstetric surgery
AUTHOR NAMES
Livingstone H.L.
Dresner M.
AUTHOR ADDRESSES
(Livingstone H.L., harvey.l@cwcom.net; Dresner M.) Department of
Anaesthesia, The General Infirmary at Leeds, Great George Street, Leeds, LS1
3EX, United Kingdom.
CORRESPONDENCE ADDRESS
H.L. Livingstone, Department of Anaesthesia, The General Infirmary at Leeds,
Great George Street, Leeds, LS1 3EX, United Kingdom. Email:
harvey.l@cwcom.net
SOURCE
Current Anaesthesia and Critical Care (2006) 17:3-4 (143-150). Date of
Publication: 2006
ISSN
0953-7112
ABSTRACT
The obstetric anaesthetist may be required to anaesthetize women for a
variety of procedures ranging from the relatively minor elective operation
to the dire life threatening emergency. We discuss the procedures that will
be commonly encountered and the anaesthetic options currently available. ©
2006 Elsevier Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS
alfentanil (drug therapy)
anesthetic agent (adverse drug reaction, drug toxicity, epidural drug
administration, intraspinal drug administration)
bupivacaine (drug dose)
cyclizine (drug therapy)
diamorphine (drug combination, drug therapy, intraspinal drug
administration)
diclofenac (drug dose, drug therapy)
dihydrocodeine (drug dose, drug therapy)
fentanyl
local anesthetic agent (drug combination, drug dose)
morphine (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
nitrous oxide (drug toxicity)
nitrous oxide plus oxygen (drug therapy)
opiate derivative (adverse drug reaction, drug therapy, intrathecal drug
administration, parenteral drug administration)
paracetamol (drug dose, drug therapy)
phenylephrine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
obstetric anesthesia
obstetric operation
EMTREE MEDICAL INDEX TERMS
anesthesiological procedure
anesthesist
article
cesarean section
dizziness (side effect)
drug dose regimen
drug induced headache (side effect)
elective surgery
emergency health service
epidural anesthesia
fatality
fetus distress (side effect)
general anesthesia
human
hypotension (drug therapy, prevention, side effect)
informed consent
low birth weight
minor surgery
perineum injury
postoperative nausea and vomiting (drug therapy, prevention, side effect)
postoperative pain (complication, drug therapy, prevention)
priority journal
pruritus (drug therapy, prevention, side effect)
regional anesthesia
retained placenta
spinal anesthesia
spontaneous abortion
teratogenicity
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
cyclizine (303-25-3, 5897-18-7, 82-92-8)
diamorphine (1502-95-0, 561-27-3)
diclofenac (15307-79-6, 15307-86-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
nitrous oxide (10024-97-2)
paracetamol (103-90-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006549316
PUI
L44712698
DOI
10.1016/j.cacc.2006.02.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cacc.2006.02.008
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1007
TITLE
Valuation of the drug addict patient in Emergency services
ORIGINAL (NON-ENGLISH) TITLE
Valoración del enfermo drogodependiente en los Servicios de Urgencies
AUTHOR NAMES
Mayán Conesa P.
García Fraga J.A.
AUTHOR ADDRESSES
(Mayán Conesa P., pmayan@canalejo.org) Servicio de Urgencias, CHU Juan
Canalejo, .
(García Fraga J.A.) Área Docente de A Coruña, .
(Mayán Conesa P., pmayan@canalejo.org) Servicio de Urgencias, CHU Juan
Canalejo, Juan Las Jubias s/n 15006, A Coruña.
CORRESPONDENCE ADDRESS
P. Mayán Conesa, Servicio de Urgencias, CHU Juan Canalejo, Juan Las Jubias
s/n 15006, A Coruña. Email: pmayan@canalejo.org
SOURCE
Adicciones (2006) 18:SUPPL. 1 (263-283). Date of Publication: 2006
ISSN
0214-4840
ABSTRACT
In Emergency services the attention of drug addict patients is usual, due to
processes of administration or the use, abuse and abandonment of drugs.
Cases of overdose by opiates, alcohol, benzodiazepines and/or cocaine are
the most frequent. On the first three as a coma and, on those caused by
cocaine, the most usual is chest pain and physic irregularities. In practice
there are few effective antidotes, those being for opiates (naloxone) and
benzodiazepines (flumazenil). For the other cases we have to stick to the
general measures for the treatment of any intoxication and, most of all, try
to avoid the possible complications derived from a low level of conscience.
Currently there is a rising number of substance abuse regarding synthetic
substances with basically sympathomimetic effect, which we can only treat in
a general way, decreasing this effect with benzodiazepines.
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent
alcohol
antidote
benzodiazepine
cocaine
flumazenil (drug therapy)
naloxone (drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
coma (etiology)
drug dependence
drug detoxification
drug withdrawal
emergency health service
human
intrinsic sympathomimetic activity
mental disease
review
substance abuse
thorax pain
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2006555028
PUI
L44735295
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1008
TITLE
Towards evidence-based emergency medicine: best BETs from the Manchester
Royal Infirmary. Diagnosis of drug overdose by rapid reversal with naloxone.
AUTHOR NAMES
Barrie J.
May G.
AUTHOR ADDRESSES
(Barrie J.; May G.) Manchester Medical School, Manchester, UK.
CORRESPONDENCE ADDRESS
J. Barrie, Manchester Medical School, Manchester, UK.
SOURCE
Emergency medicine journal : EMJ (2006) 23:11 (874-875). Date of
Publication: Nov 2006
ISSN
1472-0213 (electronic)
ABSTRACT
A short-cut review was carried out to establish whether naloxone may have an
awakening effect in patients who have not taken opiates, thereby clouding
its use as a diagnostic manoeuvre. The clinical bottom line is that opioid
antagonists are able to reverse symptoms such as altered consciousness in
patients who have not taken an overdose of opiates. It is unclear in which
conditions or circumstances this occurs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
narcotic agent (drug toxicity)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
evidence based medicine
EMTREE MEDICAL INDEX TERMS
adult
differential diagnosis
emergency
Glasgow coma scale
human
intoxication (diagnosis, drug therapy)
male
review
standard
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17057146 (http://www.ncbi.nlm.nih.gov/pubmed/17057146)
PUI
L44991196
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1009
TITLE
Determinants of variation in analgesic and opioid prescribing practice in an
emergency department.
AUTHOR NAMES
Heins A.
Grammas M.
Heins J.K.
Costello M.W.
Huang K.
Mishra S.
AUTHOR ADDRESSES
(Heins A.; Grammas M.; Heins J.K.; Costello M.W.; Huang K.; Mishra S.)
University of South Alabama Department of Emergency Medicine, Mobile, USA.
CORRESPONDENCE ADDRESS
A. Heins, University of South Alabama Department of Emergency Medicine,
Mobile, USA.
SOURCE
Journal of opioid management (2006) 2:6 (335-340). Date of Publication: 2006
Nov-Dec
ISSN
1551-7489
ABSTRACT
OBJECTIVE: Adequate treatment of patients' pain is a top priority for the
World Health Organization (WHO), American Medical Association (AMA), and
American College of Emergency Physicians (ACEP), but "adequate" is not
clearly defined. Most previous studies of emergency department (ED) pain
treatments have centered on musculoskeletal pain in terms of rates of
analgesia and disparities in treatment based on race and age. This study
will examine complaints of pain other than musculoskeletal and will focus on
treatment disparities that may result from differences inpatient and
physician characteristics. METHODS: This retrospective study is of ED
patients 18 years and older with nonmusculoskeletal pain who were seen by ED
faculty over a period of eight weeks. Logistic regression and CHI2 tests
were performed to quantify effects of doctor, patient, and clinical
characteristics on rates of ED analgesia, ED opioids, and analgesic
prescriptions at discharge. RESULTS: A total of 1360 patients were included.
There was wide variation in the type and frequency of ED analgesia depending
on the attending doctor. For example, patients seen by one specific ED
doctor were less than half as likely to receive any analgesia and seven
times less likely to receive an opioid than those seen by another doctor.
Age, race, doctor's training and experience, and whether the patient had
chronic pain were important predictors of ED analgesia. There were similar
findings for ED opioids and discharge analgesics. CONCLUSION: Pain practices
in EDs are highly variable and seem inadequate when measured against the
goals of WHO, AMA, and ACEP. Patient age, race, and type of pain and the
physician's identity, training, and experience all contribute to practice
variation. Further research is needed to identify the causes of these
variations, and there is a need to develop interventions to standardize and
improve pain assessment and treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug administration, drug therapy)
narcotic analgesic agent (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
musculoskeletal disease (drug therapy)
pain (drug therapy)
prescription
EMTREE MEDICAL INDEX TERMS
aged
article
Black person
Caucasian
chronic disease
drug effect
drug utilization
female
human
male
middle aged
pain assessment
statistical model
statistics
treatment outcome
United States
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17326595 (http://www.ncbi.nlm.nih.gov/pubmed/17326595)
PUI
L46428832
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1010
TITLE
An acidosis and electrolyte dilemma
AUTHOR NAMES
Ross D.W.
Wichman C.
AUTHOR ADDRESSES
(Ross D.W., DRDR0682@aol.com; Wichman C.)
SOURCE
Air Medical Journal (2006) 25:6 (240-241). Date of Publication:
November/December 2006
ISSN
1067-991X
1532-6497 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
bicarbonate (drug therapy, intravenous drug administration)
ceftriaxone (drug therapy, intravenous drug administration)
dopamine (drug combination)
fentanyl (intravenous drug administration)
levofloxacin (drug combination, drug therapy)
naloxone
noradrenalin (drug combination)
piperacillin plus tazobactam (drug combination, drug therapy)
potassium (drug combination, drug therapy, intravenous drug administration)
vancomycin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acidosis (diagnosis, drug therapy)
patient care
EMTREE MEDICAL INDEX TERMS
adult
air medical transport
anamnesis
article
case report
clinical assessment
deterioration
electrolyte blood level
emergency health service
female
human
intensive care unit
intubation
kidney failure
laboratory test
patient assessment
patient transport
priority journal
sepsis (diagnosis, drug therapy)
DRUG MANUFACTURERS
(United States)Abbott
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
ceftriaxone (73384-59-5, 74578-69-1)
dopamine (51-61-6, 62-31-7)
fentanyl (437-38-7)
levofloxacin (100986-85-4, 138199-71-0)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
potassium (7440-09-7)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006519124
MEDLINE PMID
17071412 (http://www.ncbi.nlm.nih.gov/pubmed/17071412)
PUI
L44615494
DOI
10.1016/j.amj.2006.07.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2006.07.001
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1011
TITLE
Recurrent opioid toxicity after pre-hospital care of presumed heroin
overdose patients
AUTHOR NAMES
Boyd J.J.
Kuisma M.J.
Alaspää A.O.
Vuori E.
Repo J.V.
Randell T.T.
AUTHOR ADDRESSES
(Boyd J.J., james.boyd@hus.fi; Kuisma M.J.; Alaspää A.O.; Repo J.V.)
Helsinki Emergency Medical Service, Helsinki University Central Hospital,
Helsinki, Finland.
(Alaspää A.O.) Department of Anaesthesiology and Intensive Care, Kanta-Hame
Central Hospital, Hameenlinna, Finland.
(Vuori E.) Department of Forensic Medicine, Helsinki University, Helsinki,
Finland.
(Randell T.T.) Department of Anaesthesiology and Intensive Care Medicine,
Helsinki University Central Hospital, Helsinki, Finland.
(Boyd J.J., james.boyd@hus.fi) Helsinki Emergency Medical Service, Helsinki
University Central Hospital, PO Box 112, Helsinki FIN-00099, Finland.
CORRESPONDENCE ADDRESS
J.J. Boyd, Helsinki Emergency Medical Service, Helsinki University Central
Hospital, PO Box 112, Helsinki FIN-00099, Finland. Email: james.boyd@hus.fi
SOURCE
Acta Anaesthesiologica Scandinavica (2006) 50:10 (1266-1270). Date of
Publication: November 2006
ISSN
0001-5172
1399-6576 (electronic)
BOOK PUBLISHER
Blackwell Munksgaard, 1 Rosenorns Alle, P.O. Box 227, Copenhagen V, Denmark.
ABSTRACT
Background: In patients with presumed heroin overdose, the recommended time
of observation after reversing heroin toxicity with naloxone varies widely.
The aims of this study were to examine the incidence of recurrent opioid
toxicity and the time interval in which it occurs after pre-hospital
treatment in presumed heroin overdose patients. Methods: We undertook a
retrospective study in Helsinki (population, 560,000). Records were reviewed
from 1 January 1995 to 31 December 2000. Patients included were treated by
the emergency medical service (EMS) for a presumed heroin overdose. Patients
with known polydrug/alcohol use or the use of opioids other than heroin were
excluded. The EMS records were compared with the cardiac arrest database and
the medical examiners' records. Results: One hundred and forty-five patients
were included. The median dose of pre-hospital administered naloxone was 0.4
mg. After pre-hospital care, 84 patients refused further care and were not
transported to an emergency department (ED). Seventy-one received
pre-hospital naloxone, and no life-threatening events were recorded during a
12-h follow-up period in these patients. After pre-hospital care, 61
patients were transported to an ED. Twelve patients received naloxone in the
ED for respiratory depression. All had signs of heroin use-related adverse
events within 1 h after receiving pre-hospital naloxone. Conclusions:
Allowing presumed heroin overdose patients to sign out after pre-hospital
care with naloxone is safe. If transported to an ED, a 1-h observation
period after naloxone administration seems to be adequate for recurrent
heroin toxicity. © 2006 Acta Anaesthesiol Scand.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration, subcutaneous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
emergency care
heroin overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol consumption
data base
female
Finland
follow up
human
major clinical study
male
medical examination
medical record
priority journal
recurrent disease (drug therapy)
respiration depression
retrospective study
review
DRUG TRADE NAMES
narcanti , SwedenBristol
DRUG MANUFACTURERS
(Sweden)Bristol
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006522159
MEDLINE PMID
17067327 (http://www.ncbi.nlm.nih.gov/pubmed/17067327)
PUI
L44624308
DOI
10.1111/j.1399-6576.2006.01172.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1399-6576.2006.01172.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1012
TITLE
Preparedness of selected pediatric offices to respond to critical
emergencies in children
AUTHOR NAMES
Santillanes G.
Gausche-Hill M.
Sosa B.
AUTHOR ADDRESSES
(Santillanes G., gsantillanes@hotmail.com) Department of Pediatrics,
Harbor-UCLA Medical Center, Torrance, CA, United States.
(Gausche-Hill M.) Department of Emergency Medicine, Harbor-UCLA Medical
Center, Torrance, CA, United States.
(Gausche-Hill M.; Sosa B.) Department of Medicine, David Geffen School of
Medicine, UCLA, Los Angeles, CA, United States.
(Gausche-Hill M.) Los Angeles Biomedical Research Institute, Harbor-UCLA,
Torrance, CA, United States.
(Santillanes G., gsantillanes@hotmail.com) Department of Pediatrics,
Harbor-UCLA Medical Center, Box 17, 1000 W. Carson St, Torrance, CA 90509,
United States.
CORRESPONDENCE ADDRESS
G. Santillanes, Department of Pediatrics, Harbor-UCLA Medical Center, Box
17, 1000 W. Carson St, Torrance, CA 90509, United States. Email:
gsantillanes@hotmail.com
SOURCE
Pediatric Emergency Care (2006) 22:11 (694-698). Date of Publication:
November 2006
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
OBJECTIVE: To determine the preparedness of pediatric offices that had
activated emergency medical services (EMS) for a critically ill child
requiring airway management. METHODS: Fifteen patients who initially
presented to pediatric or family practice offices but required EMS
activation and cardiac and/or respiratory support were identified from a
previous prospective study of airway management in children. Two to 4 years
after the emergency requiring EMS activation, the offices were contacted to
complete a written survey about office preparedness for pediatric
emergencies. RESULTS: Eight of 15 offices (53%) returned a survey.
Pediatricians staffed all responding offices, and all offices were within 5
miles of an emergency department. Airway emergencies were the most common
emergencies seen in the offices. Availability of emergency equipment and
medications varied. All offices stocked albuterol, and most (7/8) had an
oxygen source with a flowmeter. However, only half of the offices had a
fast-acting anticonvulsant, and a quarter had no anticonvulsant. Three
offices lacked bag-mask (manual) resuscitators with all appropriate sized
masks, and 3 offices lacked suction. The most common reasons cited for not
stocking all emergency equipment and drugs were quick response time of EMS
and proximity to an emergency department. CONCLUSIONS: Even after treating a
critically ill child who required advanced cardiac and/or pulmonary support,
offices were ill prepared to handle another serious pediatric illness or
injury. © 2006 Lippincott Williams & Wilkins, Inc.
EMTREE DRUG INDEX TERMS
antibiotic agent (parenteral drug administration)
anticonvulsive agent
atropine
benzodiazepine
bicarbonate
calcium chloride
diazepam
diphenhydramine (parenteral drug administration)
epinephrine
lidocaine
lorazepam
methylprednisolone
midazolam
naloxone
oxygen
phenobarbital
prednisone
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
assisted ventilation
clinical article
controlled study
critical illness
critically ill patient
drug storage
emergency care
emergency ward
female
flowmeter
general practice
health survey
human
infant
male
mask
medical device
medical staff
pediatric ward
pediatrician
suction
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
prednisone (53-03-2)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006569482
MEDLINE PMID
17110859 (http://www.ncbi.nlm.nih.gov/pubmed/17110859)
PUI
L44777225
DOI
10.1097/01.pec.0000238744.73735.0e
FULL TEXT LINK
http://dx.doi.org/10.1097/01.pec.0000238744.73735.0e
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1013
TITLE
Emergency naloxone for heroin overdose: Over the counter availability needs
careful consideration [8]
AUTHOR NAMES
Byrne A.
AUTHOR ADDRESSES
(Byrne A., ajbyrne@ozemail.com.au) 75 Redfern Street, Redfern, NSW 2016,
Australia.
CORRESPONDENCE ADDRESS
A. Byrne, 75 Redfern Street, Redfern, NSW 2016, Australia. Email:
ajbyrne@ozemail.com.au
SOURCE
British Medical Journal (2006) 333:7571 (754). Date of Publication: 7 Oct
2006
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
diamorphine
methadone (drug dose, drug therapy)
non prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
dose response
emergency treatment
human
law
letter
prescription
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006502468
MEDLINE PMID
17023479 (http://www.ncbi.nlm.nih.gov/pubmed/17023479)
PUI
L44555183
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1014
TITLE
Emergency naloxone for heroin overdose: Naloxone is not the only opioid
antagonist [10]
AUTHOR NAMES
Brewer C.
AUTHOR ADDRESSES
(Brewer C., cbrewer@doctors.net.uk) Stapleford Centre, London SW1W 9NP,
United Kingdom.
CORRESPONDENCE ADDRESS
C. Brewer, Stapleford Centre, London SW1W 9NP, United Kingdom. Email:
cbrewer@doctors.net.uk
SOURCE
British Medical Journal (2006) 333:7571 (754-755). Date of Publication: 7
Oct 2006
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug dose, pharmacology)
EMTREE DRUG INDEX TERMS
diamorphine
methadone (drug therapy)
nalmefene (drug therapy)
naltrexone (drug therapy)
opiate antagonist (drug dose, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
dose response
drug effect
human
letter
priority journal
relapse
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006502470
MEDLINE PMID
17023477 (http://www.ncbi.nlm.nih.gov/pubmed/17023477)
PUI
L44555185
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1015
TITLE
Emergency naloxone for heroin overdose: Beware of naloxone's other
characteristics [9]
AUTHOR NAMES
Ashworth A.J.
AUTHOR ADDRESSES
(Ashworth A.J., Andrew.Ashworth@lothian.scot.nhs.uk) Davidson's Mains
Medical Centre, Edinburgh EH4 5BP, United Kingdom.
CORRESPONDENCE ADDRESS
A.J. Ashworth, Davidson's Mains Medical Centre, Edinburgh EH4 5BP, United
Kingdom. Email: Andrew.Ashworth@lothian.scot.nhs.uk
SOURCE
British Medical Journal (2006) 333:7571 (754). Date of Publication: 7 Oct
2006
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE DRUG INDEX TERMS
albumin
illicit drug
methadone
opiate
steroid (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug overdose
head injury (drug therapy)
health care policy
human
letter
priority journal
resuscitation
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006502469
MEDLINE PMID
17023478 (http://www.ncbi.nlm.nih.gov/pubmed/17023478)
PUI
L44555184
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1016
TITLE
Sedation in adults
AUTHOR NAMES
Reschreiter H.
Kapila A.
AUTHOR ADDRESSES
(Reschreiter H.; Kapila A.) Henrik Reschreiter FRCA is a Specialist
Registrar in Anaesthesia and Intensive Care Medicine on the, Oxford, United
Kingdom.
(Reschreiter H.; Kapila A.) Reading, United Kingdom.
CORRESPONDENCE ADDRESS
H. Reschreiter, Henrik Reschreiter FRCA is a Specialist Registrar in
Anaesthesia and Intensive Care Medicine on the, Oxford, United Kingdom.
SOURCE
Surgery (2006) 24:10 (342-345). Date of Publication: 1 Oct 2006
Intraoperative and Postoperative Management, Book Series Title:
ISSN
0263-9319
ABSTRACT
Sedative and analgesic drugs are frequently given for comfort, amnesia of
procedures or traumatic events, and anxiety relief (particularly during
invasive procedures). In the ICU, sedation is usually also given to help
tolerate endotracheal intubation, positive-pressure ventilation, and to
control agitation. Sedation and level of consciousness is a continuum
requiring careful assessment because of the large variability in the
response to a particular drug. The 'ideal sedative' does not exist;
combinations of drugs achieve the desired effect in each clinical setting,
often with adjuncts (e.g. local anaesthesia). Negative outcomes occur not
because of the drugs, but because of administration malpractice (drug
combinations, lack of skills or knowledge, failure to follow procedures and
monitor standards). © 2006.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
sedative agent (adverse drug reaction, inhalational drug administration,
intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, rectal drug
administration)
EMTREE DRUG INDEX TERMS
alfentanil
analgesic agent
barbituric acid derivative
benzodiazepine derivative (adverse drug reaction)
butyrophenone derivative (adverse drug reaction)
diazepam
droperidol
fentanyl
flumazenil
haloperidol
inhalation anesthetic agent (inhalational drug administration)
ketamine (adverse drug reaction)
local anesthetic agent
lorazepam (intramuscular drug administration)
midazolam (intranasal drug administration)
morphine (drug combination, intramuscular drug administration)
naloxone
nitrous oxide plus oxygen (inhalational drug administration)
opiate (adverse drug reaction)
propofol (adverse drug reaction)
remifentanil (pharmacokinetics)
scopolamine (drug combination, intramuscular drug administration)
temazepam (oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
sedation
EMTREE MEDICAL INDEX TERMS
adult
agitation
amnesia
auditory evoked potential
bispectral index
blood pressure
bradycardia (side effect)
brain function
cardiovascular disease (side effect)
consciousness
continuous infusion
disease exacerbation (side effect)
drug blood level
drug contraindication
drug half life
drug indication
drug intermittent therapy
drug response
drug safety
electroencephalography
electromyography
emergency ward
endotracheal intubation
esophagus function
extrapyramidal symptom (side effect)
face muscle
hallucination (side effect)
human
intensive care unit
medication error
narcolepsy (side effect)
nausea (side effect)
operating room
outpatient care
positive end expiratory pressure
priority journal
professional competence
pruritus (side effect)
respiration depression (side effect)
respiratory tract disease (side effect)
review
scoring system
side effect (side effect)
skill
tranquilizing activity
traumatology
unpleasant dream (side effect)
DRUG TRADE NAMES
entonox
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
diazepam (439-14-5)
droperidol (548-73-2)
fentanyl (437-38-7)
flumazenil (78755-81-4)
haloperidol (52-86-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
propofol (2078-54-8)
remifentanil (132539-07-2)
scopolamine (138-12-5, 51-34-3, 55-16-3)
temazepam (846-50-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006594011
PUI
L44857991
DOI
10.1053/j.mpsur.2006.08.007
FULL TEXT LINK
http://dx.doi.org/10.1053/j.mpsur.2006.08.007
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1017
TITLE
Outcome after heroin overdose and cardiopulmonary resuscitation
AUTHOR NAMES
Boyd J.J.
Kuisma M.J.
Alaspää A.O.
Vuori E.
Repo J.V.
Randell T.T.
AUTHOR ADDRESSES
(Boyd J.J., james.boyd@hus.fi; Kuisma M.J.; Alaspää A.O.; Repo J.V.)
Helsinki Emergency Medical Service, Helsinki University Central Hospital,
Helsinki, Finland.
(Alaspää A.O.) Department of Anaesthesiology and Intensive Care, Kanta-Hame
Central Hospital, Hameenlinna, Finland.
(Vuori E.) Department of Forensic Medicine, Helsinki University, Helsinki,
Finland.
(Randell T.T.) Department of Anaesthesiology and Intensive Care Medicine,
Helsinki University Central Hospital, Helsinki, Finland.
(Boyd J.J., james.boyd@hus.fi) Helsinki Emergency Medical Service, Helsinki
University Central Hospital, PO Box 112, FIN-00099 City of Helsinki,
Finland.
CORRESPONDENCE ADDRESS
J.J. Boyd, Helsinki Emergency Medical Service, Helsinki University Central
Hospital, PO Box 112, FIN-00099 City of Helsinki, Finland. Email:
james.boyd@hus.fi
SOURCE
Acta Anaesthesiologica Scandinavica (2006) 50:9 (1120-1124). Date of
Publication: October 2006
ISSN
0001-5172
1399-6576 (electronic)
BOOK PUBLISHER
Blackwell Munksgaard, 1 Rosenorns Alle, P.O. Box 227, Copenhagen V, Denmark.
ABSTRACT
Background: The survival of heroin overdose patients resuscitated from
cardiac arrest is reported to be poor. The aim of our study was to
investigate the outcome and characteristics of survivors after cardiac
arrest caused by heroin overdose. Methods: This was a retrospective study in
a medium-sized city (population, 560,000). Between 1 January 1997 and 31
December 2000, there were 94 combined cardiac arrests caused by acute drug
poisonings. The main outcome measure was survival to discharge. Results:
Cardiopulmonary resuscitation was attempted in 19 heroin overdose patients
(group A) and in 53 patients with cardiac arrest caused by other poisonings
(group B). Three (16%) vs. six (11%) patients were discharged alive (group A
vs. B, respectively). The survivors in group A had an Emergency Medical
Service (EMS)-witnessed cardiac arrest or the Emergency Dispatching Centre
was called before the arrest occurred. There was no statistically
significant difference between the two groups in terms of survival.
Survivors in both groups suffered from acute renal failure (two),
hypoglycaemia (four) and hypothermia (three). Conclusion: Survival after
cardiac arrest caused by heroin overdose is possible if the arrest is EMS
witnessed or the Emergency Dispatching Centre is called before the cardiac
arrest occurs. In comparison with cardiac arrests caused by other
poisonings, there was no difference in survival. The incidence and mechanism
of hypoglycaemia should be examined in further studies. © 2006 The Authors.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol
amitriptyline
amphetamine
buprenorphine
cannabis
carbamazepine
chloroquine
cocaine
dextropropoxyphene
diazepam
epinephrine (drug dose, drug therapy, intravenous drug administration)
morphine
naloxone (drug dose, drug therapy, intravenous drug administration)
opiate
phenytoin
psychotropic agent
theophylline (drug dose, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, etiology)
resuscitation
EMTREE MEDICAL INDEX TERMS
acute kidney failure (complication)
adult
article
drug intoxication
female
heart arrest (drug therapy, etiology)
human
hypoglycemia (complication)
hypotension (drug therapy, etiology)
hypothermia (complication)
major clinical study
male
priority journal
retrospective study
survival rate
treatment outcome
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
buprenorphine (52485-79-7, 53152-21-9)
cannabis (8001-45-4, 8063-14-7)
carbamazepine (298-46-4, 8047-84-5)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenytoin (57-41-0, 630-93-3)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006466877
MEDLINE PMID
16987342 (http://www.ncbi.nlm.nih.gov/pubmed/16987342)
PUI
L44434752
DOI
10.1111/j.1399-6576.2006.01142.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1399-6576.2006.01142.x
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1018
TITLE
Emergency naloxone for heroin overdose
AUTHOR NAMES
Strang J.
Kelleher M.
Best D.
Mayet S.
Manning V.
AUTHOR ADDRESSES
(Strang J., j.strang@iop.kcl.ac.uk; Kelleher M.; Best D.; Mayet S.; Manning
V.) National Addiction Centre (Institute of Psychiatry/The Maudsley), London
SE5 8AF.
CORRESPONDENCE ADDRESS
J. Strang, National Addiction Centre (Institute of Psychiatry/The Maudsley),
London SE5 8AF. Email: j.strang@iop.kcl.ac.uk
SOURCE
British Medical Journal (2006) 333:7569 (614-615). Date of Publication: 23
Sep 2006
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
epinephrine
EMTREE MEDICAL INDEX TERMS
doctor patient relation
drug overdose (drug therapy)
drug tolerance
editorial
emergency care
heroin dependence (drug therapy)
human
physician
prescription
priority journal
respiratory arrest
resuscitation
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006473105
MEDLINE PMID
16990298 (http://www.ncbi.nlm.nih.gov/pubmed/16990298)
PUI
L44454186
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1019
TITLE
Performance characteristics of DRI, CEDIA, and REMEDi systems for
preliminary tests of amphetamines and opiates in human urine
AUTHOR NAMES
Huang M.-K.
Dai Y.-S.
Lee C.-H.
Liu C.
Tsay W.-I.
Li J.-H.
AUTHOR ADDRESSES
(Huang M.-K.; Dai Y.-S.; Lee C.-H.; Liu C.; Tsay W.-I.; Li J.-H.,
jhli@nbcd.gov.tw) National Bureau of Controlled Drugs, Department of Health,
Taiwan.
(Li J.-H., jhli@nbcd.gov.tw) National Bureau of Controlled Drugs, Department
of Health, 6, Linsen South Road, Taipei 10050, Taiwan.
CORRESPONDENCE ADDRESS
J.-H. Li, National Bureau of Controlled Drugs, Department of Health, 6,
Linsen South Road, Taipei 10050, Taiwan. Email: jhli@nbcd.gov.tw
SOURCE
Journal of Analytical Toxicology (2006) 30:1 (61-64). Date of Publication:
2006
ISSN
0146-4760
0146-4760 (electronic)
BOOK PUBLISHER
Preston Publications, 6600 W. Touhy Avenue, Niles, United States.
ABSTRACT
Arrestee urine specimens (930) were tested with DRI, CEDIA, and REMEDi;
those that tested positive for amphetamines and opiates (616 and 414,
respectively) were then confirmed by gas chromatography-mass spectrometry.
The performance characteristics of these three preliminary systems were
evaluated using the following commonly used parameters: true positive, true
negative, false positive, and false negative. The sensitivity, specificity,
and efficiency of these methods were also calculated. Data derived from this
study indicated DRI and CEDIA adapted by this study generated acceptable
preliminary test results for amphetamine/methamphetamine and
morphine/codeine, but not for MDA/MDMA and REMEDi has lower sensitivity than
DRI and CEDIA, but with better specificity and efficiency, supporting its
use under emergency room settings where drug concentrations in overdose
cases are expectedly at high levels.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amphetamine derivative
opiate derivative
EMTREE DRUG INDEX TERMS
codeine
methamphetamine
morphine
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug screening
gas chromatography
human
immunoassay
mass spectrometry
urinalysis
DEVICE TRADE NAMES
CEDIA Microgenics
REMEDi HS Biorad
DEVICE MANUFACTURERS
Biorad
Diagnostic Reagents
Microgenics
CAS REGISTRY NUMBERS
codeine (76-57-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006405684
MEDLINE PMID
16620534 (http://www.ncbi.nlm.nih.gov/pubmed/16620534)
PUI
L44270345
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1020
TITLE
Factors Associated With Delay to Opiate Analgesia in Emergency Departments
AUTHOR NAMES
Arendts G.
Fry M.
AUTHOR ADDRESSES
(Arendts G., glenn.arendts@sesiahs.health.nsw.gov.au; Fry M.) Department of
Emergency Medicine, St. George Hospital, Kogarah, Australia.
CORRESPONDENCE ADDRESS
G. Arendts, Department of Emergency Medicine, St. George Hospital, Kogarah,
Australia. Email: glenn.arendts@sesiahs.health.nsw.gov.au
SOURCE
Journal of Pain (2006) 7:9 (682-686). Date of Publication: September 2006
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
Patients presenting to an emergency department (ED) with painful conditions
continue to experience significant delay to analgesia. It remains unclear
whether demographic and clinical factors are associated with this outcome.
The objectives of this study were to determine 1) the proportion of patients
that require parenteral opiate analgesia for pain in an ED and who receive
the opiate in less than 60 minutes; and 2) whether any factors are
predictive for the first dose of analgesia being delayed beyond 60 minutes.
A retrospective cohort study with descriptive and comparative data analysis
was conducted. Over a 3-month period, the medical record of every patient
receiving parenteral opiates in a tertiary emergency department was reviewed
and analyzed. Of 857 patients, 451 (52.6%) received analgesia in less then
60 minutes. Multiple demographic and clinical factors are associated with
statistically significant delay to analgesia, including age, triage code,
seniority of treating doctor, diagnosis, and disposition from the ED.
Perspective: A considerable proportion of patients suffer delay to
analgesia. Identifiable factors associated with a delay to analgesia exist.
There is potential for clinicians to develop strategies to address the
population in emergency departments at risk for delay to analgesia. © 2006
American Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, parenteral drug administration)
EMTREE DRUG INDEX TERMS
glyceryl trinitrate (drug therapy)
paracetamol (drug therapy)
scopolamine butyl bromide (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency treatment
pain (drug therapy)
therapy delay
EMTREE MEDICAL INDEX TERMS
adolescent
adult
age distribution
aged
article
child
cohort analysis
comparative study
controlled study
demography
emergency ward
female
human
infant
major clinical study
male
medical record review
prediction
statistical significance
treatment duration
treatment outcome
CAS REGISTRY NUMBERS
glyceryl trinitrate (55-63-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006412798
MEDLINE PMID
16942954 (http://www.ncbi.nlm.nih.gov/pubmed/16942954)
PUI
L44291604
DOI
10.1016/j.jpain.2006.03.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2006.03.003
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1021
TITLE
Treatment of Severe Carbon Monoxide Poisoning Using a Portable Hyperbaric
Oxygen Chamber
AUTHOR NAMES
Lueken R.J.
Heffner A.C.
Parks P.D.
AUTHOR ADDRESSES
(Lueken R.J., onholdemd@cox.net) United States Navy, Virginia Beach, VA,
United States.
(Heffner A.C.) Department of Emergency Medicine, Naval Medical Center
Portsmouth, Portsmouth, VA, United States.
(Parks P.D.) United States Navy, Norfolk, VA, United States.
CORRESPONDENCE ADDRESS
R.J. Lueken, United States Navy, Virginia Beach, VA, United States. Email:
onholdemd@cox.net
SOURCE
Annals of Emergency Medicine (2006) 48:3 (319-322). Date of Publication:
September 2006
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
We report the first case of suspected carbon monoxide poisoning treated by
hyperbaric oxygen therapy by using a portable hyperbaric stretcher. A
40-year-old British man in Kabul, Afghanistan, was found unresponsive in his
apartment. Initial treatment consisted of oxygen by mask at a Combat Support
Hospital for several hours, with minimal improvement. Operational security
and risk prevented his immediate evacuation to the nearest fixed hyperbaric
facilities. He was subsequently treated twice using an Emergency Evacuation
Hyperbaric Stretcher, according to the US Navy Diving Manual treatment Table
9. The patient showed marked neurologic improvement after the first
treatment and experienced near complete recovery before eventual evacuation.
This case illustrates the practical use of portable chambers for the
treatment of suspected cases of carbon monoxide poisoning in an austere
environment. © 2006 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
carbon monoxide intoxication (drug therapy, therapy)
hyperbaric oxygen therapy
portable equipment
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical examination
clinical feature
convalescence
disease severity
emergency treatment
gas mask
Glasgow coma scale
hospitalization
human
male
priority journal
treatment outcome
DEVICE MANUFACTURERS
(United Kingdom)Sos
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006408107
MEDLINE PMID
16934652 (http://www.ncbi.nlm.nih.gov/pubmed/16934652)
PUI
L44278303
DOI
10.1016/j.annemergmed.2006.01.014
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2006.01.014
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1022
TITLE
The underuse of analgesia and sedation in pediatric emergency medicine
AUTHOR NAMES
Razzaq Q.
AUTHOR ADDRESSES
(Razzaq Q., qmrazzaq@hotmail.com) Department of Emergency Medicine, Tawam
Hospital, P.O. Box 15258, Al Ain, United Arab Emirates.
CORRESPONDENCE ADDRESS
Q.M. Razzaq, Department of Emergency Medicine, Tawam Hospital, P.O. Box
15258, Al Ain, United Arab Emirates. Email: qmrazzaq@hotmail.com
SOURCE
Annals of Saudi Medicine (2006) 26:5 (375-381). Date of Publication:
September/October 2006
ISSN
0256-4947
1319-9226 (electronic)
BOOK PUBLISHER
Medknow Publications and Media Pvt. Ltd, A-109, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai, India.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, drug therapy)
analgesic agent (adverse drug reaction, clinical trial, drug therapy,
intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, pharmacology,
topical drug administration)
benzodiazepine (drug therapy)
cocaine (drug combination, drug therapy, topical drug administration)
codeine (drug therapy, intravenous drug administration, oral drug
administration)
diamorphine (clinical trial, drug therapy, intranasal drug administration)
diclofenac (drug therapy, oral drug administration, rectal drug
administration)
epinephrine (drug combination, drug therapy, topical drug administration)
fentanyl (adverse drug reaction, drug therapy, intranasal drug
administration, intravenous drug administration)
ibuprofen (drug therapy, oral drug administration)
ketamine (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration, pharmacology)
lidocaine (drug combination, drug therapy, topical drug administration)
lidocaine plus prilocaine (adverse drug reaction, drug therapy, topical drug
administration)
midazolam (drug therapy, intranasal drug administration, intravenous drug
administration, oral drug administration)
morphine (drug therapy, intravenous drug administration, oral drug
administration)
naloxone (drug therapy)
neurotransmitter (endogenous compound)
nitrous oxide (drug therapy, inhalational drug administration)
opiate (drug therapy)
paracetamol (drug therapy, oral drug administration, rectal drug
administration)
pethidine (adverse drug reaction, drug therapy, intravenous drug
administration)
sucrose (drug therapy, oral drug administration)
tetracaine (drug combination, drug therapy, topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency care
pain (drug therapy, therapy)
pediatrics
sedation
EMTREE MEDICAL INDEX TERMS
abdominal discomfort (drug therapy, side effect)
abdominal pain (drug therapy)
acupuncture
bandages and dressings
behavior therapy
child
clinical practice
clinical protocol
clinical trial
convulsion (side effect)
drug contraindication
drug efficacy
drug indication
drug safety
education program
evidence based medicine
guided imagery
health care availability
health care delivery
health personnel attitude
health practitioner
human
hypnosis
medical specialist
muscle rigidity (drug therapy, side effect)
myelination
nervous system
neurotransmission
nociception
pain assessment
pediatric surgery
play therapy
postgraduate education
prematurity
priority journal
review
Reye syndrome (side effect)
skin receptor
splinting
transcutaneous electrical nerve stimulation
visual analog scale
DRUG TRADE NAMES
ametop S and N Health
aspirin
DRUG MANUFACTURERS
Astra
S and N Health
CAS REGISTRY NUMBERS
EMLA (101362-25-8)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
diclofenac (15307-79-6, 15307-86-5)
fentanyl (437-38-7)
ibuprofen (15687-27-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
sucrose (122880-25-5, 57-50-1)
tetracaine (136-47-0, 94-24-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006579828
MEDLINE PMID
17019094 (http://www.ncbi.nlm.nih.gov/pubmed/17019094)
PUI
L44810528
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1023
TITLE
Randomized Clinical Trial of Morphine in Acute Abdominal Pain
AUTHOR NAMES
Gallagher E.J.
Esses D.
Lee C.
Lahn M.
Bijur P.E.
AUTHOR ADDRESSES
(Gallagher E.J., jgallagh@montefiore.org; Esses D.; Lee C.; Lahn M.; Bijur
P.E.) Department of Emergency Medicine, Albert Einstein College of Medicine,
Montefiore Medical Center, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
E.J. Gallagher, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY, United States. Email:
jgallagh@montefiore.org
SOURCE
Annals of Emergency Medicine (2006) 48:2
(150-160,160.e1,160.e2,160.e3,160.e4). Date of Publication: August 2006
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: Administration of analgesia to patients with acute
abdominal pain is controversial. We test the hypothesis that morphine given
to emergency department (ED) patients with acute abdominal pain will reduce
discomfort and improve clinically important diagnostic accuracy. Methods:
Pain was measured with a standard 0- to 100-mm visual analog scale. ED
patients with acute abdominal pain were randomized in a double-blind fashion
to 0.1 mg/kg intravenous morphine or placebo. The primary endpoint was the
difference between the 2 study arms in clinically important diagnostic
accuracy. Clinically important diagnostic accuracy was defined a priori by
its complement, clinically important diagnostic error, using 2 independent,
blinded investigators to identify any discordance between the provisional
and final diagnoses that might adversely affect the patient's health status.
The provisional diagnosis was provided by an ED attending physician, who
examined the patient only once, 15 minutes after administration of the study
agent. The final diagnosis was obtained through follow-up at least 6 weeks
after the index ED visit. Results: We randomized 160 patients, of whom 153
patients were available for analysis, 78 patients in the morphine group and
75 patients in the placebo group. Baseline features were similar in both
groups, including initial median visual analog scale scores of 98 mm and 99
mm. The median decrease in visual analog scale score at 15 minutes was 33 mm
in the morphine group and 2 mm in the placebo group. There were 11 instances
of diagnostic discordance in each group, for a clinically important
diagnostic accuracy of 86% (67/78) in the morphine group and 85% (64/75) in
the placebo group. The difference in clinically important diagnostic
accuracy between the 2 groups was 1% (95% confidence interval [CI] -11% to
12%). Analysis by efficacy and intention to treat yielded similar results. κ
for interobserver concordance in classification of clinically important
diagnostic accuracy was 0.94 (95% CI 0.79 to 1.00). No patients required
naloxone. Conclusion: Although administration of intravenous morphine to
adult ED patients with acute abdominal pain could lead to as much as a 12%
difference in diagnostic accuracy, equally favoring opioid or placebo, our
data are most consistent with the inference that morphine safely provides
analgesia without impairing clinically important diagnostic accuracy. © 2006
American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, clinical trial, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical trial
controlled clinical trial
controlled study
diagnostic accuracy
diagnostic error
double blind procedure
emergency ward
female
follow up
health status
human
hypotension (side effect)
male
nausea (side effect)
physician
priority journal
randomized controlled trial
visual analog scale
vomiting (side effect)
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006339703
MEDLINE PMID
16953529 (http://www.ncbi.nlm.nih.gov/pubmed/16953529)
PUI
L44062022
DOI
10.1016/j.annemergmed.2005.11.020
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2005.11.020
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1024
TITLE
Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine
in Acute Pain: A Randomized Clinical Trial
AUTHOR NAMES
Chang A.K.
Bijur P.E.
Meyer R.H.
Kenny M.K.
Solorzano C.
Gallagher E.J.
AUTHOR ADDRESSES
(Chang A.K., achang@montefiore.org; Bijur P.E.; Meyer R.H.; Kenny M.K.;
Gallagher E.J.) Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY, United States.
(Solorzano C.) Department of Pharmacy, Albert Einstein College of Medicine,
Montefiore Medical Center, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
A.K. Chang, Department of Emergency Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY, United States. Email:
achang@montefiore.org
SOURCE
Annals of Emergency Medicine (2006) 48:2 (164-172). Date of Publication:
August 2006
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: We compare a standard weight-based dose of intravenous
hydromorphone (Dilaudid) to a standard weight-based dose of intravenous
morphine in adults presenting to the ED with acute severe pain. Methods:
This was a prospective, randomized, double-blind, clinical trial conducted
in an academic medical center. Of the 198 adult patients presenting to the
ED with acute severe pain who were randomized to receive either intravenous
hydromorphone at 0.015 mg/kg or intravenous morphine at 0.1 mg/kg, 191
patients had sufficient data for analysis. The main outcome measure was the
difference between the 2 groups in pain reduction at 30 minutes as measured
on a validated numeric rating scale. Adverse effects, pain reduction at 5
minutes and 2 hours postbaseline, and additional analgesics and antiemetics
were tracked as secondary outcome measures. Results: The mean change of pain
from baseline to 30 minutes postbaseline in patients allocated to
intravenous hydromorphone was -5.5 numeric rating scale units versus -4.1 in
patients allocated to intravenous morphine (difference -1.3; 95% confidence
interval -2.2 to -0.5). Adverse effects were similar in both groups, with
the exception of pruritus, which did not occur in patients receiving
hydromorphone (0% versus 6% [difference -6%; 95% confidence interval -11% to
-1%]). No patient required naloxone. Conclusion: For the treatment of acute,
severe pain in the emergency department, intravenous hydromorphone at 0.015
mg/kg represents a feasible alternative to intravenous morphine at 0.1
mg/kg. © 2006 American College of Emergency Physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (clinical trial, drug therapy, intravenous drug
administration)
morphine (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
analgesic agent
antiemetic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug efficacy
drug safety
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical trial
controlled clinical trial
controlled study
data analysis
double blind procedure
emergency ward
female
human
major clinical study
male
priority journal
pruritus (side effect)
randomized controlled trial
rating scale
DRUG TRADE NAMES
dilaudid
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006339711
MEDLINE PMID
16857467 (http://www.ncbi.nlm.nih.gov/pubmed/16857467)
PUI
L44062030
DOI
10.1016/j.annemergmed.2006.03.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2006.03.005
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1025
TITLE
Prediction of fatal overdose in opiate addicts
AUTHOR NAMES
Mackway-Jones K.
AUTHOR ADDRESSES
(Mackway-Jones K., kevin.mackway-jones@man.ac.uk) Department of Emergency
Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL,
United Kingdom.
CORRESPONDENCE ADDRESS
K. Mackway-Jones, Department of Emergency Medicine, Manchester Royal
Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. Email:
kevin.mackway-jones@man.ac.uk
SOURCE
Emergency Medicine Journal (2006) 23:8 (647). Date of Publication: Aug 2006
ISSN
1472-0205
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
benzodiazepine (drug toxicity)
diamorphine (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
alcoholism
Cinahl
Cochrane Library
death
drug fatality
drug overdose
Embase
emergency ward
evidence based medicine
follow up
heroin dependence (drug therapy, therapy)
human
Medline
prediction
priority journal
prison
resuscitation
short survey
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006414576
PUI
L44295231
DOI
10.1136/emj.2006.039099
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2006.039099
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1026
TITLE
Underdosing of morphine in comparison with other parenteral opioids in an
acute hospital: A quality of care challenge
AUTHOR NAMES
O'Connor A.B.
Lang V.J.
Quill T.E.
AUTHOR ADDRESSES
(O'Connor A.B., alec_oconnor@urmc.rochester.edu; Lang V.J.) University of
Rochester, School of Medicine and Dentistry, Hospital Medicine Division, 601
Elmwood Avenue, Rochester, NY 14642, United States.
(Quill T.E.) Department of Medicine, University of Rochester, School of
Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United
States.
CORRESPONDENCE ADDRESS
A.B. O'Connor, University of Rochester, School of Medicine and Dentistry,
Hospital Medicine Division, 601 Elmwood Avenue, Rocherster, NY 14642, United
States. Email: alec_oconnor@urmc.rochester.edu
SOURCE
Pain Medicine (2006) 7:4 (299-307). Date of Publication: August 2006
ISSN
1526-2375
1526-4637 (electronic)
BOOK PUBLISHER
Blackwell Publishing Inc., 350 Main Street, Malden, United States.
ABSTRACT
Objective. We observed that parenteral morphine is routinely prescribed in
doses that are quite low in relation to doses of alternative parenteral
opioids and in comparison with published effective doses and guidelines. The
present study was undertaken to determine: 1) whether different parenteral
opioids are dosed equivalently; 2) which patient factors affect
equianalgesic dose; and 3) which patient factors affect opioid choice.
Design. At a 750-bed tertiary care, teaching hospital in Rochester, NY,
patients on the medical and surgical floors and in the emergency department
who received one or more doses of parenteral morphine, hydromorphone, or
meperidine were identified using computerized pharmacy records. A detailed
chart review was performed for each patient, recording a variety of patient
variables, which were then correlated separately with opioid dose and
choice. Results. Of the 293 patients treated with boluses of a parenteral
opioid, 75% received morphine at a median dose of only 2 mg. Patients
prescribed hydromorphone or meperidine received median equianalgesic doses
that were 6.7 and 3.4 times higher, respectively. A rescriber's choice of
opioid affected the equianalgesic dose more significantly than any of the
patient variables studied, including active home opioid use. Conclusions. At
our institution, parenteral morphine boluses are routinely given at
relatively low doses compared with: 1) other opioids; 2) patient-controlled
analgesic dosing; 3) usual doses required for analgesia from previous
studies; and 4) a historical control in the same hospital. The reasons for
this pattern are largely unexplained by patient variables. Inadequate bolus
dosing of morphine may be a barrier to appropriate patient analgesia. © 2006
American Academy of Pain Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (adverse drug reaction, drug comparison, drug dose, drug
therapy, parenteral drug administration)
morphine (adverse drug reaction, drug comparison, drug dose, drug therapy,
parenteral drug administration)
pethidine (adverse drug reaction, drug comparison, drug dose, drug therapy,
parenteral drug administration)
EMTREE DRUG INDEX TERMS
creatinine (endogenous compound)
narcotic analgesic agent (adverse drug reaction, drug comparison, drug dose,
drug therapy, parenteral drug administration)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adult
article
bolus injection
cancer pain (drug therapy)
controlled study
correlation analysis
drug choice
drug dose regimen
drug hypersensitivity (side effect)
emergency health service
female
health care quality
human
logistic regression analysis
major clinical study
male
medical record
patient controlled analgesia
postoperative pain (drug therapy)
prescription
sickle cell crisis (drug therapy)
teaching hospital
tertiary health care
thorax pain (drug therapy)
United States
CAS REGISTRY NUMBERS
creatinine (19230-81-0, 60-27-5)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006351254
MEDLINE PMID
16898939 (http://www.ncbi.nlm.nih.gov/pubmed/16898939)
PUI
L44102884
DOI
10.1111/j.1526-4637.2006.00183.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1526-4637.2006.00183.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1027
TITLE
Opiates at the end of life in an emergency department in Spain: Euthanasia
or good clinical practice?
AUTHOR NAMES
Del Nogal Sáez F.
AUTHOR ADDRESSES
(Del Nogal Sáez F., fnogal.hsvo@salud.madrid.org) Hospital Severo Ochoa,
ICU, Avda Orellana s/n, 28911 Leganés Madrid, Spain.
CORRESPONDENCE ADDRESS
F. Del Nogal Sáez, Hospital Severo Ochoa, ICU, Avda Orellana s/n, 28911
Leganés Madrid, Spain. Email: fnogal.hsvo@salud.madrid.org
SOURCE
Intensive Care Medicine (2006) 32:7 (1086-1087). Date of Publication: July
2006
ISSN
0342-4642
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
euthanasia
good clinical practice
pain (drug therapy, epidemiology)
terminal care
EMTREE MEDICAL INDEX TERMS
dying
human
legal aspect
medical decision making
medical ethics
mortality
note
palliative therapy
religion
sedation
Spain
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006305448
MEDLINE PMID
16791673 (http://www.ncbi.nlm.nih.gov/pubmed/16791673)
PUI
L43952727
DOI
10.1007/s00134-006-0140-7
FULL TEXT LINK
http://dx.doi.org/10.1007/s00134-006-0140-7
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1028
TITLE
Exploratory Buprenorphine Ingestion in an Infant
AUTHOR NAMES
Cho C.S.
Calello D.P.
Osterhoudt K.C.
AUTHOR ADDRESSES
(Cho C.S.; Calello D.P.; Osterhoudt K.C.) The Children's Hospital of
Philadelphia, Division of Emergency Medicine, Philadelphia, PA, United
States.
CORRESPONDENCE ADDRESS
C.S. Cho, The Children's Hospital of Philadelphia, Division of Emergency
Medicine, Philadelphia, PA, United States.
SOURCE
Annals of Emergency Medicine (2006) 48:1 (109). Date of Publication: July
2006
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine plus naloxone (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug dose, drug therapy, intravenous drug administration,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
case report
clinical feature
emergency medicine
emergency ward
high performance liquid chromatography
human
infant
ingestion
letter
male
pediatrics
priority journal
respiration depression
somnolence
tandem mass spectrometry
DRUG TRADE NAMES
suboxone
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006278014
MEDLINE PMID
16781931 (http://www.ncbi.nlm.nih.gov/pubmed/16781931)
PUI
L43867063
DOI
10.1016/j.annemergmed.2006.02.031
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2006.02.031
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1029
TITLE
Medicaid coverage and access to publicly funded opiate treatment
AUTHOR NAMES
Deck D.D.
Wiitala W.L.
Laws K.E.
AUTHOR ADDRESSES
(Deck D.D., ddeck@rmccorp.com; Wiitala W.L., wwiitala@rmccorp.com; Laws
K.E., klaws@rmccorp.com) RMC Research Corporation, 111 S.W. Columbia,
Portland, OR 97201-5843, United States.
CORRESPONDENCE ADDRESS
D.D. Deck, RMC Research Corporation, 111 S.W. Columbia, Portland, OR
97201-5843, United States. Email: ddeck@rmccorp.com
SOURCE
Journal of Behavioral Health Services and Research (2006) 33:3 (324-334).
Date of Publication: July 2006
ISSN
1094-3412
BOOK PUBLISHER
Springer New York, 233 Springer Street, New York, United States.
ABSTRACT
This observational study examines changes in access to methadone maintenance
treatment following Oregon's decision to remove substance abuse treatment
from the Medicaid benefit for an expansion population. Access was compared
before and after the benefit change for two cohorts of adults addicted to
opiates presenting for publicly funded treatment. Propensity score analysis
helped model some selective disenrollment from Medicaid that occurred after
the benefit change. Logistic regression was used to compare access to
methadone by cohort controlling for client characteristics. Opiate users
presenting for publicly funded treatment after the change were less than
half as likely (OR = 0.40) to be placed in an opiate treatment program
compared to the prior year. Further analysis revealed that those with no
recent treatment history were less likely to present for treatment after the
benefit change. These results have implications for states considering
Medicaid cuts, especially if the anticipated increases in illegal activity,
emergency room utilization, unemployment, and mortality can be demonstrated.
© 2006 National Council for Community Behavioral Healthcare.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
funding
health care access
medicaid
methadone treatment
EMTREE MEDICAL INDEX TERMS
adult
article
cohort analysis
comparative study
controlled study
drug dependence
drug dependence treatment
drug use
emergency ward
female
health care utilization
health insurance
human
logistic regression analysis
male
mortality
observational study
scoring system
substance abuse
unemployment
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006463145
MEDLINE PMID
16752109 (http://www.ncbi.nlm.nih.gov/pubmed/16752109)
PUI
L44421324
DOI
10.1007/s11414-006-9018-2
FULL TEXT LINK
http://dx.doi.org/10.1007/s11414-006-9018-2
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1030
TITLE
The influence of chief complaint on opioid use in the emergency department.
AUTHOR NAMES
Puntillo K.
Neighbor M.
Chan G.K.
Garbez R.
AUTHOR ADDRESSES
(Puntillo K.; Neighbor M.; Chan G.K.; Garbez R.) University of California,
San Francisco School of Nursing, USA.
CORRESPONDENCE ADDRESS
K. Puntillo, University of California, San Francisco School of Nursing, USA.
SOURCE
Journal of opioid management (2006) 2:4 (228-235). Date of Publication: 2006
Jul-Aug
ISSN
1551-7489
ABSTRACT
The aim of this study was to explore factors influencing emergency
department (ED) clinicians' use of opioids in treating selected patients.
Patients who either received or did not receive opioids in the ED, as well
as their nurses and physicians, were interviewed before patient discharge.
We found that the decrease in patients' mean (SD) pain intensity from the
time of admission to the ED (7.3 +/- 2.4 on a 0 to 10 numeric rating scale)
to discharge (5.0 +/- 2.9) was statistically significant (t93 = 8.4, p <
0.001, 95 percent CI = 1.7, 2.8) for all groups except those with
trauma-related pain. The factor that most frequently led physicians of
patients with abdominal pain and nurses in general to administer no opioids
was that the patient was "not in that much pain." However, the patients in
question had self-reported pain scores that indicated moderate pain. Our
findings lead us to conclude that clinicians inaccurately infer severity of
patient pain. This in turn can influence the prescription of opioids and the
patient's decrease in pain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
pain (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
drug utilization
female
human
male
methodology
middle aged
nurse
pain assessment
physician
LANGUAGE OF ARTICLE
English
MEDLINE PMID
17319484 (http://www.ncbi.nlm.nih.gov/pubmed/17319484)
PUI
L46428817
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1031
TITLE
Disparities in Analgesia and Opioid Prescribing Practices for Patients With
Musculoskeletal Pain in the Emergency Department
AUTHOR NAMES
Heins J.K.
Heins A.
Grammas M.
Costello M.
Huang K.
Mishra S.
AUTHOR ADDRESSES
(Heins J.K., knkansas@hotmail.com; Heins A.; Grammas M.; Costello M.; Huang
K.; Mishra S.)
CORRESPONDENCE ADDRESS
J.K. Heins, Mobile, Ala, United States. Email: knkansas@hotmail.com
SOURCE
Journal of Emergency Nursing (2006) 32:3 (219-224). Date of Publication:
June 2006
ISSN
0099-1767
1527-2966 (electronic)
BOOK PUBLISHER
Mosby Inc.
ABSTRACT
Introduction: Healthy People 2010 seeks to eliminate racial and ethnic
disparities in health care; however, disparities due to age and race have
been described in emergency department pain treatment. Although pain is a
common patient complaint in emergency departments, many people receive no
analgesia. This study examined the influence of patient and provider
characteristics on ED and discharge analgesia and opioid prescribing
practices. Methods: This descriptive study used chart review of selected
variables from ED patients 18 years and older who presented with
musculoskeletal pain and were treated by core ED faculty. Logistic
regression analyses were performed to determine whether analgesia- and
opioid-prescribing disparities existed and were influenced by patient and
provider characteristics. Results: A total of 868 patient records were
examined. Physician characteristics and wide variation in practice were the
only sources of disparities in the prescription of analgesics in the
emergency department, but patient characteristics including race, age,
chronic pain, and trauma influenced prescription of ED opioids and discharge
analgesics. No gender or financial status disparities were found. Fewer
opioids and discharge analgesics were prescribed for black patients than for
white patients. Younger patients, those with trauma, and those with chronic
pain received more opioids and discharge analgesics compared with older
patients and those without trauma or chronic pain. Providers who completed
emergency medicine residencies and had fewer than 3 years' experience
prescribed more analgesics in the emergency department. Discussion: Pain
management in our emergency department is widely variable, with some
disparities based on patient and physician characteristics. Multicenter
prospective studies are needed to validate these findings and examine
knowledge and attitude development about pain and its management. Protocols
for nurse-initiated analgesia may help improve and standardize ED pain care.
© 2006 Emergency Nurses Association.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical practice
emergency health service
musculoskeletal disease (drug therapy)
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
African American
age
article
Caucasian
comparative study
drug utilization
female
health care delivery
human
male
middle aged
multivariate analysis
retrospective study
statistical model
United States
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
16730276 (http://www.ncbi.nlm.nih.gov/pubmed/16730276)
PUI
L43757928
DOI
10.1016/j.jen.2006.01.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2006.01.010
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1032
TITLE
Lack of Influence of Patient Self-Report of Pain Intensity on Administration
of Opioids for Suspected Long-Bone Fractures
AUTHOR NAMES
Bijur P.E.
Bérard A.
Esses D.
Nestor J.
Schechter C.
Gallagher E.J.
AUTHOR ADDRESSES
(Bijur P.E., bijur@aecom.yu.edu; Bérard A.; Esses D.; Nestor J.; Schechter
C.; Gallagher E.J.) Departments of Emergency Medicine and Family and Social
Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
P.E. Bijur, Departments of Emergency Medicine and Family and Social
Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.
Email: bijur@aecom.yu.edu
SOURCE
Journal of Pain (2006) 7:6 (438-444). Date of Publication: June 2006
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
The purpose of the present study was to prospectively investigate the extent
to which emergency providers base their decisions about pain management of
suspected long-bone fracture on patient's self-reported pain intensity. Of
100 long-bone fracture patients presenting to 2 inner-city emergency
departments, 69% received opioids as compared to 30% of 110 patients without
long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by
pain ratings on a validated self-reported numerical rating scale, fracture
patients remained twice as likely to receive opioids as those without
fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment
for self-reported pain intensity had little effect on the observed
association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency
providers do not primarily base their decisions about pain management of
suspected long-bone fractures on patient self-reporting of pain intensity.
Perspective: This article addresses the question of the role of
self-reported pain intensity rating on the treatment of suspected fractures.
The findings indicate that self-reported pain is not used as the most
important measure of pain as recommended by expert panels. We speculate this
may contribute to oligoanalgesia in the Emergency Department. © 2006
American Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bone pain (diagnosis, drug therapy)
pain assessment
self report
EMTREE MEDICAL INDEX TERMS
adult
article
comparative study
confidence interval
controlled study
emergency care
emergency ward
female
fracture
human
long bone
major clinical study
male
mathematical computing
medical decision making
multivariate analysis
prospective study
rating scale
stratification
validation study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006253925
MEDLINE PMID
16750800 (http://www.ncbi.nlm.nih.gov/pubmed/16750800)
PUI
L43794889
DOI
10.1016/j.jpain.2006.01.451
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2006.01.451
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1033
TITLE
2005 American Heart Association (AHA) guidelines for cardiopulmonary
resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and
neonatal patients: Pediatric advanced life support
AUTHOR NAMES
Atkins D.L.
Berg M.D.
Berg R.A.
Bhutta A.T.
Biarent D.
Bingham R.
Braner D.
Carrera R.
Chameides L.
Coovadia A.
De Caen A.
Diekema D.S.
Fendya D.G.
Fiedor M.L.
Fiser R.T.
Fuchs S.
Gerardi M.
Hammill W.
Hatch Jr. G.W.
Hazinski M.F.
Hickey R.W.
Kattwinkel J.
Kleinman M.E.
López-Herce J.
Morley P.
Morris M.
Nadkarni V.M.
Nolan J.
Perlman J.
Proctor L.T.
Quan L.
Reis A.G.
Richmond S.
Rodriguez-Nuñez A.
Samson R.
Scalzo A.J.
Scherer III L.R.
Schexnayder S.M.
Schleien C.L.
Shimizu N.
Shore P.M.
Srinivasan V.
Stapleton E.R.
Tibballs J.
Van Der Jagt E.W.
Zaritsky A.
Zideman D.
AUTHOR ADDRESSES
(Atkins D.L.; Berg M.D.; Berg R.A.; Bhutta A.T.; Biarent D.; Bingham R.;
Braner D.; Carrera R.; Chameides L.; Coovadia A.; De Caen A.; Diekema D.S.;
Fendya D.G.; Fiedor M.L.; Fiser R.T.; Fuchs S.; Gerardi M.; Hammill W.;
Hatch Jr. G.W.; Hazinski M.F.; Hickey R.W.; Kattwinkel J.; Kleinman M.E.;
López-Herce J.; Morley P.; Morris M.; Nadkarni V.M.; Nolan J.; Perlman J.;
Proctor L.T.; Quan L.; Reis A.G.; Richmond S.; Rodriguez-Nuñez A.; Samson
R.; Scalzo A.J.; Scherer III L.R.; Schexnayder S.M.; Schleien C.L.; Shimizu
N.; Shore P.M.; Srinivasan V.; Stapleton E.R.; Tibballs J.; Van Der Jagt
E.W.; Zaritsky A.; Zideman D.)
SOURCE
Pediatrics (2006) 117:5 (e1005-e1028). Date of Publication: May 2006
ISSN
0031-4005
0210-5721 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
EMTREE DRUG INDEX TERMS
adenosine (drug therapy)
amiodarone (drug therapy, intraosseous drug administration, intravenous drug
administration)
amrinone (intraosseous drug administration, intravenous drug administration)
atropine (drug therapy, intraosseous drug administration, intratracheal drug
administration, intravenous drug administration)
benzodiazepine derivative (drug therapy)
beta adrenergic receptor stimulating agent
bicarbonate (drug therapy, intraosseous drug administration, intravenous
drug administration)
calcium (drug therapy)
calcium chloride (drug therapy, intraosseous drug administration,
intravenous drug administration)
cocaine
dobutamine (intraosseous drug administration, intravenous drug
administration)
dopamine (drug comparison, drug therapy, intraosseous drug administration,
intravenous drug administration)
epinephrine (drug comparison, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration)
glucose (drug therapy, intraosseous drug administration, intravenous drug
administration)
glyceryl trinitrate (drug therapy)
isoprenaline (drug therapy)
lidocaine (adverse drug reaction, drug therapy, intraosseous drug
administration, intratracheal drug administration, intravenous drug
administration)
magnesium sulfate (drug therapy, intraosseous drug administration,
intravenous drug administration)
milrinone (intraosseous drug administration, intravenous drug
administration)
naloxone (drug therapy, intraosseous drug administration, intratracheal drug
administration, intravenous drug administration)
nitroprusside sodium
noradrenalin (drug comparison, drug therapy)
opiate
phentolamine (drug therapy)
procainamide (drug therapy, intraosseous drug administration, intravenous
drug administration)
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
aortic arch syndrome (drug therapy, therapy)
assisted ventilation
bradycardia (drug therapy, therapy)
coronary artery spasm (drug therapy)
drowsiness (side effect)
drug intoxication (drug therapy)
electrocardiography
end tidal carbon dioxide tension
extracorporeal oxygenation
heart arrest
heart arrhythmia (drug therapy)
human
hypotension
ischemia (side effect)
laryngeal mask
medical society
muscle twitch
myocardial disease (side effect)
newborn care
nonhuman
priority journal
pulse oximetry
respiratory failure
review
seizure (side effect)
shock
side effect (side effect)
suction drainage
tachycardia (drug therapy)
torsade des pointes (drug therapy)
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amrinone (60719-84-8)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
calcium chloride (10043-52-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
milrinone (78415-72-2)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phentolamine (50-60-2, 73-05-2)
procainamide (51-06-9, 614-39-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007025276
MEDLINE PMID
16651281 (http://www.ncbi.nlm.nih.gov/pubmed/16651281)
PUI
L46071364
DOI
10.1542/peds.2006-0346
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2006-0346
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1034
TITLE
2005 American Heart Association (AHA) guidelines for cardiopulmonary
resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and
neonatal patients: Neonatal resuscitation guidelines
AUTHOR NAMES
Kattwinkel J.
Perlman J.M.
Boyle D.
Engle W.A.
Escobedo M.
Goldsmith J.P.
Halamek L.P.
McGowan J.
Singhal N.
Weiner G.M.
Wiswell T.
Zaichkin J.
Simon W.M.
AUTHOR ADDRESSES
(Kattwinkel J.; Perlman J.M.; Boyle D.; Engle W.A.; Escobedo M.; Goldsmith
J.P.; Halamek L.P.; McGowan J.; Singhal N.; Weiner G.M.; Wiswell T.;
Zaichkin J.; Simon W.M.)
SOURCE
Pediatrics (2006) 117:5 (e1029-e1038). Date of Publication: May 2006
ISSN
0031-4005
0210-5721 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
EMTREE DRUG INDEX TERMS
epinephrine
glucose
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
practice guideline
resuscitation
EMTREE MEDICAL INDEX TERMS
assisted ventilation
endotracheal tube
human
hypothermia
medical society
newborn care
nonhuman
oxygen supply
priority journal
professional practice
recommended drug dose
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2007025277
MEDLINE PMID
16651282 (http://www.ncbi.nlm.nih.gov/pubmed/16651282)
PUI
L46071365
DOI
10.1542/peds.2006-0349
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2006-0349
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1035
TITLE
Decreasing errors in pediatric continuous intravenous infusions
AUTHOR NAMES
Lehmann C.U.
Kim G.R.
Gujral R.
Veltri M.A.
Clark J.S.
Miller M.R.
AUTHOR ADDRESSES
(Lehmann C.U.) Clinical Information Technology, Johns Hopkins Children's
Medical and Surgical Center, Johns Hopkins University School of Medicine,
United States.
(Lehmann C.U.) Department of Pediatrics, Health, Sciences Informatics and
Dermatology, Johns Hopkins University School of Medicine, United States.
(Kim G.R.) Division of Health Sciences Informatics, Johns Hopkins University
School of Medicine, United States.
(Gujral R.) Division of Psychiatry Products, Food and Drug Administration,
Columbia, MD, United States.
(Veltri M.A.) Pediatric Intensive Care, Department of Pharmacy, Johns
Hopkins Hospital, Baltimore, MD, United States.
(Clark J.S.) Pediatrics, Johns Hopkins Hospital, Baltimore, MD, United
States.
(Miller M.R.) Quality and Safety Initiatives, Johns Hopkins Children's
Center, Baltimore, MD, United States.
CORRESPONDENCE ADDRESS
C.U. Lehmann, Clinical Information Technology, Johns Hopkins Children's
Medical and Surgical Center, Johns Hopkins University School of Medicine,
United States.
SOURCE
Pediatric Critical Care Medicine (2006) 7:3 (225-230). Date of Publication:
May 2006
ISSN
1529-7535
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327,
Philadelphia, United States.
ABSTRACT
Objective: To evaluate the effect of a Web-based calculator and
decision-support system on infusion ordering errors and to estimate error
frequency in pharmacy infusion preparation. Design: Data on ordering error
frequency and typology were collected before and after implementation of an
online infusion ordering system. Data on pharmacy preparation errors of
infusions were collected. Setting: A children's hospital at an academic
medical center. Patients: None. Data were abstracted from infusion orders.
Interventions: Introduction of a voluntary-use Web-based calculator into
infusion ordering workflow. Observation only. Main Outcome measures: Number
and type of errors in handwritten and calculator-generated orders. Number
and type of errors in pharmacy infusion preparation. Results: Before
calculator deployment, 129 sequential handwritten infusion orders were
collected over 5 weeks. After deployment, of 162 sequential infusion orders,
88% (142) were calculator-generated. Calculator-generated infusion orders
contained 83% fewer (p < .001) orders containing one or more errors than
handwritten orders. Calculator-generated orders contained no high-risk
errors (incorrect decimal, dose, or unit of measure) when compared with
handwritten orders and were associated with fewer pharmacy interventions. In
118 sequential pharmacy infusion preparations over 4 wks, there were no
errors observed. Conclusion: A Web-based calculator reduced significantly
the total number of errors and eliminated all high-risk errors in the
prescribing process for continuous pediatric infusions. With no observed
errors in pharmacy preparation, this study provides data to support the use
of computerized ordering as an independent safe and viable method for
ordering continuous pediatric infusions. Copyright © 2006 by the Society of
Critical Care Medicine and the World Federation of Pediatric Intensive and
Critical Care Societies.
EMTREE DRUG INDEX TERMS
aminocaproic acid (drug dose)
amiodarone (drug dose)
bicarbonate (drug dose)
dobutamine (drug dose)
dopamine (drug dose)
epinephrine (drug dose)
esmolol (drug dose)
fentanyl (drug dose)
furosemide (drug dose)
glyceryl trinitrate (drug dose)
heparin (drug dose)
hydromorphone (drug dose)
insulin (drug dose)
ketamine (drug dose)
labetalol (drug dose)
lidocaine (drug dose)
midazolam (drug dose)
milrinone (drug dose)
morphine (drug dose)
naloxone (drug dose)
nicardipine (drug dose)
nitroprusside sodium (drug dose)
noradrenalin (drug dose)
octreotide (drug dose)
phenylephrine (drug dose)
prostaglandin E1 (drug dose)
terbutaline (drug dose)
vasopressin (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug infusion
medication error
EMTREE MEDICAL INDEX TERMS
child
child health care
clinical research
computer analysis
continuing education
decision support system
dose calculation
emergency ward
hospital pharmacy
human
infant
intensive care unit
Internet
newborn
newborn intensive care
oncology
operating room
patient care
patient safety
pediatric hospital
priority journal
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminocaproic acid (1319-82-0, 60-32-2)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
bicarbonate (144-55-8, 71-52-3)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
esmolol (81147-92-4, 81161-17-3)
fentanyl (437-38-7)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydromorphone (466-99-9, 71-68-1)
insulin (9004-10-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
labetalol (32780-64-6, 36894-69-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
milrinone (78415-72-2)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nicardipine (54527-84-3, 55985-32-5)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
octreotide (83150-76-9)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
prostaglandin E1 (745-65-3)
terbutaline (23031-25-6)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006249172
MEDLINE PMID
16575355 (http://www.ncbi.nlm.nih.gov/pubmed/16575355)
PUI
L43778589
DOI
10.1097/01.PCC.0000216415.12120.FF
FULL TEXT LINK
http://dx.doi.org/10.1097/01.PCC.0000216415.12120.FF
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1036
TITLE
Evaluation of a risk score for interhospital transport of critically ill
patients
AUTHOR NAMES
Markakis C.
Dalezios M.
Chatzicostas C.
Chalkiadaki A.
Politi K.
Agouridakis P.J.
AUTHOR ADDRESSES
(Markakis C.; Dalezios M.; Chalkiadaki A.; Agouridakis P.J.) ICU, General
Hospital of Rethymnon, Crete, Greece.
(Chatzicostas C.) Department of Gastroenterology, General Hospital of
Rethymnon, Crete, Greece.
(Politi K.) Department of Anaesthesiology, General Hospital of Rethymnon,
Crete, Greece.
(Agouridakis P.J.) 48 G Georgiadou Street, 71305 Heraklion, Crete, Greece.
CORRESPONDENCE ADDRESS
P.J. Agouridakis, 48 G Georgiadou Street, 71305 Heraklion, Crete, Greece.
SOURCE
Emergency Medicine Journal (2006) 23:4 (313-317). Date of Publication: April
2006
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Background: Interhospital transfer imposes essential risk for critically ill
patients. The Risk Score for Transport Patients (RSTP) scale can be used as
a triage tool for patient severity. Methods: In total, 128 transfers of
critically ill patients were classified in two groups of severity according
to the RSTP. Statistical analysis was performed using the receiver operating
characteristic (ROC) curve and goodness of fit statistics. Results: In
total, 66 patients (51.5%) were classified as group I and 62 (48.4%) as
group II. Major en route complications were more common in group II patients
(19.3% v 3%, p<0.001). Haemodynamic instability was the most common
complication. There were significant differences in the mean risk scores
between group I and II patients (mean (SD) 4.48 (1.01) v 11.04 (3.47),
p<0.001). Discrimination power of RSTP was acceptable (area under the ROC
curve 0.743; cutoff value ≥8). Goodness of fit was adequate (p=0.390).
Conclusion: The RSTP had acceptable discrimination and adequate goodness of
fit and could be considered as a triage tool. Haemodynamic instability is
the most common problem encountered during transfer.
EMTREE DRUG INDEX TERMS
analgesic agent
anesthetic agent
antiarrhythmic agent
anticonvulsive agent
bicarbonate
fibrinolytic agent
furosemide (drug therapy, oral drug administration)
inotropic agent (drug combination)
mannitol
naloxone
oxygen (drug therapy)
steroid
uterus spasmolytic agent
vasodilator agent (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
critical illness
patient transport
risk assessment
EMTREE MEDICAL INDEX TERMS
acute heart infarction (drug therapy, therapy)
adolescent
adult
aged
ambulance
article
cardiovascular disease (complication)
chi square test
child
classification
controlled study
disease severity
emergency health service
female
hemodynamic monitoring
human
infant
lung edema (complication, drug therapy)
major clinical study
male
positive end expiratory pressure
priority journal
receiver operating characteristic
scoring system
statistical analysis
statistical significance
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
furosemide (54-31-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006414671
MEDLINE PMID
16549583 (http://www.ncbi.nlm.nih.gov/pubmed/16549583)
PUI
L44295326
DOI
10.1136/emj.2005.026435
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2005.026435
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1037
TITLE
Emergence of functional δ-opioid receptors induced by long-term treatment
with morphine
AUTHOR NAMES
Ma J.
Zhang Y.
Kalyuzhny A.E.
Pan Z.Z.
AUTHOR ADDRESSES
(Ma J.; Zhang Y.; Pan Z.Z., zzpan@mdanderson.org) Department of
Anesthesiology and Pain Medicine, University of Texas, MD Anderson Cancer
Center, Houston, TX, United States.
(Kalyuzhny A.E.) Department of Neuroscience, University of Minnesota,
Minneapolis, MN, United States.
(Pan Z.Z., zzpan@mdanderson.org) Department of Anesthesiology and Pain
Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe
Boulevard, Houston, TX 77030, United States.
CORRESPONDENCE ADDRESS
Z.Z. Pan, Department of Anesthesiology and Pain Medicine, University of
Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX
77030, United States. Email: zzpan@mdanderson.org
SOURCE
Molecular Pharmacology (2006) 69:4 (1137-1145). Date of Publication: April
2006
ISSN
0026-895X
1521-0111 (electronic)
BOOK PUBLISHER
American Society for Pharmacology and Experimental Therapy, 9650 Rockville
Pike, Bethesda, United States.
ABSTRACT
Opioid analgesics remain the choice for the treatment of moderate to severe
pain. Recent research has established that the μ-opioid receptor is
predominantly responsible for mediating many opioid actions, including
analgesia and opioid tolerance. However, the function of δ-opioid receptors
is rather puzzling at present, with inconsistent reports of system effects
by agonists of δ-opioid receptors. The functional interaction between
μ-opioid receptors and δ-opioid receptors is also poorly understood. In this
study, we demonstrated that in a brainstem site critically involved in
opioid analgesia, agonists of δ-opioid receptors, ineffective in opioid
naive rats, significantly inhibit presynaptic GABA release in the brainstem
neurons from morphine-tolerant rats. In membrane preparation from control
brainstem tissues, Western blot detected no proteins of δ-opioid receptors,
but consistent δ-opioid receptor proteins were expressed in membrane
preparation from morphine-tolerant rats. Immunohistochemical studies
revealed that long-term morphine treatment significantly increases the
number of δ-opioid receptor-immunoreactive varicosities that appose the
postsynaptic membrane of these neurons. The colocalization of δ-opioid
receptor-immunoreactive varicosities with the labeling of the
GABA-synthesizing enzyme glutamic acid decarboxylase is also significantly
increased. From a behavioral perspective, activation of δ-opioid receptors
in the brainstem nucleus, lacking an effect in opioid naive rats, became
analgesic in morphine-tolerant rats and significantly reduced morphine
tolerance. These findings indicate that long-term morphine treatment induces
the emergence of functional δ-opioid receptors and δ-opioid
receptor-mediated analgesia, probably through receptor translocation to
surface membrane in GABAergic terminals. They also suggest that opioid drugs
with preference for δ-opioid receptors may have better therapeutic effect in
a μ-opioid-tolerant state. Copyright © 2006 The American Society for
Pharmacology and Experimental Therapeutics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
delta opiate receptor (drug concentration, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid (endogenous compound)
delta opiate receptor agonist (drug concentration, pharmacology)
deltorphin (drug combination, drug concentration, pharmacology)
dextro phenylalanylcysteinyltyrosyl dextro
tryptophylarginylthreonylpenicillaminylthreoninamide 2,7 disulfide
(pharmacology)
glutamate decarboxylase (endogenous compound)
morphine
naltriben (drug combination, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
spinal pain
EMTREE MEDICAL INDEX TERMS
4 aminobutyric acid release
amino acid synthesis
analgesia
animal cell
animal experiment
animal model
animal tissue
article
brain nerve cell
brain stem
controlled study
drug activation
IC50
immunohistochemistry
male
morphine tolerance
nonhuman
priority journal
protein analysis
protein expression
raphe magnus nucleus
rat
Western blotting
CAS REGISTRY NUMBERS
4 aminobutyric acid (28805-76-7, 56-12-2)
deltorphin (119975-64-3)
dextro phenylalanylcysteinyltyrosyl dextro
tryptophylarginylthreonylpenicillaminylthreoninamide 2,7 disulfide
(103429-32-9)
glutamate decarboxylase (9024-58-2)
morphine (52-26-6, 57-27-2)
naltriben (111555-58-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006140567
MEDLINE PMID
16399848 (http://www.ncbi.nlm.nih.gov/pubmed/16399848)
PUI
L43434906
DOI
10.1124/mol.105.019109
FULL TEXT LINK
http://dx.doi.org/10.1124/mol.105.019109
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1038
TITLE
Toxicologic hazards for police dogs involved in drug detection
AUTHOR NAMES
Llera R.M.
Volmer P.A.
AUTHOR ADDRESSES
(Llera R.M.; Volmer P.A.) Department of Veterinary Biosciences, College of
Veterinary Medicine, University of Illinois, Urbana, IL 61802, United
States.
CORRESPONDENCE ADDRESS
P.A. Volmer, Department of Veterinary Biosciences, College of Veterinary
Medicine, University of Illinois, Urbana, IL 61802, United States.
SOURCE
Journal of the American Veterinary Medical Association (2006) 228:7
(1028-1032). Date of Publication: 1 Apr 2006
ISSN
0003-1488
BOOK PUBLISHER
American Veterinary Medical Association, 1931 N. Meacham Road, Suite 100,
Schaumburg, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
illicit drug (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug dose, drug therapy, oral drug administration)
ammonium chloride (drug therapy, oral drug administration)
amphetamine derivative (drug toxicity)
antiinfective agent (drug therapy)
apomorphine (drug administration, drug dose, drug therapy, drug toxicity,
intramuscular drug administration, intravenous drug administration, oral
drug administration, subcutaneous drug administration)
barbituric acid derivative (drug therapy)
bicarbonate (drug therapy)
cannabis (drug toxicity)
chlorpromazine (drug therapy)
cocaine (drug toxicity)
diazepam (drug therapy)
glucocorticoid (drug therapy)
haloperidol (drug therapy)
hydrogen peroxide (drug dose, drug therapy, oral drug administration)
laxative (drug dose, drug therapy, oral drug administration)
magnesium sulfate (drug dose, drug therapy, oral drug administration)
naloxone (drug dose, drug therapy, intravenous drug administration)
opiate (drug toxicity)
phencyclidine (drug toxicity)
propranolol (drug therapy)
riot control agent (drug toxicity)
sodium sulfate (drug dose, drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dog
drug intoxication (diagnosis, drug therapy, etiology, prevention, therapy)
EMTREE MEDICAL INDEX TERMS
article
central nervous system depression
clinical feature
cooling
dangerous goods
drug detoxification
emergency treatment
fluid therapy
hypotension (drug therapy)
laboratory
nonhuman
oxygen therapy
police
respiration depression (drug therapy, etiology)
respiratory tract infection (drug therapy, etiology)
sedation
seizure (drug therapy)
stomach lavage
tachycardia (drug therapy)
thermoregulation
toxicokinetics
urine acidification
vomiting
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
ammonium chloride (12125-02-9)
apomorphine (314-19-2, 58-00-4)
bicarbonate (144-55-8, 71-52-3)
cannabis (8001-45-4, 8063-14-7)
chlorpromazine (50-53-3, 69-09-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
haloperidol (52-86-8)
hydrogen peroxide (7722-84-1)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phencyclidine (77-10-1, 956-90-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
sodium sulfate (7757-82-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Environmental Health and Pollution Control (46)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006160178
MEDLINE PMID
16579778 (http://www.ncbi.nlm.nih.gov/pubmed/16579778)
PUI
L43494464
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1039
TITLE
Acute pain management in proximal femoral fractures. Femoral nerve block
(catheter technique) vs. systemic pain therapy using a clinic internal
organisation model
ORIGINAL (NON-ENGLISH) TITLE
Akutschmerztherapie bei patienten mit hüftgelenknahen frakturen.
N.-femoralis-katheter-analgesie vs. systemische schmerztherapie unter
anwendung eines klinikinternen organisationsmodells
AUTHOR NAMES
Gille J.
Gille M.
Gahr R.
Wiedemann B.
AUTHOR ADDRESSES
(Gille J., Jochen.Gille@sanktgeorg.de; Wiedemann B.) Klinik für
Anästhesiologie, Intensiv- und Schmerztherapie, Städt. Klinikum St. Georg,
Leipzig, Germany.
(Gille M.) Evangelisches Diakonissenkrankenhaus, Leipzig, Germany.
(Gahr R.) Zentrum für Traumatologie Mit Brandverletztenzentrum, Städt.
Klinikum St. Georg, Leipzig, Germany.
(Gille J., Jochen.Gille@sanktgeorg.de) Klinikum St. Georg, Delitzscher Str.
141, 04129 Leipzig, Germany.
CORRESPONDENCE ADDRESS
J. Gille, Klinikum St. Georg, Delitzscher Str. 141, 04129 Leipzig, Germany.
Email: Jochen.Gille@sanktgeorg.de
SOURCE
Anaesthesist (2006) 55:4 (414-422). Date of Publication: April 2006
ISSN
0003-2417
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
Background. The aim of this study was to compare catheter-mediated femoral
nerve block analgesia with systemic pain therapy in patients with proximal
femoral fractures in the pre- and postoperative setting. Methods. In a
prospective randomised trial of patients attending the emergency department,
100 individuals were selected. Group A (n=50) received a catheter-mediated
femoral nerve block with 1% prilocaine and post-operatively 0.2%
ropivacaine. Group B (n=50) initially received intravenous metamizol and a
fixed combination of oral tilidine + naloxone. In the post-operative period
regular oral ibuprofen in addition to oral tilidine + naloxone was given as
required for break through pain. Pain intensity was measured using a verbal
rating scale (VRS). Pain scores were recorded at rest and during passive
anteflection of the hip. Results. Significant pain relief was achieved in
both groups following initial administration of analgesia, yet the total
pain scores in group A were significantly lower than those recorded for
group B. No difference was noted between the 2 groups during the first 3
postoperative days. No severe complications occurred as a result of
analgesia. Conclusion. Catheter mediated femoral nerve block should be
considered as the method of choice in initial pain therapy. The inherent
cubersome logistics of the catheter technique within the postoperative
setting limits its pratical application. © Springer Medizin Verlag 2005.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dipyrone (clinical trial, drug combination, drug dose, drug therapy,
intravenous drug administration)
ibuprofen (clinical trial, drug combination, drug dose, drug therapy, oral
drug administration)
naloxone (clinical trial, drug combination, drug dose, drug therapy, oral
drug administration)
prilocaine (clinical trial, drug dose, drug therapy)
ropivacaine (clinical trial, drug dose, drug therapy)
tilidine (clinical trial, drug combination, drug dose, drug therapy, oral
drug administration)
EMTREE DRUG INDEX TERMS
etomidate
ibuprofen plus pseudoephedrine
isoflurane
naloxone plus tilidine
rocuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
catheterization
femoral neck fracture
femoral nerve
nerve block
pain (complication, drug therapy)
systemic therapy
EMTREE MEDICAL INDEX TERMS
aged
analgesia
article
catheter
clinic internal organization model
clinical trial
controlled clinical trial
controlled study
emergency ward
female
Germany
human
intermethod comparison
major clinical study
male
model
organization
outcome assessment
pain assessment
passive movement
postoperative care
preoperative treatment
prospective study
randomized controlled trial
rest
DRUG TRADE NAMES
ibuhexal
naropin
novaminsulfon
valoron n
xylonest
CAS REGISTRY NUMBERS
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
ibuprofen (15687-27-1)
isoflurane (26675-46-7)
naloxone (357-08-4, 465-65-6)
prilocaine (1786-81-8, 721-50-6)
rocuronium (119302-91-9)
ropivacaine (84057-95-4)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2006207603
MEDLINE PMID
16320011 (http://www.ncbi.nlm.nih.gov/pubmed/16320011)
PUI
L43651787
DOI
10.1007/s00101-005-0949-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s00101-005-0949-4
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1040
TITLE
A tale of two sisters
AUTHOR NAMES
Wheeler D.S.
Mehta R.
Fisher Jr. L.E.
Segeleon J.E.
Pearson-Shaver A.L.
AUTHOR ADDRESSES
(Wheeler D.S.) Division of Critical Care Medicine, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States.
(Wheeler D.S.) Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, United States.
(Wheeler D.S.) Kindervelt Laboratory for Critical Care Medicine Research,
Children's Hospital Research Foundation, Cincinnati, OH, United States.
(Mehta R.; Fisher Jr. L.E.; Pearson-Shaver A.L.) Section of Critical Care
Medicine, Medical College of Georgia Children's Medical Center, Augusta, GA,
United States.
(Mehta R.; Fisher Jr. L.E.; Pearson-Shaver A.L.) Department of Pediatrics,
Medical College of Georgia, Augusta, GA, United States.
(Segeleon J.E.) Section of Critical Care Medicine, Sioux Valley Hospital,
Sioux Falls, SD, United States.
(Segeleon J.E.) Department of Pediatrics, University of South Dakota School
of Medicine, Sioux Falls, SD, United States.
CORRESPONDENCE ADDRESS
D.S. Wheeler, Division of Critical Care Medicine, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States.
SOURCE
Pediatric Emergency Care (2006) 22:3 (197-200). Date of Publication: March
2006
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
defoliant agent (drug toxicity)
organophosphate (drug toxicity)
phosphorotrithioic acid tributyl ester (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcholinesterase (endogenous compound)
atropine
benzodiazepine derivative
ceftriaxone
diazepam
lorazepam
midazolam
naloxone
phenytoin
pralidoxime
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cholinergic activity
intoxication (diagnosis, etiology)
EMTREE MEDICAL INDEX TERMS
African American
article
artificial ventilation
aspiration pneumonia (diagnosis)
bradycardia
case report
central nervous system depression
clinical feature
computer assisted tomography
diaphoresis
diarrhea
emergency ward
female
fever
gastrointestinal symptom
human
lacrimation
lethargy
lung edema (diagnosis)
miosis
preschool child
respiration depression (etiology)
salivation
seizure
somnolence
tonic clonic seizure
urine incontinence
vomiting
CAS REGISTRY NUMBERS
acetylcholinesterase (9000-81-1)
atropine (51-55-8, 55-48-1)
ceftriaxone (73384-59-5, 74578-69-1)
diazepam (439-14-5)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
phenytoin (57-41-0, 630-93-3)
phosphorotrithioic acid tributyl ester (78-48-8)
pralidoxime (6735-59-7)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006241005
MEDLINE PMID
16628108 (http://www.ncbi.nlm.nih.gov/pubmed/16628108)
PUI
L43753959
DOI
10.1097/01.pec.0000203389.44855.16
FULL TEXT LINK
http://dx.doi.org/10.1097/01.pec.0000203389.44855.16
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1041
TITLE
Opiate toxicity in patients with renal failure
AUTHOR NAMES
Conway B.R.
Fogarty D.G.
Nelson W.E.
Doherty C.C.
AUTHOR ADDRESSES
(Conway B.R., BryanConway@ntlworld.com; Fogarty D.G.; Nelson W.E.; Doherty
C.C.) Department of Nephrology, Belfast City Hospital, Belfast BT9 7AB,
United Kingdom.
CORRESPONDENCE ADDRESS
B.R. Conway, Department of Nephrology, Belfast City Hospital, Belfast BT9
7AB, United Kingdom. Email: BryanConway@ntlworld.com
SOURCE
British Medical Journal (2006) 332:7537 (345-346). Date of Publication: 11
Feb 2006
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
atropine
codeine (adverse drug reaction, drug therapy)
creatinine (endogenous compound)
dextropropoxyphene plus paracetamol (adverse drug reaction, drug therapy)
epinephrine
glucose (endogenous compound)
morphine (adverse drug reaction, drug therapy)
potassium (endogenous compound)
sodium (endogenous compound)
urea (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
angina pectoris
article
backache (drug therapy)
cardiopulmonary insufficiency (side effect)
case report
conservative treatment
creatinine blood level
electrocardiogram
emergency ward
female
fluid resuscitation
Glasgow coma scale
glomerulus filtration rate
glucose blood level
hemodialysis
human
hyperkalemia (drug therapy)
ischemic heart disease
kidney failure
knee amputation
non insulin dependent diabetes mellitus
obesity
oliguria (side effect)
pH
postoperative pain (drug therapy)
priority journal
resuscitation
treatment outcome
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
codeine (76-57-3)
creatinine (19230-81-0, 60-27-5)
dextropropoxyphene plus paracetamol (39400-85-6)
glucose (50-99-7, 84778-64-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
potassium (7440-09-7)
sodium (7440-23-5)
urea (57-13-6)
EMBASE CLASSIFICATIONS
Urology and Nephrology (28)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006085151
MEDLINE PMID
16470057 (http://www.ncbi.nlm.nih.gov/pubmed/16470057)
PUI
L43253752
DOI
10.1136/bmj.332.7537.345
FULL TEXT LINK
http://dx.doi.org/10.1136/bmj.332.7537.345
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1042
TITLE
Intravenous bolus of ultra-low-dose naloxone added to morphine does not
enhance analgesia in emergency department patients
AUTHOR NAMES
Bijur P.E.
Schechter C.
Esses D.
Chang A.K.
Gallagher E.J.
AUTHOR ADDRESSES
(Bijur P.E., bijur@aecom.yu.edu; Schechter C.; Esses D.; Chang A.K.;
Gallagher E.J.) Departments of Emergency Medicine and Family and Social
Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.
(Bijur P.E., bijur@aecom.yu.edu) Albert Einstein College of Medicine, Rose
F. Kennedy Center, 1410 Pelham Parkway South, Bronx, NY 10461, United
States.
CORRESPONDENCE ADDRESS
P.E. Bijur, Albert Einstein College of Medicine, Rose F. Kennedy Center,
1410 Pelham Parkway South, Bronx, NY 10461, United States. Email:
bijur@aecom.yu.edu
SOURCE
Journal of Pain (2006) 7:2 (75-81). Date of Publication: February 2006
ISSN
1526-5900
1528-8447 (electronic)
BOOK PUBLISHER
Churchill Livingstone Inc., 650 Avenue of the Americas, New York, United
States.
ABSTRACT
There is some evidence from in vitro, animal, and postoperative clinical
studies that low doses of opioid antagonists combined with morphine increase
analgesia. The theoretical model of this effect posits that ultra-low doses
of opioid antagonists selectively antagonize excitatory, but not inhibitory,
opioid receptor-mediated signaling. To determine whether this effect occurs
in emergency department patients presenting with severe acute pain, we
conducted a randomized, double-blind placebo-controlled trial to assess the
relative analgesic effect of morphine administered with 3 different doses of
naloxone versus morphine alone. Patients received 0.1 mg/kg morphine
intravenously (IV) over 2 min plus one of 3 different doses of naloxone (0.1
ng/kg, 0.01 ng/kg, or 0.001 ng/kg) or normal saline. A 0 to 10 numerical
rating scale (NRS) was used to measure pain intensity at baseline and every
30 min up to 4 hours. One hundred fifty-six patients with a median NRS of 10
(IQR: 8-10) were studied. There were no clinically or statistically
significant differences in the mean pain intensity of patients in the 4
treatment groups over the 4-hour study period, nor were there differences in
the administration of additional analgesics or incidence of side effects. ©
2006 by the American Pain Society.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, clinical trial, drug combination, drug
therapy, intravenous drug administration)
naloxone (adverse drug reaction, clinical trial, drug combination, drug
dose, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
placebo
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
clinical trial
controlled clinical trial
controlled study
dose response
double blind procedure
emergency care
emergency ward
female
human
low drug dose
major clinical study
male
nausea (side effect)
outcome assessment
pain (drug therapy)
pain assessment
randomized controlled trial
treatment outcome
vomiting (side effect)
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006068804
MEDLINE PMID
16459272 (http://www.ncbi.nlm.nih.gov/pubmed/16459272)
PUI
L43197615
DOI
10.1016/j.jpain.2005.08.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpain.2005.08.008
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1043
TITLE
Paediatric prehospital analgesia in Auckland
AUTHOR NAMES
Watkins N.
AUTHOR ADDRESSES
(Watkins N., nicholasw@adhb.govt.nz) Children's Emergency Department,
Starship Hospital, Auckland, New Zealand.
(Watkins N., nicholasw@adhb.govt.nz) Children's Emergency Department,
Starship Hospital, Private Bag 92024, Auckland, New Zealand.
CORRESPONDENCE ADDRESS
N. Watkins, Children's Emergency Department, Starship Hospital, Private Bag
92024, Auckland, New Zealand. Email: nicholasw@adhb.govt.nz
SOURCE
EMA - Emergency Medicine Australasia (2006) 18:1 (51-56). Date of
Publication: February 2006
ISSN
1742-6731
1742-6723 (electronic)
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
Objectives: The objectives of the present study were: To determine whether
the age of a child influences the likelihood of their receiving prehospital
analgesia from the Auckland ambulance service. To investigate the effect of
age on ambulance officers' decision-making and use of analgesia. Methods: A
prospective study of children arriving by ambulance at Starship Children's
Emergency Department Auckland, with a diagnosis of limb fracture or burn,
was undertaken over 2 months in 2002. A concurrent questionnaire survey
investigated ambulance officers' use of analgesia in children. Results: No
child aged less than 5 years (n = 10) compared with 51% between 5 and 15
years of age (n = 35) received prehospital analgesia (P = 0.003). On arrival
in hospital 70% aged less than 5 years compared with 54% older than 5 years
required i.v. opiate analgesia. Ambulance officers did not perceive that a
child's age would significantly alter their decision to use analgesia.
Conclusions: In children, younger age is a significant risk factor for
receiving inadequate prehospital analgesia. Ambulance officers' concern
about the pain of injection is the major identified factor for the relative
underuse of morphine observed in younger children. © 2006 Australasian
College for Emergency Medicine and Australasian Society for Emergency
Medicine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, drug therapy, intravenous
drug administration)
EMTREE DRUG INDEX TERMS
morphine (adverse drug reaction, drug therapy)
naloxone
nitrous oxide plus oxygen
opiate (drug therapy, intravenous drug administration)
paracetamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatric anesthesia
EMTREE MEDICAL INDEX TERMS
adolescent
age distribution
ambulance
analgesia
article
burn
child
controlled study
drug use
elixir
emergency care
human
infant
injection pain (side effect)
limb fracture
medical decision making
pain (drug therapy)
pediatric hospital
priority journal
questionnaire
risk factor
DRUG TRADE NAMES
entonox
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006135580
MEDLINE PMID
16454775 (http://www.ncbi.nlm.nih.gov/pubmed/16454775)
PUI
L43423866
DOI
10.1111/j.1742-6723.2006.00808.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1742-6723.2006.00808.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1044
TITLE
Emergency antidotes
ORIGINAL (NON-ENGLISH) TITLE
Antidotes aux urgences
AUTHOR NAMES
Tournoud C.
Nisse P.
Saviuc P.
Hantson P.
Danel V.
AUTHOR ADDRESSES
(Tournoud C.) Centre Antipoison de Strasbourg, Hôpital Civil, 1 place de
l'Hôpital, 67091 Strasbourg Cedex.
(Nisse P.) Centre Antipoison de Lille, Centre Hospitalier Universitaire, 5,
avenue Oscar-Lambret, 59037 Lille Cedex.
(Saviuc P.; Danel V.) Unité de Toxicologie Clinique, Centre Hospitalier
Universitaire, BP 217, 38043 Grenoble Cedex 9.
(Hantson P.) Département de Soins Intensifs, Cliniques Saint-Luc, Université
Catholique de Louvain, avenue Hippocrate, 10, B-1200 Bruxelles, Belgium.
CORRESPONDENCE ADDRESS
C. Tournoud, Centre Antipoison de Strasbourg, Hôpital Civil, 1 place de
l'Hôpital, 67091 Strasbourg Cedex.
SOURCE
JEUR (2006) 19:1 (43-50). Date of Publication: Jan 2006
ISSN
0993-9857
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration, pharmacology)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (adverse drug reaction, drug therapy, pharmacology)
acetylcysteine (adverse drug reaction, drug therapy, pharmacology)
alcohol (adverse drug reaction, drug therapy, pharmacology)
aniline (drug toxicity)
antiarrhythmic agent (drug toxicity)
anticonvulsive agent
atropine (adverse drug reaction, intravenous drug administration,
pharmacology)
bal
bicarbonate (adverse drug reaction, drug therapy, pharmacology)
chloroquine (drug toxicity)
cobalt edetate (adverse drug reaction, drug therapy, pharmacology)
deferoxamine mesylate
diazepam (adverse drug reaction, drug therapy, pharmacology)
digoxin antibody F(ab) fragment (adverse drug reaction, drug therapy,
pharmacology)
flumazenil (drug dose, drug interaction, drug therapy, intravenous drug
administration, pharmacology)
glucagon (adverse drug reaction, drug therapy, pharmacology)
gluconate calcium (adverse drug reaction, drug therapy, pharmacology)
hydroxocobalamin
hydroxocobalamin (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacology)
insecticide (drug toxicity)
lactate sodium (adverse drug reaction, drug therapy, pharmacology)
legalon sil
levocarnil
liver extract
methylene blue (adverse drug reaction, drug therapy, pharmacology)
metoclopramide
midomafetamine
naloxone (adverse drug reaction, drug therapy, pharmacology)
nitrate (drug toxicity)
octreotide
organophosphorus compound (drug toxicity)
penicillamine
phytomenadione (adverse drug reaction, drug dose, drug therapy, intravenous
drug administration, pharmacology)
pralidoxime (adverse drug reaction, drug therapy, pharmacology)
pralidoxime mesilate
pyridoxine (adverse drug reaction, drug therapy, pharmacology)
recombinant glucagon
succicaptal
tricyclic antidepressant agent (drug interaction, drug toxicity)
tropatepine (adverse drug reaction, drug therapy, pharmacology)
valproic acid
valpromide
viperfav
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
abnormally high substrate concentration in blood (side effect)
agitation
constipation (side effect)
convulsion (side effect)
detoxification
digestive system function disorder (side effect)
diplopia (side effect)
disease exacerbation (side effect)
drug absorption
drug efficacy
drug elimination
drug hypersensitivity (side effect)
drug induced headache (side effect)
drug safety
dyspnea (side effect)
face edema (side effect)
heart arrhythmia (side effect)
hemolytic anemia (side effect)
human
hypercalcemia (side effect)
hypertension (side effect)
hypoglycemia (side effect)
hypokalemia (side effect)
hypotension (side effect)
immunotherapy
interstitial pneumonia (side effect)
larynx spasm (side effect)
mental disease (side effect)
metabolic acidosis (side effect)
metabolic alkalosis (side effect)
methemoglobinemia (side effect)
nausea (side effect)
neuropathy (side effect)
neurotoxicity (side effect)
paresthesia (side effect)
priority journal
pruritus (side effect)
rash (side effect)
respiratory distress (side effect)
review
safety
sedation
side effect (side effect)
stomach hemorrhage (side effect)
tachycardia (side effect)
urine color
urine retention (side effect)
urticaria (side effect)
vertigo (side effect)
visual field defect (side effect)
visual impairment (side effect)
vomiting (side effect)
DRUG TRADE NAMES
anexate
atropine
bal
contrathion
curethyl
cyanokit
depakine
depamide
desferal
digidot
fluimucil
fomepizole
glucagen
kelocyanor
legalon sil
lepticur
levocarnil
nalone
primperan
sandostatine
succicaptal
trolovol
valium
viperfav
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
alcohol (64-17-5)
aniline (142-04-1, 62-53-3)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
cobalt edetate (14931-83-0, 36499-65-7)
deferoxamine mesylate (138-14-7, 5115-09-3)
diazepam (439-14-5)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
lactate sodium (72-17-3)
liver extract (72980-85-9)
methylene blue (61-73-4)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
nitrate (14797-55-8)
penicillamine (2219-30-9, 52-67-5)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime mesilate (154-97-2)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
tropatepine (27574-24-9)
valproic acid (1069-66-5, 99-66-1)
valpromide (2430-27-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2006161784
PUI
L43500370
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1045
TITLE
Changing opioid use for right lower quadrant abdominal pain in the emergency
department
AUTHOR NAMES
Neighbor M.L.
Baird C.H.
Kohn M.A.
AUTHOR ADDRESSES
(Neighbor M.L., mneighbor@sfghed.ucsf.edu; Baird C.H.; Kohn M.A.) University
of California, San Francisco, Lafayette, CA, United States.
(Neighbor M.L., mneighbor@sfghed.ucsf.edu) 1E21 Emergency Services, San
Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110,
United States.
CORRESPONDENCE ADDRESS
M.L. Neighbor, 1E21 Emergency Services, San Francisco General Hospital, 1001
Potrero Avenue, San Francisco, CA 94110, United States. Email:
mneighbor@sfghed.ucsf.edu
SOURCE
Academic Emergency Medicine (2005) 12:12 (1216-1220). Date of Publication:
December 2005
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: To compare the use of opioid analgesia in the treatment of
emergency department patients with acute right lower quadrant (RLQ)
abdominal pain between 1998 and 2003 and to explore the relationship between
opioid use and abdominal computed tomography (CT) scanning. Methods: This
was a retrospective cohort study of patients presenting in 1998 and 2003 to
an urban emergency department with a triage complaint of RLQ pain. The
authors abstracted use and timing of abdominal CT scanning and opioid
analgesia. Other predictor variables were patient demographics. Risk ratio
for receiving opioids with CT scan versus without CT scan, stratifying by
year, were calculated. Proportional-hazards analysis was used to control for
time in the emergency department. Results: Of the 187 patients seen in 1998,
38 (20%) underwent CT scanning and 43 (23%) received opioids. Of the 137
patients seen in 2003, 77 (56%) underwent CT scanning and 72 (53%) received
opioids. In 1998, the risk ratio for receiving opioids in patients who
underwent CT scanning (vs. without) was 3.7 (95% confidence interval [CI] =
2.3 to 6.1); in 2003, it was 1.5 (95% CI = 1.0 to 2.1). Opioids were
overwhelmingly given before CT scanning in those patients who received both
(81% in 1998 and 98% in 2003). The mean time to administration of the first
opioid dose in 1998 was 155 minutes and in 2003 was 94 minutes. The
proportional-hazards analysis confirmed a strong association between CT
scanning and opioid administration in 1998 (relative hazard, 2.7; 95% CI =
1.5 to 5.1) and substantial attenuation of the association in 2003 (relative
hazard, 1.3; 95% CI = 0.8 to 2.1). The hospitalization rate was not
significantly different in 2003 (33%) versus 1998 (27%) (p = 0.28). The risk
ratio of receiving opioids in admitted patients was 2.8 (95% CI = 1.7 to
4.6) in 1998 and 2.0 (95% CI = 1.5 to 2.7) in 2003. Conclusions: Opioid
administration to patients with RLQ pain has dramatically increased between
1998 and 2003. During these five years, the number of patients receiving
opioids more than doubled and the time to first administration of opioids
decreased by one hour. The authors show that this cannot be attributed to an
increased use of CT scanning.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain
emergency ward
EMTREE MEDICAL INDEX TERMS
adolescent
adult
analgesia
article
calculation
cohort analysis
comparative study
computer assisted tomography
confidence interval
controlled study
demography
emergency health service
female
hazard assessment
hospitalization
human
major clinical study
male
prediction
priority journal
retrospective study
risk assessment
time series analysis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005532576
MEDLINE PMID
16293897 (http://www.ncbi.nlm.nih.gov/pubmed/16293897)
PUI
L41681174
DOI
10.1197/j.aem.2005.07.024
FULL TEXT LINK
http://dx.doi.org/10.1197/j.aem.2005.07.024
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1046
TITLE
Take-home naloxone to reduce heroin death
AUTHOR NAMES
Baca C.T.
Grant K.J.
AUTHOR ADDRESSES
(Baca C.T., baca5@unm.edu; Grant K.J.) Center on Alcoholism, Substance
Abuse, and Addictions (CASAA), Family and Community Medicine, University of
New Mexico, Albuquerque, NM, United States.
(Baca C.T., baca5@unm.edu) 160 Washington SE #62, Albuquerque, NM 87108,
United States.
CORRESPONDENCE ADDRESS
C.T. Baca, 160 Washington SE #62, Albuquerque, NM 87108, United States.
Email: baca5@unm.edu
SOURCE
Addiction (2005) 100:12 (1823-1831). Date of Publication: December 2005
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Background: This paper reviews the relevant literature related to the
distribution of take-home naloxone. Methods: A Medline search was conducted
on articles published between January 1990 and June 2004 to identify
scientific literature relevant to this subject. Those publications were
reviewed, and from them other literature was identified and reviewed.
Results: The prevalence, pathophysiology and circumstances of heroin
overdose, and also bystander response are included in this review. Naloxone
peer distribution has been instituted to varying degrees in the United
States, Italy, Spain, Germany and the United Kingdom. Conclusion: At this
point the evidence supporting naloxone distribution is primarily anecdotal,
although promising. Although the distribution of naloxone holds promise for
further reducing heroin overdose mortality, problems remain. Naloxone alone
may be insufficient in some cases to revive the victim, and cardiopulmonary
resuscitation (CPR), especially rescue breathing, may also be needed. A
second dose of naloxone might be necessary. Complications following
resuscitation from overdose may infrequently need in-hospital care.
Mortality from injecting without anyone else present will be unaffected by
take-home naloxone. Take-home naloxone should be studied in a rigorous
scientific manner. © 2005 Society for the Study of Addiction.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (adverse drug reaction, drug administration, drug dose, drug
therapy, intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration,
pharmacoeconomics, subcutaneous drug administration, sublingual drug
administration)
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine
cocaine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heroin dependence (drug therapy)
EMTREE MEDICAL INDEX TERMS
alcohol consumption
cocaine dependence
drug cost
drug hypersensitivity (side effect)
drug mechanism
drug overdose (drug therapy, epidemiology, etiology)
emergency health service
first aid
health care distribution
heart massage
human
intravenous drug abuse
medical education
medical literature
Medline
mortality
pathophysiology
peer review
prescription
prevalence
publication
resuscitation
review
seizure (side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005566620
MEDLINE PMID
16367983 (http://www.ncbi.nlm.nih.gov/pubmed/16367983)
PUI
L41775207
DOI
10.1111/j.1360-0443.2005.01259.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.2005.01259.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1047
TITLE
Airway management in emergency situations
AUTHOR NAMES
Dörges V.
AUTHOR ADDRESSES
(Dörges V., v.doerges@t-online.de) Department of Anaesthesiology and
Intensive Care Medicine, University Hospital Schleswig-Holstein, Schwanenweg
21, D-24105 Kiel, Germany.
CORRESPONDENCE ADDRESS
V. Dörges, Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Schwanenweg 21, D-24105 Kiel,
Germany. Email: v.doerges@t-online.de
SOURCE
Best Practice and Research: Clinical Anaesthesiology (2005) 19:4 (699-715).
Date of Publication: December 2005
Difficult Airway Management, Book Series Title:
ISSN
1521-6896
BOOK PUBLISHER
Bailliere Tindall Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Securing and monitoring the airway are among the key requirements of
appropriate therapy in emergency patients. Failures to secure the airways
can drastically increase morbidity and mortality of patients within a very
short time. Therefore, the entire range of measures needed to secure the
airway in an emergency, without intermediate ventilation and oxygenation, is
limited to 30-40 seconds. Endotracheal intubation is often called the 'gold
standard' for airway management in an emergency, but multiple failed
intubation attempts do not result in maintaining oxygenation; instead, they
endanger the patient by prolonging hypoxia and causing additional trauma to
the upper airways. Thus, knowledge and availability of alternative
procedures are also essential in every emergency setting. Given the great
variety of techniques available, it is important to establish a
well-planned, methodical protocol within the framework of an algorithm. This
not only facilitates the preparation of equipment and the training of
personnel, it also ensures efficient decision-making under time pressure.
Most anaesthesia-related deaths are due to hypoxaemia when difficulty in
securing the airway is encountered, especially in obstetrics during
induction of anaesthesia for caesarean delivery. The most commonly occurring
adverse respiratory events are failure to intubate, failure to recognize
oesophageal intubation, and failure to ventilate. Thus, it is essential that
every anaesthesiologist working on the labour and delivery ward is
comfortable with the algorithm for the management of failed intubation. The
algorithm for emergency airway management describing the sequence of various
procedures has to be adapted to internal standards and to techniques that
are available. © 2005 Elsevier Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS
atropine
epinephrine
lidocaine
naloxone
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
airway obstruction
emergency treatment
EMTREE MEDICAL INDEX TERMS
algorithm
anesthesia induction
anesthesiological procedure
apnea
artificial ventilation
biomedical technology assessment
capnometry
cesarean section
clinical protocol
endotracheal intubation
esophagus intubation
general anesthesia
hemodynamics
human
hypoxemia
hypoxia
laryngeal mask
medical decision making
morbidity
mortality
oxygenation
patient monitoring
priority journal
pulse oximetry
regional anesthesia
respiratory failure
resuscitation
review
risk assessment
safety
standardization
tracheostomy
treatment failure
treatment indication
DEVICE TRADE NAMES
Combitube
Easytube
ILMA
LMA
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Otorhinolaryngology (11)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006008562
MEDLINE PMID
16408542 (http://www.ncbi.nlm.nih.gov/pubmed/16408542)
PUI
L43023772
DOI
10.1016/j.bpa.2005.07.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.bpa.2005.07.003
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1048
TITLE
Pediatric care recommendations for freestanding urgent care facilities
AUTHOR NAMES
Krug S.E.
Bojko T.
Dolan M.A.
Frush K.S.
O'Malley P.J.
Sapien R.E.
Shaw K.N.
Shook J.E.
Sirbaugh P.E.
Yamamoto L.G.
AUTHOR ADDRESSES
(Krug S.E.; Bojko T.; Dolan M.A.; Frush K.S.; O'Malley P.J.; Sapien R.E.;
Shaw K.N.; Shook J.E.; Sirbaugh P.E.; Yamamoto L.G.)
SOURCE
Pediatrics (2005) 116:1 (258-260). Date of Publication: 2005
ISSN
0031-4005
0031-4005 (electronic)
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
Freestanding urgent care centers are not emergency departments or medical
homes, yet they are sometimes used as a source of pediatric care. The
purpose of this policy statement is to provide updated and expanded
recommendations for ensuring appropriate stabilization in pediatric
emergency situations and timely and appropriate transfer to a hospital for
definitive care when necessary. Copyright © 2005 by the American Academy of
Pediatrics.
EMTREE DRUG INDEX TERMS
activated carbon
antibiotic agent
anticonvulsive agent
atropine
bicarbonate
corticosteroid (oral drug administration, parenteral drug administration)
diazepam
diphenhydramine
epinephrine
glucose
lorazepam
naloxone
oxygen
Ringer lactate solution
salbutamol
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
EMTREE MEDICAL INDEX TERMS
emergency ward
health care facility
health care policy
hospital equipment
priority journal
short survey
CAS REGISTRY NUMBERS
Ringer lactate solution (8022-63-7)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006323837
MEDLINE PMID
15995067 (http://www.ncbi.nlm.nih.gov/pubmed/15995067)
PUI
L44011363
DOI
10.1542/peds.2005-0958
FULL TEXT LINK
http://dx.doi.org/10.1542/peds.2005-0958
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1049
TITLE
The reliability of immunoassay for determining the presence of opiates in
the forensic setting
AUTHOR NAMES
Molina D.K.
DiMaio V.J.
AUTHOR ADDRESSES
(Molina D.K., kmolina@co.bexar.tx.us; DiMaio V.J.) Bexar County Forensic
Science Center, San Antonio, TX, United States.
(Molina D.K., kmolina@co.bexar.tx.us) Bexar County Forensic Science Center,
7337 Louis Pasteur Drive, San Antonio, TX 78229, United States.
CORRESPONDENCE ADDRESS
D.K. Molina, Bexar County Forensic Science Center, 7337 Louis Pasteur Drive,
San Antonio, TX 78229, United States. Email: kmolina@co.bexar.tx.us
SOURCE
American Journal of Forensic Medicine and Pathology (2005) 26:4 (303-304).
Date of Publication: December 2005
ISSN
0195-7910
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Urine immunoassays are commonly used as a rapid screen for drugs of abuse in
emergency room, hospital, clinic, and forensic settings. The authors were
concerned whether or not a negative screen of the urine for opiates was of
significance and indicative that analysis of blood for opiates was not
necessary. Specifically, we wished to determine whether a negative test for
opiates by immunoassay absolutely rules out an acute overdose, and if not,
what percentage of cases with negative results have opiates in the blood. A
retrospective analysis was performed using the toxicology results for cases
ruled an acute narcotic overdose at the Bexar County Medical Examiner's
Office between 1998 and 2003. One hundred eighty-three cases met the
criteria for the study. A false-negative rate of approximately 15% was found
using an immunoassay as compared with blood analysis for narcotics. The
authors feel that while this rate may be acceptable in a clinical setting,
it is unacceptable in a forensic setting. Copyright © 2005 by Lippincott
Williams & Wilkins.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
morphine
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug screening
immunoassay
EMTREE MEDICAL INDEX TERMS
article
blood analysis
drug overdose
forensic medicine
human
laboratory diagnosis
reliability
urinalysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006439943
MEDLINE PMID
16304459 (http://www.ncbi.nlm.nih.gov/pubmed/16304459)
PUI
L44357125
DOI
10.1097/01.paf.0000188089.10062.f4
FULL TEXT LINK
http://dx.doi.org/10.1097/01.paf.0000188089.10062.f4
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1050
TITLE
Effect of an opioid management system on opioid prescribing and unscheduled
visits in a large primary care clinic
AUTHOR NAMES
Goldberg K.C.
Simel D.L.
Oddone E.Z.
AUTHOR ADDRESSES
(Goldberg K.C., kenneth.goldberg@duke.edu; Simel D.L.; Oddone E.Z.) Duke
University Medical Center, Durham VA Medical Center, Box 11C, Durham, NC
27705, United States.
CORRESPONDENCE ADDRESS
K.C. Goldberg, Durham VA Medical Center, Duke University Medical Center, Box
11C, Durham, NC 27705, United States. Email: kenneth.goldberg@duke.edu
SOURCE
Journal of Clinical Outcomes Management (2005) 12:12 (621-628). Date of
Publication: Dec 2005
ISSN
1079-6533
ABSTRACT
• Objective: To measure the effect of an explicit pain management program on
unscheduled patient visits, prescribing behavior, and opioid use. • Design:
Retrospective cohort study. • Setting: General medicine practice of a
university-affiliated Veterans Affairs (VA) hospital. • Participants: All
patients who had a formal pain management contract and a matched comparison
group of patients without evidence of such a contract were evaluated. •
Intervention: Establishment of a pain management contract, placement of the
contract in the medical record, implementation of an opioid prescribing
system, and focused attention to pain management by the primary care
provider. • Measurements: Visits to the emergency department (ED), number of
providers of and prescriptions for opioids, consumption of oxycodone, and
visits to other VA medical centers. • Results: 91 patients with a pain
management contract were identified. After implementation, visit frequency
to the ED, the number of providers issuing prescriptions, the number of
separate prescriptions for opioids, and the number of dispensed oxycodone
tablets decreased significantly (P < 0.001 for each measure). Visits to
other VA hospitals within the state did not increase. In a matched group of
224 patients receiving opioids, ED visit frequency decreased during the
observation period, but to a lesser degree. The number of separate providers
issuing opioids to these patients and the number of unique prescriptions did
not change over time, although the number of oxycodone tablets consumed
increased steadily. • Conclusions: A pain management program made explicit
by a provider-patient contract can result in fewer unscheduled visits and a
consolidation of opioid prescribing toward a single provider.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid plus oxycodone plus oxycodone terephthalate (drug
therapy)
hydrocodone bitartrate plus paracetamol (drug therapy)
methadone (drug therapy)
morphine (drug therapy)
morphine sulfate
oxycodone (drug therapy)
oxycodone plus paracetamol (drug therapy)
oxycodone plus paracetamol (drug therapy)
paracetamol (drug therapy)
pethidine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
ambulatory care
analgesia
article
cohort analysis
consultation
controlled study
drug use
drug utilization
electronic medical record
emergency care
emergency ward
female
health care utilization
health program
human
major clinical study
male
medical record
pain assessment
patient selection
prescription
primary medical care
retrospective study
sustained release formulation
DRUG TRADE NAMES
demerol
ms contin
tylenol
vicodin
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
percodan (64336-56-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006047138
PUI
L43137084
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1051
TITLE
The roadside high: Jimson weed toxicity
AUTHOR NAMES
Clark J.D.
AUTHOR ADDRESSES
(Clark J.D.) Life Lion, Penn State Hershey Medical Center, Hershey, PA,
United States.
CORRESPONDENCE ADDRESS
J.D. Clark, Life Lion, Penn State Hershey Medical Center, Hershey, PA,
United States.
SOURCE
Air Medical Journal (2005) 24:6 (234-237). Date of Publication:
November/December 2005
ISSN
1067-991X
1532-6497 (electronic)
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
A 19-year-old man was brought to a local emergency department by the police
with EMS providing care. While en route to the hospital, police urged
hospital staff to be prepared for a combative patient with a possible
overdose; he was reported to have erratic behavior at a concert. Once in the
emergency department, he was placed on a stretcher for evaluation, with
police and hospital security at the bedside. He was looking into the corner
of the room and obviously panicked by what he saw. He became combative and
tried to run out of the room, yelling, "Get him away from me. It wants to
take me!" The patient's face was flushed, and he was drenched with sweat. He
was having visual hallucinations that terrified him. After he was placed
back on the litter and leather restraints were applied, he started yelling,
"Look at me! I'm dead! Hold on to me so I don't float away." The patient's
baseline vital signs were obtained, and an IV line was quickly established.
He was given benzodiazepines to facilitate mild sedation and relaxation. His
skin was hot to touch. He was hypertensive, and his ECG showed a heart rate
of 160 beats per minute. Friends who had accompanied him to the concert
denied the use of drugs or alcohol. However, a small plastic bag was found
inside the patient's pants pocket; the contents resembled tomato seeds.
After a full examination, the diagnosis of anticholinergic toxicity/Jimson
weed poisoning was made. Arrangements were made for the patient to be
transferred by helicopter to a tertiary care center with toxicology
services. Copyright 2005 by Air Medical Journal Associates.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
stramonium (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
antidepressant agent
antihistaminic agent
benzodiazepine
diazepam
lorazepam
midazolam
mydriatic agent
naloxone (drug therapy, intravenous drug administration)
neuroleptic agent
physostigmine salicylate (adverse drug reaction, drug therapy, intravenous
drug administration)
spasmolytic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
case report
clinical feature
electrocardiogram
emergency ward
endotracheal intubation
human
male
patient care
patient transport
physical examination
priority journal
resuscitation
sedation
seizure (side effect)
stomach lavage
visual hallucination
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
benzodiazepine (12794-10-4)
diazepam (439-14-5)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
physostigmine salicylate (57-64-7, 71214-04-5)
stramonium (8063-18-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2006001950
MEDLINE PMID
16314276 (http://www.ncbi.nlm.nih.gov/pubmed/16314276)
PUI
L43008600
DOI
10.1016/j.amj.2005.08.007
FULL TEXT LINK
http://dx.doi.org/10.1016/j.amj.2005.08.007
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1052
TITLE
Chasing "chasing the dragon" with MRI: Leukoencephalopathy in drug abuse
AUTHOR NAMES
Bartlett E.
Mikulis D.J.
AUTHOR ADDRESSES
(Bartlett E.) Department of Neuroradiology, Toronto Western Hospital,
University Health Network, 399 Bathurst Street, Toronto, Ont. M5T 2S8,
Canada.
(Mikulis D.J.) Department of Medical Imaging, Toronto Western Hospital,
University Health Network, 399 Bathurst Street, Toronto, Ont. M5T 2S8,
Canada.
(Bartlett E.) Northwestern University, Chicago, IL, United States.
CORRESPONDENCE ADDRESS
E. Bartlett, Northwestern University, Chicago, IL, United States.
SOURCE
British Journal of Radiology (2005) 78:935 (997-1004). Date of Publication:
November 2005
ISSN
0007-1285
BOOK PUBLISHER
British Institute of Radiology, 36 Portland Place, London, United Kingdom.
ABSTRACT
Spongiform leukoencephalopathy is a rare complication from inhalation of
heated heroin vapour, a practice called "chasing the dragon". The MRI
findings are considered pathognomonic, making MRI important for diagnosis.
This is especially true in busy urban emergency departments where a variety
of patients may present obtunded, unable or unwilling to provide a useful
history. Even though the MR pattern of "chasing" toxicity is considered
pathognomonic, there are mimickers. We compare the MRI findings of two
classic cases of chasing leukoencephalopathy with one case of mimickery from
cocaine exposure only. All three cases had diffuse symmetrical white matter
changes. MR spectroscopy (MRS) in chasing patients showed increased lactic
acid and myo-inositol, decreased N-acetyl aspartate and creatine, normal to
slightly decreased choline, and normal lipid peak. MRS in the cocaine
exposure patient showed marked increase in lactic acid and lipids. MR
perfusion in one chasing patient was normal. In conclusion: (1) All three
cases have MR findings suggestive of spongiform leukoencephalopathy. MRS may
help differentiate toxicity due to inhaled heroin from other non-heroin
related toxicities. (2) Discordance between perfusion and spectroscopy in
one chasing patient adds evidence that the disease is due to impaired energy
metabolism at the cellular level. (3) MR findings of spongiform
leukoencephalopathy secondary to chasing heroin can progress despite
apparent abstinence of the drug and during clinical improvement, suggesting
the MR changes may represent an evolving injury. © 2005 The British
Institute of Radiology.
EMTREE DRUG INDEX TERMS
carbon monoxide (drug toxicity)
choline (endogenous compound)
cocaine (drug toxicity)
creatine (endogenous compound)
diamorphine (drug toxicity)
inositol (endogenous compound)
lactic acid (endogenous compound)
lipid (endogenous compound)
n acetylaspartic acid (endogenous compound)
naloxone (drug therapy)
thiamine (drug therapy, intravenous drug administration)
ubiquinone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
leukoencephalopathy (complication, diagnosis)
nuclear magnetic resonance imaging
EMTREE MEDICAL INDEX TERMS
adult
article
carbon monoxide intoxication (diagnosis)
case report
clinical feature
cocaine dependence
computer assisted tomography
controlled study
diagnostic value
differential diagnosis
drug exposure
drug withdrawal
electroencephalography
energy metabolism
follow up
heroin dependence
hospital admission
hospital discharge
human
hypoxia (diagnosis, drug therapy)
image analysis
intermethod comparison
laboratory test
lymphoma (diagnosis)
male
nuclear magnetic resonance spectroscopy
perfusion weighted imaging
prognosis
progressive multifocal leukoencephalopathy (diagnosis)
seizure (diagnosis)
signal processing
vasculitis (diagnosis)
white matter
CAS REGISTRY NUMBERS
carbon monoxide (630-08-0)
choline (123-41-1, 13232-47-8, 1927-06-6, 4858-96-2, 62-49-7, 67-48-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
creatine (57-00-1)
diamorphine (1502-95-0, 561-27-3)
inositol (55608-27-0, 6917-35-7, 87-89-8)
lactic acid (113-21-3, 50-21-5)
lipid (66455-18-3)
n acetylaspartic acid (22304-28-5, 997-55-7)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
ubiquinone (1339-63-5)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Radiology (14)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005534019
MEDLINE PMID
16249600 (http://www.ncbi.nlm.nih.gov/pubmed/16249600)
PUI
L41684027
DOI
10.1259/bjr/61535842
FULL TEXT LINK
http://dx.doi.org/10.1259/bjr/61535842
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1053
TITLE
Attitudes of emergency medical service providers toward naloxone
distribution programs
AUTHOR NAMES
Tobin K.E.
Gaasch W.R.
Clarke C.
MacKenzie E.
Latkin C.A.
AUTHOR ADDRESSES
(Tobin K.E., ktobin@jhsph.edu; MacKenzie E.; Latkin C.A.) Department of
Health Policy and Management, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, United States.
(Gaasch W.R.) Department of Surgery, Division of Emergency Medicine,
University of Maryland School of Medicine, Baltimore, MD, United States.
(Clarke C.) School of Public Health, Morgan State University, Baltimore, MD,
United States.
(Tobin K.E., ktobin@jhsph.edu) Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health, 1629 East Baltimore Street,
Baltimore, MD 21231, United States.
CORRESPONDENCE ADDRESS
K.E. Tobin, Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, 1629 East Baltimore Street, Baltimore, MD
21231, United States. Email: ktobin@jhsph.edu
SOURCE
Journal of Urban Health (2005) 82:2 (296-302). Date of Publication: 2005
ISSN
1099-3460
BOOK PUBLISHER
Springer Science and Business Media Deutschland GmbH, Heidelberger Platz 3,
Berlin, Germany.
ABSTRACT
Training and distributing naloxone to drug users is a promising method for
reducing deaths associated with heroin overdose. Emergency Medical Service
(EMS) providers have experience responding to overdose, administering
naloxone, and performing clinical management of the patient. Little is known
about the attitudes of EMS providers toward training drug users to use
naloxone. We conducted an anonymous survey of 327 EMS providers to assess
their attitudes toward a pilot naloxone program. Of 176 who completed the
survey, the majority were male (79%) and Caucasian (75%). The average number
of years working as an EMS provider was 7 (SD = 6). Overall attitudes toward
training drug users to administer naloxone were negative with 56% responding
that this training would not be effective in reducing overdose deaths.
Differences in attitudes did not vary by gender, level of training, or age.
Providers with greater number of years working in EMS were more likely to
view naloxone trainings as effective in reducing overdose death. Provider
concerns included drug users' inability to properly administer the drug,
program condoning and promoting drug use, and unsafe disposal of used
needles. Incorporating information about substance abuse and harm reduction
approaches in continuing education classes may improve the attitudes of
provider toward naloxone training programs. © The Author 2005. Published by
Oxford University Press on behalf of the New York Academy of Medicine. All
rights reserved.
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
health personnel attitude
health program
medical service
EMTREE MEDICAL INDEX TERMS
adult
article
Caucasian
continuing education
disposable equipment
drug overdose (prevention)
drug use
female
health survey
human
major clinical study
male
medical information
priority journal
substance abuse
training
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005391191
MEDLINE PMID
15917504 (http://www.ncbi.nlm.nih.gov/pubmed/15917504)
PUI
L41214945
DOI
10.1093/jurban/jti052
FULL TEXT LINK
http://dx.doi.org/10.1093/jurban/jti052
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1054
TITLE
Naloxone distribution and cardiopulmonary resuscitation training for
injection drug users to prevent heroin overdose death: A pilot intervention
study
AUTHOR NAMES
Seal K.H.
Thawley R.
Gee L.
Bamberger J.
Kral A.H.
Ciccarone D.
Downing M.
Edlin B.R.
AUTHOR ADDRESSES
(Seal K.H., karens@itsa.ucsf.edu) Department of Medicine, San Francisco VA
Medical Center, University of California, San Francisco, CA, United States.
(Thawley R.; Gee L.; Kral A.H.; Ciccarone D.; Downing M.; Edlin B.R.) Urban
Health Study, University of California, San Francisco, CA, United States.
(Bamberger J.) San Francisco Department of Public Health, San Francisco, CA,
United States.
(Edlin B.R.) Center for the Study of Hepatitis C, Weill Medical College of
Cornell University, New York, NY, United States.
(Seal K.H., karens@itsa.ucsf.edu) Department of Medicine, San Francisco VA
Medical Center, University of California, San Francisco, 4150 Clement
Street, San Francisco, CA 94121, United States.
CORRESPONDENCE ADDRESS
K.H. Seal, Department of Medicine, San Francisco VA Medical Center,
University of California, San Francisco, 4150 Clement Street, San Francisco,
CA 94121, United States. Email: karens@itsa.ucsf.edu
SOURCE
Journal of Urban Health (2005) 82:2 (303-311). Date of Publication: 2005
ISSN
1099-3460
BOOK PUBLISHER
Springer Science and Business Media Deutschland GmbH, Heidelberger Platz 3,
Berlin, Germany.
ABSTRACT
Fatal heroin overdose has become a leading cause of death among injection
drug users (IDUs). Several recent feasibility studies have concluded that
naloxone distribution programs for heroin injectors should be implemented to
decrease heroin overdose deaths, but there have been no prospective trials
of such programs in North America. This pilot study was undertaken to
investigate the safety and feasibility of training injection drug using
partners to perform cardiopulmonary resuscitation (CPR) and administer
naloxone in the event of heroin overdose. During May and June 2001, 24 IDUs
(12 pairs of injection partners) were recruited from street settings in San
Francisco. Participants took part in 8-hour training in heroin overdose
prevention, CPR, and the use of naloxone. Following the intervention,
participants were prospectively followed for 6 months to determine the
number and outcomes of witnessed heroin overdoses, outcomes of participant
interventions, and changes in participants' knowledge of overdose and drug
use behavior. Study participants witnessed 20 heroin overdose events during
6 months follow-up. They performed CPR in 16 (80%) events, administered
naloxone in 15 (75%) and did one or the other in 19 (95%). All overdose
victims survived. Knowledge about heroin overdose management increased,
whereas heroin use decreased. IDUs can be trained to respond to heroin
overdose emergencies by performing CPR and administering naloxone. Future
research is needed to evaluate the effectiveness of this peer intervention
to prevent fatal heroin overdose. © The Author 2005. Published by Oxford
University Pressen behalf of the New York Academy of Medicine. All rights
reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (prevention)
resuscitation
EMTREE MEDICAL INDEX TERMS
adult
article
drug use
emergency health service
female
follow up
human
major clinical study
male
medical education
pilot study
priority journal
safety
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005391192
MEDLINE PMID
15872192 (http://www.ncbi.nlm.nih.gov/pubmed/15872192)
PUI
L41214946
DOI
10.1093/jurban/jti053
FULL TEXT LINK
http://dx.doi.org/10.1093/jurban/jti053
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1055
TITLE
Respiratory agents: Irritant gases, riot control agents, incapacitants, and
caustics
AUTHOR NAMES
Warden C.R.
AUTHOR ADDRESSES
(Warden C.R., wardenc@ohsu.edu) Oregon Health and Science University, UHN52,
Department of Emergency Medicine, 3181 SW Sam Jackson Park Road, Portland,
OR 97201, United States.
CORRESPONDENCE ADDRESS
C.R. Warden, Oregon Health and Science University, UHN52, Department of
Emergency Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97201,
United States. Email: wardenc@ohsu.edu
SOURCE
Critical Care Clinics (2005) 21:4 (719-737). Date of Publication: October
2005
Terrorism and Critical Care: Chemical, Biological, Radiologic, and Nuclear
Weapons, Book Series Title:
ISSN
0749-0704
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
There are many chemical respiratory agents suitable for use by terrorists.
They are the oldest chemical agents used and have caused the most casualties
throughout the 20th century. Many are available in large quantities for
industrial use and are susceptible to potential sabotage. This paper will
concentrate on respiratory agents that are readily available and have the
potential to cause a large number of casualties and panic. These agents have
a lower rate of lethality when compared to other chemical agents but could
produce many casualties that may overwhelm the emergency medical system. ©
2005 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
caustic agent (drug toxicity)
irritant agent (drug toxicity)
riot control agent (drug toxicity)
EMTREE DRUG INDEX TERMS
analgesic agent
antibiotic agent
antipruritic agent
benzodiazepine (drug toxicity, inhalational drug administration,
pharmacokinetics)
beta adrenergic receptor stimulating agent (inhalational drug
administration)
bicarbonate (inhalational drug administration)
bronchodilating agent
carfentanil (drug toxicity)
central stimulant agent
diazepam
fentanyl (drug dose, drug toxicity)
flumazenil (pharmacology)
gluconate calcium (inhalational drug administration, intraarterial drug
administration, intravenous drug administration, topical drug
administration)
halothane (drug toxicity)
hypnotic sedative agent
inotropic agent
ipratropium bromide (inhalational drug administration)
naloxone (pharmacology)
narcotic agent (drug toxicity)
opiate (drug toxicity)
physostigmine (adverse drug reaction, pharmacology)
psychedelic agent
salbutamol (inhalational drug administration)
steroid (topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
respiratory system
EMTREE MEDICAL INDEX TERMS
article
artificial ventilation
cholinergic system
diagnostic test
differential diagnosis
drug absorption
drug fatality (side effect)
drug megadose
emergency ward
first aid
hallucination
human
intensive care
lethality
paranoia
priority journal
side effect (side effect)
skin decontamination
symptomatology
terrorism
weapon
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
carfentanil (59708-52-0)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
gluconate calcium (299-28-5)
halothane (151-67-7, 66524-48-9)
ipratropium bromide (22254-24-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
physostigmine (57-47-6, 64-47-1)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005416381
MEDLINE PMID
16168311 (http://www.ncbi.nlm.nih.gov/pubmed/16168311)
PUI
L41306214
DOI
10.1016/j.ccc.2005.05.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ccc.2005.05.008
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1056
TITLE
Case of the month #105
AUTHOR NAMES
Vedd V.
Colistro R.
Nugent R.
AUTHOR ADDRESSES
(Vedd V.; Colistro R., robcolis@hotmail.com; Nugent R.) Department of
Radiology, Vancouver General Hospital, University of British Columbia,
Vancouver, BC, Canada.
(Colistro R., robcolis@hotmail.com) 306-955 West 14th Ave., Vancouver, BC
V5Z 1R3, Canada.
CORRESPONDENCE ADDRESS
R. Colistro, 306-955 West 14th Ave., Vancouver, BC V5Z 1R3, Canada. Email:
robcolis@hotmail.com
SOURCE
Canadian Association of Radiologists Journal (2005) 56:4 (251). Date of
Publication: Oct 2005
ISSN
0846-5371
0846-5371 (electronic)
EMTREE DRUG INDEX TERMS
ethylene glycol
etomidate
lidocaine
methanol
naloxone
paracetamol
salicylic acid derivative
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
computer assisted tomography
electroencephalography
neurologic examination
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical feature
diagnostic approach route
emergency ward
follow up
hospital admission
human
intensive care unit
intoxication
intubation
laboratory test
male
neuroimaging
rectal temperature
vital sign
CAS REGISTRY NUMBERS
ethylene glycol (107-21-1)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Radiology (14)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006059578
PUI
L43170007
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1057
TITLE
[Effect of the pre-hospital systematic treatment on prognosis patients of
with severe acute organophosphorus pesticide poisoning].
AUTHOR NAMES
Wang W.Z.
Li Y.Q.
Zhang J.Z.
Wang L.
Ma G.Y.
Cao S.Q.
AUTHOR ADDRESSES
(Wang W.Z.) Emergency Department, Harrison International Peace Hospital,
Hengshui, Hebei Province 053000, China.
(Li Y.Q.; Zhang J.Z.; Wang L.; Ma G.Y.; Cao S.Q.)
CORRESPONDENCE ADDRESS
W.Z. Wang, Emergency Department, Harrison International Peace Hospital,
Hengshui, Hebei Province 053000, China.
SOURCE
Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng
zhiyebing zazhi = Chinese journal of industrial hygiene and occupational
diseases (2005) 23:5 (371-373). Date of Publication: Oct 2005
ISSN
1001-9391
ABSTRACT
To investigate if the duration from poisoning to treatment (no treatment
period) is related to the prognosis of patients with severe acute
organophosphorus pesticide poisoning (SAOPP). One hundred and seventy-four
patients with the pre-hospital systematic treatment served as the treatment
group while 160 patients going to the hospital by themselves without
treatment or rejecting gastrolavage served as the control group. Patients in
both groups were treated by gastrolavage, pralidoxime chloride, atropine and
other expectant treatment. The duration of no treatment period, death, and
severe complication were observed. The time of disappearance of symptoms,
the recovery time of acetyl cholinesterase (AChE), atropinization time,
atropine dosage, pralidoxime chloride dosage, naloxone dosage,
hospitalization days and other targets were also observed. The duration of
no treatment period in treatment group [(1.2 +/- 0.3) h] was significantly
shorter than that in control group [(2.8 +/- 0.5) h, (P < 0.01)]. The
mortality rate in treatment group was 6.32% while that in control group
22.5% (P < 0.01). The incidence of respiratory failure, heart injury, brain
injury, atropine poisoning, intermediate syndrome, liver injury in treatment
group (12.64%, 5.75%, 8.62%, 1.72%, 4.60%, 5.17% respectively) were lower
than those in control group (25.63%, 13.75%, 17.50%, 6.25%, 7.50%, 9.38%
respectively, P < 0.05 or P < 0.01). The time of symptoms disappearance, the
recovery time of AChE, atropinization time, atropine dosage, pralidoxime
chloride dosage, naloxone dosage, hospitalization days in treatment group
were significantly superior to those in control group (P < 0.05 or P <
0.01). The pre-hospital systematic treatment can improve the prognosis of
the patients with SAOPP, which is worth popularizing and using.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
organophosphorus compound (drug toxicity)
pesticide (drug toxicity)
EMTREE DRUG INDEX TERMS
insecticide (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
article
case control study
female
human
male
prognosis
LANGUAGE OF ARTICLE
Chinese
MEDLINE PMID
16266519 (http://www.ncbi.nlm.nih.gov/pubmed/16266519)
PUI
L41899801
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1058
TITLE
Naloxone in opioid poisoning: Walking the tightrope
AUTHOR NAMES
Clarke S.F.J.
Dargan P.I.
Jones A.L.
AUTHOR ADDRESSES
(Clarke S.F.J., sfjclarke@doctors.org.uk) Department of Emergency Medicine,
South Manchester University Hospital Trust, Manchester, United Kingdom.
(Dargan P.I.; Jones A.L.) Department of Clinical Pharmacology, National
Poisons Information Service (London), Guy's and St Thomas' NHS Trust,
London, United Kingdom.
CORRESPONDENCE ADDRESS
S.F.J. Clarke, Department of Emergency Medicine, South Manchester University
Hospital Trust, London, United Kingdom. Email: sfjclarke@doctors.org.uk
SOURCE
Emergency Medicine Journal (2005) 22:9 (612-616). Date of Publication:
September 2005
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Acute opioid intoxication and overdose are common causes of presentation to
emergency departments. Although naloxone, a pure opioid antagonist, has been
available for many years, there is still confusion over the appropriate dose
and route of administration. This article looks at the reasons for this
uncertainty and undertakes a literature review from which a treatment
algorithm is presented.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration, pharmacokinetics,
pharmacology, subcutaneous drug administration)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
alfentanil (drug toxicity)
buprenorphine (drug toxicity)
codeine (drug toxicity)
dextromoramide (drug toxicity)
dextropropoxyphene (drug toxicity)
diamorphine (drug toxicity)
dihydrocodeine (drug toxicity)
diphenoxylate (drug toxicity)
dipipanone (drug toxicity)
fentanyl (drug toxicity)
meptazinol (drug toxicity)
methadone (drug toxicity)
morphine (drug toxicity)
nalbuphine (drug toxicity)
opiate antagonist (adverse drug reaction, drug dose, drug therapy,
intramuscular drug administration, intravenous drug administration,
pharmacokinetics, pharmacology, subcutaneous drug administration)
oxycodone (drug toxicity)
pentazocine (drug toxicity)
pethidine (drug toxicity)
phenazocine (drug toxicity)
remifentanil (drug toxicity)
tramadol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
algorithm
diarrhea (side effect)
disease exacerbation (side effect)
drug administration route
drug distribution
drug dose regimen
drug half life
drug overdose (drug therapy)
drug receptor binding
emergency ward
heart arrhythmia (side effect)
human
hypertension (side effect)
lacrimal gland disease (side effect)
lacrimation
lung edema (side effect)
medical literature
nausea (side effect)
nonhuman
priority journal
receptor occupancy
reflex disorder (side effect)
restlessness (side effect)
review
rhinorrhea (side effect)
seizure (side effect)
sleep disorder (side effect)
vomiting (side effect)
withdrawal syndrome (side effect)
yawning
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
dextromoramide (2922-44-3, 357-56-2)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
diphenoxylate (3810-80-8, 915-30-0)
dipipanone (467-83-4)
fentanyl (437-38-7)
meptazinol (54340-58-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenazocine (1239-04-9, 127-35-5)
remifentanil (132539-07-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005386743
MEDLINE PMID
16113176 (http://www.ncbi.nlm.nih.gov/pubmed/16113176)
PUI
L41200623
DOI
10.1136/emj.2003.009613
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2003.009613
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1059
TITLE
Reducing hospital presentations for opioid overdose in patients treated with
sustained release naltrexone implants
AUTHOR NAMES
Hulse G.K.
Tait R.J.
Comer S.D.
Sullivan M.A.
Jacobs I.G.
Arnold-Reed D.
AUTHOR ADDRESSES
(Hulse G.K.; Tait R.J., rjtait@cyllene.uwa.edu.au; Comer S.D.; Sullivan
M.A.; Arnold-Reed D.) School of Psychiatry and Clinical Neurosciences,
University of Western Australia, QE II Medical Centre, Nedlands, WA 6009,
Australia.
(Comer S.D.; Sullivan M.A.) Division on Substance Abuse, Department of
Psychiatry, Columbia University, New York, NY 10032, United States.
(Jacobs I.G.) Emergency Care Hospitalisation and Outcome Study, University
of Western Australia, QE II Medical Centre, Nedlands, WA 6009, Australia.
CORRESPONDENCE ADDRESS
R.J. Tait, School of Psychiatry and Clinical Neurosciences, University of
Western Australia, QE II Medical Centre, Nedlands, WA 6009, Australia.
Email: rjtait@cyllene.uwa.edu.au
SOURCE
Drug and Alcohol Dependence (2005) 79:3 (351-357). Date of Publication: 1
Sep 2005
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Background: Non-fatal overdoses represent a significant morbidity for
regular heroin users. Naltrexone is an opioid antagonist capable of blocking
the effects of heroin, thereby preventing accidental overdose. However,
treatment with oral naltrexone is often associated with non-compliance. An
alternative is the use of a sustained release preparation of naltrexone. The
aim of this study was to assess the change in number of opioid and other
drug overdoses in a large cohort of heroin dependent persons (n = 361; 218
males) before and after treatment with a sustained release naltrexone
implant. A sub-group of this cohort (n = 146; 83 males) had previously
received treatment with oral naltrexone, which also allowed a comparison of
overdoses pre- and post-oral and also post-implant treatments. Method: We
used a pre-post design, with data prospectively collected via the West
Australian Health Services Research Linked Database, and the Emergency
Department Information System. Participants were treated under the
Australian Therapeutic Goods Administration's special access guidelines.
Results: Most (336, 93%) of the cohort was in one or both databases. We
identified 21 opioid overdoses involving 20 persons in the 6 months
pre-treatment that required emergency department presentation or hospital
admission: none were observed in the 6 months post-treatment. This is
consistent with the existing pharmacokinetic data on this implant, which
indicates maintenance of blood naltrexone levels at or above 2 ng/ml for
approximately 6 months. A reduced number of opioid overdoses were also
observed 7-12 months post-implant. The study found a significant increase in
sedative "overdoses", some of which occurred in the 10 days following
implant treatment and were likely associated with opioid withdrawal and/or
implant treatment. For those previously treated with oral naltrexone, more
opioid overdoses occurred in both the 6-months prior to and after oral
compared to the 6-months post-implant treatment. Conclusions: The findings
support the clinical efficacy of this sustained release naltrexone implant
in preventing opioid overdose. However, given the high prevalence of
poly-substance use among dependent heroin users, programs offering this type
of treatment should also focus on preventing, detecting and managing
poly-substance use. © 2005 Elsevier Ireland Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naltrexone (drug concentration, drug therapy, oral drug administration,
pharmaceutics, subcutaneous drug administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
opiate addiction (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
comparative study
controlled study
data base
drug blood level
drug withdrawal
female
heroin dependence (drug therapy)
hospital admission
human
male
priority journal
prospective study
sustained drug release
CAS REGISTRY NUMBERS
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005364318
MEDLINE PMID
15899557 (http://www.ncbi.nlm.nih.gov/pubmed/15899557)
PUI
L41127163
DOI
10.1016/j.drugalcdep.2005.02.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2005.02.009
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1060
TITLE
Drugs for the doctor's bag: 1 - Adults
AUTHOR ADDRESSES
SOURCE
Drug and Therapeutics Bulletin (2005) 43:9 (65-68). Date of Publication:
September 2005
ISSN
0012-6543
BOOK PUBLISHER
Consumers' Association, 2 Marylebone Road, London, United Kingdom.
ABSTRACT
Many GPs have given up responsibility for out-of-hours services, as these
are delivered by providers commissioned by primary care trusts. However,
there is still a need for many GPs to carry a range of medicines for use in
acute situations when on home visits. The choice of what to include in the
GP's bag is determined by the medical conditions likely to be met; the
medicines the GP is confident in using; the storage requirements, shelf-life
and costs of such treatments; the extent of ambulance paramedic cover; the
proximity of the nearest hospital; and the availability of a 24-hour
pharmacy. Here we suggest a list of medicines suitable for the GP to take on
home visits for use in an emergency or for the acute treatment of adult
patients, updating our previous advice. A later article will cover treatment
for children. Whenever a medicine is first mentioned, our suggested
formulation is included in brackets. The intention is not to imply that
every doctor must carry every drug mentioned. Instead, we aim to highlight
some of the key treatments and suggest choices in some of the more common
clinical scenarios that GPs may have to deal with in everyday practice.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (drug therapy, oral drug administration)
diamorphine (drug therapy, intramuscular drug administration, intravenous
drug administration, subcutaneous drug administration)
diclofenac (drug therapy, intramuscular drug administration)
dihydrocodeine (drug therapy)
morphine (drug therapy, intramuscular drug administration, intravenous drug
administration, oral drug administration, subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
amoxicillin (drug combination, drug therapy, oral drug administration)
antiinfective agent (drug therapy, intravenous drug administration, oral
drug administration)
cefotaxime (drug therapy, intramuscular drug administration, intravenous
drug administration)
chloramphenicol (drug therapy, intravenous drug administration)
clarithromycin (drug combination, drug therapy, oral drug administration)
cyclizine (drug therapy, intramuscular drug administration, intravenous drug
administration, oral drug administration)
diazepam (oral drug administration)
domperidone (drug therapy, oral drug administration, rectal drug
administration)
erythromycin (drug combination, drug therapy, oral drug administration)
flucloxacillin (drug combination, drug therapy, oral drug administration)
hydrocortisone (drug combination, drug therapy, intravenous drug
administration)
ibuprofen (drug therapy)
ipratropium bromide (drug combination, drug therapy)
metoclopramide (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration, oral drug administration)
naloxone (intravenous drug administration)
opiate (adverse drug reaction)
paracetamol (drug therapy)
penicillin G (drug therapy, intramuscular drug administration, intravenous
drug administration)
prednisolone (drug combination, drug therapy, oral drug administration)
prochlorperazine (adverse drug reaction, drug therapy, intramuscular drug
administration, oral drug administration, rectal drug administration)
procyclidine (drug therapy, intramuscular drug administration, intravenous
drug administration)
salbutamol (drug combination, drug therapy, inhalational drug
administration)
terbutaline (drug combination, drug therapy, inhalational drug
administration)
trimethoprim (drug therapy, oral drug administration)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
general practice
EMTREE MEDICAL INDEX TERMS
adult
ambulance
article
asthma (drug therapy)
bacterial infection (drug therapy)
bacterial meningitis (drug therapy)
disease exacerbation (side effect)
drug indication
drug storage
dystonia (side effect)
emergency treatment
general practitioner
health care cost
health care delivery
heart failure
hospital
human
medical service
meningococcemia (drug therapy)
nausea and vomiting (drug therapy, etiology, side effect)
oculogyric crisis (drug therapy, side effect)
pain (drug therapy)
paramedical personnel
pharmacy
pneumonia (drug therapy)
primary medical care
professional practice
responsibility
CAS REGISTRY NUMBERS
amoxicillin (26787-78-0, 34642-77-8, 61336-70-7)
cefotaxime (63527-52-6, 64485-93-4)
chloramphenicol (134-90-7, 2787-09-9, 56-75-7)
clarithromycin (81103-11-9)
codeine (76-57-3)
cyclizine (303-25-3, 5897-18-7, 82-92-8)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
domperidone (57808-66-9)
erythromycin (114-07-8, 70536-18-4)
flucloxacillin (1847-24-1, 5250-39-5)
hydrocortisone (50-23-7)
ibuprofen (15687-27-1)
ipratropium bromide (22254-24-6)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
penicillin G (1406-05-9, 61-33-6)
prednisolone (50-24-8)
prochlorperazine (58-38-8)
procyclidine (1508-76-5, 77-37-2)
salbutamol (18559-94-9)
terbutaline (23031-25-6)
trimethoprim (738-70-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005415875
MEDLINE PMID
16175999 (http://www.ncbi.nlm.nih.gov/pubmed/16175999)
PUI
L41300878
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1061
TITLE
Pediatric emergency medicine: Legal briefs
AUTHOR NAMES
Selbst S.M.
AUTHOR ADDRESSES
(Selbst S.M., sselbst@nemours.org) Division of Emergency Medicine, A.I.
duPont Hospital for Children, Wilmington, DE 19899, United States.
(Selbst S.M., sselbst@nemours.org) Jefferson Medical College of Thomas
Jefferson University, Philadelphia, PA, United States.
CORRESPONDENCE ADDRESS
S.M. Selbst, Division of Emergency Medicine, A.I. duPont Hospital for
Children, Wilmington, DE 19899, United States. Email: sselbst@nemours.org
SOURCE
Pediatric Emergency Care (2005) 21:9 (633-636). Date of Publication:
September 2005
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
EMTREE DRUG INDEX TERMS
aciclovir (drug therapy)
antibiotic agent (drug therapy, intravenous drug administration)
diamorphine
DNA
gentamicin (drug therapy, intravenous drug administration)
ibuprofen (drug therapy)
insulin (drug therapy)
laxative
morphine
naloxone
paracetamol
piperacillin plus tazobactam (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
pediatrics
EMTREE MEDICAL INDEX TERMS
abdominal bleeding (therapy)
abdominal pain
abdominal radiography
acute hemorrhagic pancreatitis (diagnosis)
adult
alpha hemolytic Streptococcus
bleeding (complication)
blood culture
blood transfusion
case report
central nervous system infection (diagnosis, drug therapy)
child
computer assisted tomography
diabetic ketoacidosis (drug therapy)
diagnostic error
Doppler ultrasonography
epiglottitis (diagnosis)
female
foreign body (diagnosis)
herpes simplex (diagnosis)
human
infant
law suit
lumbar puncture
male
malpractice
negligence
newborn
note
nuclear magnetic resonance imaging
respiratory arrest (therapy)
resuscitation
sepsis (drug therapy)
shoulder pain
spleen injury (diagnosis, surgery)
splenectomy
Streptococcus infection (diagnosis, etiology)
testis torsion (complication, diagnosis)
toxic shock syndrome (diagnosis, etiology)
treatment refusal
urine culture
virus culture
DRUG TRADE NAMES
narcan
zosyn
CAS REGISTRY NUMBERS
DNA (9007-49-2)
aciclovir (59277-89-3)
diamorphine (1502-95-0, 561-27-3)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
ibuprofen (15687-27-1)
insulin (9004-10-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005433041
MEDLINE PMID
16160675 (http://www.ncbi.nlm.nih.gov/pubmed/16160675)
PUI
L41362228
DOI
10.1097/01.pec.0000177208.44644.54
FULL TEXT LINK
http://dx.doi.org/10.1097/01.pec.0000177208.44644.54
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1062
TITLE
A prospective epidemiological study of acute poisoning in Hong Kong
AUTHOR NAMES
Chan Y.C.
Fung H.T.
Lee C.K.
Tsui S.H.
Ngan H.K.
Sy M.Y.
Tse M.L.
Kam C.W.
Wong G.C.K.
Tong H.K.
Lit A.C.H.
Wong T.W.
Lau F.L.
AUTHOR ADDRESSES
(Chan Y.C., yctw0804@netvigator.com) United Christian Hospital, Accident and
Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.
(Fung H.T.; Kam C.W.) Tuen Mun Hospital, Accident and Emergency Department,
Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong.
(Lee C.K.) Queen Elizabeth Hospital, Accident and Emergency Department, 30
Gascoigne Road, Kowloon, Hong Kong.
(Tsui S.H.; Tong H.K.) Queen Mary Hospital, Accident and Emergency
Department, Pokfulam Road, Hong Kong, Hong Kong.
(Ngan H.K.; Lit A.C.H.) Yan Chai Hospital, Accident and Emergency
Department, Tsuen Wan, N.T., Hong Kong.
(Sy M.Y.; Wong T.W.) Pamela Youde Nethersole Eastern Hospital, Accident and
Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong.
(Wong G.C.K.) North District Hospital, Accident and Emergency Department, 9
Po Kin Road, Sheung Shui, N.T., Hong Kong.
(Tse M.L.; Lau F.L.)
CORRESPONDENCE ADDRESS
Y.C. Chan, United Christian Hospital, Accident and Emergency Department, 130
Hip Wo Street, Kwun Tong, Kowloon, Hong Kong. Email: yctw0804@netvigator.com
SOURCE
Hong Kong Journal of Emergency Medicine (2005) 12:3 (156-161). Date of
Publication: 2005
ISSN
1024-9079
ABSTRACT
Objective: To update our epidemiological knowledge of acute poisoning in
Hong Kong. Methods: A multicentred prospective study was conducted for six
months in six major accident and emergency departments in Hong Kong. A
specially designed form was used to collect demographic data, type of poison
involved, cause of poisoning, management, disposal as well as final outcome
of the poisoned patients. Results: A total of 1,467 patients (male: 588,
female: 879) were included in the study. Most of them were young adults (32%
were between 20 and 40 years old). Suicidal attempt (64%) was the most
common cause of poisoning. Notably, 379 (26%) patients took more than one
poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and
analgesics (18%) were the most commonly used drugs and paracetamol was the
commonest single ingredient involved in poisoning. Most patients were
treated with supportive measures, and about 40% and 15% of the patients were
given gastrointestinal decontamination and specific antidotes respectively
in their management, in which activated charcoal and N-acetylcysteine were
the most common. Concerning disposal from the emergency department, 91% of
the poisoned cases required in-patient management. Most patients had an
uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%)
died. Suicidal carbon monoxide poisoning was the leading cause of mortality
in our study. Conclusions: Most acute poisonings in Hong Kong were suicidal
in nature and paracetamol was the commonest agent. Activated charcoal was
the most commonly used decontamination method and most patients had an
uneventful recovery.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
acetylsalicylic acid (drug toxicity)
activated carbon (drug therapy)
analgesic agent (drug toxicity)
anticonvulsive agent (drug toxicity)
antidote (drug therapy)
bicarbonate (drug therapy)
carbon monoxide (drug toxicity)
cardiac agent (drug toxicity)
central stimulant agent (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
dextropropoxyphene (drug toxicity)
domestic chemical (drug toxicity)
flumazenil (drug therapy)
herbaceous agent (drug toxicity)
industrial toxic substance (drug toxicity)
naloxone (drug therapy)
narcotic analgesic agent (drug toxicity)
oxygen (drug therapy)
paracetamol (drug toxicity)
phytomenadione (drug therapy)
psychedelic agent (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
venom antiserum (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
carbon monoxide intoxication (drug therapy, therapy)
controlled study
death
demography
detoxification
drug intoxication (drug therapy, therapy)
emergency ward
female
Hong Kong
hospital care
human
hyperbaric oxygen therapy
information processing
major clinical study
male
mortality
prospective study
stomach lavage
suicide attempt
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
carbon monoxide (630-08-0)
dextropropoxyphene (1639-60-7, 469-62-5)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
paracetamol (103-90-2)
phytomenadione (11104-38-4, 84-80-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Chinese
EMBASE ACCESSION NUMBER
2005313864
PUI
L40975008
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1063
TITLE
Circumstances of witnessed drug overdose in New York City: Implications for
intervention
AUTHOR NAMES
Tracy M.
Piper T.M.
Ompad D.
Bucciarelli A.
Coffin P.O.
Vlahov D.
Galea S.
AUTHOR ADDRESSES
(Tracy M.; Piper T.M.; Ompad D.; Bucciarelli A.; Coffin P.O.; Vlahov D.;
Galea S., sgalea@nyam.org) Center for Urban Epidemiologic Studies, New York
Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, United States.
(Vlahov D.; Galea S., sgalea@nyam.org) Department of Epidemiology, Columbia
University, Mailman School of Public Health, New York, NY 10032, United
States.
CORRESPONDENCE ADDRESS
S. Galea, Center for Urban Epidemiologic Studies, New York Academy of
Medicine, 1216 Fifth Avenue, New York, NY 10029, United States. Email:
sgalea@nyam.org
SOURCE
Drug and Alcohol Dependence (2005) 79:2 (181-190). Date of Publication: 1
Aug 2005
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Drug users frequently witness the nonfatal and fatal drug overdoses of their
peers, but often fail to intervene effectively to reduce morbidity and
mortality. We assessed the circumstances of witnessed heroin-related
overdoses in New York City (NYC) among a predominantly minority population
of drug users. Among 1184 heroin, crack, and cocaine users interviewed
between November 2001 and February 2004, 672 (56.8%) had witnessed at least
one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%)
reported that they or someone else present called for medical help for the
overdose victim at the last witnessed overdose. In multivariable models, the
respondent never having had an overdose her/himself and the witnessed
overdose occurring in a public place were associated with the likelihood of
calling for medical help. Fear of police response was the most commonly
cited reason for not calling or delaying before calling for help (52.2%).
Attempts to revive the overdose victim through physical stimulation (e.g.,
applying ice, causing pain) were reported by 59.7% of respondents, while
first aid measures were attempted in only 11.9% of events. Efforts to equip
drug users to manage overdoses effectively, including training in first aid
and the provision of naloxone, and the reduction of police involvement at
overdose events may have a substantial impact on overdose-related morbidity
and mortality. © 2005 Elsevier Ireland Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS
cocaine
diamorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
article
cocaine dependence (epidemiology)
emergency health service
female
first aid
heroin dependence (epidemiology)
human
interview
major clinical study
male
morbidity
mortality
priority journal
stimulation
United States
witness
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005303903
MEDLINE PMID
16002027 (http://www.ncbi.nlm.nih.gov/pubmed/16002027)
PUI
L40942108
DOI
10.1016/j.drugalcdep.2005.01.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.drugalcdep.2005.01.010
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1064
TITLE
Coma - The interdisciplinary problem
ORIGINAL (NON-ENGLISH) TITLE
Problem interdyscyplinarny - Śpia̧czka
AUTHOR NAMES
Samborska-Sablik A.
Gaszyński W.
Gaszyński T.
Sablik Z.
AUTHOR ADDRESSES
(Samborska-Sablik A., kotek.lek1@poczta.fm) Zakład Medycyny Ratunkowej i
Medycyny Katastrof, Katedra Anestezjologii i Intensywnej Terapii,
Uniwersytetu Medycznego, Łodz, Poland.
(Gaszyński W.; Gaszyński T.) Zakład Anestezjologii i Intensywnej Terapii,
Katedra Anestezjologii i Intensywnej Terapii, Uniwersytetu Medycznego, Łodz,
Poland.
(Sablik Z.) Klinika Kardiologii, I Katedra Kardiologii i Kardiochirurgii,
Uniwersytetu Medycznego, Łodz, Poland.
(Samborska-Sablik A., kotek.lek1@poczta.fm) Zakład Medycyny Ratunkowej i
Medycyny Katastrof, Katedra Anestezjologii i Intensywnej Terapii,
Uniwersytet Medyczny, ul. Kopcinskiego 22, 90-153 Łodź, Poland.
CORRESPONDENCE ADDRESS
A. Samborska-Sablik, Zakład Medycyny Ratunkowej i Medycyny Katastrof,
Katedra Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny, ul.
Kopcinskiego 22, 90-153 Łodź, Poland. Email: kotek.lek1@poczta.fm
SOURCE
Polski Merkuriusz Lekarski (2005) 18:108 (703-708). Date of Publication:
2005
ISSN
1426-9686
BOOK PUBLISHER
Medpress, ul. Slonki 67, Warsaw, Poland.
ABSTRACT
5% of all patients admitted to emergency units suffer from disturbances of
state of consciousness. Early assessment/appreciation of degree of
unconsciousness and identification of its etiology influences on and
sometimes decides success of its therapy. In the article below epidemiology,
diagnosis, prognosis and main principles of procedures employed in senseless
patients are discussed.
EMTREE DRUG INDEX TERMS
diazepam (drug dose, intravenous drug administration)
flumazenil (drug dose, intravenous drug administration)
glucagon (drug dose, intravenous drug administration)
glucose (drug dose, intravenous drug administration)
lorazepam (drug dose, intravenous drug administration)
naloxone (drug dose, intravenous drug administration)
thiamine (drug dose, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (diagnosis, epidemiology, etiology)
EMTREE MEDICAL INDEX TERMS
consciousness disorder (diagnosis, epidemiology, etiology)
early diagnosis
emergency ward
human
medical decision making
prognosis
review
unconsciousness
CAS REGISTRY NUMBERS
diazepam (439-14-5)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Polish
LANGUAGE OF SUMMARY
English, Polish
EMBASE ACCESSION NUMBER
2005304301
MEDLINE PMID
16124388 (http://www.ncbi.nlm.nih.gov/pubmed/16124388)
PUI
L40942506
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1065
TITLE
Are one or two dangerous? Opioid exposure in toddlers
AUTHOR NAMES
Sachdeva D.K.
Stadnyk J.M.
AUTHOR ADDRESSES
(Sachdeva D.K.) Department of Emergency Medicine, Georgetown University,
Washington, DC, United States.
(Sachdeva D.K.) Fort Washington Hospital, Emergency Department, Fort
Washington, MD, United States.
(Stadnyk J.M.) Department of Emergency Medicine, George Washington
University, Washington, DC, United States.
(Sachdeva D.K.) Fort Washington Hospital, Emergency Department, 11711
Livingston Road, Fort Washington, MD 20744, United States.
CORRESPONDENCE ADDRESS
D.K. Sachdeva, Fort Washington Hospital, Emergency Department, 11711
Livingston Road, Fort Washington, MD 20744, United States.
SOURCE
Journal of Emergency Medicine (2005) 29:1 (77-84). Date of Publication: July
2005
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Ingestions of opioid analgesics by children may lead to significant toxicity
as a result of depression of the respiratory and central nervous systems. A
review of the medical literature was performed to determine whether low
doses of opioids are dangerous in the pediatric population under 6 years
old. Methadone was found to be the most toxic of the opioids; doses as low
as a single tablet can lead to death. All children who have ingested any
amount of methadone need to be observed in an Emergency Department (ED) for
at least 6 h and considered for hospital admission. Most other opioids are
better tolerated in ingestions as small as one or two tablets. Based on the
limited data available for these opioids, we conclude that equianalgesic
doses of 5 mg/kg of codeine or greater require 4 to 6 h of observation in
the ED. Data for propoxyphene and all extended-release preparations are
limited; their prolonged half-lives would suggest the need for longer
observation periods. All opioid ingestions leading to respiratory depression
or significant central nervous system depression require admission to an
intensive care unit. © 2005 Elsevier Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
analgesic agent (drug toxicity)
codeine (drug toxicity)
dextropropoxyphene (drug toxicity)
fentanyl (drug toxicity, transdermal drug administration)
hydrocodone (drug toxicity)
hydromorphone (drug toxicity)
methadone (drug toxicity)
morphine (drug toxicity)
naloxone (drug therapy)
oxycodone (drug toxicity)
pethidine (drug toxicity)
tramadol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug exposure
drug intoxication
drug toxicity (drug therapy)
EMTREE MEDICAL INDEX TERMS
central nervous system depression
clinical feature
emergency ward
hospital admission
human
intensive care unit
low drug dose
medical literature
pathophysiology
patient monitoring
poison center
priority journal
respiration depression
review
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005259200
MEDLINE PMID
15961014 (http://www.ncbi.nlm.nih.gov/pubmed/15961014)
PUI
L40800245
DOI
10.1016/j.jemermed.2004.12.015
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2004.12.015
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1066
TITLE
Admissions due to intoxication to the emergency unit of a third-level
hospital: Epidemiology and use of antidotes
ORIGINAL (NON-ENGLISH) TITLE
Ingresos en urgencias por intoxicación en un hospital de tercer nivel:
Epidemiología y utilización de antídotos
AUTHOR NAMES
Mercadal Orfila G.
Martorell Puigserver C.
Pastó Cardona L.
Machí Ribes J.J.
Jodar Masanés R.
AUTHOR ADDRESSES
(Mercadal Orfila G.; Martorell Puigserver C.; Pastó Cardona L.; Machí Ribes
J.J.; Jodar Masanés R.) Servicio de Farmacia, Hospital Universitario de
Bellvitge, L'Hospitalet, Barcelona, Spain.
CORRESPONDENCE ADDRESS
G. Mercadal Orfila, Servicio de Farmacia, Hospital Universitario de
Bellvitge, L'Hospitalet, Barcelona, Spain.
SOURCE
Atencion Farmaceutica (2005) 7:4 (314-318). Date of Publication: Jul 2005
ISSN
1139-7357
ABSTRACT
Objective: To study the intoxications being assisted at a third-level
hospital. Method: An observational prospective study took place during
March, 2004. Using the hospital's computer registry, the clinical reports
and the medical interview, we collected demographic data, clinical
antecedents as well as data relative to the intoxication. Results: 116
patients (55 men and 61 women) were included with an average age of 37.4
years that presented 126 entrances (prevalence of 1.2% of the total
admissions to the emergency room). Only eight cases (6.3%) required to be
admitted. 65% of intoxications were of a voluntary kind, 25% accidental and
10% of unknown origin. Benzodiazepines and alcohol were the most frequently
implicated toxic agents. In 56 cases (44.4%) it was used some type of
support treatment, symptomatologic, of decontamination and/or any antagonist
or antidote, being the decontamination ones the most used. The most used
antidotes were naloxone and flumazenile. Conclusions: The periodic
epidemiologic study of the intoxications in the hospital allows to knowing
their profile in the health area of intervention. This allows to readjusting
the offering and the supply of antidotes in the pharmacy services, as well
as the protocols for acting.
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
accident
adult
article
demography
emergency ward
female
health insurance
hospital admission
human
interview
major clinical study
male
patient
pharmacy
prevalence
register
waste management
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2005549584
PUI
L41726458
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1067
TITLE
Direct costs of opioid abuse in an insured population in the United States.
AUTHOR NAMES
White A.G.
Birnbaum H.G.
Mareva M.N.
Daher M.
Vallow S.
Schein J.
Katz N.
AUTHOR ADDRESSES
(White A.G.; Birnbaum H.G.; Mareva M.N.; Daher M.; Vallow S.; Schein J.;
Katz N.) Analysis Group, Inc., 111 Huntington Ave., 10th Fl., Boston, MA
02199, USA.
CORRESPONDENCE ADDRESS
A.G. White, Analysis Group, Inc., 111 Huntington Ave., 10th Fl., Boston, MA
02199, USA. Email: awhite@analysisgroup.com
SOURCE
Journal of managed care pharmacy : JMCP (2005) 11:6 (469-479). Date of
Publication: 2005 Jul-Aug
ISSN
1083-4087
ABSTRACT
OBJECTIVE: To (a) describe the demographics of opioid abusers; (b) compare
the prevalence rates of selected comorbidities and the medical and drug
utilization patterns of opioid abusers with patients from a control group,
for the period from 1998 to 2002; and (c) calculate the mean annual
per-patient total health care costs (e.g., inpatient, outpatient, emergency
room, drug, other) from the perspective of a private payer. METHODS: An
administrative database of medical and pharmacy claims from 1998 to 2002 of
16 self-insured employer health plans with approximately 2 million lives was
used to identify "opioid abusers"--patients with claims associated with
ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical
Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0
[excluding 965.01]). A control group of nonabusers was selected using a
matched sample (by age, gender, employment status, and census region) in a
3:1 ratio. Per-patient annual health care costs (mean total medical and drug
costs) were measured in 2003 U.S. dollars. Multivariate regression
techniques were also used to control for comorbidities and to compare costs
with a benchmark of depressed patients. RESULTS: 740 patients were
identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to
64 years continuously enrolled in health care plans for whom 12 months of
data were available for calculating costs. Opioid abusers, compared with
nonabusers, had significantly higher prevalence rates for a number of
specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or
C), psychiatric illnesses, and pancreatitis, which were approximately 78,
36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers.
Opioid abusers also had higher levels of medical and prescription drug
utilization. Almost 60% of opioid abusers had prescription drug claims for
opioids compared with approximately 20% for nonabusers. Prevalence rates for
hospital inpatient visits for opioid abusers were more than 12 times higher
compared with nonabusers (P<0.01). Mean annual direct health care costs for
opioid abusers were more than 8 times higher than for nonabusers ($15,884
versus $1,830, respectively, P < 0.01). Hospital inpatient and
physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of
opioid abusers. health care costs, compared with 17% ($310) and 50% ($906),
respectively, for nonabusers. Mean drug costs for opioid abusers were more
than 5 times higher than costs for nonabusers ($2,034 vs. $386,
respectively, P<0.01), driven by higher drug utilization (including opioids)
for opioid abusers. Even when controlling for comorbidities using a
multivariate regression model of a matched control of depressed patients,
the average health care costs of opioid abusers were 1.8 times higher than
the average health care costs of depressed patients. CONCLUSION: The high
costs of opioid abuse were driven primarily by high prevalence rates of
costly comorbidites and high utilization rates of medical services and
prescription drugs.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cost of illness
insurance
opiate addiction (epidemiology, rehabilitation)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
child
clinical trial
comparative study
controlled clinical trial
controlled study
demography
economics
female
human
male
middle aged
prevalence
randomized controlled trial
United States (epidemiology)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
15998164 (http://www.ncbi.nlm.nih.gov/pubmed/15998164)
PUI
L41470048
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1068
TITLE
Toxicological biomarkers in acute intoxications
ORIGINAL (NON-ENGLISH) TITLE
Bio marqueurs de toxicité dans les principales intoxications graves
AUTHOR NAMES
Szymanowicz A.
Danel V.
AUTHOR ADDRESSES
(Szymanowicz A., anton.szymanowicz@ch-roanne.fr) Laboratoire de Biochimie,
Centre Hospitalier de Roanne, 28, rue de Charlieu, 42328 Roanne Cedex,
France.
(Danel V.) Fédération de Toxicologie Clinique et Biologique, CHU de
Grenoble, BP 217, 38043 Grenoble Cedex 09, France.
CORRESPONDENCE ADDRESS
A. Szymanowicz, Laboratoire de Biochimie, Centre Hospitalier de Roanne, 28,
rue de Charlieu, 42328 Roanne Cedex, France. Email:
anton.szymanowicz@ch-roanne.fr
SOURCE
Immuno-Analyse et Biologie Specialisee (2005) 20:3 (144-160). Date of
Publication: June 2005
ISSN
0923-2532
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
The number of acute poisonings admitted to emergency departments increases
constantly. These add to a more and more increasing emergency activity.
There for it becomes necessary to defined in each hospital a suited
organisation depending on the means and relative frequencies of the acute
poisonings admitted. The biologist and emergency physician working together
have to set up the most appropriate strategies to the best taking charge of
patients in acute poisonings. Clinical chemistry analysis may bring deciding
in formations instead of toxic substances measurements. Today this quite
well documented approach is particularly efficient in clinical chemistry
laboratories, which don't have specific toxicological equipment. The aim of
this article is to suggest proximity procedures, which have a good
cost/benefit ratio. © 2005 Elsevier SAS. Tous droits réservés.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
biological marker
EMTREE DRUG INDEX TERMS
'carbomix'
2 propanol (drug toxicity)
4 methylpyrazole (drug therapy)
acetone (drug toxicity)
acetylcysteine (drug therapy)
activated carbon (drug therapy)
alcohol (drug therapy, drug toxicity)
alprazolam (drug toxicity)
amitriptyline
amoxapine
amphetamine (drug toxicity)
antiarrhythmic agent (drug toxicity)
anticoagulant agent (drug toxicity)
antidepressant agent (drug toxicity)
antidiabetic agent (drug toxicity)
antidote (drug therapy)
antihistaminic agent (drug toxicity)
arsenic (drug toxicity)
atropine (drug therapy)
barbituric acid derivative (drug toxicity)
benzodiazepine (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
beta adrenergic receptor stimulating agent (drug toxicity)
bromazepam (drug toxicity)
buprenorphine (drug toxicity)
calcium (drug therapy)
cannabis (drug toxicity)
carbamazepine (drug toxicity)
carbamic acid derivative (drug toxicity)
carbon monoxide (drug toxicity)
carbromal (drug toxicity)
charcoal (drug therapy)
chloroquine (drug toxicity)
citalopram
clomipramine
cocaine (drug toxicity)
colchicine (drug toxicity)
cyanuric acid (drug toxicity)
dantrolene (drug therapy)
deferoxamine (drug therapy)
desipramine
dextropropoxyphene (drug toxicity)
diazepam (drug toxicity)
digitalis (drug toxicity)
digitoxin (drug toxicity)
digoxin (drug toxicity)
digoxin antibody F(ab) fragment (drug therapy)
dimercaprol (drug therapy)
dosulepin
doxepin
edetate calcium disodium (drug therapy)
edetic acid (drug therapy)
effexort
elavyl
ethylene glycol (drug toxicity)
flumazenil (drug therapy)
flunitrazepam (drug toxicity)
fluoxetine
fluvoxamine maleate
glucagon (drug therapy)
glycol (drug toxicity)
heparin derivative (drug toxicity)
hydroxocobalamin (drug therapy)
inotropic agent
insulin (drug toxicity)
iproniazid
lactate sodium (drug therapy)
lithium (drug toxicity)
lorazepam (drug toxicity)
maprotiline (drug toxicity)
meprobamate (drug toxicity)
mercury (drug toxicity)
methadone (drug toxicity)
methanol (drug toxicity)
methotrexate (drug toxicity)
methylene blue (drug therapy)
mianserin (drug toxicity)
midomafetamine (drug toxicity)
milnacipran
mirtazapine
moclobemide
monoamine oxidase inhibitor (drug toxicity)
morphine (drug toxicity)
motival
nalorphine (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
opiate (drug toxicity)
opipramol
organophosphorus compound (drug toxicity)
paracetamol (drug toxicity)
paraquat (drug toxicity)
paroxetine
phenothiazine (drug toxicity)
phenytoin (drug toxicity)
phytomenadione (drug therapy)
pralidoxime (drug therapy)
protamine (drug therapy)
quinupramine
salicylic acid (drug toxicity)
serotonin uptake inhibitor (drug toxicity)
sertraline
sodium chloride (drug therapy)
succimer (drug therapy)
tetracycline derivative (drug toxicity)
theophylline (drug toxicity)
thiopental (drug toxicity)
tianeptine
tofranyl
toloxatone
toxic substance (drug toxicity)
toxicarb (drug therapy)
triazolam (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
trimipramine
unclassified drug
valproic acid (drug toxicity)
viloxazine
zolpidem tartrate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (disease management, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
acute toxicity
analytic method
blood toxicity
chemical analysis
clinical feature
cost benefit analysis
dosimetry
emergency medicine
emergency ward
high performance liquid chromatography
hospital admission
human
laboratory
liver toxicity
lung toxicity
measurement
metabolic acidosis
nephrotoxicity
oxygen therapy
pathophysiology
patient care
priority journal
qualitative analysis
quantitative analysis
review
standard
stomach lavage
syndrome
toxicological parameters
toxicology
DRUG TRADE NAMES
'carbomix'
anafranyl
athymil
defanyl
deroxat
digidot
effexort
elavyl
floxyfral
halcion
humoryl
insidon
ixel
kinupril
laroxyl
ludiomil
marsilid
moclamine
motival
norset
pertofran
prothiaden
prozac
quitaxon
rohypnol
seropram
sinequan
stablon
stilnox
subutex
surmontil
temesta
tofranyl
toxicarb
vivalan
zoloft
CAS REGISTRY NUMBERS
2 propanol (67-63-0)
3,4 methylenedioxymethamphetamine (42542-10-9)
4 methylpyrazole (7554-65-6)
acetone (67-64-1)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
alprazolam (28981-97-7)
amitriptyline (50-48-6, 549-18-8)
amoxapine (14028-44-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
arsenic (7440-38-2)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
bromazepam (1812-30-2)
buprenorphine (52485-79-7, 53152-21-9)
calcium (14092-94-5, 7440-70-2)
cannabis (8001-45-4, 8063-14-7)
carbamazepine (298-46-4, 8047-84-5)
carbon monoxide (630-08-0)
carbromal (77-65-6)
charcoal (16291-96-6)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
citalopram (59729-33-8)
clomipramine (17321-77-6, 303-49-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
colchicine (64-86-8)
cyanuric acid (108-80-5, 2624-17-1)
dantrolene (14663-23-1, 7261-97-4)
deferoxamine (70-51-9)
desipramine (50-47-5, 58-28-6)
dextropropoxyphene (1639-60-7, 469-62-5)
diazepam (439-14-5)
digitalis (8031-42-3, 8053-83-6)
digitoxin (71-63-6)
digoxin (20830-75-5, 57285-89-9)
dimercaprol (59-52-9)
dosulepin (113-53-1, 897-15-4)
doxepin (1229-29-4, 1668-19-5)
edetate calcium disodium (62-33-9)
edetic acid (150-43-6, 60-00-4)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
fluvoxamine maleate (61718-82-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
insulin (9004-10-8)
iproniazid (305-33-9, 54-92-2)
lactate sodium (72-17-3)
lithium (7439-93-2)
lorazepam (846-49-1)
maprotiline (10262-69-8, 10347-81-6)
meprobamate (57-53-4)
mercury (14302-87-5, 7439-97-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methanol (67-56-1)
methotrexate (15475-56-6, 59-05-2, 7413-34-5)
methylene blue (61-73-4)
mianserin (21535-47-7, 24219-97-4)
milnacipran (101152-94-7, 86181-08-0, 92623-85-3, 96847-55-1)
moclobemide (71320-77-9)
morphine (52-26-6, 57-27-2)
motival (66555-51-9)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
opipramol (315-72-0, 909-39-7)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
paroxetine (61869-08-7)
phenothiazine (92-84-2)
phenytoin (57-41-0, 630-93-3)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime (6735-59-7)
protamine (11061-43-1, 9007-31-2, 9012-00-4)
quinupramine (31721-17-2)
salicylic acid (63-36-5, 69-72-7)
sertraline (79617-96-2)
sodium chloride (7647-14-5)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiopental (71-73-8, 76-75-5)
tianeptine (66981-73-5)
toloxatone (29218-27-7)
triazolam (28911-01-5)
trimipramine (25332-13-2, 521-78-8, 739-71-9)
valproic acid (1069-66-5, 99-66-1)
viloxazine (35604-67-2, 46817-91-8)
zolpidem tartrate (99294-93-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2005262526
PUI
L40807163
DOI
10.1016/j.immbio.2005.04.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.immbio.2005.04.002
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1069
TITLE
Drug interactions - A review
AUTHOR NAMES
Manzi S.F.
Shannon M.
AUTHOR ADDRESSES
(Manzi S.F.) Emergency Department Clinical Pharmacist, Children's Hospital
Boston, 300 Longwood Ave., Boston, MA 02115, United States.
(Manzi S.F.) Northeastern University, Boston, MA 02115, United States.
(Shannon M.) Division of Emergency Medicine, Children's Hospital Boston, 300
Longwood Ave., Boston, MA 02115, United States.
(Shannon M.) Harvard Medical School, Boston, MA 02115, United States.
CORRESPONDENCE ADDRESS
S.F. Manzi, Emergency Department Clinical Pharmacist, Children's Hospital
Boston, 300 Longwood Ave., Boston, MA 02115, United States.
SOURCE
Clinical Pediatric Emergency Medicine (2005) 6:2 (93-102). Date of
Publication: Jun 2005
ISSN
1522-8401
ABSTRACT
The incidence and severity of drug interactions are on the rise as more
medications are brought to market. Following the absorption, distribution,
metabolism, and excretion model of pharmacokinetics, this review will
provide an overview of the varied mechanisms of drug-drug, drug-herb, and
drug-food interactions with emphasis placed on the interactions most likely
to cause harm. This information is intended to assist the pediatric
emergency physician in recognizing drug interactions to identify and remove
the offending agent when appropriate. Understanding the mechanisms of drug
interactions will assist all clinicians in avoiding these serious, often
preventable, events. © 2005 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
amitriptyline (pharmacology)
antacid agent (drug combination, drug interaction)
antibiotic agent (drug administration, drug combination, drug interaction,
intramuscular drug administration, intravenous drug administration,
pharmacology)
calcium (drug combination, drug interaction, drug therapy)
chlorpromazine (pharmacology)
cisapride (adverse drug reaction, drug combination, drug interaction)
clofibrate (pharmacology)
cyclosporine (drug interaction, pharmacology)
cytochrome P450 inhibitor (pharmacology)
diazepam (pharmacology)
erythromycin (drug interaction, pharmacology)
fluconazole (drug interaction, pharmacology)
flumazenil (drug therapy)
hydroxymethylglutaryl coenzyme A reductase inhibitor (drug interaction)
iron (drug combination, drug interaction)
itraconazole (drug interaction, pharmacology)
ketoconazole (drug interaction, pharmacology)
linezolid (drug interaction)
metronidazole (adverse drug reaction, drug combination, drug interaction)
monoamine oxidase inhibitor (pharmacology)
nalmefene (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug interaction)
pethidine (drug interaction)
phenytoin (drug combination, drug concentration, drug interaction,
pharmacology)
proteinase inhibitor (drug interaction, pharmacology)
ranitidine
rifampicin (drug interaction, pharmacology)
serotonin uptake inhibitor (drug interaction)
theophylline (drug interaction, pharmacology)
warfarin (drug combination, drug interaction, drug toxicity, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatrics
toxicology
EMTREE MEDICAL INDEX TERMS
disease severity
drug absorption
drug binding
drug blood level
drug distribution
drug excretion
drug fatality (side effect)
drug intoxication (drug therapy)
drug metabolism
drug overdose (drug therapy)
drug potentiation
emergency health service
food drug interaction
heart arrhythmia (side effect)
human
incidence
nausea and vomiting (side effect)
pediatrician
review
torsade des pointes (side effect)
DRUG TRADE NAMES
zantac
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
calcium (7440-70-2)
chlorpromazine (50-53-3, 69-09-0)
cisapride (81098-60-4)
clofibrate (637-07-0)
cyclosporin (79217-60-0)
diazepam (439-14-5)
erythromycin (114-07-8, 70536-18-4)
fluconazole (86386-73-4)
flumazenil (78755-81-4)
iron (14093-02-8, 53858-86-9, 7439-89-6)
itraconazole (84625-61-6)
ketoconazole (65277-42-1)
linezolid (165800-03-3)
metronidazole (39322-38-8, 443-48-1)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenytoin (57-41-0, 630-93-3)
proteinase inhibitor (37205-61-1)
ranitidine (66357-35-5, 66357-59-3)
rifampicin (13292-46-1)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005299990
PUI
L40932003
DOI
10.1016/j.cpem.2005.04.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cpem.2005.04.006
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1070
TITLE
International EMS: Austria
AUTHOR NAMES
Weninger P.
Hertz H.
Mauritz W.
AUTHOR ADDRESSES
(Weninger P.; Hertz H.) Trauma Surgery, Trauma Hospital Lorenz Boehler,
Vienna, Austria.
(Mauritz W., walter.mauritz@auva.at) Department of Anaesthesia and Critical
Care Medicine, Trauma Hospital Lorenz Boehler, Donaueschingenstrasse 13,
A-1200 Vienna, Austria.
CORRESPONDENCE ADDRESS
W. Mauritz, Department of Anaesthesia and Critical Care Medicine, Trauma
Hospital Lorenz Boehler, Donaueschingenstrasse 13, A-1200 Vienna, Austria.
Email: walter.mauritz@auva.at
SOURCE
Resuscitation (2005) 65:3 (249-254). Date of Publication: June 2005
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
EMTREE DRUG INDEX TERMS
4 dimethylaminophenol
acetylsalicylic acid
activated carbon
adenosine
ajmaline (drug dose)
alcuronium
alteplase (drug dose)
atracurium besilate (drug dose)
atropine (drug dose)
beclometasone
bicarbonate
budesonide
diazepam
dipyrone (drug dose)
dobutamine (drug dose)
dopamine (drug dose)
droperidol
epinephrine (drug dose)
esmolol (drug dose)
etilefrine
etomidate
fenoterol
fentanyl (drug dose)
flumazenil (drug dose)
furosemide (drug dose)
gluconate calcium
glyceryl trinitrate
haloperidol
hexoprenaline (drug dose)
ketamine (drug dose)
lidocaine
methylergometrine
methylprednisolone (drug dose)
metildigoxin
metoclopramide
midazolam (drug dose)
mivacurium (drug dose)
morphine
nalbuphine (drug dose)
naloxone
nifedipine (drug dose)
noradrenalin (drug dose)
ondansetron (drug dose)
orciprenaline (drug dose)
oxytocin (drug dose)
pancuronium
paracetamol (drug dose)
pethidine (drug dose)
phenytoin
physostigmine
piritramide
prednisolone (drug dose)
promethazine
propofol (drug dose)
reteplase
rocuronium (drug dose)
scopolamine butyl bromide
sodium thiosulfate
suxamethonium
terbutaline
theophylline
thiopental (drug dose)
tramadol (drug dose)
urapidil (drug dose)
urokinase (drug dose)
vecuronium (drug dose)
verapamil (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
Austria
emergency medicine
financial management
geography
health care cost
health insurance
human
patient transport
priority journal
review
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
ajmaline (4360-12-7, 73089-81-3)
alcuronium (15180-03-7, 23214-96-2)
alteplase (105857-23-6)
atracurium (64228-79-1)
atropine (51-55-8, 55-48-1)
beclometasone (4419-39-0)
bicarbonate (144-55-8, 71-52-3)
budesonide (51333-22-3)
diazepam (439-14-5)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
droperidol (548-73-2)
esmolol (81147-92-4, 81161-17-3)
etilefrine (10128-36-6, 534-87-2, 709-55-7, 943-17-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fenoterol (13392-18-2, 1944-12-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
furosemide (54-31-9)
gluconate calcium (299-28-5)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
hexoprenaline (3215-70-1, 32266-10-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methylergometrine (113-42-8)
methylprednisolone (6923-42-8, 83-43-2)
metildigoxin (30685-43-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
mivacurium (106791-40-6, 106861-44-3)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
noradrenalin (1407-84-7, 51-41-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
orciprenaline (586-06-1, 5874-97-5)
oxytocin (50-56-6, 54577-94-5)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
piritramide (302-41-0)
prednisolone (50-24-8)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
reteplase (133652-38-7)
rocuronium (119302-91-9)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
suxamethonium (306-40-1, 71-27-2)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiopental (71-73-8, 76-75-5)
tramadol (27203-92-5, 36282-47-0)
urapidil (34661-75-1)
urokinase (139639-24-0)
vecuronium (50700-72-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005251774
MEDLINE PMID
15919560 (http://www.ncbi.nlm.nih.gov/pubmed/15919560)
PUI
L40779333
DOI
10.1016/j.resuscitation.2005.03.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2005.03.006
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1071
TITLE
Acute poisoning - Clinical aspects for the practicing physician
ORIGINAL (NON-ENGLISH) TITLE
Vergiftungen und drogennotfall in der praxis
AUTHOR NAMES
Kohler H.P.
Nohl F.
AUTHOR ADDRESSES
(Kohler H.P., hanspeter.kohler@insel.ch; Nohl F.) Notfallzentrum,
Inselspital, CH-3010 Bern, Switzerland.
CORRESPONDENCE ADDRESS
H.P. Kohler, Notfallzentrum, Inselspital, CH-3010 Bern, Switzerland. Email:
hanspeter.kohler@insel.ch
SOURCE
Therapeutische Umschau (2005) 62:6 (405-411). Date of Publication: June 2005
ISSN
0040-5930
BOOK PUBLISHER
Verlag Hans Huber AG, Langgassstrasse 76, Bern, Switzerland.
ABSTRACT
Intoxicated patients make up 5-10% of all patients seen at emergency
departments. The management of these patients is not always simple. Many of
them are seen after ingestions of relatively non-toxic substances that
require minimal medical care, intentional poisoning however often requires
the highest standards of medical and nursing care and therefore the
admission to an emergency department is mandatory. At admission, the
involved substances are often not known since some of the patients are
comatose. In such cases, the information from relatives and friends can be
very crucial but to get hold of these sometimes essential "hints" is not
always easy. Knowledge of the specific toxic agent allows the physician to
plan a rational approach to the definitive management of the intoxicated
patient after the vital functions have been stabilised. In some cases, very
rare intoxications but with typical clinical signs do occur (e.g scromboid
fish poisoning, coprinus-syndrome), which needs special diagnostic and
therapeutic steps and a great deal of clinical experience. In most cases it
is preferable to contact the Poison Control Center for additional advice. ©
2005 by Verlag Hans Huber.
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
acetylcysteine (drug therapy)
antidote (drug therapy)
flumazenil (drug therapy)
lysergide (drug toxicity)
midomafetamine (drug toxicity)
naloxone (drug therapy, intravenous drug administration)
psychedelic agent (drug toxicity)
toxic substance (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
clinical practice
coma
Coprinus
drug intoxication (drug therapy)
emergency ward
fish
friend
hospital admission
human
ingestion
nursing
poison center
relative
review
syndrome
treatment planning
DRUG TRADE NAMES
anexate
fluimucil
narcan
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 hydroxybutyric acid (591-81-1)
acetylcysteine (616-91-1)
flumazenil (78755-81-4)
lysergide (50-37-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2005286192
MEDLINE PMID
15999939 (http://www.ncbi.nlm.nih.gov/pubmed/15999939)
PUI
L40883084
DOI
10.1024/0040-5930.62.6.405
FULL TEXT LINK
http://dx.doi.org/10.1024/0040-5930.62.6.405
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1072
TITLE
The ABC of community emergency care. 14 Assessment and management of
neurological problems (1)
AUTHOR NAMES
Gray J.T.
Gavin C.M.
AUTHOR ADDRESSES
(Gray J.T.; Gavin C.M., carole.gavin@srht.nhs.uk) Hope Hospital, Salford M6
8HD, United Kingdom.
CORRESPONDENCE ADDRESS
C.M. Gavin, Department of Emergency Medicine, Hope Hospital, Salford M6 8HD,
United Kingdom. Email: carole.gavin@srht.nhs.uk
SOURCE
Emergency Medicine Journal (2005) 22:6 (440-445). Date of Publication: June
2005
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Neurological emergencies are seen relatively common by the community
practitioner and require careful assessment in order to identify potential
serious pathology. Headache presents a particular diagnostic challenge and a
good history and examination is vital to avoid missing potentially
life-threatening conditions such as subarachnoid haemorrhage. This article
aims to provide a system to guide assessment and management, however, it is
clear that in most cases patients will require secondary care assessment.
Neurological conditions are extremely frightening for both patients and
carers who often fear they may be having a stroke or brain tumour, therefore
reassurance and support is a crucial part of the primary care professionals
role.
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
antibiotic agent (drug therapy)
antiemetic agent (drug combination, drug therapy)
antiinflammatory agent (drug combination, drug therapy)
antimigraine agent (drug therapy)
benzodiazepine derivative (drug toxicity)
carbon monoxide (drug toxicity)
cephalosporin (drug therapy, intramuscular drug administration)
diazepam (drug therapy, intravenous drug administration, rectal drug
administration)
diclofenac (drug combination, drug therapy)
glucagon (drug therapy, intramuscular drug administration)
glucose (endogenous compound)
lorazepam (drug therapy)
metoclopramide (drug combination, drug therapy)
midazolam (buccal drug administration, drug therapy)
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration)
opiate (drug toxicity)
penicillin G (drug therapy, intravenous drug administration)
sumatriptan (drug therapy)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neurologic disease (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
airway obstruction
anamnesis
article
brain tumor (diagnosis)
breathing rate
cerebrovascular accident (diagnosis)
cerebrovascular disease (diagnosis)
clinical examination
computer assisted tomography
diagnostic error
disease severity
drug intoxication (diagnosis)
emergency medicine
encephalitis (diagnosis)
epilepsy (diagnosis, drug therapy)
general practitioner
Glasgow coma scale
head injury (diagnosis)
headache
human
hypoglycemia (complication, drug therapy)
hypothermia (diagnosis)
interpersonal communication
medical assessment
meningitis (diagnosis, drug therapy)
mental health
migraine (drug therapy)
neck pain
neurologic examination
nonketotic diabetic coma (complication, diagnosis)
oxygen saturation
palpation
patient attitude
patient care
patient referral
physician attitude
primary medical care
priority journal
pulse rate
respiratory tract examination
sepsis (diagnosis)
speech discrimination
subarachnoid hemorrhage (diagnosis)
subdural hematoma (diagnosis)
systolic blood pressure
treatment planning
unconsciousness
visual system examination
CAS REGISTRY NUMBERS
alcohol (64-17-5)
carbon monoxide (630-08-0)
cephalosporin (11111-12-9)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
lorazepam (846-49-1)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
penicillin G (1406-05-9, 61-33-6)
sumatriptan (103628-46-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Endocrinology (3)
Radiology (14)
Drug Literature Index (37)
Epilepsy Abstracts (50)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005251493
MEDLINE PMID
15911958 (http://www.ncbi.nlm.nih.gov/pubmed/15911958)
PUI
L40779002
DOI
10.1136/emj.2005.026658
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2005.026658
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1073
TITLE
Refining emergency severity index triage criteria
AUTHOR NAMES
Tanabe P.
Travers D.
Gilboy N.
Rosenau A.
Sierzega G.
Rupp V.
Martinovich Z.
Adams J.G.
AUTHOR ADDRESSES
(Tanabe P., p-tanabe@northwestern.edu; Adams J.G.) Department of Emergency
Medicine, Chicago, IL, United States.
(Tanabe P., p-tanabe@northwestern.edu) Institute for Health Services
Research and Policy Studies, Chicago, IL, United States.
(Martinovich Z.) Northwestern University, Chicago, IL, United States.
(Travers D.) Department of Emergency Medicine, University of North Carolina,
Chapel Hill, NC, United States.
(Gilboy N.) Emergency Department, Brigham and Women's Hospital, Boston, MA,
United States.
(Rosenau A.; Sierzega G.; Rupp V.) Department of Emergency Medicine, Lehigh
Valley Hospital and Health Network, Allentown, PA, United States.
(Martinovich Z.) Department of Psychiatry, Mental Health Services and Policy
Program, Northwestern University Medical School, Chicago, IL, United States.
(Tanabe P., p-tanabe@northwestern.edu) 417 S. Jefferson, #408, Chicago, IL
60607, United States.
CORRESPONDENCE ADDRESS
P. Tanabe, 417 S. Jefferson, #408, Chicago, IL 60607, United States. Email:
p-tanabe@northwestern.edu
SOURCE
Academic Emergency Medicine (2005) 12:6 (497-501). Date of Publication: June
2005
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: The Emergency Severity Index (ESI) version 3 is a five-level
triage acuity scale with demonstrated reliability and validity. Patients are
rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity).
Clinical experience has demonstrated two levels of ESI level 2 patients:
those who require immediate intervention and those who are stable to wait
for at least ten minutes. Studies have found that few patients are rated ESI
level 1, and it has been suggested that revisions to the ESI might result in
appropriate reclassification of some sickest level 2 patients as level 1.
The purpose of this study was to identify level 2 patients who might be
reclassified as level 1 patients. Methods: This was a multisite, prospective
study. The authors identified ESI level 2 patients who required immediate,
lifesaving intervention and calculated chi-square statistics and odds ratios
for variables that predicted which ESI level 2 patients actually received
immediate intervention. Results: Immediate lifesaving interventions were
provided for 117 (20.2%) of the 589 patients included in the study.
Seventeen predictors of the need for immediate intervention were identified.
The strongest predictor was the triage nurse's judgment of the need for
immediate intervention, especially airway and medications. Conclusions:
Specific clinical findings at triage for a subset of ESI level 2 patients
were associated with immediate delivery of lifesaving interventions.
Revisions to the ESI level 1 criteria may be beneficial.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
adenosine
charcoal
diphenhydramine
famotidine
fentanyl
furosemide
glyceryl trinitrate
heparin
hydromorphone
labetalol
lorazepam
methylprednisolone
metoprolol
morphine
naloxone
phenobarbital
phenytoin
prednisone
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
emergency severity index
scoring system
EMTREE MEDICAL INDEX TERMS
adult
aged
airway dynamics
article
artificial ventilation
calculation
chi square test
clinical practice
confidence interval
controlled study
disease classification
disease severity
emergency medicine
female
heart hemodynamics
human
major clinical study
male
medical decision making
nebulization
nurse
prediction
priority journal
process development
prospective study
respiratory tract intubation
risk assessment
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adenosine (58-61-7)
charcoal (16291-96-6)
diphenhydramine (147-24-0, 58-73-1)
famotidine (76824-35-6)
fentanyl (437-38-7)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydromorphone (466-99-9, 71-68-1)
labetalol (32780-64-6, 36894-69-6)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
metoprolol (37350-58-6)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
prednisone (53-03-2)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005237676
MEDLINE PMID
15930399 (http://www.ncbi.nlm.nih.gov/pubmed/15930399)
PUI
L40732331
DOI
10.1197/j.aem.2004.12.015
FULL TEXT LINK
http://dx.doi.org/10.1197/j.aem.2004.12.015
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1074
TITLE
Transdermal patches: An unseen risk for harm
AUTHOR NAMES
Paparella S.
AUTHOR ADDRESSES
(Paparella S., spaparella@ismp.org) Consulting Services, Institute for Safe
Medication Practices, Huntingdon Valley, PA, United States.
(Paparella S., spaparella@ismp.org) ENA's ED Safety Workgroup, United
States.
(Paparella S., spaparella@ismp.org) 1800 Byberry Rd., Huntingdon Valley, PA
19006, United States.
CORRESPONDENCE ADDRESS
S. Paparella, 1800 Byberry Rd, Huntingdon Valley, PA 19006, United States.
Email: spaparella@ismp.org
SOURCE
Journal of Emergency Nursing (2005) 31:3 (278-281). Date of Publication:
June 2005
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS
clonidine (drug administration, drug therapy, pharmaceutics, transdermal
drug administration)
fentanyl (drug administration, drug therapy, transdermal drug
administration)
glyceryl trinitrate (adverse drug reaction, drug administration, transdermal
drug administration)
naloxone
nicotine (adverse drug reaction, drug administration, transdermal drug
administration)
scopolamine (drug administration, transdermal drug administration)
testosterone (drug administration, transdermal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
medication error
transdermal patch
EMTREE MEDICAL INDEX TERMS
article
burn (side effect)
chronic disease
drug information
drug misuse
drug nomenclature
drug packaging
drug safety
emergency ward
human
hypertension (drug therapy)
pain (drug therapy)
patient compliance
DRUG TRADE NAMES
androderm
catapres tts
deponit
duragesic Janssen
nicotrol
nitro dur
transderm scop
DRUG MANUFACTURERS
Janssen
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
fentanyl (437-38-7)
glyceryl trinitrate (55-63-0)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
scopolamine (138-12-5, 51-34-3, 55-16-3)
testosterone (58-22-0)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
15983583 (http://www.ncbi.nlm.nih.gov/pubmed/15983583)
PUI
L40862425
DOI
10.1016/j.jen.2005.01.010
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2005.01.010
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1075
TITLE
Pharmacotherapeutic guideline of the Dutch College of General Practitioners:
Drugs for emergency situations
ORIGINAL (NON-ENGLISH) TITLE
NHG-farmacotherapeutische richtlijn: Geneesmiddelen in spoedeisende
situaties
AUTHOR NAMES
Draijer L.W.
Kolnaar B.G.M.
Bouma M.
Eizenga W.H.
AUTHOR ADDRESSES
(Draijer L.W.; Kolnaar B.G.M.; Bouma M.; Eizenga W.H.)
SOURCE
Huisarts en Wetenschap (2005) 48:6 (295-303). Date of Publication: 2 May
2005
ISSN
0018-7070
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anticonvulsive agent (drug therapy)
antihistaminic agent (drug therapy)
cardiovascular agent (drug therapy)
neuroleptic agent (drug therapy)
respiratory tract agent (drug therapy, inhalational drug administration)
EMTREE DRUG INDEX TERMS
atropine (drug therapy, intravenous drug administration)
biperiden (drug therapy, intramuscular drug administration)
carbasalate calcium (drug therapy)
chlordiazepoxide (drug therapy)
clemastine (drug therapy, intramuscular drug administration)
clorazepate (drug therapy, intramuscular drug administration)
coumarin derivative (drug therapy)
dexamethasone (drug therapy, intramuscular drug administration)
diazepam (drug therapy, intravenous drug administration, rectal drug
administration)
diclofenac (drug therapy, intramuscular drug administration, subcutaneous
drug administration)
droperidol plus fentanyl (drug therapy)
epinephrine (drug therapy, intramuscular drug administration, intravenous
drug administration)
ergometrine (drug therapy)
fentanyl (drug therapy, intramuscular drug administration, intravenous drug
administration)
furosemide (drug therapy, intravenous drug administration)
glucagon (drug therapy)
glucose (drug therapy)
glyceryl trinitrate (drug therapy)
haloperidol (drug therapy, intramuscular drug administration)
ipratropium bromide (drug therapy)
isosorbide dinitrate (drug therapy)
lidocaine (drug therapy)
lorazepam (drug therapy)
methadone (drug therapy)
metoclopramide (drug therapy)
midazolam (drug therapy, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
morphine (drug therapy, intramuscular drug administration, intravenous drug
administration)
naloxone (drug therapy, intravenous drug administration)
opiate (drug toxicity)
oxazepam (drug therapy)
oxytocin (drug therapy, intramuscular drug administration, intravenous drug
administration)
promethazine (drug therapy)
salbutamol (drug therapy, inhalational drug administration)
scopolamine butyl bromide (drug therapy, intramuscular drug administration,
intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug utilization
emergency treatment
general practitioner
EMTREE MEDICAL INDEX TERMS
acute heart failure (drug therapy)
acute psychosis (drug therapy)
anaphylaxis (drug therapy)
asthma (drug therapy)
bradycardia (drug therapy)
chronic obstructive lung disease (drug therapy)
convulsion (drug therapy)
drug contraindication
drug indication
dyspnea (drug therapy)
dystonia (drug therapy)
epilepsy (drug therapy)
heart muscle ischemia (drug therapy)
human
hypoglycemia (drug therapy)
hypotension (drug therapy)
intoxication (drug therapy, etiology)
medical society
Netherlands
pain (drug therapy)
postpartum hemorrhage (drug therapy)
practice guideline
review
urticaria (drug therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
carbasalate calcium (3063-60-3, 5749-67-7)
chlordiazepoxide (438-41-5, 58-25-3)
clemastine (15686-51-8)
clorazepate (20432-69-3, 23887-31-2)
dexamethasone (50-02-2)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
droperidol plus fentanyl (8004-27-1, 8067-59-2)
ergometrine (60-79-7)
fentanyl (437-38-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
ipratropium bromide (22254-24-6)
isosorbide dinitrate (87-33-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
oxytocin (50-56-6, 54577-94-5)
promethazine (58-33-3, 60-87-7)
salbutamol (18559-94-9)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
Dutch
EMBASE ACCESSION NUMBER
2005270642
PUI
L40834476
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1076
TITLE
Opioid analgesia and assessment of the sonographic Murphy sign
AUTHOR NAMES
Nelson B.P.
Senecal E.L.
Hong C.
Ptak T.
Thomas S.H.
AUTHOR ADDRESSES
(Nelson B.P.; Senecal E.L.; Thomas S.H.) Div. Emergency Med. Harvard A.,
Harvard Medical School, Boston, MA, United States.
(Hong C.; Thomas S.H.) Department of Emergency Services, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States.
(Ptak T.) Department of Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States.
(Thomas S.H.) Department of Emergency Services, Massachusetts General
Hospital, Clinics Building, 55 Fruit Street, Boston, MA 02114, United
States.
CORRESPONDENCE ADDRESS
S.H. Thomas, Department of Emergency Services, Massachusetts General
Hospital, Clinics Building, 55 Fruit Street, Boston, MA 02114, United
States.
SOURCE
Journal of Emergency Medicine (2005) 28:4 (409-413). Date of Publication:
May 2005
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Administration of intravenous opioid analgesia to patients with
undifferentiated abdominal pain remains a controversial topic in many
emergency departments. To determine whether opioid analgesia impacts
assessment of the sonographic Murphy sign (SM) in evaluating acute
gallbladder disease (GBD), a retrospective chart review was undertaken. The
chart review encompassed 119 patients, 21% of whom, having received opioid
analgesia before ultrasound, constituted the opioid group. Between the
opioid and control (i.e., no opioid analgesia) groups, there were no
significant differences in SM sensitivity (48.2%; CI 28.7-68.1% vs. 68.8%;
CI 41.3-89%, respectively) or specificity (92.5%; CI 83.4-97.5% vs. 88.9%;
CI 51.8-99.7%, respectively) for GBD. There was no association between
opioid analgesia and false-positive SM (OR 0.74, CI 0.08-6.65), or
false-negative SM (OR 1.42, CI 0.46-4.43). We conclude that the test
characteristics of SM are unaffected by opioid analgesia. © 2005 Elsevier
Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
analgesic agent (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
clinical feature
gallbladder disease (diagnosis)
side effect (side effect)
sonographic murphy sign (side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adult
article
clinical article
controlled study
diagnostic accuracy
disease marker
echography
female
human
male
medical record
priority journal
retrospective study
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005174941
MEDLINE PMID
15837021 (http://www.ncbi.nlm.nih.gov/pubmed/15837021)
PUI
L40523688
DOI
10.1016/j.jemermed.2004.12.009
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jemermed.2004.12.009
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1077
TITLE
Nurse-initiated, titrated intravenous opioid analgesia reduces time to
analgesia for selected painful conditions
AUTHOR NAMES
Kelly A.M.
Brumby C.
Barnes C.
AUTHOR ADDRESSES
(Kelly A.M., anne-maree.kelly@wh.org.au) Joseph Epstein Centre for Emergency
Medicine Research, Western Hospital, Melbourne, Vic., Australia.
(Kelly A.M., anne-maree.kelly@wh.org.au) Department of Medicine, University
of Melbourne, Melbourne, Vic., Australia.
(Brumby C.) Advanced Medical Science Program, University of Melbourne,
Melbourne, Vic., Australia.
(Barnes C.) Department of Emergency Medicine, Western Hospital, Melbourne,
Vic., Australia.
(Kelly A.M., anne-maree.kelly@wh.org.au) Department of Emergency Medicine,
Western Hospital, Footscray 3011, Private Bag, Melbourne, Vic., Australia.
CORRESPONDENCE ADDRESS
A.M. Kelly, Department of Emergency Medicine, Western Hospital, Footscray
3011, Private Bag, Melbourne, Vic., Australia. Email:
anne-maree.kelly@wh.org.au
SOURCE
Canadian Journal of Emergency Medicine (2005) 7:3 (149-154). Date of
Publication: May 2005
ISSN
1481-8035
1481-8035 (electronic)
ABSTRACT
Objectives: Traditionally, patients have to wait until assessed by a
physician for opioid analgesia to be administered, which contributes to
delays to analgesia. Western Hospital developed a protocol enabling nurses
to initiate opioid analgesia prior to medical assessment for selected
conditions. The aim of this study was to determine the impact of this
protocol on time to first opioid dose in patients presenting to the
emergency department (ED) with renal or biliary colic. Methods: This was an
explicit medical record review of all adult patients with an ED discharge
diagnosis of renal or biliary colic presenting to a metropolitan teaching
hospital ED. Patients were identified via the ED data management system.
Data collected included demographics, condition, triage category, time of
presentation, whether analgesia was nurse-initiated or not, and interval
from arrival to first opioid analgesic dose. The narcotic drug register for
the relevant period was also searched to cross-check whether opiates were
doctor-or nurse-initiated. Results: There were 58 presentations in the
nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated
analgesia group. Groups were reasonably well matched for gender, triage
category and time of presentation, but there was a higher proportion of
biliary colic in the non-nurse-initiated analgesia group. Median time to
first analgesic dose was 31 minutes in the nurse-initiated group and 57
minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes;
95% confidence interval 16-36 min; p < 0.0001]. There were no major adverse
events in either group. Conclusion: A nurse-initiated opioid analgesia
protocol reduces delays to opioid analgesia for patients with renal and
biliary colic.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
narcotic agent
EMTREE MEDICAL INDEX TERMS
analgesia
biliary colic
cholelithiasis
demography
emergency health service
human
kidney colic
medical record
nurse attitude
nursing staff
pain (drug therapy)
review
titrimetry
urolithiasis
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2005529495
PUI
L41670455
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1078
TITLE
Prehospital management of spinal cord injuries
ORIGINAL (NON-ENGLISH) TITLE
Präklinisches management von rückenmarkverletzungen
AUTHOR NAMES
Bernhard M.
Gries A.
Kremer P.
Martin-Villalba A.
Böttiger B.W.
AUTHOR ADDRESSES
(Bernhard M., Michael.Bernhard@med.uni-heidelberg.de; Gries A.; Böttiger
B.W.) Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Germany.
(Gries A.) Deutsche Rettungsflugwacht, Luftrettungszentrum Christoph 53,
Mannheim, Germany.
(Kremer P.) Neurochirurgische Klinik, Universitätsklinikum Heidelberg,
Germany.
(Martin-Villalba A.) Deutsches Krebsforschungszentrum, Heidelberg, Germany.
(Bernhard M., Michael.Bernhard@med.uni-heidelberg.de) Klinik für
Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110,
69120 Heidelberg, Germany.
CORRESPONDENCE ADDRESS
M. Bernhard, Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg,
Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Email:
Michael.Bernhard@med.uni-heidelberg.de
SOURCE
Anaesthesist (2005) 54:4 (357-376). Date of Publication: April 2005
ISSN
0003-2417
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
In both the United States and Europe about 10,000 patients suffer from
spinal cord injury (SCI) each year and 20% die before being admitted to
hospital. Prehospital management of SCI is very important since 25% of SCI
damage may occur after the initial event. Emergency treatment includes
examination of the patient, spinal immobilization, careful airway
management, cardiovascular stabilization (maintenance of mean arterial blood
pressure above 90 mmHg) and glucose levels within the normal range. From an
evidence-based point of view, it is still not known whether additional
specific therapy is useful and studies have not convincingly demonstrated
that methylprednisolone (MPS) or other substances have clinically important
benefits. Recently published statements from the US do not support the
therapeutic use of MPS in patients suffering from SCI in the prehospital
setting. Moreover, it is not known whether hypothermia or any other
pharmacological interventions have beneficial effects. Networks for clinical
studies in SCI patients should be established as a basic requirement for
further improvement in outcome in these patients. © Springer Medizin Verlag
2005.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methylprednisolone (adverse drug reaction, clinical trial, drug comparison,
drug therapy, intravenous drug administration, pharmacology)
EMTREE DRUG INDEX TERMS
agmatine
alpha tocopherol (drug therapy, pharmacology)
calcium channel blocking agent (drug therapy, pharmacology)
corticosteroid
dextran (drug therapy, pharmacology)
dimethyl sulfoxide (drug therapy, pharmacology)
erythropoietin
ganglioside GM1 (drug therapy, pharmacology)
glucocorticoid (drug therapy)
glycerol (drug therapy, pharmacology)
inosine
leteprinim
mannitol (drug therapy, pharmacology)
naloxone (clinical trial, drug comparison, drug therapy, intravenous drug
administration, pharmacology)
opiate antagonist (drug therapy, pharmacology)
protirelin (drug therapy, pharmacology)
thromboxane receptor blocking agent (drug therapy, pharmacology)
tirilazad (drug comparison, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
spinal cord injury (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
arterial pressure
cerebrovascular accident (side effect)
clinical trial
emergency treatment
fluid therapy
glucose blood level
hematemesis (side effect)
human
hypotension
hypothermia
hypovolemia
intubation
melena (side effect)
motor performance
nervous system injury (drug therapy)
neurologic disease
neuroprotection
pathophysiology
pneumonia (side effect)
review
risk assessment
treatment outcome
wound infection (side effect)
CAS REGISTRY NUMBERS
agmatine (306-60-5)
alpha tocopherol (1406-18-4, 1406-70-8, 52225-20-4, 58-95-7, 59-02-9)
dextran (87915-38-6, 9014-78-2)
dimethyl sulfoxide (67-68-5)
erythropoietin (11096-26-7)
ganglioside GM1 (37758-47-7)
glycerol (56-81-5)
inosine (58-63-9)
leteprinim (138117-50-7, 192564-13-9)
mannitol (69-65-8, 87-78-5)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
protirelin (24305-27-9)
tirilazad (110101-66-1, 110101-67-2, 111793-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2005231789
MEDLINE PMID
15682329 (http://www.ncbi.nlm.nih.gov/pubmed/15682329)
PUI
L40718838
DOI
10.1007/s00101-005-0807-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s00101-005-0807-4
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1079
TITLE
Emergency medical services in Zimbabwe
AUTHOR NAMES
Thomson N.
AUTHOR ADDRESSES
(Thomson N., dr.n.thomson@btopenworld.com) City Harare Fire Brigade A.,
Harare, Zimbabwe.
(Thomson N., dr.n.thomson@btopenworld.com) London Ambulance Service NHS
Trust, United Kingdom.
(Thomson N., dr.n.thomson@btopenworld.com) Accident and Emergency
Department, Charing Cross Hospital, London, United Kingdom.
CORRESPONDENCE ADDRESS
N. Thomson, City Harare Fire Brigade A., Harare, Zimbabwe. Email:
dr.n.thomson@btopenworld.com
SOURCE
Resuscitation (2005) 65:1 (15-19). Date of Publication: April 2005
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Emergency medical services in Zimbabwe are of a very variable standard, and
exist in many forms: • Reasonably well-developed urban emergency medical
services systems mixed with very poorly resourced and under-developed rural
services. • Very high patient workloads, with severely ill medical patients
and a large proportion of major trauma and multiple-casualty situations
(public safety is given a low priority, and public transport is poorly
regulated). • Long emergency response times and patient transport distances.
• Somewhat under resourced and under developed emergency departments, with
large numbers of critically ill acute patients, as well as many
non-emergency/chronic patients who have no other access to appropriate
health care. This paper provides a description of the development of
ambulance services and acute health care in Zimbabwe, and outline the
current demands on the system. Particular reference is made to the City of
Harare Ambulance Service, which is considered to be the most developed of
the local authority services. © 2005 Elsevier Ireland Ltd. All rights
reserved.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
activated carbon (oral drug administration)
amiodarone
atropine
diazepam
etomidate
glucose
infusion fluid
lidocaine
midazolam
nalbuphine
naloxone (intravenous drug administration)
nitrous oxide plus oxygen
salbutamol
suxamethonium
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
accident
agriculture
ambulance
authority
city
disease severity
emergency ward
government
health care access
health care personnel
health care planning
hospital care
hospital service
human
incidence
injury
law
mining
priority journal
profit
response time
review
rural area
safety
staff training
standard
urban area
welfare
workload
Zimbabwe
DRUG TRADE NAMES
aspirin
entonox
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
salbutamol (18559-94-9)
suxamethonium (306-40-1, 71-27-2)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005141038
MEDLINE PMID
15797271 (http://www.ncbi.nlm.nih.gov/pubmed/15797271)
PUI
L40417451
DOI
10.1016/j.resuscitation.2005.01.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2005.01.008
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1080
TITLE
Acute poisoning: Understanding 90% of cases in a nutshell
AUTHOR NAMES
Greene S.L.
Dargan P.I.
Jones A.L.
AUTHOR ADDRESSES
(Greene S.L., Shaun.Greene@gstt.nhs.uk) Medical Toxicology Unit, Avonley
Road, New Cross, London SE14 5ER, United Kingdom.
(Greene S.L., Shaun.Greene@gstt.nhs.uk; Dargan P.I.; Jones A.L.) National
Poisons Information Service, Guy's and St Thomas's NHS Trust, London, United
Kingdom.
CORRESPONDENCE ADDRESS
S.L. Greene, Medical Toxicology Unit, Avonley Road, New Cross, London SE14
5ER, United Kingdom. Email: Shaun.Greene@gstt.nhs.uk
SOURCE
Postgraduate Medical Journal (2005) 81:954 (204-216). Date of Publication:
April 2005
ISSN
0032-5473
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
The acutely poisoned patient remains a common problem facing doctors working
in acute medicine in the United Kingdom and worldwide. This review examines
the initial management of the acutely poisoned patient. Aspects of general
management are reviewed including immediate interventions, investigations,
gastrointestinal decontamination techniques, use of antidotes, methods to
increase poison elimination, and psychological assessment. More common and
serious poisonings caused by paracetamol, salicylates, opioids, tricyclic
antidepressants, selective serotonin reuptake inhibitors, benzodiazepines,
non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail.
Specific aspects of common paediatric poisonings are reviewed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug dose, drug therapy, oral drug administration)
antidote (drug therapy)
ipecac (drug therapy)
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
4 methylpyrazole (drug therapy)
acetylcysteine (drug therapy)
acetylsalicylic acid (drug toxicity)
alcohol (drug therapy)
amitriptyline (drug toxicity)
antiarrhythmic agent (drug therapy)
anticoagulant agent (drug toxicity, oral drug administration)
atropine (drug therapy)
benzodiazepine derivative (drug therapy, drug toxicity, intravenous drug
administration)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (drug therapy)
cobalt edetate (drug therapy)
cocaine (drug toxicity)
codeine (drug toxicity)
cyanide (drug toxicity)
cyproheptadine (drug therapy)
dantrolene (drug therapy)
deferoxamine (drug therapy)
dextropropoxyphene plus paracetamol (drug toxicity)
diazepam (drug therapy, drug toxicity, intravenous drug administration)
digoxin (drug toxicity)
digoxin antibody F(ab) fragment (drug therapy)
ethylene glycol (drug toxicity)
fluoxetine (drug toxicity)
glucagon (drug therapy)
glucose (drug therapy)
heavy metal (drug toxicity)
hydroxocobalamin (drug therapy)
ibuprofen (drug toxicity)
insulin
iron (drug toxicity)
lorazepam (drug therapy, intramuscular drug administration, intravenous drug
administration)
macrogol
methanol (drug toxicity)
midomafetamine (drug toxicity)
naloxone (drug therapy)
nonsteroid antiinflammatory agent (drug toxicity)
octreotide (drug therapy)
opiate (drug toxicity)
organophosphate (drug toxicity)
paracetamol (drug toxicity)
paroxetine (drug toxicity)
phytomenadione (drug therapy)
salicylic acid derivative (drug toxicity)
serotonin uptake inhibitor (drug toxicity)
sulfonylurea derivative (drug toxicity)
temazepam (drug toxicity)
thiamine
thiosulfate (drug therapy)
tricyclic antidepressant agent (drug toxicity)
zopiclone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
accident
agitation
blood pressure
body temperature
body weight
breathing rate
cardioversion
drug blood level
drug overdose
drug urine level
emergency ward
heart arrest (complication, therapy)
heart arrhythmia (complication, drug therapy)
heart muscle ischemia (complication)
heart rate
human
hyperthermia (complication, drug therapy, therapy)
hypoglycemia (complication, drug therapy, therapy)
hypotension (complication, therapy)
ingestion
intestine lavage
mortality
psychologic assessment
resuscitation
review
risk factor
seizure (complication, drug therapy)
stomach lavage
United Kingdom
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 hydroxybutyric acid (591-81-1)
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
cobalt edetate (14931-83-0, 36499-65-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
cyanide (57-12-5)
cyproheptadine (129-03-3, 969-33-5)
dantrolene (14663-23-1, 7261-97-4)
deferoxamine (70-51-9)
dextropropoxyphene plus paracetamol (39400-85-6)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
ethylene glycol (107-21-1)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
ibuprofen (15687-27-1)
insulin (9004-10-8)
ipecac (8012-96-2)
iron (14093-02-8, 53858-86-9, 7439-89-6)
lorazepam (846-49-1)
macrogol (25322-68-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
octreotide (83150-76-9)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paroxetine (61869-08-7)
phytomenadione (11104-38-4, 84-80-0)
temazepam (846-50-4)
thiamine (59-43-8, 67-03-8)
thiosulfate (14383-50-7)
zopiclone (43200-80-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005182498
MEDLINE PMID
15811881 (http://www.ncbi.nlm.nih.gov/pubmed/15811881)
PUI
L40546613
DOI
10.1136/pgmj.2004.024794
FULL TEXT LINK
http://dx.doi.org/10.1136/pgmj.2004.024794
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1081
TITLE
Reproductive emergencies
AUTHOR NAMES
Jutkowitz L.A.
AUTHOR ADDRESSES
(Jutkowitz L.A., jutkowitz@cvm.msu.edu) Dept. of Small Animal Clinical Sci.,
College of Veterinary Medicine, Michigan State University, East Lansing, MI
48824-1314, United States.
CORRESPONDENCE ADDRESS
L.A. Jutkowitz, Dept. of Small Animal Clinical Sci., College of Veterinary
Medicine, Michigan State University, East Lansing, MI 48824-1314, United
States. Email: jutkowitz@cvm.msu.edu
SOURCE
Veterinary Clinics of North America - Small Animal Practice (2005) 35:2
SPEC. ISS. (397-420). Date of Publication: March 2005
ISSN
0195-5616
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS
aminoglycoside (drug combination, drug therapy)
amoxicillin plus clavulanic acid (drug therapy)
ampicillin (drug combination, drug therapy)
antibiotic agent (drug therapy)
calcium (drug dose, drug therapy)
cefalexin (drug therapy)
cefazolin (drug combination, drug therapy)
chloramphenicol (drug therapy)
clindamycin (drug therapy)
cotrimazine (drug therapy)
cotrimoxazole (drug therapy)
doxapram (drug toxicity)
endotoxin
enrofloxacin (drug combination, drug therapy)
epinephrine (drug dose, intraosseous drug administration, intrathecal drug
administration, intravenous drug administration)
gluconate calcium (drug combination, drug dose, drug therapy, drug toxicity,
intravenous drug administration, subcutaneous drug administration)
glucose
ketamine (drug toxicity)
lidocaine (drug dose, epidural drug administration)
medetomidine (drug toxicity)
megestrol acetate (drug toxicity)
methoxyflurane (drug toxicity)
metronidazole (drug combination, drug therapy)
naloxone (drug dose)
oxytocin (drug combination, drug dose, drug therapy, intramuscular drug
administration, pharmacology)
propofol (drug dose, intravenous drug administration, pharmacokinetics)
prostaglandin F2 alpha trometamol (drug combination, drug dose, drug
therapy, drug toxicity, subcutaneous drug administration)
thiopental (drug toxicity)
unindexed drug
xylazine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
breeding
emergency treatment
veterinary medicine
EMTREE MEDICAL INDEX TERMS
abdominal discomfort (etiology)
animal behavior
animal care
blood transfusion
cesarean section
clinical practice
diagnostic procedure
drug mechanism
drug metabolism
dystocia (diagnosis, drug therapy, etiology, surgery)
eclampsia (complication, diagnosis, drug therapy, etiology, therapy)
endometritis (complication, diagnosis, drug therapy, etiology, surgery)
epidural anesthesia
fetus maturity
genital system
gestational age
granuloma (etiology)
hemorrhagic shock (complication, etiology, surgery, therapy)
hydrotherapy
hysterectomy
intravenous drug administration
laparotomy
mastitis (complication, diagnosis, drug therapy, etiology, surgery, therapy)
medical information
nonhuman
ovariectomy
patient monitoring
peritonitis (etiology)
physical examination
pyometra (diagnosis, drug therapy, etiology, surgery)
resuscitation
review
sexual behavior
skin irritation (etiology)
torsion (complication, diagnosis, etiology, surgery)
uterus bleeding (complication, diagnosis, etiology, surgery, therapy)
uterus contraction
uterus disease (diagnosis, drug therapy, etiology, surgery)
uterus prolapse (complication, etiology, surgery, therapy)
uterus rupture (etiology)
vagina cytology
vomiting (etiology)
DRUG TRADE NAMES
augmentin
clavamox
keflex
ovaban
tribrissen
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1)
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
calcium (7440-70-2)
cefalexin (15686-71-2, 23325-78-2)
cefazolin (25953-19-9, 27164-46-1)
chloramphenicol (134-90-7, 2787-09-9, 56-75-7)
clindamycin (18323-44-9)
cotrimazine (39474-58-3)
cotrimoxazole (8064-90-2)
doxapram (113-07-5, 309-29-5, 7081-53-0)
enrofloxacin (93106-60-6)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
medetomidine (119717-21-4, 86347-14-0)
megestrol acetate (595-33-5)
methoxyflurane (56274-14-7, 76-38-0)
metronidazole (39322-38-8, 443-48-1)
naloxone (357-08-4, 465-65-6)
oxytocin (50-56-6, 54577-94-5)
propofol (2078-54-8)
prostaglandin F2 alpha trometamol (38562-01-5)
thiopental (71-73-8, 76-75-5)
xylazine (23076-35-9, 7361-61-7)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Developmental Biology and Teratology (21)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005073332
MEDLINE PMID
15698917 (http://www.ncbi.nlm.nih.gov/pubmed/15698917)
PUI
L40220844
DOI
10.1016/j.cvsm.2004.10.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cvsm.2004.10.006
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1082
TITLE
Anesthetic protocols for common emergencies
AUTHOR NAMES
Campbell V.L.
AUTHOR ADDRESSES
(Campbell V.L., vcampbel@lamar.colostate.edu) J. L. Voss Veterinary Teaching
Hosp., Colorado State University, 300 West Drake Road, Fort Collins, CO
80523-1620, United States.
CORRESPONDENCE ADDRESS
V.L. Campbell, J. L. Voss Veterinary Teaching Hosp., Colorado State
University, 300 West Drake Road, Fort Collins, CO 80523-1620, United States.
Email: vcampbel@lamar.colostate.edu
SOURCE
Veterinary Clinics of North America - Small Animal Practice (2005) 35:2
SPEC. ISS. (435-453). Date of Publication: March 2005
ISSN
0195-5616
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Anesthesia, sedation, and pain management should be taken seriously in the
emergency patient. Proper knowledge of the drugs available and their
pharmacokinetics and pharmacodynamics are necessary to administer anesthesia
safely to critical patients. A proactive approach regarding monitoring,
titration of anesthetic drugs, and anticipation of life-threatening
complications helps in achieving successful anesthetic outcomes. © 2005
Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
acepromazine (drug toxicity, intramuscular drug administration, intravenous
drug administration, pharmaceutics, pharmacology, subcutaneous drug
administration)
alpha adrenergic receptor stimulating agent (drug toxicity, pharmacology)
atipamezole
barbituric acid derivative (drug comparison, drug toxicity, pharmaceutics,
pharmacology)
benzodiazepine derivative (drug toxicity, intramuscular drug administration,
pharmacoeconomics, pharmacokinetics, subcutaneous drug administration)
buprenorphine (buccal drug administration, drug comparison, drug dose, drug
toxicity, intramuscular drug administration, intravenous drug
administration, oral drug administration, pharmacology, subcutaneous drug
administration)
butorphanol (drug comparison, drug dose, drug toxicity, intramuscular drug
administration, intravenous drug administration, pharmaceutics,
pharmacology, subcutaneous drug administration)
diazepam (drug dose, drug toxicity, intravenous drug administration,
pharmacokinetics)
etomidate (drug dose, drug toxicity, intravenous drug administration,
pharmacokinetics, pharmacology)
fentanyl (drug interaction, drug toxicity, pharmacology)
hydromorphone (drug dose, drug interaction, drug toxicity, pharmacology)
ketamine (drug comparison, drug dose, drug toxicity, intravenous drug
administration, pharmacokinetics, pharmacology)
long acting drug (drug toxicity, intramuscular drug administration,
intravenous drug administration, pharmaceutics, pharmacology, subcutaneous
drug administration)
medetomidine (drug toxicity, pharmacology)
methadone (drug interaction, drug toxicity, pharmacology)
midazolam (drug toxicity, intramuscular drug administration, intravenous
drug administration, pharmacoeconomics, pharmacokinetics, subcutaneous drug
administration)
morphine (drug dose, drug interaction, drug toxicity, intravenous drug
administration, pharmacology, subcutaneous drug administration)
naloxone (drug dose, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
naltrexone
opiate (drug comparison)
oxymorphone (drug dose, drug interaction, drug toxicity, intramuscular drug
administration, intravenous drug administration, pharmacology, subcutaneous
drug administration)
pethidine (drug interaction, drug toxicity, pharmacology)
phenothiazine (drug toxicity, pharmaceutics, pharmacology)
propofol (drug combination, drug comparison, drug dose, drug toxicity,
intravenous drug administration, pharmaceutics, pharmacokinetics)
sedative agent (drug interaction, drug toxicity, pharmacokinetics,
pharmacology)
short acting drug (drug toxicity, pharmaceutics, pharmacology)
thiopental (drug combination, drug comparison, drug dose, drug toxicity,
intravenous drug administration, pharmaceutics)
unindexed drug
xylazine (drug toxicity, intramuscular drug administration, intravenous drug
administration, pharmacology, subcutaneous drug administration)
yohimbine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesiology
clinical protocol
emergency treatment
EMTREE MEDICAL INDEX TERMS
aggression
analgesia
anemia (etiology)
anesthesia complication (complication)
anesthesiological procedure
apnea (etiology)
atrioventricular block (etiology)
bradycardia (etiology)
diuresis
drug absorption
drug cost
drug dose regimen
drug information
drug mechanism
drug metabolism
drug monitoring
drug safety
dysphoria (etiology)
excitement
general anesthesia
hallucination (etiology)
heart arrhythmia (etiology)
Heinz body (etiology)
hyperglycemia (etiology)
hypertension (etiology)
hypotension (etiology)
injection pain (etiology)
injection site reaction (etiology)
intracranial hypertension (etiology)
muscle twitch
nonhuman
outcomes research
pharmacodynamics
respiration depression (etiology)
review
salivation
sedation
stridor (etiology)
titrimetry
vomiting (etiology)
CAS REGISTRY NUMBERS
acepromazine (61-00-7)
atipamezole (104054-27-5)
buprenorphine (52485-79-7, 53152-21-9)
butorphanol (42408-82-2)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
medetomidine (119717-21-4, 86347-14-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxymorphone (357-07-3, 76-41-5)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenothiazine (92-84-2)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
xylazine (23076-35-9, 7361-61-7)
yohimbine (146-48-5, 65-19-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005073334
MEDLINE PMID
15698919 (http://www.ncbi.nlm.nih.gov/pubmed/15698919)
PUI
L40220846
DOI
10.1016/j.cvsm.2004.10.005
FULL TEXT LINK
http://dx.doi.org/10.1016/j.cvsm.2004.10.005
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1083
TITLE
SOCRATES 5 (Synopsis of Cochrane Reviews applicable to Emergency Services)
AUTHOR NAMES
Gilligan P.
Lumsden G.
Jones J.
Brenchley J.
Hegarty D.
Khan A.
Shepherd M.
Kitching G.
Taylor A.
Law H.
AUTHOR ADDRESSES
(Gilligan P., hegartydeirdre@ireland.com; Lumsden G.; Jones J.; Brenchley
J.; Khan A.; Shepherd M.; Kitching G.; Taylor A.; Law H.) Department of
Emergency Medicine, The Yorkshire Rotation, Yorkshire, United Kingdom.
(Hegarty D.)
(Gilligan P., hegartydeirdre@ireland.com) 1 Far Moss, Alwoodley, Leeds,
Yorkshire LS17 7NU, United Kingdom.
CORRESPONDENCE ADDRESS
P. Gilligan, 1 Far Moss, Alwoodley, Leeds, Yorkshire LS17 7NU, United
Kingdom. Email: hegartydeirdre@ireland.com
SOURCE
Emergency Medicine Journal (2005) 22:3 (198-199). Date of Publication: March
2005
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS
anticonvulsive agent (clinical trial, drug therapy)
barbituric acid derivative (adverse drug reaction, clinical trial, drug
therapy)
calcium channel blocking agent (clinical trial, drug therapy)
carbamazepine (clinical trial, drug therapy)
corticosteroid (clinical trial, drug therapy)
ganglioside GM1 (clinical trial, drug therapy)
mannitol (clinical trial, drug comparison, drug therapy)
methylprednisolone (clinical trial, drug therapy)
methylprednisolone sodium succinate (clinical trial, drug therapy)
naloxone (clinical trial, drug therapy)
nimodipine (clinical trial, drug therapy)
phenobarbital (clinical trial, drug comparison, drug therapy)
phenytoin (clinical trial, drug therapy)
placebo
protirelin (clinical trial, drug therapy)
tirilazad (clinical trial, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain injury (drug therapy)
spinal cord injury (drug therapy)
EMTREE MEDICAL INDEX TERMS
brain perfusion
brain vasospasm (drug therapy, prevention)
clinical trial
Cochrane Library
convalescence
drug efficacy
emergency health service
high risk patient
hospital admission
human
hypotension (side effect)
intracranial pressure
maintenance therapy
meta analysis
mortality
priority journal
review
seizure (drug therapy, prevention)
subarachnoid hemorrhage (drug therapy)
systematic review
treatment outcome
CAS REGISTRY NUMBERS
carbamazepine (298-46-4, 8047-84-5)
ganglioside GM1 (37758-47-7)
mannitol (69-65-8, 87-78-5)
methylprednisolone (6923-42-8, 83-43-2)
methylprednisolone sodium succinate (2375-03-3, 2921-57-5)
naloxone (357-08-4, 465-65-6)
nimodipine (66085-59-4)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
protirelin (24305-27-9)
tirilazad (110101-66-1, 110101-67-2, 111793-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005121875
MEDLINE PMID
15735273 (http://www.ncbi.nlm.nih.gov/pubmed/15735273)
PUI
L40361376
DOI
10.1136/emj.2004.019760
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2004.019760
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1084
TITLE
Update on pediatric advanced life support guidelines
AUTHOR NAMES
Lankster M.A.
Brasfield III M.S.
AUTHOR ADDRESSES
(Lankster M.A., mlankster@tha.westal.net; Brasfield III M.S.) Bryan W.
Whitfield Memorial Hospital, 105 Highway 80 East, Demopolis, AL 36732,
United States.
CORRESPONDENCE ADDRESS
M.A. Lankster, Bryan W. Whitfield Memorial Hospital, 105 Highway 80 East,
Demopolis, AL 36732, United States. Email: mlankster@tha.westal.net
SOURCE
Critical Care Nursing Clinics of North America (2005) 17:1 (59-64). Date of
Publication: March 2005
ISSN
0899-5885
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Management of pediatric patients in emergency departments and prehospital
settings represents a challenge for health care providers. The 2000 PALS
guidelines provide medical care practitioners with a systematic and
organized approach for the management of emergency situations in infants and
children. These new guidelines provide nurses and physicians with the
knowledge to implement early identification and treatment of emergency
situations. Up-to-date knowledge of current standards is imperative to
promote successful resuscitative outcomes with minimal neurologic
dysfunction. Through continued changes and expanded health care provider
knowledge, lives of children who experience such emergencies can be saved.
EMTREE DRUG INDEX TERMS
atropine
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
accident
child health care
EMTREE MEDICAL INDEX TERMS
airway obstruction
asphyxia
burn
death
defibrillator
drowning
emergency
foreign body
groups by age
gunshot injury
heart arrest
heart disease
human
intoxication
life
lung burn
lung clearance
medical society
motor vehicle
oxygenation
practice guideline
quality of life
resuscitation
review
survival
vascular access
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
15749403 (http://www.ncbi.nlm.nih.gov/pubmed/15749403)
PUI
L40321029
DOI
10.1016/j.ccell.2004.09.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ccell.2004.09.008
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1085
TITLE
Where will patients go out of hours for help and advice about medicines?
AUTHOR NAMES
Bellingham C.
AUTHOR ADDRESSES
(Bellingham C.)
SOURCE
Pharmaceutical Journal (2005) 274:7335 (140-141). Date of Publication: 5 Feb
2005
ISSN
0031-6873
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
antihistaminic agent
atropine
chlorpheniramine
codeine
cyclizine
dexamethasone
diamorphine
diazepam
diclofenac
domperidone
epinephrine
furosemide
glyceryl trinitrate
haloperidol
hydrocortisone
ipratropium bromide
ketorolac
levomepromazine
levonorgestrel
loperamide
midazolam
naloxone
penicillin G
prednisolone
procyclidine
salbutamol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
patient guidance
pharmaceutical care
EMTREE MEDICAL INDEX TERMS
drug formulary
drug information
drug marketing
emergency health service
general practitioner
health care delivery
health care need
health care planning
human
medical decision making
note
patient referral
pharmacist
pharmacy
prescription
primary medical care
publication
DRUG TRADE NAMES
aspirin
methotrimeprazine
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
chlorpheniramine (132-22-9)
codeine (76-57-3)
cyclizine (303-25-3, 5897-18-7, 82-92-8)
dexamethasone (50-02-2)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
domperidone (57808-66-9)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
hydrocortisone (50-23-7)
ipratropium bromide (22254-24-6)
ketorolac (74103-06-3)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
levonorgestrel (797-63-7)
loperamide (34552-83-5, 53179-11-6)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
prednisolone (50-24-8)
procyclidine (1508-76-5, 77-37-2)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005094647
PUI
L40287567
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1086
TITLE
Randomised trial of intranasal versus intramuscular naloxone in prehospital
treatment for suspected opioid overdose
AUTHOR NAMES
Kelly A.-M.
Kerr D.
Dietze P.
Patrick I.
Walker T.
Koutsogiannis Z.
AUTHOR ADDRESSES
(Kelly A.-M., Anne-Maree.Kelly@wh.org.au; Kerr D.; Koutsogiannis Z.) Western
Hospital, Private Bag, Melbourne, Vic. 3011, Australia.
(Dietze P.) Turning Point Alcohol/Drug Centre, Melbourne, Vic., Australia.
(Patrick I.) Metropolitan Ambulance Service, Melbourne, Vic., Australia.
(Walker T.) Rural Ambulance Victoria, Ballarat, Vic., Australia.
(Kelly A.-M., Anne-Maree.Kelly@wh.org.au) J. Epstein Ctr. Emergency Med.
Res., University of Melbourne, Western Hospital, Private Bag, Melbourne,
Vic. 3011, Australia.
(Kerr D.) J. Epstein Ctr. Emergency Med. Res., Western Hospital, Private
Bag, Melbourne, Vic. 3011, Australia.
(Patrick I.) Clinical/Non-Emergency Operations, Metropolitan Ambulance
Service, Melbourne, Vic., Australia.
CORRESPONDENCE ADDRESS
A.-M. Kelly, Western Hospital, Private Bag, Melbourne, Vic. 3011, Australia.
Email: Anne-Maree.Kelly@wh.org.au
SOURCE
Medical Journal of Australia (2005) 182:1 (24-27). Date of Publication: 3
Jan 2005
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
ABSTRACT
Objective: To determine the effectiveness of intranasal (IN) naloxone
compared with intramuscular (IM) naloxone for treatment of respiratory
depression due to suspected opiate overdose in the prehospital setting.
Design: Prospective, randomised, unblinded trial of either 2 mg naloxone
injected intramuscularly or 2 mg naloxone delivered intranasally with a
mucosal atomiser. Participants and setting: 155 patients (71 IM and 84 IN)
requiring treatment for suspected opiate overdose and attended by paramedics
of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria
(RAV) in Victoria. Main outcome measures: Response time to regain a
respiratory rate greater than 10 per minute. Secondary outcome measures were
proportion of patients with respiratory rate greater than 10 per minute at 8
minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue
naloxone; rate of adverse events; proportion of the IN group for whom IN
naloxone alone was sufficient treatment. Results: The IM group had more
rapid response than the IN group, and were more likely to have more than 10
spontaneous respirations per minute within 8 minutes (82% v 63%; P =
0.0173). There was no statistically significant difference between the IM
and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group];
P = 0.0558). There were no major adverse events. For patients treated with
IN naloxone, this was sufficient to reverse opiate toxicity in 74%.
Conclusion: IN naloxone is effective in treating opiate-induced respiratory
depression, but is not as effective as IM naloxone. IN delivery of naxolone
could reduce the risk of needlestick injury to ambulance officers and, being
relatively safe to make more widely available, could increase access to
life-saving treatment in the community.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, clinical trial, drug administration, drug
dose, drug therapy, intramuscular drug administration, intranasal drug
administration)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
respiration depression (drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
agitation
ambulance
article
Australia
breathing rate
clinical trial
community care
controlled clinical trial
controlled study
drug efficacy
emergency health service
female
headache (side effect)
health care access
human
major clinical study
male
nausea (side effect)
needlestick injury (prevention)
outcomes research
paramedical personnel
prospective study
randomized controlled trial
response time
risk reduction
rural health care
scoring system
side effect (side effect)
statistical significance
sweating
tremor (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005026902
MEDLINE PMID
15651944 (http://www.ncbi.nlm.nih.gov/pubmed/15651944)
PUI
L40089873
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1087
TITLE
Low-dose naloxone does not improve morphine-induced nausea, vomiting, or
pruritus
AUTHOR NAMES
Greenwald P.W.
Provataris J.
Coffey J.
Bijur P.
Gallagher E.J.
AUTHOR ADDRESSES
(Greenwald P.W., pg2014@columbia.edu) New York-Presbyt. Emergency Medicine,
College of Physicians and Surgeons, Columbia University, New York, NY 10032,
United States.
(Provataris J.; Coffey J.; Bijur P.; Gallagher E.J.) Department of Emergency
Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United
States.
CORRESPONDENCE ADDRESS
P.W. Greenwald, New York-Presbyt. Emergency Medicine, College of Physicians
and Surgeons, Columbia University, New York, NY 10032, United States. Email:
pg2014@columbia.edu
SOURCE
American Journal of Emergency Medicine (2005) 23:1 (35-39). Date of
Publication: January 2005
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
We tested the hypothesis that low-dose naloxone delivered with intravenous
(IV) bolus morphine to emergency department patients in pain would reduce
nausea. Randomized, double-blind, placebo-controlled trial. Patients
receiving 0.10 mg/kg morphine IV bolus rated pain, nausea, and pruritus on
100-mm visual analog scales at enrollment and 20 minutes. Patients were
randomized to 0.25 μg/kg naloxone or equal volume placebo administered with
IV morphine. One hundred thirty-one enrolled, 99 (76%) treated according to
protocol with sufficient data for analysis. At 20 minutes the difference
between groups (naloxone-placebo) was 1 mm (95% CI [confidence interval], -9
to 11) for nausea, 1 mm (95% CI, -3 to 3) for pruritus, 4% (95% CI, -1 to 9)
for vomiting, and 0% (95% CI, -5 to 5) for rescue antiemetics. Pain was
significantly reduced in both groups. Addition of 0.25 μg/kg naloxone to
bolus morphine does not improve nausea, pruritus, vomiting, or reduce use of
rescue antiemetics when administered to emergency department patients in
pain. © 2005 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug therapy, intravenous drug
administration)
naloxone (clinical trial, drug dose, drug therapy, intravenous drug
administration, pharmacology)
EMTREE DRUG INDEX TERMS
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
low drug dose
nausea (drug therapy, side effect)
pruritus (drug therapy, side effect)
vomiting (drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical protocol
clinical trial
confidence interval
controlled clinical trial
controlled study
double blind procedure
emergency ward
female
human
major clinical study
male
pain (drug therapy)
pain assessment
priority journal
randomized controlled trial
visual analog scale
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005052926
MEDLINE PMID
15672335 (http://www.ncbi.nlm.nih.gov/pubmed/15672335)
PUI
L40163995
DOI
10.1016/j.ajem.2004.01.001
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ajem.2004.01.001
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1088
TITLE
Pediatric pain management in the Emergency Department
AUTHOR NAMES
Bauman B.H.
McManus Jr. J.G.
AUTHOR ADDRESSES
(Bauman B.H., baumanb@ohsu.edu; McManus Jr. J.G.) Department of Emergency
Medicine, OR Health and Sciences University, CDW-EM, 3181 SW Sam Jackson
Park Road, Portland, OR 97239, United States.
(Bauman B.H., baumanb@ohsu.edu) Department of Pediatrics, OR Health and
Sciences University, DC10S, 3181 SW Sam Jackson Park Road, Portland, OR
97239, United States.
CORRESPONDENCE ADDRESS
B.H. Bauman, Department of Emergency Medicine, OR Health and Sciences
University, CDW-EM, 3181 SW Sam Jackson Park Road, Portland, OR 97239,
United States. Email: baumanb@ohsu.edu
SOURCE
Emergency Medicine Clinics of North America (2005) 23:2 (393-414). Date of
Publication: May 2005
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
EMTREE DRUG INDEX TERMS
analgesic agent (drug combination, parenteral drug administration)
atropine (drug interaction)
barbituric acid derivative (adverse drug reaction, drug therapy)
benzodiazepine (adverse drug reaction, drug combination, drug therapy,
inhalational drug administration, intramuscular drug administration,
intravenous drug administration, oral drug administration, pharmacology)
chlorpromazine (adverse drug reaction, drug combination, intramuscular drug
administration)
codeine (drug therapy, oral drug administration)
diazepam (pharmacology)
elamax
etomidate (adverse drug reaction, intravenous drug administration,
pharmacology)
fentanyl (intravenous drug administration, subcutaneous drug administration)
glycopyrronium (drug interaction)
hydrocodone (drug combination, drug therapy, oral drug administration)
hydromorphone (intravenous drug administration, subcutaneous drug
administration)
ibuprofen (drug therapy, oral drug administration)
ketamine (adverse drug reaction, drug interaction, intramuscular drug
administration, intravenous drug administration, oral drug administration,
pharmacology, rectal drug administration)
ketorolac (drug therapy, intramuscular drug administration, intravenous drug
administration)
lidocaine plus prilocaine
local anesthetic agent (drug toxicity, topical drug administration)
lorazepam (pharmacology)
morphine (intravenous drug administration, subcutaneous drug administration)
naloxone (drug therapy)
narcotic agent (adverse drug reaction)
nonsteroid antiinflammatory agent (drug therapy)
opiate (adverse drug reaction, pharmacokinetics)
oxycodone (drug therapy, oral drug administration)
paracetamol (drug combination, drug therapy, oral drug administration,
parenteral drug administration, pharmacology, rectal drug administration)
pentobarbital (intramuscular drug administration, intravenous drug
administration, pharmacology, rectal drug administration)
pethidine (adverse drug reaction, drug combination, intramuscular drug
administration)
promethazine (adverse drug reaction, drug combination, intramuscular drug
administration)
propofol (adverse drug reaction, drug concentration, pharmacokinetics,
pharmacology)
sedative agent (adverse drug reaction, drug combination, intramuscular drug
administration)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
adverse drug reaction (drug therapy, side effect)
apnea (side effect)
behavior
cognition
disease severity
emergency ward
human
hypotension (side effect)
iontophoresis
laceration
larynx spasm (side effect)
pain assessment
priority journal
rating scale
respiration control
respiration depression (side effect)
review
scoring system
sedation
side effect (side effect)
tendon reflex
DRUG TRADE NAMES
elamax , United StatesFerndale
EMLA , United StatesAstra Zeneca
DRUG MANUFACTURERS
(United States)Astra Zeneca
(United States)Ferndale
(United States)Gebauer Chemical Company
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
chlorpromazine (50-53-3, 69-09-0)
codeine (76-57-3)
diazepam (439-14-5)
EMLA (101362-25-8)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
glycopyrronium bromide (596-51-0)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
lorazepam (846-49-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2005167388
MEDLINE PMID
15829389 (http://www.ncbi.nlm.nih.gov/pubmed/15829389)
PUI
L40501872
DOI
10.1016/j.emc.2004.12.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2004.12.008
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1089
TITLE
Procedural sedation and analgesia in the Emergency Department: What are the
risks?
AUTHOR NAMES
Miller M.A.
Levy P.
Patel M.M.
AUTHOR ADDRESSES
(Miller M.A., Michael.miller3@amedd.army.mil) Department of Emergency
Medicine, Darnall Army Community Hospital, Box 32, 36000 Darnall Loop, Ft.
Hood, TX 76544, United States.
(Levy P.) Department of Emergency Medicine, Wayne State University, Detroit
Receving Hospital, 4201 St. Antoine 6G, Detroit, MI 48202, United States.
(Patel M.M.) Emory University, School of Medicine, Department of Emergency
Medicine, 1365 Clifton Road, Atlanta, GA 30322, United States.
CORRESPONDENCE ADDRESS
M.A. Miller, Department of Emergency Medicine, Darnall Army Community
Hospital, Box 32, 36000 Darnall Loop, Ft. Hood, TX 76544, United States.
Email: Michael.miller3@amedd.army.mil
SOURCE
Emergency Medicine Clinics of North America (2005) 23:2 (551-572). Date of
Publication: May 2005
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The practitioner of emergency medicine is routinely faced with patients in
need of emergent procedures and pain control and sedation. Our challenge is
to make our patients' experiences as painless and as safe as possible, while
maximizing our ability to perform the procedure at hand; this is not always
an easy task given the propensity of each human body to react differently to
interventions and stimuli. We can best meet this challenge by understanding
how our patients and pharmaceutical agents intermingle in the risk-benefit
equation we formulate before starting our "experiment." Coupling this
information with fundamentally sound patient care and monitoring will
mimimize bad experiences with PSA for both the patient and practitioner. ©
2005 Elsevier Inc. All rights reserved.
EMTREE DRUG INDEX TERMS
alfentanil (adverse drug reaction, drug combination, drug comparison, drug
dose)
barbituric acid derivative (adverse drug reaction, drug combination, drug
comparison, drug dose)
benzodiazepine (adverse drug reaction, drug combination, drug comparison)
buprenorphine (adverse drug reaction, drug combination, drug comparison)
chloral hydrate (adverse drug reaction, drug combination, drug comparison,
drug dose)
chlorpromazine (adverse drug reaction, drug combination, drug interaction)
cimetidine (drug interaction)
codeine (adverse drug reaction, drug combination, drug comparison, drug
dose)
dexmedetomidine (adverse drug reaction, drug comparison)
dextromethorphan (adverse drug reaction, drug combination, drug comparison,
drug dose)
diazepam (adverse drug reaction, drug comparison)
erythromycin (drug interaction)
etomidate (adverse drug reaction, drug combination, drug comparison, drug
dose)
fentanyl (adverse drug reaction, drug combination, drug comparison, drug
dose, drug interaction, intravenous drug administration)
flumazenil (adverse drug reaction, drug comparison)
ketamine (adverse drug reaction, drug combination, drug comparison,
intramuscular drug administration)
ketoconazole (drug interaction)
methohexital (adverse drug reaction, clinical trial, drug combination, drug
comparison)
midazolam (adverse drug reaction, drug combination, drug comparison, drug
interaction)
morphine (adverse drug reaction, drug combination, drug comparison, drug
dose, intramuscular drug administration, intravenous drug administration,
subcutaneous drug administration)
nalbuphine (adverse drug reaction, drug combination, drug comparison)
naloxone (adverse drug reaction, drug comparison, drug dose, drug toxicity,
intravenous drug administration)
opiate (adverse drug reaction, drug combination, drug comparison)
pethidine (adverse drug reaction, drug combination, drug interaction)
promethazine (adverse drug reaction, drug combination, drug interaction)
propofol (adverse drug reaction, drug comparison, drug dose)
remifentanil (adverse drug reaction, drug combination, drug comparison)
sufentanil (adverse drug reaction, drug combination, drug comparison)
thiopental (adverse drug reaction, drug combination, drug comparison)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
risk assessment
sedation
EMTREE MEDICAL INDEX TERMS
adrenal cortex insufficiency (side effect)
agitation
amnesia (side effect)
analgesic nephropathy (side effect)
anamnesis
apnea (side effect)
aspiration pneumonia (side effect)
ataxia (side effect)
bradycardia (side effect)
breathing disorder (side effect)
bronchospasm (side effect)
cardiotoxicity (side effect)
cause of death
clinical examination
clinical trial
comorbidity
coughing (side effect)
diplopia (side effect)
disease exacerbation (side effect)
drug choice
drug contraindication
drug dose regimen
drug hypersensitivity (side effect)
drug misuse
drug potentiation
drug safety
emergency medicine
gastrointestinal toxicity (side effect)
glottis
health care cost
health care delivery
heart arrest (side effect)
heart arrhythmia (side effect)
heart block (side effect)
heart failure (side effect)
heart muscle ischemia (side effect)
heart muscle oxygen consumption
heart output
heart perfusion
heart work
hemodynamics
hiccup (side effect)
high output heart failure (side effect)
human
hypertension (side effect)
hypotension (side effect)
hypoventilation (side effect)
hypoxemia (side effect)
hypoxia (side effect)
kidney injury (side effect)
larynx spasm (side effect)
lung edema (side effect)
lung injury (side effect)
lung toxicity (side effect)
mast cell degranulation
medical assessment
medical practice
metabolic acidosis (side effect)
methemoglobinemia (side effect)
motor dysfunction (side effect)
muscle rigidity (side effect)
myoclonus (side effect)
nausea (side effect)
nausea and vomiting (side effect)
nephrotoxicity (side effect)
neurotoxicity (side effect)
nonhuman
pain assessment
patient care
patient monitoring
patient satisfaction
physical examination
premedication
priority journal
pruritus (side effect)
pulmonary hypertension (side effect)
pulse oximetry
quality of life
reliability
respiration depression (side effect)
restlessness (side effect)
review
risk benefit analysis
seizure
serotonin syndrome (side effect)
side effect (side effect)
skin toxicity (side effect)
sleep disordered breathing (side effect)
stridor (side effect)
tachycardia (side effect)
thorax wall
treatment withdrawal
upper respiratory tract obstruction (side effect)
vein dilatation
vomiting (side effect)
DRUG TRADE NAMES
demerol
phenergan
thorazine
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
chloral hydrate (302-17-0)
chlorpromazine (50-53-3, 69-09-0)
cimetidine (51481-61-9, 70059-30-2)
codeine (76-57-3)
dexmedetomidine (113775-47-6)
dextromethorphan (125-69-9, 125-71-3)
diazepam (439-14-5)
erythromycin (114-07-8, 70536-18-4)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketoconazole (65277-42-1)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
remifentanil (132539-07-2)
sufentanil (56030-54-7)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005167395
MEDLINE PMID
15829397 (http://www.ncbi.nlm.nih.gov/pubmed/15829397)
PUI
L40501879
DOI
10.1016/j.emc.2004.12.016
FULL TEXT LINK
http://dx.doi.org/10.1016/j.emc.2004.12.016
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1090
TITLE
Factors affecting emergency department opioid administration to severely
injured patients
AUTHOR NAMES
Neighbor M.L.
Honner S.
Kohn M.A.
AUTHOR ADDRESSES
(Neighbor M.L., neighbo@itsa.ucsf.edu; Honner S.; Kohn M.A.) Department of
Medicine, School of Medicine, Dept. Epidemiol. Biostatist. U., .
(Neighbor M.L., neighbo@itsa.ucsf.edu) Emergency Services 1E21, San
Francisco General Hospital, 1001 Potrero Ave., S. Francisco, C., .
CORRESPONDENCE ADDRESS
Department of Medicine, School of Medicine, Dept. Epidemiol. Biostatist. U.,
. Email: neighbo@itsa.ucsf.edu
SOURCE
Academic Emergency Medicine (2004) 11:12 (1290-1296). Date of Publication:
December 2004
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Studies of emergency department (ED) pain management in patients with trauma
have been mostly restricted to patients with fractures, yet the potential
for undertreatment of more severely injured patients is great. The authors
sought to identify factors associated with failure to receive ED opioid
administration in patients with acute trauma who subsequently required
hospitalization. At an urban Level 1 trauma center and teaching hospital, a
retrospective cohort study of trauma team activation patients requiring
hospitalization between January 1 and December 31, 1999, was conducted. The
authors excluded patients receiving opioids only within ten minutes of chest
tube insertion or fracture manipulation. The main outcome measure was ED
opioid administration. A total of 540 charts of hospitalized first-tier
trauma team activation patients were reviewed. A total of 258 (47.8%)
received intravenous opioid analgesia within three hours of ED arrival. The
median time to receiving the first dose of opioids was 95 minutes. Patients
were independently less likely to receive opioids if they were younger or
older, were intubated, had a lower Revised Trauma Score, or did not require
fracture manipulation. Patients with these factors were less likely to
receive opioids independent of the amount of time they spent in the ED. Many
trauma activation patients requiring hospitalization do not receive opioid
analgesia in the ED. Patients at particular risk for oligoanalgesia include
those who are younger or older and those who are more seriously injured, as
defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and
intubation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug dose, drug therapy, intravenous drug administration)
opiate (drug dose, drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
injury (drug therapy)
EMTREE MEDICAL INDEX TERMS
acute disease
adult
age distribution
aged
analgesia
article
cohort analysis
controlled study
disease severity
dose response
emergency ward
female
fracture
hospitalization
human
intubation
major clinical study
male
medical record
priority journal
retrospective study
scoring system
teaching hospital
time
tube
urban area
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004511856
MEDLINE PMID
15576519 (http://www.ncbi.nlm.nih.gov/pubmed/15576519)
PUI
L39572886
DOI
10.1197/j.aem.2004.07.014
FULL TEXT LINK
http://dx.doi.org/10.1197/j.aem.2004.07.014
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1091
TITLE
Characteristics of non-fatal opioid overdoses attended by ambulance services
in Australia
AUTHOR NAMES
Dietze P.
Jolley D.
Cvetkovski S.
Cantwell K.
Jacobs I.
Indig D.
AUTHOR ADDRESSES
(Dietze P., pauld@turningpoint.org.au; Cvetkovski S.) Turning Point
Alcohol/Drug Ctr. Inc., 54-62 Gertrude Street, Fitzroy, Vic. 3065,
Australia.
(Dietze P., pauld@turningpoint.org.au; Jolley D.) School of Health/Social
Development, Deakin University, 54-62 Gertrude Street, Fitzroy, Vic. 3065,
Australia.
(Cantwell K.) Metropolitan Ambulance Service, Melbourne, Vic., Australia.
(Jacobs I.) Prehospital Care Research Unit, University of Western Australia,
Perth, WA, Australia.
(Indig D.) Centre for Drug and Alcohol, New South Wales Health Department,
Sydney, NSW, Australia.
CORRESPONDENCE ADDRESS
P. Dietze, Turning Point Alcohol/Drug Ctr. Inc., Deakin University, School
of Health/Social Development, 54-62 Gertrude Street, Fitzroy, Vic. 3065,
Australia. Email: pauld@turningpoint.org.au
SOURCE
Australian and New Zealand Journal of Public Health (2004) 28:6 (569-575).
Date of Publication: December 2004
ISSN
1326-0200
BOOK PUBLISHER
Public Health Association of Australia Inc., PO Box 319, Curtin, Australia.
ABSTRACT
Objective: To examine the feasibility of establishing a database on
non-fatal opioid overdose in order to examine patterns and characteristics
of these overdoses across Australia. Methods: Unit record data on opioid
overdose attended by ambulances were obtained from ambulance services in the
five mainland States of Australia for available periods, along with
information on case definition and opioid overdose management within these
jurisdictions. Variables common across States were examined including the
age and sex of cases attended, the time of day and day of week of the
attendance, and the transportation outcome (whether the victim was left at
the scene or transported to hospital). Results: The monthly rate of
non-fatal opioid overdose attended by ambulance was generally highest in
Victoria (Melbourne) followed by NSW, with the rates substantially lower in
the remaining States over the period January 1999 to February 2001.
Non-fatal opioid overdose victims were most likely to be male in all States,
with the proportion of males highest in Victoria (77%), and were aged around
28 years with ages lowest in Western Australia (m=26) and highest in NSW
(m=30). Most of the attendances occurred in the afternoon/early evening and
towards the later days of the working week in all States. The rates of
transportation varied according to ambulance service practice across the
States with around 94% of cases transported in Western Australia and around
18% and 29% of cases transported in Melbourne and NSW respectively.
Conclusions: It is feasible to establish a database of comparable data on
non-fatal opioid overdoses attended by ambulances in Australia. This
compilation represents a useful adjunct to existing surveillance systems on
heroin (and other opioid) use and related harms.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug interaction, drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug interaction, drug therapy)
narcotic agent (drug interaction, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (disease management, drug therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
article
Australia
drug antagonism
drug fatality
feasibility study
female
first aid
geographic distribution
Glasgow coma scale
human
major clinical study
male
medical information system
medical record
outcomes research
patient transport
population research
prediction
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005100440
MEDLINE PMID
15707208 (http://www.ncbi.nlm.nih.gov/pubmed/15707208)
PUI
L40305503
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1092
TITLE
Resuscitation in neonates, infants and children
ORIGINAL (NON-ENGLISH) TITLE
Reanimation von neugeborenen, säuglingen und kindern
AUTHOR NAMES
Höhn T.
AUTHOR ADDRESSES
(Höhn T., thomas.hoehn@uni-duesseldorf.de) Bereich Neonatologie Padiatrische
I., Klin. F. Allgemeine Pädiatrie, Heinrich-Heine-Universität, Düsseldorf,
Germany.
(Höhn T., thomas.hoehn@uni-duesseldorf.de) Bereich Neonatologie Padiatrische
I., Klin. F. Allgemeine Pädiatrie, Heinrich-Heine-Universität, Moorenstraße
5, 40225 Düsseldorf, Germany.
CORRESPONDENCE ADDRESS
T. Höhn, Bereich Neonatologie Padiatrische I., Klin. F. Allgemeine
Pädiatrie, Heinrich-Heine-Universität, Moorenstraße 5, 40225 Düsseldorf,
Germany. Email: thomas.hoehn@uni-duesseldorf.de
SOURCE
Monatsschrift fur Kinderheilkunde (2004) 152:12 (1341-1354). Date of
Publication: Dec 2004
ISSN
0026-9298
ABSTRACT
In pediatric medicine, resuscitation requiring the administration of drugs
(ABCD) is fortunately rarely necessary. This makes it even more important to
be optimally prepared for this scenario, both mentally and in terms of
having the equipment needed available. As in other branches of medicine, the
evidence on which the standard procedures used in resuscitation are based is
checked at regular intervals and, if appropriate, the international
recommendations deduced from it are modified. One striking difference
between pediatric and adult resuscitation is the importance of ventilation
in reversing asystole in neonates and children. The main reason for this is
that in the case of pediatric resuscitation it can be assumed that no
myocardial disease is present in the vast majority of patients, so that once
ventilation is successfully achieved the circulation generally also rapidly
becomes adequate.
EMTREE DRUG INDEX TERMS
bicarbonate
epinephrine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
newborn care
resuscitation
EMTREE MEDICAL INDEX TERMS
circulation
emergency treatment
heart arrest
human
lung ventilation
myocardial disease
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Anesthesiology (24)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2005034095
PUI
L40104712
DOI
10.1007/s00112-004-1046-5
FULL TEXT LINK
http://dx.doi.org/10.1007/s00112-004-1046-5
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1093
TITLE
Integrated treatment of co-occurring mental illness and addiction: Clinical
invervention, program, and system perspectives
AUTHOR NAMES
Ziedonis D.M.
AUTHOR ADDRESSES
(Ziedonis D.M., ziedondm@umdnj.edu) Department of Psychiatry, Robert Wood
Johnson Medical School, University of Medicine and Dentistry, Piscataway,
NJ, United States.
(Ziedonis D.M., ziedondm@umdnj.edu) Robert Wood Johnson Medical School, 675
Hoes Lane, Piscataway, NJ 08854, United States.
CORRESPONDENCE ADDRESS
D.M. Ziedonis, Robert Wood Johnson Medical School, 675 Hoes Lane,
Piscataway, NJ 08854, United States. Email: ziedondm@umdnj.edu
SOURCE
CNS Spectrums (2004) 9:12 (892+894-904+925). Date of Publication: December
2004
ISSN
1092-8529
BOOK PUBLISHER
MBL Communications, 333 Hudson St. 7th Floor, New York, United States.
ABSTRACT
Individuals with mental illness and addiction comprise at least half of the
patients in most mental health treatment systems. This combination results
in increased risk for frequent psychiatric relapses, poor medication
compliance, violence, suicide, legal problems, and high utilization of the
emergency room or inpatient services. Traditional mental health and
addiction treatments have not adequately addressed these co-occurring
disorders due to clinical interventions, programs, and system flaws that
have not addressed the individual's needs. Integrated treatment requires
both an understanding of mental illness and addiction and the means to
integrate and modify the traditional treatment approaches in both the mental
health and addiction treatment fields. There is strong evidence to support
the efficacy and effectiveness of integrated treatment in this population.
All mental health clinicians should become experienced and skilled in the
core psychotherapy approaches to treating substance use disorders, including
motivational enhancement therapy, relapse prevention (cognitive-behavioral
therapy), and 12-step facilitation. In addition, integrated treatment
includes integrating medications for both addiction and mental illness with
the behavioral therapies and other psychosocial interventions. This article
reviews the clinical intervention, program, and system components of
integrated treatment and specific clinical interventions for this
population.
EMTREE DRUG INDEX TERMS
acamprosate (drug therapy)
acetylmethadol (drug therapy)
amfebutamone (drug therapy)
barbituric acid derivative (drug therapy)
benzodiazepine derivative (drug therapy)
buprenorphine (drug therapy)
clonidine (drug therapy)
disulfiram (drug therapy, pharmacokinetics)
methadone (drug therapy)
nalmefene (drug therapy)
naloxone (drug therapy)
naltrexone (drug therapy)
nicotine (drug therapy)
opiate agonist (drug therapy)
opiate antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (drug therapy, therapy)
health care system
health program
mental disease (therapy)
EMTREE MEDICAL INDEX TERMS
alcoholism (drug therapy)
behavior therapy
cocaine dependence
cognitive therapy
comorbidity
emergency ward
health care utilization
health service
hospital patient
human
mental health
money
motivation
opiate addiction (drug therapy)
priority journal
psychosocial care
psychotherapy
review
risk assessment
schizophrenia (therapy)
substance abuse
suicide
tobacco dependence (therapy)
treatment outcome
violence
CAS REGISTRY NUMBERS
acamprosate (77337-73-6)
acetylmethadol (17199-59-6, 509-74-0)
amfebutamone (31677-93-7, 34911-55-2)
buprenorphine (52485-79-7, 53152-21-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
disulfiram (97-77-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
nicotine (54-11-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2005015558
MEDLINE PMID
15618940 (http://www.ncbi.nlm.nih.gov/pubmed/15618940)
PUI
L40052420
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1094
TITLE
A toxicological emergency: "Happy drops" (liquid ecstasy)
ORIGINAL (NON-ENGLISH) TITLE
Der toxikologische notfall: Glückstropfen
AUTHOR NAMES
Martens F.
AUTHOR ADDRESSES
(Martens F., frank.martens@charite.de) Charite - Universitatsmedizin Berlin,
Campus Virchow Klinikum, Klin. Nephrol./Internistische I., Berlin, Germany.
(Martens F., frank.martens@charite.de) Charite - Universitatsmedizin Berlin,
Campus Virchow Klinikum, Klin. Nephrol./Internistische I., Augustenburger
Platz 1, 13353 Berlin, Germany.
CORRESPONDENCE ADDRESS
F. Martens, Charite - Universitatsmedizin Berlin, Campus Virchow Klinikum,
Klin. Nephrol./Internistische I., Augustenburger Platz 1, 13353 Berlin,
Germany. Email: frank.martens@charite.de
SOURCE
Notarzt (2004) 20:6 (215-216). Date of Publication: Dec 2004
ISSN
0177-2309
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
midomafetamine (drug toxicity)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
flumazenil
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute toxicity
emergency treatment
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
alcohol consumption
article
case report
clinical feature
disease course
GABAergic transmission
human
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
2005007815
PUI
L40029639
DOI
10.1055/s-2004-828340
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2004-828340
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1095
TITLE
An intentional opiate intoxication of an infant: When medical toxicology and
child maltreatment services merge
AUTHOR NAMES
Perez A.
Scribano P.V.
Perry H.
AUTHOR ADDRESSES
(Perez A., aaperez@harthosp.org) Division of Medical Toxicology, Dept. of
Emergency Med./Traumatol., Univ. of Connecticut Health Center, Farmington,
CT, United States.
(Scribano P.V.) Department of Pediatrics, Ohio State Univ. College of
Medicine, Columbus, OH, United States.
(Perry H.) Department of Pediatrics, Univ. of Connecticut Health Center,
Farmington, CT, United States.
(Perez A., aaperez@harthosp.org) Division of Medical Toxicology, Department
of Emergency Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT
06102, United States.
CORRESPONDENCE ADDRESS
A. Perez, Division of Medical Toxicology, Department of Emergency Medicine,
Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, United States.
Email: aaperez@harthosp.org
SOURCE
Pediatric Emergency Care (2004) 20:11 (769-772). Date of Publication:
November 2004
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
We present an instructive case of a 5-week-old infant seen in the emergency
department with acute inspiratory stridor and depressed level of
consciousness. His emergency department course identified an acute opiate
intoxication. The child also developed chest wall rigidity, a rare
complication of narcotic use. We discuss the emergency department
management, as well as the toxicologic and child protection investigations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (drug toxicity)
morphine (drug concentration, drug toxicity)
opiate (drug toxicity)
oxycodone (drug dose)
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent (adverse drug reaction, pharmaceutics)
atropine
ceftriaxone
fentanyl (drug dose, intravenous drug administration)
ibuprofen
insulin (drug therapy)
lorazepam (drug dose)
naloxone (drug dose, drug therapy)
oxycodone plus paracetamol
oxygen
paracetamol (drug therapy)
simethicone (drug therapy, pharmaceutics)
suxamethonium (drug dose)
unclassified drug
vaponephrine (adverse drug reaction, pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
article
case report
child abuse
colic (drug therapy)
consciousness disorder
emergency ward
high performance liquid chromatography
human
immunoassay
infant
male
Munchausen syndrome
pain (drug therapy)
physical examination
respiratory distress (side effect, therapy)
rigidity
stridor (drug therapy, side effect)
DRUG TRADE NAMES
tylox
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
ceftriaxone (73384-59-5, 74578-69-1)
codeine (76-57-3)
fentanyl (437-38-7)
ibuprofen (15687-27-1)
insulin (9004-10-8)
lorazepam (846-49-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxygen (7782-44-7)
paracetamol (103-90-2)
simethicone (53663-76-6, 8050-81-5)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004496941
MEDLINE PMID
15502660 (http://www.ncbi.nlm.nih.gov/pubmed/15502660)
PUI
L39525249
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1096
TITLE
Anesthetic considerations for fracture management in the outpatient setting
AUTHOR NAMES
Blasier R.D.
AUTHOR ADDRESSES
(Blasier R.D., blasierrobertd@uams.edu) Arkansas Children's Hospital, Little
Rock, AR, United States.
(Blasier R.D., blasierrobertd@uams.edu) Department of Orthopaedic Surgery,
Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202,
United States.
CORRESPONDENCE ADDRESS
R.D. Blasier, Department of Orthopaedic Surgery, Arkansas Children's
Hospital, 800 Marshall Street, Little Rock, AR 72202, United States. Email:
blasierrobertd@uams.edu
SOURCE
Journal of Pediatric Orthopaedics (2004) 24:6 (742-746). Date of
Publication: November/December 2004
ISSN
0271-6798
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
There are numerous techniques for analgesia and anesthesia for outpatient
fracture management. The treating orthopaedic surgeon must make the decision
regarding analgesia based on personal experience, local custom,
accessibility of special devices, credentialing and privileges, fracture
type, and patient comorbidities and cooperation ability. Regional or local
blocks will usually be administered by the treating orthopaedist. Conscious
sedation is usually administered by another physician (anesthesiologist or
emergency room physician) to free the orthopaedist to concentrate on the
reduction. Blocks are particularly well suited for the child who has
recently eaten, is not too anxious, and can tolerate a needle stick. Nitrous
oxide is very user-friendly and quite effective except in the roughly 10% of
patients who are nonresponders; also, not all facilities have equipment
necessary for its administration. Conscious sedation is very effective and
particularly well suited for an anxious or uncooperative child. It cannot be
performed by the orthopaedist alone, as attention must be given to the child
during the administration of the drugs and ongoing recovery. In the absence
of equipment and personnel to provide attention and monitoring, this
technique should not be used. Ketamine has enjoyed a recent rise in
popularity due to its relative ease of administration. The risk of an
unpleasant hallucinatory reaction during emergence can be reduced by
pretreating with midazolam and using ketamine only in children less than 10
years old. Ideally, the physician will be trained in several methods of
analgesia and anesthesia in case one method is contraindicated for a
specific patient. Use of sedation alone should be condemned; pain management
has become a social and moral priority. With solid knowledge of various
techniques, the orthopaedist can minimize patient discomfort during fracture
or dislocation management.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent (adverse drug reaction, drug administration, drug
combination, drug comparison, drug dose, drug therapy, inhalational drug
administration, intramuscular drug administration, intranasal drug
administration, intravenous drug administration, oral drug administration,
pharmacokinetics, rectal drug administration)
EMTREE DRUG INDEX TERMS
atropine (drug administration, intramuscular drug administration,
intravenous drug administration)
benzodiazepine (drug administration, drug combination, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, oral drug administration, pharmacology, rectal drug
administration)
diazepam (drug comparison, intravenous drug administration, pharmacology)
epinephrine
fentanyl (adverse drug reaction, drug comparison, intravenous drug
administration, pharmacokinetics, pharmacology)
flumazenil (drug dose, drug therapy, intravenous drug administration)
glycopyrronium (intramuscular drug administration, intravenous drug
administration)
ketamine (adverse drug reaction, drug comparison, drug dose, intramuscular
drug administration, intravenous drug administration, pharmacology)
lidocaine (adverse drug reaction, drug dose, drug toxicity, intravenous drug
administration, pharmacology)
midazolam (drug comparison, drug dose, drug therapy, intravenous drug
administration, pharmacology)
morphine (drug comparison, intravenous drug administration,
pharmacokinetics)
naloxone (drug therapy, intravenous drug administration)
narcotic agent (drug administration, drug combination, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, oral drug administration, pharmacology, rectal drug
administration)
nitrous oxide (adverse drug reaction, inhalational drug administration,
pharmacology)
pethidine (drug comparison, intravenous drug administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fracture (disease management)
EMTREE MEDICAL INDEX TERMS
amnesia (side effect)
analgesia
anesthesia
anesthesist
bacterium contamination
brachial plexus anesthesia
comorbidity
diaphragm injury (side effect)
dizziness (side effect)
dysphoria (side effect)
excitement
hallucination (drug therapy, prevention, side effect)
heart arrhythmia (side effect)
hematoma (side effect)
Horner syndrome (side effect)
human
hypertension (side effect)
hypotension (side effect)
intracranial hypertension (side effect)
nasal pruritus (side effect)
nausea and vomiting (side effect)
nerve paralysis (side effect)
orthopedic surgery
outpatient
paresthesia (side effect)
pneumothorax (side effect)
priority journal
pruritus (side effect)
rash (side effect)
respiration depression (drug therapy, side effect)
review
rigidity
sedation
seizure (side effect)
surgeon
tachycardia (side effect)
tranquilizing activity
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
glycopyrronium bromide (596-51-0)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Orthopedic Surgery (33)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004460207
MEDLINE PMID
15502581 (http://www.ncbi.nlm.nih.gov/pubmed/15502581)
PUI
L39425645
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1097
TITLE
Refractory ventricular fibrillation in accidental hypothermia: Salvage with
cardiopulmonary bypass
AUTHOR NAMES
Mulpur A.K.
Mirsadraee S.
Hassan T.B.
McKeague H.
Kaul P.
AUTHOR ADDRESSES
(Mulpur A.K.; Mirsadraee S.) Yorkshire Heart Centre, Jubilee Wing, Leeds LS6
4NZ, United Kingdom.
(Hassan T.B.) Department of Accident and Emergency, Leeds General Infirmary,
Jubilee Wing, Leeds LS6 4NZ, United Kingdom.
(McKeague H.) Anaesthetics Department, Leeds General Infirmary, Jubilee
Wing, Leeds LS6 4NZ, United Kingdom.
(Kaul P., pankaj.kaul@leedsth.nhs.uk) Department of Cardiothoracic Surgery,
Yorkshire Heart Centre, Jubilee Wing, Leeds LS6 4NZ, United Kingdom.
CORRESPONDENCE ADDRESS
P. Kaul, Yorkshire Heart Centre, The General Infirmary at Leeds, Jubilee
Wing, Leeds LS6 4NZ, United Kingdom. Email: pankaj.kaul@leedsth.nhs.uk
SOURCE
Perfusion (2004) 19:5 (311-314). Date of Publication: 2004
ISSN
0267-6591
BOOK PUBLISHER
SAGE Publications Ltd, 55 City Road, London, United Kingdom.
ABSTRACT
A 20-year old woman presented with prolonged refractory ventricular
fibrillation and pulmonary oedema following hypothermia while she was under
self-administered heroin in an attempt to commit suicide. She was
successfully resuscitated with cardiopulmonary bypass for core rewarming and
internal defibrillation. © Arnold 2004.
EMTREE DRUG INDEX TERMS
atropine (drug combination)
diamorphine (drug toxicity)
epinephrine (drug combination)
infusion fluid (drug therapy, intravenous drug administration)
naloxone (drug combination, intramuscular drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
accidental hypothermia (drug therapy, therapy)
cardiopulmonary bypass
heart ventricle fibrillation (therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
bypass surgery
case report
defibrillation
drug overdose
emergency treatment
female
human
intensive care unit
lung edema (complication, surgery)
priority journal
resuscitation
salvage therapy
suicide attempt
treatment outcome
warming
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004437948
MEDLINE PMID
15506037 (http://www.ncbi.nlm.nih.gov/pubmed/15506037)
PUI
L39359409
DOI
10.1191/0267659104pf760oa
FULL TEXT LINK
http://dx.doi.org/10.1191/0267659104pf760oa
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1098
TITLE
Suspected Opioid-related Emergency Medical Services Encounters in a Rural
State, 1997-2002
AUTHOR NAMES
Alexander J.L.
Burton J.H.
Bradshaw J.R.
Colin F.
AUTHOR ADDRESSES
(Alexander J.L., alexajo@mmc.org; Burton J.H.; Bradshaw J.R.; Colin F.)
Department of Emergency Medicine, Maine Medical Center, Portland, Maine;
Maine Emergency M., .
(Alexander J.L., alexajo@mmc.org) Department of Emergency Medicine, Maine
Medical Center, 47 Bramhall St., Portland, ME 04102., .
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, Maine Medical Center, Portland, Maine;
Maine Emergency M., . Email: alexajo@mmc.org
SOURCE
Prehospital Emergency Care (2004) 8:4 (427-430). Date of Publication:
October/November 2004
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
News organizations and governmental agencies have reported substantial
increases in the number of opioid-related overdose cases in recent years. To
describe the utilization of emergency medical services (EMS) for suspected
opioid-related overdose cases in a rural state during the period 1997
through 2002. Statewide EMS records were reviewed for 1997 through 2002.
Data reviewed included prehospital diagnosis and medications given to all
patients by prehospital providers. For cases with a prehospital diagnosis of
poisoning or overdose, data reviewed included medications given to patients
by prehospital providers, pupil size, and respiratory rate. All records were
reviewed in a defined sequence. The study period encompassed 1,175,781
patient encounters. Poisoning or overdose patients accounted for 19,808
(1.7%) encounters. Naloxone was administered by the EMS provider to 2,668
(0.2%) patients. For all poisoning or overdose patients, 1,308 (6.6%) had
miotic pupils, 450 (2.2%) had a respiratory rate of <12 breaths/min, and
1,569 (7.9%) received naloxone. During the investigation period, total EMS
patient encounters increased 25%, while patients with a complaint of
poisoning or overdose increased 47%. The incidences of EMS overdose patients
with miotic pupils, respiratory rate <10 breaths/min, and naloxone
administration increased 167%, 295%, and 154%, respectively. In this rural
state, prehospital patients with findings suspicious for opioid overdose
disproportionately outpaced the growth of all EMS encounters as well as
general overdose encounters during the defined investigation period.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
drug overdose (drug therapy)
emergency health service
health care utilization
EMTREE MEDICAL INDEX TERMS
breathing rate
dose response
health care organization
health survey
human
medical record
pupil
review
rural area
rural population
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004418772
MEDLINE PMID
15626007 (http://www.ncbi.nlm.nih.gov/pubmed/15626007)
PUI
L39298763
DOI
10.1016/j.prehos.2004.06.019
FULL TEXT LINK
http://dx.doi.org/10.1016/j.prehos.2004.06.019
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1099
TITLE
Clinical policy: Evidence-based approach to pharmacologic agents used in
pediatric sedation and analgesia in the emergency department
AUTHOR NAMES
Mace S.E.
Barata I.A.
Cravero J.P.
Dalsey W.C.
Godwin S.A.
Kennedy R.M.
Malley K.C.
Moss R.L.
Sacchetti A.D.
Warden C.R.
Wears R.L.
Brennan J.A.
Whitson R.R.
Crown H.
Kavanaugh D.
Role S.E.
AUTHOR ADDRESSES
(Mace S.E.; Barata I.A.; Dalsey W.C.; Godwin S.A.; Sacchetti A.D.; Warden
C.R.; Wears R.L.; Brennan J.A.; Whitson R.R.; Crown H.; Kavanaugh D.; Role
S.E.) American College of Emer. Physicians, .
(Cravero J.P.) Amern Soc of Anesthesiologists, .
(Kennedy R.M.) American Academy of Pediatrics, .
(Malley K.C.) Emergency Nurses Association, .
(Moss R.L.) American Pediatric Surgical Assoc., .
CORRESPONDENCE ADDRESS
American College of Emer. Physicians, .
SOURCE
Journal of Emergency Nursing (2004) 30:5 (447-461). Date of Publication:
October 2004
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS
etomidate (adverse drug reaction, drug comparison)
fentanyl (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration)
flumazenil
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison, intramuscular drug administration, intravenous drug
administration, pharmacology)
methohexital (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacology, rectal drug administration)
midazolam (adverse drug reaction, clinical trial, drug combination, drug
comparison, intramuscular drug administration, intranasal drug
administration, intravenous drug administration)
morphine (drug comparison, intravenous drug administration)
naloxone
naltrexone
oxygen (drug therapy)
pentobarbital (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration, oral drug administration,
pharmacology)
propofol (adverse drug reaction, clinical trial, drug combination, drug
comparison, intravenous drug administration, pharmacology)
salbutamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
child care
emergency medicine
sedation
EMTREE MEDICAL INDEX TERMS
agitation
airway obstruction (side effect)
anterograde amnesia (side effect)
apnea (side effect, therapy)
article
artificial ventilation
child
clinical practice
clinical protocol
clinical trial
coughing (side effect)
cyanosis (side effect)
drug efficacy
drug mechanism
drug safety
human
hypotension (side effect)
hypoxia (drug therapy, side effect)
larynx spasm (side effect)
myoclonus (side effect)
respiration depression (side effect)
scoring system
side effect (side effect, therapy)
skin manifestation (side effect)
statistical analysis
statistical significance
validation process
vomiting (side effect)
wheezing (drug therapy, side effect)
CAS REGISTRY NUMBERS
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
oxygen (7782-44-7)
pentobarbital (57-33-0, 76-74-4)
propofol (2078-54-8)
salbutamol (18559-94-9)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
15452523 (http://www.ncbi.nlm.nih.gov/pubmed/15452523)
PUI
L39562213
DOI
10.1016/j.jen.2004.07.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2004.07.004
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1100
TITLE
Clinical policy: Evidence-based approach to pharmacologic agents used in
pediatric sedation and analgesia in the emergency department
AUTHOR ADDRESSES
SOURCE
Journal of Pediatric Surgery (2004) 39:10 (1472-1484). Date of Publication:
October 2004
ISSN
0022-3468
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
sedative agent (adverse drug reaction, clinical trial, drug combination,
drug comparison, drug interaction, intravenous drug administration,
pharmacology)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (adverse drug reaction, clinical trial, drug
combination, drug interaction, intravenous drug administration,
pharmacology)
chlorpromazine (drug comparison)
etomidate (pharmacology)
fentanyl (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug dose, drug interaction, intravenous drug administration,
pharmacology)
flumazenil (drug interaction)
imidazole derivative (pharmacology)
ketamine (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug dose, intramuscular drug administration, intravenous drug
administration, pharmacology)
methohexital (adverse drug reaction, clinical trial, drug administration,
intramuscular drug administration, intravenous drug administration,
pharmacology, rectal drug administration)
midazolam (adverse drug reaction, clinical trial, drug combination, drug
interaction, intravenous drug administration, pharmacology)
morphine (drug comparison)
naloxone (drug interaction)
naltrexone (drug interaction)
opiate derivative (adverse drug reaction, clinical trial, drug interaction,
intravenous drug administration, pharmacology)
pentobarbital (adverse drug reaction, clinical trial, pharmacology)
pethidine (drug comparison)
promethazine (drug comparison)
propofol (adverse drug reaction, clinical trial, drug combination,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatrics
EMTREE MEDICAL INDEX TERMS
airway obstruction (side effect)
analgesia
apnea (side effect)
article
artificial ventilation
bronchospasm (side effect)
bronchus hyperreactivity (side effect)
clinical trial
correlation analysis
coughing (side effect)
drug antagonism
drug effect
drug efficacy
drug megadose
drug potency
drug potentiation
drug safety
emergency ward
evidence based medicine
fatty acid desaturation
health care policy
human
hypotension (side effect)
hypoventilation (side effect)
hypoxemia (side effect)
meta analysis
nausea (side effect)
priority journal
procedures
pruritus (side effect)
respiration depression (side effect)
sedation
side effect (side effect)
statistical significance
vomiting (side effect)
CAS REGISTRY NUMBERS
chlorpromazine (50-53-3, 69-09-0)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2004436915
MEDLINE PMID
15486890 (http://www.ncbi.nlm.nih.gov/pubmed/15486890)
PUI
L39349728
DOI
10.1016/j.jpedsurg.2004.07.002
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jpedsurg.2004.07.002
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1101
TITLE
Acute intoxications in adults
ORIGINAL (NON-ENGLISH) TITLE
Akutna otrovanja odraslih
AUTHOR NAMES
Bilušić M.
Šarinić V.M.
AUTHOR ADDRESSES
(Bilušić M., mbilusic@zkf.hr; Šarinić V.M.) Zavod za Klinicku Farmakologiju,
Interne Klinike, KBC Rebro Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
CORRESPONDENCE ADDRESS
M. Bilušić, Zavod za Klinicku Farmakologiju, Interne Klinike, KBC Rebro
Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia. Email: mbilusic@zkf.hr
SOURCE
Medicina (2004) 40:3 (194-197). Date of Publication: 2004
ISSN
0025-7729
ABSTRACT
Acute intoxications in adults are usually underestimated although acute
intoxications take a relatively important role in the morbidity of adult
population. In this article we tried to outline the problem of acute
intoxications. The results from the survey of acutely intoxicated patients
assisted in the emergency unit revealed a structure of acute intoxications.
Tablets were found to be the most frequent cause of intoxication, taking
plane in about 40.5 of all intoxications in the adult population. Alcohol is
in the second place with the prevalence of 22.5%, and is followed by
opiates, mushrooms, and other causes. The cause of intoxicaton remained
unknown in only 3.37% of cases. In the comparison with children, when the
majority of all intoxications are accidental, in adults intoxications occur
by design, mainly as a suicide attempt. About 40% of acute intoxications in
adult population include a suicide attempt. Regardless of the great number
and variety of potentially toxic agents, the treatment procedure with the
acutely intoxicated patient is generally based on the same principles, a
specific antidote being available only for a very few poisons.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
acetylsalicylic acid (drug toxicity)
alcohol (drug toxicity)
amitriptyline (drug toxicity)
antidepressant agent (drug toxicity)
antidote (drug therapy)
atropine (drug therapy)
benzodiazepine derivative (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (drug therapy)
calcium channel blocking agent (drug toxicity)
carbamazepine (drug toxicity)
cocaine (drug toxicity)
diclofenac (drug toxicity)
digoxin (drug toxicity)
diphenhydramine (drug toxicity)
flumazenil (drug therapy)
fluoxetine (drug toxicity)
glucagon (drug therapy, drug toxicity)
metildigoxin (drug toxicity)
naloxone (drug therapy)
narcotic agent (drug toxicity)
opiate (drug toxicity)
organophosphate insecticide (drug toxicity)
paracetamol (drug toxicity)
pralidoxime (drug therapy)
promazine (drug toxicity)
salicylic acid (drug toxicity)
tramadol (drug toxicity)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol intoxication (drug therapy)
article
disease classification
drug intoxication (diagnosis, drug therapy)
emergency ward
health survey
human
laboratory diagnosis
morbidity
mushroom poisoning (drug therapy)
prevalence
suicide attempt
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
carbamazepine (298-46-4, 8047-84-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diclofenac (15307-79-6, 15307-86-5)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
metildigoxin (30685-43-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
promazine (53-60-1, 58-40-2)
salicylic acid (63-36-5, 69-72-7)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Croatian
LANGUAGE OF SUMMARY
Croatian, English
EMBASE ACCESSION NUMBER
2004397868
PUI
L39232801
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1102
TITLE
The ABC of community emergency care. 6 Assessment and management of
paediatric primary survey negative patients
AUTHOR NAMES
Jewkes F.
Woollard M.
AUTHOR ADDRESSES
(Jewkes F.) Wiltshire Ambulance Serv. NHS Trust, Wiltshire, United Kingdom.
(Woollard M., Malcolm.woollard@ukgateway.net) Pre-hospital Care Research
Unit, Dept. of Academic Emergency Medicine, The James Cook University
Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom.
(Woollard M., Malcolm.woollard@ukgateway.net) Pre-hospital Care Research
Unit, Dept. of Academic Emergency Medicine, University of Teeside, Teesside,
United Kingdom.
CORRESPONDENCE ADDRESS
M. Woollard, Dept. of Academic Emergency Medicine, Education Centre, The
James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United
Kingdom. Email: Malcolm.woollard@ukgateway.net
SOURCE
Emergency Medicine Journal (2004) 21:5 (595-605). Date of Publication:
September 2004
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS
antibiotic agent (drug therapy, intraocular drug administration, topical
drug administration)
antidiarrheal agent
antiemetic agent
antipyretic agent (drug therapy)
bronchodilating agent (drug therapy)
budesonide (drug therapy, inhalational drug administration)
cefotaxime (drug therapy)
dexamethasone (drug therapy, oral drug administration)
diazepam (drug therapy)
epinephrine (drug therapy)
fusidic acid (drug therapy, intraocular drug administration)
glucose (drug therapy, endogenous compound)
hydrocortisone (drug therapy)
ibuprofen (drug therapy)
ipratropium bromide (drug therapy)
morphine (drug therapy)
naloxone (drug therapy)
paracetamol (drug therapy)
penicillin G (drug therapy)
prednisolone (drug therapy, oral drug administration)
salbutamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child health care
childhood disease (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
abdominal disease (diagnosis, drug therapy, therapy)
abdominal pain (diagnosis)
article
child
clinical feature
diagnostic test
diarrhea (diagnosis, therapy)
differential diagnosis
ear disease (diagnosis, drug therapy)
eye disease (diagnosis, drug therapy, therapy)
fever (diagnosis, drug therapy)
glucose blood level
health survey
hospital admission
human
interpersonal communication
irritability
medical assessment
medical examination
neurologic disease (diagnosis, drug therapy)
nose disease (diagnosis)
otorhinolaryngology
patient referral
priority journal
respiratory tract disease (diagnosis, drug therapy)
reticuloendothelial system
skin disease (diagnosis, drug therapy)
skin examination
symptomatology
temperature measurement
throat disease (diagnosis, drug therapy)
treatment planning
urine culture
virus infection (diagnosis, drug therapy)
vomiting (diagnosis, therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
budesonide (51333-22-3)
cefotaxime (63527-52-6, 64485-93-4)
dexamethasone (50-02-2)
diazepam (439-14-5)
fusidic acid (6990-06-3)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
ibuprofen (15687-27-1)
ipratropium bromide (22254-24-6)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
penicillin G (1406-05-9, 61-33-6)
prednisolone (50-24-8)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Otorhinolaryngology (11)
Dermatology and Venereology (13)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2004397265
MEDLINE PMID
15333546 (http://www.ncbi.nlm.nih.gov/pubmed/15333546)
PUI
L39232198
DOI
10.1136/emj.2004.017780
FULL TEXT LINK
http://dx.doi.org/10.1136/emj.2004.017780
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1103
TITLE
Emergency drug availability on general paediatric units
AUTHOR NAMES
Perkin M.R.
Wey E.Q.
AUTHOR ADDRESSES
(Perkin M.R., mperkin@sghms.ac.uk; Wey E.Q.) Department of Child Health, St.
George's Hospital Medical School, SW17 0RE, London, United Kingdom.
CORRESPONDENCE ADDRESS
M.R. Perkin, Department of Child Health, St. George's Hospital Medical
School, SW17 0RE, London, United Kingdom. Email: mperkin@sghms.ac.uk
SOURCE
Resuscitation (2004) 62:2 (243-247). Date of Publication: August 2004
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Following an incident where intravenous lorazepam was not available on a
general paediatric ward we undertook a national survey of emergency drug
availability on general paediatric units in the United Kingdom. Drugs chosen
were those recommended in the Advanced Paediatric Life Support manual and
the British National Formulary for the management of the most common
paediatric emergencies. Twelve drugs were chosen covering emergencies in the
following systems: cardiovascular (adrenaline (epinephrine), atropine and
adenosine); neurological (flumazenil, lorazepam, paraldehyde, phenytoin and
mannitol); metabolic (Hypostop Gel and glucagon); analgesia related
(naloxone); and respiratory (aminophylline). A thirteenth drug, intravenous
salbutamol was included in a reminder letter sent to non-responding units.
Questionnaires were sent to 274 units. Replies were received from 242
(88.3%), of whom 20 did not have a general paediatric ward, leaving 222
units (81.0%). Drug availability varied for the different drugs: adrenaline
(available on 100% of units), atropine (98.2%), naloxone (96.4%), phenytoin
(95.9%), aminophylline (93.2%), paraldehyde (92.3%), mannitol (87.8%),
lorazepam (86.9%), glucagon (86.5%), Hypostop Gel (80.6%), adenosine (72.1%)
and flumazenil (66.7%). Six of the drugs were classified as first line
agents (adrenaline, atropine, adenosine, lorazepam, paraldehyde and
aminophylline). Over one in 10 units did not stock two or more of these
first line drugs. Consideration needs to be given to the compiling of a
consensus based list of drugs that ought to be stocked on all general
paediatric units. © 2004 Elsevier Ireland Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS
adenosine
aminophylline
analgesic agent
atropine
epinephrine
flumazenil
glucagon
lorazepam
mannitol
naloxone
paraldehyde
phenytoin
salbutamol (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug bioavailability
emergency health service
EMTREE MEDICAL INDEX TERMS
article
cardiovascular system
consensus
drug surveillance program
emergency treatment
human
intensive care
metabolic syndrome X
neurologic disease
priority journal
questionnaire
respiratory system
United Kingdom
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
lorazepam (846-49-1)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
paraldehyde (123-63-7)
phenytoin (57-41-0, 630-93-3)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Portuguese, Spanish
EMBASE ACCESSION NUMBER
2004338350
MEDLINE PMID
15294411 (http://www.ncbi.nlm.nih.gov/pubmed/15294411)
PUI
L39037267
DOI
10.1016/j.resuscitation.2004.03.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.resuscitation.2004.03.004
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1104
TITLE
High-dose steroids for acute spinal cord injury in emergency medical
services
AUTHOR NAMES
Bledsoe B.E.
Wesley A.K.
Salomone J.P.
AUTHOR ADDRESSES
(Bledsoe B.E.) Department of Emergency Medicine, University of North Texas,
Health Sciences Center, Midlothian, TX, United States.
(Wesley A.K.) Eau Claire County EMS, Chippewa Valley Emergency Care, Eau
Claire, WI, United States.
(Salomone J.P.) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States.
CORRESPONDENCE ADDRESS
B.E. Bledsoe, Department of Emergency Medicine, University of North Texas,
Health Sciences Center, Midlothian, TX, United States.
SOURCE
Prehospital Emergency Care (2004) 8:3 (313-316). Date of Publication:
July/September 2004
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
steroid (adverse drug reaction, clinical trial, drug comparison, drug dose,
drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
antiinflammatory agent (adverse drug reaction, clinical trial, drug
comparison, drug dose, drug therapy, pharmacology)
corticosteroid (drug therapy)
methylprednisolone (adverse drug reaction, clinical trial, drug comparison,
drug dose, drug therapy, pharmacology)
naloxone (clinical trial, drug dose, drug therapy)
narcotic antagonist (clinical trial, drug dose, drug therapy)
nimodipine (drug therapy)
tirilazad (drug comparison, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
spinal cord injury (drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical trial
death
first aid
gastrointestinal hemorrhage (side effect)
human
hyperglycemia (side effect)
infection (side effect)
meta analysis
neurologic disease (drug therapy)
nonhuman
pneumonia (side effect)
respiratory failure (side effect)
review
septicemia (side effect)
wound healing impairment (side effect)
CAS REGISTRY NUMBERS
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
nimodipine (66085-59-4)
tirilazad (110101-66-1, 110101-67-2, 111793-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2004292662
MEDLINE PMID
15295735 (http://www.ncbi.nlm.nih.gov/pubmed/15295735)
PUI
L38887168
DOI
10.1016/j.prehos.2004.03.008
FULL TEXT LINK
http://dx.doi.org/10.1016/j.prehos.2004.03.008
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1105
TITLE
Outpatient management of sickle cell pain with chronic opioid
pharmacotherapy
AUTHOR NAMES
Shaiova L.
Wallenstein D.
AUTHOR ADDRESSES
(Shaiova L., lshaiova@bethisraelny.org; Wallenstein D.)
(Shaiova L., lshaiova@bethisraelny.org; Wallenstein D.) Dept. of Pain
Med./Palliative Care, Beth Israel Medical Center, New York, NY, United
States.
(Shaiova L., lshaiova@bethisraelny.org) Dept. of Pain Med./Palliative Care,
Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003,
United States.
CORRESPONDENCE ADDRESS
L. Shaiova, Dept. of Pain Med./Palliative Care, Beth Israel Medical Center,
First Avenue at 16th Street, New York, NY 10003, United States. Email:
lshaiova@bethisraelny.org
SOURCE
Journal of the National Medical Association (2004) 96:7 (984-986). Date of
Publication: July 2004
ISSN
0027-9684
BOOK PUBLISHER
National Medical Association, 1012 Tenth Street NW, Washington, United
States.
ABSTRACT
We report our experience of providing chronic opioid pharmacotherapy on an
outpatient basis to selected patients with frequent episodes of
moderate-to-severe pain from sickle cell disease (SCD). Three cases
illustrate our clinical experience in approximately 40 patients with sickle
cell pain. Patients were seen at our sickle cell pain clinic at Beth Israel
Hospital once each month for a three-hour visit. Visits included group music
therapy and individual medical care, including comprehensive blood work and
scheduling of medical tests when appropriate. Between visits, the pain and
palliative care physicians followed patients on an as-needed basis. The SCD
pain opioid pharmacotherapy protocol was modeled on a regimen used to treat
malignant pain-typically a long-acting opioid in combination with a
short-acting opioid, such as oral transmucosal fentanyl citrate (OTFC®;
Actiq®) for breakthrough pain (BTP). Emergency department (ED) visits and
hospital admissions were dramatically reduced in the three patients whose
pain was managed by adapting the cancer pain model. During the year before
their first visit to our pain clinic, the patients each had between six and
18 ED visits, which resulted in six- to 13 hospital admissions amounting to
32-182 inpatient days per patient. Each of the patients was prescribed a
long-acting opioid (methadone, control-release oxycodone, or transdermal
fentanyl) with a short-acting opioid for BTP from crises (oral transmucosal
fentanyl citrate for two patients; short-acting oxycodone for one patient).
Pain was well controlled. For each patient, hospital admissions were reduced
to ≤1 visit per year. These reduced levels of ED visits and hospital
admissions have remained constant for more than three years.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (clinical trial, drug combination, drug therapy, transdermal drug
administration)
fentanyl citrate (clinical trial, drug combination, drug therapy, oral drug
administration)
methadone (clinical trial, drug combination, drug therapy)
oxycodone (clinical trial, drug combination, drug therapy, pharmaceutics)
EMTREE DRUG INDEX TERMS
long acting drug (clinical trial, drug combination, drug therapy,
pharmaceutics, transdermal drug administration)
opiate (clinical trial, drug combination, drug therapy, oral drug
administration, pharmaceutics, transdermal drug administration)
short acting drug (clinical trial, drug combination, drug therapy, oral drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
outpatient care
pain (complication, drug therapy, etiology, therapy)
sickle cell anemia
EMTREE MEDICAL INDEX TERMS
adult
article
blood chemistry
clinical article
clinical protocol
clinical trial
controlled clinical trial
controlled release formulation
controlled study
disease severity
emergency treatment
experience
female
hospital admission
human
laboratory test
male
medical examination
music therapy
pain assessment
prescription
priority journal
treatment outcome
DRUG TRADE NAMES
actiq
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Hematology (25)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004272865
MEDLINE PMID
15253332 (http://www.ncbi.nlm.nih.gov/pubmed/15253332)
PUI
L38823515
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1106
TITLE
Procedure in patient with acute poisoning
ORIGINAL (NON-ENGLISH) TITLE
Procedimiento en paciente con intoxicación
AUTHOR NAMES
Rodríguez Soler A.J.
Quesada Pérez M.T.
AUTHOR ADDRESSES
(Rodríguez Soler A.J., ajroso@yahoo.es) Servicio de UCI y Coronarias, Hosp.
Univ. Ntra. Sra. de Candelaria, Sta. Cruz de Tenerife, Spain.
(Quesada Pérez M.T.) Hospital Vigil de Quinones. Sevilla, Comn. Docente
Master Enfermeria E., Universidad de Sevilla, .
(Rodríguez Soler A.J., ajroso@yahoo.es) C/ Porlier n 91, 2 B, 38006 Santa
Cruz de Tenerife, Spain.
CORRESPONDENCE ADDRESS
A.J. Rodríguez Soler, C/ Porlier n 91, 2 B, 38006 Santa Cruz de Tenerife,
Spain. Email: ajroso@yahoo.es
SOURCE
Puesta al Dia en Urgencias, Emergencias y Catastrofes (2004) 5:3 (107-117).
Date of Publication: Jul 2004
ISSN
1576-0316
ABSTRACT
The objective of this article is to serve as guide for the professional of
infirmary in the matter of poisonings, not only in classic and the most
habitual ones but in others of more recent incorporation to our society as
they are accidents with dangerous substances, chemical, toxic, etc. In this
article also it is explained the most habitual techniques to those than the
nurse must face and that they require of specific knowledge of the matter.
In summary, this article tries: to establish the general measures of
performance of the infirmary personnel before an intoxicated patient, to
clarify key points that can affect the correct application of the treatment,
establish general guidelines of performance before extrahospitable and
hospitable poisonings and know new forms poisonings which infirmary at the
present time faces.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug dose, drug therapy, intravenous drug administration)
activated carbon
alcohol (drug dose, drug therapy, drug toxicity)
amphetamine derivative (drug toxicity)
antidote (drug therapy)
atropine (drug dose, drug therapy, intravenous drug administration)
benzodiazepine derivative (drug toxicity)
cocaine (drug toxicity)
colestyramine (drug dose, drug therapy)
coumarin derivative (drug toxicity)
ethylene glycol (drug toxicity)
flumazenil (drug dose, drug therapy, intravenous drug administration)
fuller earth (drug therapy, oral drug administration)
naloxone (drug dose, drug therapy)
obidoxime (drug dose, drug therapy)
opiate (drug toxicity)
organophosphate insecticide (drug toxicity)
paracetamol (drug toxicity)
paraquat (drug toxicity)
pralidoxime (drug dose, drug therapy)
pyridoxine derivative (drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration)
thiamine (drug dose, drug therapy, intramuscular drug administration)
toxic gas (drug toxicity)
toxic substance
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
absorption
dangerous goods
detoxification
emergency treatment
health care personnel
hospital
hospital care
human
intestine transit time
nursing
procedures
protective equipment
review
stomach lavage
toxin analysis
vomiting (diagnosis)
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
colestyramine (11041-12-6, 58391-37-0)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
fuller earth (8031-18-3)
naloxone (357-08-4, 465-65-6)
obidoxime (114-90-9, 7683-36-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
pralidoxime (6735-59-7)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2005057289
PUI
L40175243
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1107
TITLE
Coma - Emergency management of the unconscious patient
AUTHOR NAMES
Booth S.A.
Leary T.S.
AUTHOR ADDRESSES
(Booth S.A.) Dept. of Anaesthesia Intensive Care, Peterborough Hospitals,
Peterborough, United Kingdom.
(Booth S.A.; Leary T.S., tim.leary@nnuh.nhs.uk) Department of Anaesthesia,
Norfolk/Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY,
United Kingdom.
CORRESPONDENCE ADDRESS
T.S. Leary, Department of Anaesthesia, Norfolk/Norwich University Hospital,
Colney Lane, Norwich, Norfolk NR4 7UY, United Kingdom. Email:
tim.leary@nnuh.nhs.uk
SOURCE
CPD Journal Acute Medicine (2004) 3:1 (9-16). Date of Publication: 2004
ISSN
1476-5063
ABSTRACT
The acute presentation of an unconscious individual is a common scenario and
it indicates a severe pathological insult. Aetiology may not be apparent at
initial assessment and maximal use of available resources should be made to
identify the cause. Initial management should be directed towards
resuscitation and stabilisation of the individual, followed by further
clinical assessment. The prevention of secondary brain injury is essential
and so respiratory, circulatory and metabolic abnormalities should be
treated aggressively. Early involvement of critical care physicians may be
required. Detailed aspects of acute management and specific care of head
injured, intoxicated and post-cardiac arrest patients is discussed.
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
amphetamine (drug toxicity)
antihistaminic agent (drug toxicity)
barbituric acid derivative (drug toxicity)
benzodiazepine (drug therapy)
benzodiazepine receptor blocking agent (adverse drug reaction, drug
interaction, drug therapy, intravenous drug administration)
beta adrenergic receptor blocking agent (drug toxicity)
captopril (drug toxicity)
carbamazepine (adverse drug reaction, drug interaction)
carbon monoxide (drug toxicity)
central stimulant agent (drug toxicity)
chloral hydrate (adverse drug reaction, drug interaction)
cholinergic receptor blocking agent (drug toxicity)
clonidine (drug toxicity)
cocaine (drug toxicity)
diazepam (drug therapy, intravenous drug administration)
flumazenil (adverse drug reaction, drug interaction, drug therapy,
intravenous drug administration)
glucose (drug therapy, intravenous drug administration)
hypertensive factor (drug therapy)
ketamine (drug toxicity)
lithium (drug toxicity)
lorazepam (drug therapy, intravenous drug administration)
monoamine oxidase inhibitor (drug toxicity)
naloxone (adverse drug reaction, drug therapy, intravenous drug
administration)
opiate (drug toxicity)
pabrinex
salicylic acid derivative (drug toxicity)
thiamine (drug therapy, intravenous drug administration)
tricyclic antidepressant agent (adverse drug reaction, drug interaction)
unindexed drug
valproic acid (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (diagnosis, drug therapy, etiology, therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
acute disease (diagnosis, drug therapy, etiology, therapy)
alcohol intoxication (drug therapy, etiology)
brain injury (complication, prevention)
clinical examination
clinical feature
disease severity
drug intoxication (diagnosis, drug therapy, etiology)
head injury (diagnosis, drug therapy, therapy)
heart arrest (diagnosis, drug therapy)
heart arrhythmia (side effect)
human
intensive care
ischemia
lung edema (side effect)
medical assessment
metabolic disorder
pathology
physician
resource allocation
respiratory tract disease
resuscitation
review
seizure (drug therapy, side effect)
treatment planning
unconsciousness (diagnosis, drug therapy, etiology, therapy)
DRUG TRADE NAMES
pabrinex
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
benzodiazepine (12794-10-4)
captopril (62571-86-2)
carbamazepine (298-46-4, 8047-84-5)
carbon monoxide (630-08-0)
chloral hydrate (302-17-0)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lithium (7439-93-2)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
thiamine (59-43-8, 67-03-8)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Adverse Reactions Titles (38)
General Pathology and Pathological Anatomy (5)
Toxicology (52)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004229664
PUI
L38678510
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1108
TITLE
Measuring the emergence of tobacco dependence: The contribution of negative
reinforcement models
AUTHOR NAMES
Eissenberg T.
AUTHOR ADDRESSES
(Eissenberg T., teissenb@vcu.edu) Department of Psychology, Inst. for Drug
and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United
States.
(Eissenberg T., teissenb@vcu.edu) Department of Psychology, Inst. for Drug
and Alcohol Studies, Virginia Commonwealth University, Richmond, VA
23298-0205, United States.
CORRESPONDENCE ADDRESS
T. Eissenberg, Department of Psychology, Inst. for Drug and Alcohol Studies,
Virginia Commonwealth University, Richmond, VA 23298-0205, United States.
Email: teissenb@vcu.edu
SOURCE
Addiction (2004) 99:SUPPL. 1 (5-29). Date of Publication: June 2004
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
This review of negative reinforcement models of drug dependence is part of a
series that takes the position that a complete understanding of current
concepts of dependence will facilitate the development of reliable and valid
measures of the emergence of tobacco dependence. Other reviews within the
series consider models that emphasize positive reinforcement and social
learning/cognitive models. This review summarizes negative reinforcement in
general and then presents four current negative reinforcement models that
emphasize withdrawal, classical conditioning, self-medication and
opponent-processes. For each model, the paper outlines central aspects of
dependence, conceptualization of dependence development and influences that
the model might have on current and future measures of dependence.
Understanding how drug dependence develops will be an important part of
future successful tobacco dependence measurement, prevention and treatment
strategies.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
cannabis
cocaine
mu opiate receptor agonist
naloxone
nicotine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
smoking
tobacco dependence
EMTREE MEDICAL INDEX TERMS
abstinence
avoidance behavior
conditioning
confidence interval
correlation analysis
drug withdrawal
emotional disorder
futurology
human
interview
measurement
medical assessment
medical research
nonhuman
prediction
preventive medicine
procedures
reinforcement
reliability
review
self report
smoking cessation
social learning
withdrawal syndrome
CAS REGISTRY NUMBERS
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004250185
MEDLINE PMID
15128378 (http://www.ncbi.nlm.nih.gov/pubmed/15128378)
PUI
L38746156
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1109
TITLE
Opioid therapy and headache: A cause and a cure
AUTHOR NAMES
Lipton R.B.
Bigal M.E.
AUTHOR ADDRESSES
(Lipton R.B., rlipton@aecom.yu.edu) Department of Neurology, Albert Einstein
College of Medicine, Bronx, NY, United States.
(Lipton R.B., rlipton@aecom.yu.edu) Dept. of Epidemiol. and Pop. Health,
Albert Einstein College of Medicine, Bronx, NY, United States.
(Lipton R.B., rlipton@aecom.yu.edu) Montefiore Headache Unit, Bronx, NY,
United States.
(Bigal M.E.) New England Center for Headache, Stamford, CT, United States.
(Lipton R.B., rlipton@aecom.yu.edu) Albert Einstein College of Medicine,
Rousso Building, 1300 Morris Park Avenue, Bronx, NY 10461, United States.
CORRESPONDENCE ADDRESS
R.B. Lipton, Albert Einstein College of Medicine, Rousso Building, 1300
Morris Park Avenue, Bronx, NY 10461, United States. Email:
rlipton@aecom.yu.edu
SOURCE
Neurology (2004) 62:10 (1662-1663). Date of Publication: 25 May 2004
ISSN
0028-3878
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
dihydroergotamine (drug therapy)
neuroleptic agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
pethidine (drug therapy)
serotonin agonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
headache (drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
drug efficacy
drug misuse
editorial
emergency ward
human
long term care
migraine (drug therapy, prevention)
priority journal
relapse
sedation
CAS REGISTRY NUMBERS
dihydroergotamine (511-12-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2004226352
MEDLINE PMID
15159457 (http://www.ncbi.nlm.nih.gov/pubmed/15159457)
PUI
L38661716
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1110
TITLE
Metoclopramide versus placebo with opioid
AUTHOR NAMES
Alsalim W.
Leung W.C.
Butler J.
AUTHOR ADDRESSES
(Alsalim W.; Leung W.C.; Butler J.)
SOURCE
Emergency Medicine Journal (2004) 21:3 (334-335). Date of Publication: May
2004
ISSN
1472-0205
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
A short cut review was carried out to establish whether metoclopramide
reduced nausea and vomiting after the administration of morphine. Altogether
405 papers were found using the reported search, of which one presented the
best evidence to answer the clinical question. The author, date and country
of publication, patient group studied, study type, relevant outcomes,
results and study weaknesses of this best paper are tabulated. A clinical
bottom line is stated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
metoclopramide (drug therapy)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
morphine (adverse drug reaction, drug therapy)
placebo
EMTREE MEDICAL INDEX TERMS
adult
case report
disease severity
drug efficacy
emergency ward
human
leg fracture (diagnosis)
leg pain (drug therapy)
male
medical literature
medical research
nausea and vomiting (drug therapy, prevention, side effect)
priority journal
short survey
CAS REGISTRY NUMBERS
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004199727
MEDLINE PMID
15107376 (http://www.ncbi.nlm.nih.gov/pubmed/15107376)
PUI
L38585111
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1111
TITLE
Acute methemoglobinemia after endoscopy
AUTHOR NAMES
Bayard M.
Farrow J.
Tudiver F.
AUTHOR ADDRESSES
(Bayard M.; Tudiver F.) Department of Family Medicine, Quillen College of
Medicine, East Tennessee State University, Johnson City, TN, United States.
(Farrow J.) Department of Internal Medicine, Quillen College of Medicine,
East Tennessee State University, Johnson City, TN, United States.
(Bayard M.) ETSU Family Medicine Associates, 917 W. Walnut St., Johnson
City, TN 37604, United States.
CORRESPONDENCE ADDRESS
M. Bayard, ETSU Family Medicine Associates, 917 W. Walnut St., Johnson City,
TN 37604, United States.
SOURCE
Journal of the American Board of Family Practice (2004) 17:3 (227-229). Date
of Publication: May/June 2004
ISSN
0893-8652
1544-8770 (electronic)
BOOK PUBLISHER
American Board of Family Medicine, 2228 Young Drive, Lexington, United
States.
EMTREE DRUG INDEX TERMS
benzocaine (adverse drug reaction)
flumazenil (drug therapy)
hemoglobin (endogenous compound)
methylene blue (drug therapy, intravenous drug administration)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
endoscopy
methemoglobinemia (complication, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
cyanosis (complication, drug therapy, side effect)
emergency ward
female
human
hypotension
laboratory test
oxygen therapy
tachypnea
thorax radiography
treatment outcome
CAS REGISTRY NUMBERS
benzocaine (1333-08-0, 94-09-7)
flumazenil (78755-81-4)
hemoglobin (9008-02-0)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2006186671
MEDLINE PMID
15226289 (http://www.ncbi.nlm.nih.gov/pubmed/15226289)
PUI
L43597262
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1112
TITLE
Buprenorphine: A Primer for Emergency Physicians
AUTHOR NAMES
Sporer K.A.
AUTHOR ADDRESSES
(Sporer K.A., ksporer@itsa.ucsf.edu) Department of Emergency Services, San
Francisco General Hospital, Univ. of California-San Francisco, San
Francisco, CA, United States.
(Sporer K.A., ksporer@itsa.ucsf.edu) Department of Emergency Services, San
Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110,
United States.
CORRESPONDENCE ADDRESS
K.A. Sporer, Department of Emergency Services, San Francisco General
Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
Email: ksporer@itsa.ucsf.edu
SOURCE
Annals of Emergency Medicine (2004) 43:5 (580-584). Date of Publication: May
2004
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
The recent approval of office-based treatment for opioid addiction and US
Food and Drug Administration approval of buprenorphine will expand treatment
options for opioid addiction. Buprenorphine is classified as a partial μ
opioid agonist and a weak κ antagonist. It has a high affinity for the μ
receptor, with slow dissociation resulting in a long duration of action and
an analgesic potency 25 to 40 times more potent than morphine. At higher
doses, its agonist effects plateau and it begins to behave more like an
antagonist, limiting the maximal analgesic effect and respiratory
depression. This "ceiling effect" confers a high safety profile clinically,
a low level of physical dependence, and only mild withdrawal symptoms on
cessation after prolonged administration. Suboxone contains a mixture of
buprenorphine and naloxone. The naloxone is poorly absorbed sublingually and
is designed to discourage intravenous use. Subutex, buprenorphine only, will
also be available primarily as an initial test dose. Clinicians will be
using this drug for detoxification or for maintenance of opioid addiction.
Patients with recent illicit opioid use may develop a mild precipitated
withdrawal syndrome with the induction of buprenorphine. Acute buprenorphine
intoxication may present with some diffuse mild mental status changes, mild
to minimal respiratory depression, small but not pinpoint pupils, and
relatively normal vital signs. Naloxone may improve respiratory depression
but will have limited effect on other symptoms. Patients with significant
symptoms related to buprenorphine should be admitted to the hospital for
observation because symptoms will persist for 12 to 24 hours.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug combination, drug dose, drug interaction, drug therapy,
drug toxicity, intravenous drug administration, oral drug administration,
pharmacokinetics, pharmacology, subcutaneous drug administration, sublingual
drug administration)
EMTREE DRUG INDEX TERMS
carbamazepine (drug interaction)
diamorphine
erythromycin (drug interaction)
kappa opiate receptor antagonist (drug dose, drug therapy, pharmacology)
ketoconazole (drug interaction)
methadone (drug therapy)
morphine
mu opiate receptor agonist (drug dose, drug therapy, pharmacology)
naloxone (drug administration, drug combination, drug therapy, intravenous
drug administration, sublingual drug administration)
opiate (intravenous drug administration)
phenobarbital (drug interaction)
phenytoin (drug interaction)
proteinase inhibitor (drug interaction)
subuxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
EMTREE MEDICAL INDEX TERMS
analgesic activity
dose response
heroin dependence (drug therapy)
human
opiate addiction (drug therapy)
physician
priority journal
receptor affinity
respiration depression (complication, drug therapy)
review
withdrawal syndrome
DRUG TRADE NAMES
subutex
subuxone , United KingdomReckitt Benckiser
DRUG MANUFACTURERS
(United Kingdom)Reckitt Benckiser
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
carbamazepine (298-46-4, 8047-84-5)
diamorphine (1502-95-0, 561-27-3)
erythromycin (114-07-8, 70536-18-4)
ketoconazole (65277-42-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
proteinase inhibitor (37205-61-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004193040
MEDLINE PMID
15111917 (http://www.ncbi.nlm.nih.gov/pubmed/15111917)
PUI
L38560403
DOI
10.1016/j.annemergmed.2003.11.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2003.11.006
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1113
TITLE
Office preparedness for pediatric emergencies: Baseline preparedness and the
impact of guideline distribution
AUTHOR NAMES
Walsh-Kelly C.M.
Bergholte J.
Erschen M.J.
Melzer-Lange M.
AUTHOR ADDRESSES
(Walsh-Kelly C.M., cwalsh@mail.mcw.edu; Bergholte J.; Melzer-Lange M.)
Medical College of Wisconsin, Milwaukee, WI, United States.
(Erschen M.J.) WI Emergency Med. Serv. Children, Madison, WI, United States.
(Walsh-Kelly C.M., cwalsh@mail.mcw.edu) MS677, 9000 West Wisconsin Avenue,
Milwaukee, WI 53226, United States.
CORRESPONDENCE ADDRESS
C.M. Walsh-Kelly, MS677, 9000 West Wisconsin Avenue, Milwaukee, WI 53226,
United States. Email: cwalsh@mail.mcw.edu
SOURCE
Pediatric Emergency Care (2004) 20:5 (289-296). Date of Publication: May
2004
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Objective: To determine the baseline level of preparedness of Wisconsin
primary care physician offices for pediatric emergencies and to assess the
impact of mail distribution of guidelines on this level of preparedness.
Method: Preintervention surveys were mailed to all Wisconsin physicians
requesting information about pediatric equipment, medications, training, and
policies. Guidelines were distributed by mail to all physicians who returned
completed surveys. An identical postintervention survey was mailed to these
physicians, and an analysis of the paired surveys for each respondent was
performed. Results: Baseline preparedness of 1051 Wisconsin physician
offices ranged from 37% with intraosseous needles to 96% with albuterol
solution for inhalation. Physician certification in pediatric advanced life
support was required in 26% of offices. A total of 568 paired
preintervention and postintervention surveys were analyzed. Improvements
were identified for the availability of equipment and medications, transport
policies, and reference guides. Conclusions: Mail distribution of guidelines
was minimally effective in improving the preparedness of Wisconsin offices
for pediatric emergencies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ceftriaxone (pharmaceutics)
epinephrine (pharmaceutics)
lorazepam (pharmaceutics)
naloxone (pharmaceutics)
salbutamol (inhalational drug administration, pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
management
pediatrics
practice guideline
EMTREE MEDICAL INDEX TERMS
certification
devices
endotracheal tube
health care policy
health program
health survey
human
information
intravenous catheter
mask
postal mail
primary health care
review
suction
training
United States
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
ceftriaxone (73384-59-5, 74578-69-1)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004221376
MEDLINE PMID
15123899 (http://www.ncbi.nlm.nih.gov/pubmed/15123899)
PUI
L38649798
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1114
TITLE
Variability in Emergency Physician Decisionmaking about Prescribing Opioid
Analgesics
AUTHOR NAMES
Tamayo-Sarver J.H.
Dawson N.V.
Cydulka R.K.
Wigton R.S.
Baker D.W.
AUTHOR ADDRESSES
(Cydulka R.K.) Department of Emergency Medicine, MetroHealth Medical Center,
Cleveland, OH, United States.
(Dawson N.V.) Ctr. for Hlth. Care Res. and Policy, Case W. Reserve Univ.
Sch. of Med., Department of Medicine, Cleveland, OH, United States.
(Tamayo-Sarver J.H., sarver@po.cwru.edu) Case W. Reserve Univ. Sch. of Med.,
Cleveland, OH, United States.
(Wigton R.S.) Div. of General Internal Medicine, Department of Internal
Medicine, Univ. Nebraska Med. Ctr. Coll. Med., Omaha, NE, United States.
(Baker D.W.) Div. of General Internal Medicine, Department of Medicine,
Feinberg Sch. of Med. of NW Univ., Chicago, IL, United States.
(Tamayo-Sarver J.H., sarver@po.cwru.edu) 4009 Cullen Drive, Cleveland, OH
44105, United States.
CORRESPONDENCE ADDRESS
J.H. Tamayo-Sarver, 4009 Cullen Drive, Cleveland, OH 44105, United States.
Email: sarver@po.cwru.edu
SOURCE
Annals of Emergency Medicine (2004) 43:4 (483-493). Date of Publication:
April 2004
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: The purpose of this study is to determine what factors
influence emergency physicians' decisions to prescribe an opioid analgesic
for 3 common, painful conditions. Methods: We developed items thought to
influence the decision to prescribe an opioid analgesic through a review of
the literature, expert consultation, and interviews with practicing
emergency physicians. We developed a baseline vignette and items expected to
influence the decision for each of the 3 conditions: migraine, back pain,
and ankle fracture. We surveyed 650 physicians randomly selected from the
American College of Emergency Physicians. The influence of individual items
was explored through a univariate analysis of the response distribution.
Patterns were assessed by analytically creating scales. Results: We received
responses from 398 (63%) of the 634 eligible physicians. Physicians'
likelihoods of prescribing an opioid showed marked variability, with at
least 10% of physicians saying they were unlikely and 10% of physicians
saying they were likely to prescribe for each condition. Physician responses
to individual pieces of clinical information, such as the patient requesting
"something strong" for the pain, were also highly variable, with at least
10% of physicians saying they would be negatively influenced by this request
and at least 10% saying they would be positively influenced by it.
Conclusion: Even when faced with identical case scenarios, physicians'
decisions to prescribe opioid analgesics are highly variable. Moreover, the
same clinical information, such as a patient requesting a strong analgesic,
changes the likelihood of prescribing opioids in opposite directions for
different physicians.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
EMTREE MEDICAL INDEX TERMS
ankle fracture (drug therapy)
backache (drug therapy)
clinical practice
decision making
emergency treatment
female
human
major clinical study
male
migraine (drug therapy)
pain (drug therapy)
prescription
priority journal
review
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004151488
MEDLINE PMID
15039692 (http://www.ncbi.nlm.nih.gov/pubmed/15039692)
PUI
L38436538
DOI
10.1016/j.annemergmed.2003.10.043
FULL TEXT LINK
http://dx.doi.org/10.1016/j.annemergmed.2003.10.043
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1115
TITLE
Rationale for treating pruritus complicating chronic liver disease with
opiate antagonists
AUTHOR NAMES
Jones E.A.
AUTHOR ADDRESSES
(Jones E.A., tjones@xs4all.nl) Dept. of Gastrointestinal/Liver Dis.,
Academic Medical Center, Peppinghof 53, 1391 BB Abcoude, Netherlands.
CORRESPONDENCE ADDRESS
E.A. Jones, Dept. of Gastrointestinal/Liver Dis., Academic Medical Center,
Peppinghof 53, 1391 BB Abcoude, Netherlands. Email: tjones@xs4all.nl
SOURCE
Current Gastroenterology Reports (2004) 6:2 (87-88). Date of Publication:
April 2004
ISSN
1522-8037
BOOK PUBLISHER
Current Medicine Group LLC, 5 Marine View Plaza, Suite 218, Hoboken, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate antagonist (drug comparison, drug therapy, oral drug administration,
parenteral drug administration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
nalmefene (drug comparison, drug therapy, oral drug administration,
parenteral drug administration, pharmacokinetics, pharmacology)
naloxone (drug comparison, drug therapy, intravenous drug administration,
oral drug administration, parenteral drug administration, pharmacokinetics,
pharmacology)
opiate agonist (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chronic liver disease
pruritus (complication, drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
analgesia
cholestasis
disease exacerbation
drug bioavailability
drug half life
drug metabolism
drug potency
emergency treatment
human
note
primary biliary cirrhosis
scratching
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2004299421
MEDLINE PMID
15191684 (http://www.ncbi.nlm.nih.gov/pubmed/15191684)
PUI
L38915054
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1116
TITLE
Intranasal drug delivery: An alternative to intravenous administration in
selected emergency cases
AUTHOR NAMES
Wolfe T.R.
Bernstone T.
AUTHOR ADDRESSES
(Wolfe T.R., wolfeman@csolutions.net) Division of Emergency Medicine,
University of Utah Sch. of Medicine, Wolfe Tory Medical Inc., Salt Lake
City, UT, United States.
(Bernstone T.) Surgical Intensive Care Unit, Univ. of Utah School of
Medicine, Salt Lake City, UT, United States.
(Wolfe T.R., wolfeman@csolutions.net) 1119 East Alpine Place, Salt Lake
City, UT 84105, United States.
CORRESPONDENCE ADDRESS
T.R. Wolfe, 1119 East Alpine Place, Salt Lake City, UT 84105, United States.
Email: wolfeman@csolutions.net
SOURCE
Journal of Emergency Nursing (2004) 30:2 (141-147). Date of Publication:
April 2004
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
drug (adverse drug reaction, drug administration, drug combination, drug
comparison, drug concentration, drug dose, drug therapy, intranasal drug
administration, intravenous drug administration, oral drug administration,
pharmaceutics, pharmacokinetics, rectal drug administration, topical drug
administration)
EMTREE DRUG INDEX TERMS
anesthetic agent (intranasal drug administration, pharmacology, topical drug
administration)
benzodiazepine derivative (drug comparison, intranasal drug administration,
intravenous drug administration, pharmacology, rectal drug administration)
beta adrenergic receptor blocking agent
diazepam (drug comparison, intravenous drug administration, pharmacology,
rectal drug administration)
fentanyl (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy, intranasal drug administration, pharmacology)
ketamine (drug combination, drug dose, intranasal drug administration,
pharmacology)
lidocaine (drug combination, drug dose, intranasal drug administration,
topical drug administration)
lorazepam (intranasal drug administration, pharmacology)
midazolam (adverse drug reaction, drug comparison, drug dose, intranasal
drug administration, pharmacokinetics, pharmacology)
morphine (drug comparison, pharmacology)
naloxone (drug dose, intranasal drug administration, intravenous drug
administration, pharmacokinetics, pharmacology, subcutaneous drug
administration)
opiate (adverse drug reaction, drug combination, drug comparison, drug dose,
drug therapy, intranasal drug administration, pharmacokinetics,
pharmacology)
oxymetazoline (adverse drug reaction, drug combination, drug dose,
intranasal drug administration, pharmacology, topical drug administration)
phenylephrine (adverse drug reaction)
sufentanil (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy, intranasal drug administration, pharmacokinetics,
pharmacology)
vasoconstrictor agent (adverse drug reaction, intranasal drug
administration, pharmacology, topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug administration route
emergency health service
EMTREE MEDICAL INDEX TERMS
article
burning sensation (side effect)
drug absorption
drug bioavailability
drug blood level
drug delivery system
drug industry
drug research
first pass effect
human
hypertension (side effect)
needle
nose smear
pain (drug therapy)
respiration depression (side effect)
syringe
vein catheterization
DRUG TRADE NAMES
afrin
neosynephrine
DEVICE TRADE NAMES
Go Mdeical Nasal Inhaler , AustraliaGo Medical
MAD 100
MADomizer , United StatesWolfe Tory
Venturi Atomizer De Vilbiss , United StatesDe Vilbiss Atomizers
DEVICE MANUFACTURERS
(United States)De Vilbiss Atomizers
(Australia)Go Medical
(United States)Wolfe Tory
CAS REGISTRY NUMBERS
diazepam (439-14-5)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxymetazoline (1491-59-4, 2315-02-8)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
sufentanil (56030-54-7)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
15039670 (http://www.ncbi.nlm.nih.gov/pubmed/15039670)
PUI
L38515194
DOI
10.1016/j.jen.2004.01.006
FULL TEXT LINK
http://dx.doi.org/10.1016/j.jen.2004.01.006
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1117
TITLE
Neonatal emergencies: Basics in cardiopulmonary resuscitation
ORIGINAL (NON-ENGLISH) TITLE
Neugeborenen-notfäile: Basale kardiopulmonale reanimation
AUTHOR NAMES
Hansmann G.
Humpl T.
Zimmermann A.
AUTHOR ADDRESSES
(Hansmann G., georg.hansmann@charite.de) Char. Campus Virchow-Klinikum,
Klinik für Neonatologie, Neugeborenen-Intensivstation, Berlin, Germany.
(Humpl T.) Hospital for Sick Children, Department of Critical Care Medicine,
Toronto, Ont., Canada.
(Zimmermann A.) Kinderklinik Poliklin. TU Munchen, Klinikum Rechts der Isar,
Neugeborenen-Intensivstation, München, Germany.
(Hansmann G., georg.hansmann@charite.de) Char. Campus Virchow-Klinikum,
Klinik für Neonatologie, Neugeborenen-Intensivstation, Augustenburger Platz
1, D-13353 Berlin, Germany.
CORRESPONDENCE ADDRESS
G. Hansmann, Char. Campus Virchow-Klinikum, Klinik für Neonatologie,
Neugeborenen-Intensivstation, Augustenburger Platz 1, D-13353 Berlin,
Germany. Email: georg.hansmann@charite.de
SOURCE
Zeitschrift fur Geburtshilfe und Neonatologie (2004) 208:2 (43-56). Date of
Publication: April 2004
ISSN
0948-2393
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
ABSTRACT
The international guidelines for neonatal resuscitation were recently
updated by the American Academy of Pediatrics (AAP), the American Heart
Association (AHA) and the International Liaison Committee on Resuscitation
(ILCOR). The most important steps in resuscitation of the newly born infant
are oxygenation and ventilation, including endotracheal intubation. These
fundamental techniques will be emphasized and discussed in a
problem-oriented approach. The clinical assessment of the newly born infant
is based on a triad of respiration, heart rate and color. If indicated,
resuscitation has to be initiated approximately 30s after birth, i.e. prior
to determination of the 1min. Apgar score and umbilical artery pH. The key
to successful neonatal resuscitation is establishment of adequate
ventilation; it should commence - after oropharyngeal suctioning and
ineffective tactile stimulation - when the heart rate drops < 100bpm.
Clinical evidence supporting the hypothesis that ventilation with room air
versus 50 or 100% oxygen is preferable in terms of neurological outcome is
still preliminary and requires further investigation. Chest compressions
should be administered if the heart rate remains < 60bpm (or heart rate 60
to 80bpm and not rising) despite adequate assisted ventilation. There should
be a 3:1 ratio of compressions to ventilations to achieve approximately 120
events per minute. Moreover, the international guidelines recommend
crystalloid volume expanders (normal saline or Ringer's lactate), red blood
cells, sodium bicarbonate and naloxone for cardiopulmonary resuscitation of
the newly born infant.
EMTREE DRUG INDEX TERMS
bicarbonate
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
newborn care
resuscitation
EMTREE MEDICAL INDEX TERMS
Apgar score
arterial pH
artificial ventilation
bradypnea (therapy)
color
crystalloid
emergency medicine
endotracheal intubation
erythrocyte
heart rate
human
medical assessment
neurologic examination
newborn monitoring
oropharynx
outcomes research
oxygenation
practice guideline
respiratory function
review
suction drainage
tactile stimulation
treatment indication
umbilical artery
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Obstetrics and Gynecology (10)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2004210633
MEDLINE PMID
15112137 (http://www.ncbi.nlm.nih.gov/pubmed/15112137)
PUI
L38621706
DOI
10.1055/s-2004-818958
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2004-818958
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1118
TITLE
Prospective controlled trial of effect of medical emergency team on
postoperative morbidity and mortality rates
AUTHOR NAMES
Bellomo R.
Goldsmith D.
Uchino S.
Buckmaster J.
Hart G.
Opdam H.
Silvester W.
Doolan L.
Gutteridge G.
AUTHOR ADDRESSES
(Bellomo R.; Goldsmith D.; Uchino S.; Buckmaster J.; Hart G.; Opdam H.;
Silvester W.; Doolan L.; Gutteridge G.) Department of Intensive Care,
Department of Medicine, Austin and Repatriation Med. Centre, Melbourne,
Vic., Australia.
CORRESPONDENCE ADDRESS
R. Bellomo, Department of Intensive Care, Department of Medicine, Austin and
Repatriation Med. Centre, Melbourne, Vic., Australia.
SOURCE
Critical Care Medicine (2004) 32:4 (916-921). Date of Publication: April
2004
ISSN
0090-3493
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Objective: To determine whether the introduction of an intensive care
unit-based medical emergency team, responding to hospital-wide preset
criteria of physiologic instability, would decrease the rate of predefined
adverse outcomes in patients having major surgery. Design: Prospective,
controlled before-and-after trial. Setting: University-affiliated hospital.
Patients: Consecutive patients admitted to hospital for major surgery during
a 4-month control phase and during a 4-month intervention phase.
Interventions: Introduction of a hospital-wide intensive care unit-based
medical emergency team to evaluate and treat inpatients deemed at risk of
developing an adverse outcome by nursing, paramedical, and/or medical staff.
Measurements and Main Results: We measured incidence of serious adverse
events, mortality after major surgery, and mean duration of hospital stay.
There were 1,369 operations in 1,116 patients during the control period and
1,313 in 1,067 patients during the medical emergency team intervention
period. In the control period, there were 336 adverse outcomes in 190
patients (301 outcomes/1,000 surgical admissions), which decreased to 136 in
105 patients (127 outcomes/1,000 surgical admissions) during the
intervention period (relative risk reduction, 57.8%; p < .0001). These
changes were due to significant decreases in the number of cases of
respiratory failure (relative risk reduction, 79.1%; p < .0001), stroke
(relative risk reduction, 78.2%; p = .0026), severe sepsis (relative risk
reduction, 74.3%; p = .0044), and acute renal failure requiring renal
replacement therapy (relative risk reduction, 88.5%; p < .0001). Emergency
intensive care unit admissions were also reduced (relative risk reduction,
44.4%; p = .001). The introduction of the medical emergency team was also
associated with a significant decrease in the number of postoperative deaths
(relative risk reduction, 36.6%; p = .0178). Duration of hospital stay after
major surgery decreased from a mean of 23.8 days to 19.8 days (p = .0092).
Conclusions: The introduction of an intensive care unit-based medical
emergency team in a teaching hospital was associated with a reduced
incidence of postoperative adverse outcomes, postoperative mortality rate,
and mean duration of hospital stay.
EMTREE DRUG INDEX TERMS
amiodarone (drug therapy, intravenous drug administration)
anticonvulsive agent (drug therapy)
beta adrenergic receptor stimulating agent (drug therapy, inhalational drug
administration)
furosemide (drug therapy, intravenous drug administration)
glyceryl trinitrate (drug therapy, intravenous drug administration, topical
drug administration)
hypertensive factor (drug therapy, intravenous drug administration)
metoclopramide (drug therapy, intravenous drug administration)
morphine (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
ranitidine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
intensive care
major surgery
rapid response team
surgical mortality
EMTREE MEDICAL INDEX TERMS
acute heart infarction (complication)
acute kidney failure (complication, prevention)
adult
aged
article
cardioversion
central venous catheter
cerebrovascular accident (complication, prevention)
clinical trial
controlled clinical trial
controlled study
endotracheal intubation
female
human
length of stay
lung edema (complication)
lung embolism (complication)
major clinical study
male
medical staff
morbidity
nursing staff
paramedical personnel
priority journal
prospective study
respiratory failure (complication, drug therapy, prevention, therapy)
resuscitation
sepsis (complication, prevention)
tracheostomy
treatment outcome
university hospital
urinary catheter
CAS REGISTRY NUMBERS
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
ranitidine (66357-35-5, 66357-59-3)
EMBASE CLASSIFICATIONS
Surgery (9)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004164700
MEDLINE PMID
15071378 (http://www.ncbi.nlm.nih.gov/pubmed/15071378)
PUI
L38471509
DOI
10.1097/01.CCM.0000119428.02968.9E
FULL TEXT LINK
http://dx.doi.org/10.1097/01.CCM.0000119428.02968.9E
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1119
TITLE
Pattern of acute poisoning in childhood in Ankara: What has change in twenty
years?
AUTHOR NAMES
Andiran N.
Sarikayalar F.
AUTHOR ADDRESSES
(Andiran N.; Sarikayalar F.) Department of Pediatrics, Hacettepe University
Faculty of Med., Ankara, Turkey.
CORRESPONDENCE ADDRESS
N. Andiran, Department of Pediatrics, Hacettepe University Faculty of Med.,
Ankara, Turkey.
SOURCE
Turkish Journal of Pediatrics (2004) 46:2 (147-152). Date of Publication:
Apr 2004
ISSN
0041-4301
ABSTRACT
Poisoning represents one of the most common medical emergencies in
childhood, and epidemiological properties differ from country to country.
Thus, special epidemiological surveillance for each country is necessary to
determine the problem according to which preventive measures can be taken.
The purpose of this study was to clarify the characteristics of acute
poisoning cases admitted to a pediatric referral hospital. All poisoned
patients under 17 years of age, except for cases food poisoning, presenting
to the Emergency Department (ED) from January 1995 to December 2000 were
determined. The information about each case was recorded on standardized
forms and a retrospective chart review survey was done. Complete
epidemiological and clinical data were obtained for 489 patients. The mean
age of all poisoned patients (mean ± standard deviation) was 5.96±4.87
years, and the age range was 0.01 to 17 years. Three hundred and thirty-one
children, forming 63.6% of all patients, were under five years of age.
Slightly more boys (52.3% than girls were intoxicated at ages less than 10
years, after which more girls (79%) than boys were involved. The majority of
all cases were due to accidental poisoning (78.1% of all poisonings) which
occurred mostly in children under five years of age (73.3%). While
accidental poisonings (97.1%) were the most common mode of poisoning between
1-5 years, self-poisonings (67.3%) had the highest ratio in cases over 10
years of age. In patients younger than one year of age, 74.2% of all
poisonings were due to therapeutical error. Drugs were the most frequent
offending agent (57.7%), followed by ingestion of a caustic/corrosive
substance (16.8%) and carbon monoxide (CO) intoxication (9.4%). Analgesics
were the most common agents, forming 23.7% of all poisonings due to drugs,
followed by ingestion of multiple drugs and tricyclic antidepressants at
ratios of 21.6% and 9.6%, respectively. The most common route of poisoning
was ingestion of the poison (437/489 patients, 89.4%) and most were ingested
inside the house (93.3%). About half of all poisoned patients (50.9%) were
admitted to the ED within the first two hours of ingestion, and gastric
lavage was performed on about half of the poisoned children (48.7%). In most
of the cases, hospital treatment was non-specific, including general
measures of decontamination and supportive-symptomatic therapy. During the
six-year study period, two patients were lost due to acute poisoning,
yielding an overall mortality rate of 0.4%. While most of the poisonings
were due to accidental ingestions in infancy and primary school ages without
sex predilection, the incidence of self-poisonings, especially in girls, was
found to be increased. Analgesics, tricyclic antidepressant drugs (which
seemed to form a new and dangerous group) and caustic/corrosive substances
were the most commonly ingested agents. The early awareness of poisoning and
appropriate therapeutic measures taken seemed to be efficacious with a very
low mortality rate. The epidemiological and preventive properties of
childhood poisonings should be further searched by prospectively designed
multicentered studies throughout our country.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
amitriptyline (drug toxicity)
analgesic agent (drug toxicity)
antibiotic agent (drug toxicity)
anticonvulsive agent (drug toxicity)
antidote (drug therapy)
antiemetic agent (drug toxicity)
antitussive agent (drug toxicity)
atropine (drug therapy)
barbituric acid derivative (drug toxicity)
bronchodilating agent (drug toxicity)
carbon monoxide (drug toxicity)
cardiovascular agent (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
deferoxamine (drug therapy)
hypnotic agent (drug toxicity)
muscle relaxant agent (drug toxicity)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
nonsteroid antiinflammatory agent (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy)
pyridoxine (drug therapy)
salicylic acid (drug toxicity)
sedative agent (drug toxicity)
thiamine (drug therapy)
tranquilizer (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood disease (drug therapy, epidemiology, therapy)
intoxication (drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
child
controlled study
female
groups by age
human
infant
ingestion
major clinical study
male
mortality
population research
review
seasonal variation
sex difference
statistical analysis
statistical significance
stomach lavage
survival rate
Turkey (republic)
DRUG TRADE NAMES
laroxyl
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
deferoxamine (70-51-9)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
salicylic acid (63-36-5, 69-72-7)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004245299
PUI
L38735621
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1120
TITLE
Prehospital and emergency department burn care
AUTHOR NAMES
DeBoer S.
O'Connor A.
AUTHOR ADDRESSES
(DeBoer S., scott@Peds-R-Us.com) Peds-R-Us Medical Education, P.O. Box 601,
Dyer, IN 46311, United States.
(DeBoer S., scott@Peds-R-Us.com) Classic LifeGuard, P.O. Box 7200, Page, AZ
86040, United States.
(O'Connor A.) University of Chicago Burn Center, 5841 South Maryland Avenue,
Chicago, IL 60637, United States.
CORRESPONDENCE ADDRESS
S. DeBoer, Peds-R-Us Medical Education, P.O. Box 601, Dyer, IN 46311, United
States. Email: scott@Peds-R-Us.com
SOURCE
Critical Care Nursing Clinics of North America (2004) 16:1 (61-73). Date of
Publication: March 2004
ISSN
0899-5885
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Burn-injured patients have special needs in the prehospital and emergency
department settings. This article addresses the nursing priorities in
prehospital and emergency department care.
EMTREE DRUG INDEX TERMS
analgesic agent (intravenous drug administration, pharmacology)
anesthetic agent (adverse drug reaction, pharmacology, topical drug
administration)
codeine (pharmacology)
fentanyl citrate (intravenous drug administration, oral drug administration,
pharmacology)
glucose
ibuprofen (pharmacology)
lidocaine (adverse drug reaction, pharmacology, topical drug administration)
morphine (intravenous drug administration, pharmacology)
naloxone (pharmacology)
paracetamol (adverse drug reaction, oral drug administration, pharmacology)
Ringer lactate solution
sodium chloride
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
burn
emergency ward
first aid
patient care
EMTREE MEDICAL INDEX TERMS
airway
breathing
caregiver
chemical burn
circulation
clinical feature
comorbidity
disease classification
electric injury
electrocardiography monitoring
emergency treatment
fasciotomy
human
injury scale
lung burn (complication)
medical assessment
medical personnel
review
scald
seizure (side effect)
skin function
temperature
treatment indication
urinalysis
wound care
DRUG MANUFACTURERS
(United States)Abbott
CAS REGISTRY NUMBERS
Ringer lactate solution (8022-63-7)
codeine (76-57-3)
fentanyl citrate (990-73-8)
glucose (50-99-7, 84778-64-3)
ibuprofen (15687-27-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
sodium chloride (7647-14-5)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
15062414 (http://www.ncbi.nlm.nih.gov/pubmed/15062414)
PUI
L38609487
DOI
10.1016/j.ccell.2003.10.004
FULL TEXT LINK
http://dx.doi.org/10.1016/j.ccell.2003.10.004
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1121
TITLE
Research note - Review of corrections-based therapy for opiate-dependent
patients: Implications for buprenorphine treatment among correctional
populations
AUTHOR NAMES
Smith-Rohrberg D.
Bruce R.D.
Altice F.L.
AUTHOR ADDRESSES
(Smith-Rohrberg D.) Yale University School of Medicine, Natl. Inst. Hlth.
Med. Sci. T. P., New Haven, CT, United States.
(Bruce R.D.) Yale University AIDS Program, Yale University School of
Medicine, New Haven, CT, United States.
(Altice F.L.) Department of Medicine, Yale University AIDS Program, Yale
University School of Medicine, New Haven, CT, United States.
CORRESPONDENCE ADDRESS
D. Smith-Rohrberg, Yale University School of Medicine, Natl. Inst. Hlth.
Med. Sci. T. P., New Haven, CT, United States.
SOURCE
Journal of Drug Issues (2004) 34:2 (451-480). Date of Publication: Mar 2004
ISSN
0022-0426
ABSTRACT
Inmates with a history of opiate dependence represent a substantial
proportion of the correctional population in the United States. Opiate use
has negative consequences for both the inmate and society, including
increased recidivism rates, increased infectious disease prevalence,
avoidable emergency room use, decreased access to primary care services, and
overdose. While there have been great successes in community-based treatment
of opiate dependence, these successes have not yet been achieved in
correctional settings. This paper reviews the pharmacological treatment
options for opiate-dependent inmates, along with potential application for
community-to-correctional approaches. The recent approval by the Food and
Drug Administration (FDA) of physician-prescribed buprenorphine and the new
opportunities it presents to corrections-based treatment are also explored
in depth. Successful implementation of such strategies is likely to result
in desirable health and social outcomes for both the inmate and the
community at large.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
diamorphine (pharmacology)
opiate (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, epidemiology)
population research
EMTREE MEDICAL INDEX TERMS
community care
drug approval
drug overdose
emergency ward
food and drug administration
health care access
health status
human
outcomes research
physician
prevalence
recurrence risk
review
social aspect
United States
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004281983
PUI
L38856418
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1122
TITLE
Adverse events after naloxone treatment of episodes of suspected acute
opioid overdose.
AUTHOR NAMES
Buajordet I.
Naess A.C.
Jacobsen D.
Brørs O.
AUTHOR ADDRESSES
(Buajordet I.; Naess A.C.; Jacobsen D.; Brørs O.) Clinical Pharmacology and
Toxicology Unit, Clinical Chemistry Department, Ullevaal University
Hospital, Oslo, Norway.
CORRESPONDENCE ADDRESS
I. Buajordet, Clinical Pharmacology and Toxicology Unit, Clinical Chemistry
Department, Ullevaal University Hospital, Oslo, Norway. Email:
ingebjorg.buajordet@legemiddelverket.no
SOURCE
European journal of emergency medicine : official journal of the European
Society for Emergency Medicine (2004) 11:1 (19-23). Date of Publication: Feb
2004
ISSN
0969-9546
ABSTRACT
OBJECTIVE: An increasing and serious heroin overdose problem in Oslo has
mandated the increasing out-of-hospital use of naloxone administered by
paramedics. The aim of this study was to determine the frequencies and
characteristics of adverse events related to this out-of-hospital
administration by paramedics. METHODS: A one-year prospective observational
study from February 1998 to January 1999 was performed in patients suspected
to be acutely overdosed by an opioid. A total of 1192 episodes treated with
naloxone administered by the Emergency Medical Service system in Oslo, were
included. The main outcome variable was adverse events observed immediately
after the administration of naloxone. RESULTS: The mean age of patients
included was 32.6 years, and 77% were men. Adverse events suspected to be
related to naloxone treatment were reported in 45% of episodes. The most
common adverse events were related to opioid withdrawal (33%) such as
gastrointestinal disorders, aggressiveness, tachycardia, shivering, sweating
and tremor. Cases of confusion/restlessness (32%) might be related either to
opioid withdrawal or to the effect of the heroin in combination with other
drugs. Headache and seizures (25%) were probably related to hypoxia. Most
events were non-serious. In three episodes (0.3%) the patients were
hospitalized because of adverse events. CONCLUSION: Although adverse events
were common among patients treated for opioid overdose in an out-of-hospital
setting, serious complications were rare. Out-of-hospital naloxone treatment
by paramedics seems to save several lives a year without a high risk of
serious complications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction)
narcotic agent (drug toxicity)
narcotic antagonist (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (epidemiology, therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
acute disease
adolescent
adult
aged
article
chemically induced disorder
confusion
female
headache
human
intoxication (drug therapy)
male
methodology
middle aged
nausea
Norway (epidemiology)
prospective study
seizure
statistics
tachycardia
tremor
vomiting
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
15167188 (http://www.ncbi.nlm.nih.gov/pubmed/15167188)
PUI
L38983506
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1123
TITLE
Pharmacological therapy of acute cardiogenic pulmonary oedema in the
emergency department
AUTHOR NAMES
Graham C.A.
AUTHOR ADDRESSES
(Graham C.A., cagraham@rcsed.ac.uk) Southern General Hospital, Glasgow, G51
4TF, United Kingdom.
CORRESPONDENCE ADDRESS
C.A. Graham, Southern General Hospital, Glasgow, G51 4TF, United Kingdom.
Email: cagraham@rcsed.ac.uk
SOURCE
EMA - Emergency Medicine Australasia (2004) 16:1 (47-54). Date of
Publication: February 2004
ISSN
1742-6731
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
This paper critically reviews the major drug types that are currently used
in the management of acute cardiogenic pulmonary oedema. As decompensated
heart failure becomes an increasingly common problem in emergency
departments in the developed world, optimization of emergency drug therapy
for these critically ill patients is essential. The evidence base for
'routine therapy' in the ED is considered. The review also briefly considers
emerging pharmacological therapies that may have an impact on future
management of cardiogenic pulmonary oedema.
EMTREE DRUG INDEX TERMS
bumetanide (drug therapy)
captopril (drug combination, drug comparison, drug therapy, sublingual drug
administration)
diamorphine (drug therapy)
enalapril (drug comparison, drug therapy, intravenous drug administration)
furosemide (drug therapy, pharmacology)
glyceryl trinitrate (clinical trial, drug comparison, drug therapy,
sublingual drug administration)
hydralazine (drug combination, drug comparison, drug therapy, intravenous
drug administration)
isosorbide (drug combination, drug comparison, drug therapy, oral drug
administration)
levosimendan (drug therapy, intravenous drug administration, pharmacology)
morphine (drug therapy, pharmacology)
naloxone
nesiritide (adverse drug reaction, clinical trial, drug comparison, drug
therapy, intravenous drug administration, pharmacokinetics, pharmacology)
nitrate (drug dose, drug interaction, drug therapy, intravenous drug
administration)
prazosin (drug combination, drug comparison, drug therapy)
sildenafil (drug interaction)
tezosentan (clinical trial, drug dose, drug therapy, intravenous drug
administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
emergency ward
heart failure
lung edema (complication, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
clinical trial
critical illness
drug effect
drug elimination
drug mechanism
drug megadose
drug potentiation
emergency health service
emergency treatment
evidence based medicine
human
hypotension (side effect)
oxygen therapy
priority journal
review
CAS REGISTRY NUMBERS
bumetanide (28395-03-1)
captopril (62571-86-2)
diamorphine (1502-95-0, 561-27-3)
enalapril (75847-73-3)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
hydralazine (304-20-1, 86-54-4)
isosorbide (652-67-5)
levosimendan (141505-33-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nesiritide (124584-08-3, 189032-40-4)
nitrate (14797-55-8)
prazosin (19216-56-9, 19237-84-4)
sildenafil (139755-83-2)
tezosentan (180384-57-0)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004190772
MEDLINE PMID
15239755 (http://www.ncbi.nlm.nih.gov/pubmed/15239755)
PUI
L38552479
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1124
TITLE
Estimating the prevalence of problem opioid use in Copenhagen 1997-1998
AUTHOR NAMES
Ishøy T.
Haastrup L.
Hay G.
AUTHOR ADDRESSES
(Ishøy T., ti@dgma.dk) Department of Social Medicine, DK-2600 Glostrup,
Denmark.
(Haastrup L.) The Danish National Board of Health, Copenhagen, Denmark.
(Hay G.) Centre for Drug Research, University of Glasgow, Glasgow, United
Kingdom.
(Ishøy T., ti@dgma.dk) DGMA, Amager Hospital, DK-2300 Copenhagen S, Denmark.
CORRESPONDENCE ADDRESS
T. Ishøy, DGMA, Amager Hospital, DK-2300 Copenhagen S, Denmark. Email:
ti@dgma.dk
SOURCE
Danish Medical Bulletin (2004) 51:1 (114-116). Date of Publication: 1 Feb
2004
ISSN
0907-8916
BOOK PUBLISHER
Danish Medical Association, Esplanaden 8 C, 3., Copenhagen, Denmark.
ABSTRACT
Introduction: Estimates of the prevalence of drug use in Denmark were, until
1999, based on the mortality multiplier method. This paper presents a study
estimating the prevalence of problem opioid use in the Greater Copenhagen
region using the capture-recapture method. Methods and material: Records
from the prehospital mobile emergency care unit, The Copenhagen Prehospital
Research Database, were searched with a particular focus on treatment of
opioid overdose. In addition, data from The National Register of Drug Users
in Treatment in Greater Copenhagen were analysed for the years 1997 and
1998. Four samples were used within the capture-recapture analysis, ie the
Prehospital Research Database for 1997/1998 and the Register of Drug Users
in Treatment for the same period. Results: The estimates from the stratified
capture-recapture analyses, when summed up, suggest that there is a hidden
population of 4116 and thus a total population of 6992 opioid users in
Greater Copenhagen (population approx 700,000). This corresponds to a rate
of 10 per 1000 inhabitants aged 15-54 years. The 95% confidence attached to
this estimate is 5787 to 10,885. Discussion: The prevalence rate of 10 per
1000 inhabitants aged 15-54 years is comparable to figures found in similar
cities in Europe. A previous study of Central Copenhagen calculated the rate
to be 12.4 per 1000 inhabitants between 15 and 59 years. It seems reasonable
that the estimate of prevalence of problem drug use in Greater Copenhagen is
lower than the prevalence in Central Copenhagen, as the city area is more
urbanised and has a slightly different demographic and socio-economic
profile. About 75% of all opioid overdose incidents are assumed to occur in
the central district of the city during the observed period.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (diagnosis, epidemiology)
substance abuse
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
confidence interval
controlled study
Denmark
female
geographic distribution
groups by age
human
major clinical study
male
population distribution
population research
prevalence
risk factor
sex difference
statistical analysis
statistical significance
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004428553
MEDLINE PMID
16009076 (http://www.ncbi.nlm.nih.gov/pubmed/16009076)
PUI
L39319700
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1125
TITLE
Sex Differences in Analgesia: A Randomized Trial of μ versus κ Opioid
Agonists
AUTHOR NAMES
Miller P.L.
Ernst A.A.
AUTHOR ADDRESSES
(Miller P.L.; Ernst A.A., aernst56@aol.com) Department of Emergency
Medicine, University of California, Davis Medical Center, Sacramento, CA,
United States.
(Ernst A.A., aernst56@aol.com) Division of Emergency Medicine, Department of
Medicine, University of California, 2315 Stockton Blvd., Sacramento, CA
95817, United States.
CORRESPONDENCE ADDRESS
A.A. Ernst, Division of Emergency Medicine, Department of Medicine,
University of California, 2315 Stockton Blvd., Sacramento, CA 95817, United
States. Email: aernst56@aol.com
SOURCE
Southern Medical Journal (2004) 97:1 (35-41). Date of Publication: January
2004
ISSN
0038-4348
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Objectives: We sought to evaluate whether there is a sex difference in the
analgesic response to μ versus κ opioids in the management of acute moderate
to severe pain of injury in the emergency department. Methods: The study was
a randomized, double-blind, clinical trial comparing the prototypical
μ-receptor agonist, morphine sulfate, to the prototypical κ agonist,
butorphanol. The primary endpoints were degree of relief by visual analog
scores at 30 and 60 minutes. Statistical analysis was performed using
Mann-Whitney U test for nonparametric analysis and repeated-measures
analysis of variance. Results: Ninety-four patients were entered in the
study, with 49 (52%) males and 45 (48%) females. Forty-six received morphine
sulfate and 48 received butorphanol. There was no difference in demographics
in the two groups. At 60 minutes, females had significantly lower visual
analog scores with butorphanol compared with morphine (P = 0.046). At 60
minutes, there was a trend for a difference in response of males versus
females to morphine, with males responding better than females (P = 0.06).
Conclusion: Females had better pain scores with butorphanol than morphine at
60 minutes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
butorphanol (adverse drug reaction, clinical trial, drug comparison,
pharmacology)
kappa opiate receptor agonist (adverse drug reaction, clinical trial, drug
comparison, pharmacology)
morphine sulfate (adverse drug reaction, clinical trial, drug comparison,
pharmacology)
mu opiate receptor agonist (adverse drug reaction, clinical trial, drug
comparison, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
sex difference
EMTREE MEDICAL INDEX TERMS
adult
analysis of variance
article
clinical trial
controlled clinical trial
controlled study
double blind procedure
female
human
major clinical study
male
nausea and vomiting (side effect)
patient satisfaction
pruritus (side effect)
randomized controlled trial
statistical analysis
treatment failure
visual analog scale
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004039826
MEDLINE PMID
14746420 (http://www.ncbi.nlm.nih.gov/pubmed/14746420)
PUI
L38112473
DOI
10.1097/01.SMJ.0000085743.68121.A9
FULL TEXT LINK
http://dx.doi.org/10.1097/01.SMJ.0000085743.68121.A9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1126
TITLE
Analgesia in the pediatric emergency department
ORIGINAL (NON-ENGLISH) TITLE
Analgésie aux urgences pédiatriques
AUTHOR NAMES
Chéron G.
Cojocaru B.
Bocquet N.
AUTHOR ADDRESSES
(Chéron G., gerard.cheron@nck.ap-hop-paris.fr; Cojocaru B.; Bocquet N.)
Dept. des Urgences Pediatriques, Hôpital Necker-Enfants-Malades, 149, rue de
Sèvres, 75743 Paris Cedex 15, France.
CORRESPONDENCE ADDRESS
G. Chéron, Dept. des Urgences Pediatriques, Hôpital Necker-Enfants-Malades,
149, rue de Sèvres, 75743 Paris Cedex 15, France. Email:
gerard.cheron@nck.ap-hop-paris.fr
SOURCE
Archives de Pediatrie (2004) 11:1 (70-73). Date of Publication: January 2004
ISSN
0929-693X
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
Pain concerns more than 50% of the children cared in the emergency unit.
After evaluation, it has to be cured with drugs adapted to its level and its
origin. Residual pain needs therapeutic adjustment. The goal is to allow the
child to restart his activities. A preventive sedation analgesia is
necessary when a painful exam is to be performed, either for diagnosis or
therapeutic purpose. For this goal ideal analgesics, either for monotherapy
or associated, are easily and painlessly administered. They have rapid onset
of action, brief half-life, predictable, effective analgesic properties
without side effects and they are quickly reversible. These drugs do not
exist and every sedation procedure has a risk of hypoxemia. With the human
and equipment's investment an emergency department should be able to ensure
that procedures are performed in children under sedation with a standard of
safety that is similar to general anaesthesia. The main drawback in a
well-organised system should be a significant children's rate for which
general anaesthesia is preferred. © 2003 Elsevier SAS. Tous droits réservés.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, drug therapy, pharmacokinetics,
pharmacology)
sedative agent (adverse drug reaction, drug therapy, pharmacokinetics,
pharmacology)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (drug therapy)
codeine (drug therapy)
fentanyl
fentanyl derivative (drug therapy, intravenous drug administration)
kalinox
ketamine (adverse drug reaction, drug therapy)
morphine sulfate (drug therapy)
nalbuphine (drug therapy)
naloxone
nitrous oxide plus oxygen (adverse drug reaction, drug therapy)
opiate agonist (adverse drug reaction, drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
EMTREE MEDICAL INDEX TERMS
article
child
diagnostic procedure
drug activity
drug half life
drug indication
drug safety
general anesthesia
human
hypersalivation (side effect)
hypoxemia (side effect)
intracranial hypertension (side effect)
pain (diagnosis, drug therapy, etiology)
pain assessment
sedation
side effect (side effect)
toxicity (side effect)
visual analog scale
DRUG TRADE NAMES
entonox
fentanyl
kalinox
ketalar
narcan
nubain
sevredol
CAS REGISTRY NUMBERS
codeine (76-57-3)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2004018150
MEDLINE PMID
14700770 (http://www.ncbi.nlm.nih.gov/pubmed/14700770)
PUI
L38049365
DOI
10.1016/j.arcped.2003.09.003
FULL TEXT LINK
http://dx.doi.org/10.1016/j.arcped.2003.09.003
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1127
TITLE
Emergency management of inadvertent accelerated opiate withdrawal in
dependent opiate users
AUTHOR NAMES
Lubman D.I.
Koutsogiannis Z.
Kronborg I.
AUTHOR ADDRESSES
(Lubman D.I., dan.lubman@mh.org.au) Substance Use Res./Recobvery F.P.,
ORYGEN Research Centre, University of Melbourne, Melbourne, Vic., Australia.
(Koutsogiannis Z.) Emergency Department, Western Hospital, Vic., Australia.
(Kronborg I.) Drug and Alcohol Services, Western Hospital, Vic., Australia.
CORRESPONDENCE ADDRESS
D.I. Lubman, Substance Use Res./Recobvery F.P., ORYGEN Research Centre,
University of Melbourne, Melbourne, Vic., Australia. Email:
dan.lubman@mh.org.au
SOURCE
Drug and Alcohol Review (2003) 22:4 (433-436). Date of Publication: December
2003
ISSN
0959-5236
BOOK PUBLISHER
Routledge
ABSTRACT
Six opiate-dependent drug users presented to the local emergency department
within a 10-day period with symptoms of severe opioid withdrawal immediately
following intravenous use of recently acquired street 'heroin'. The
withdrawal picture was similar to that described in patients undergoing
rapid opioid detoxification, suggesting that the substance injected was
contaminated with an opiate antagonist. A number of potential compounds are
discussed, including naltrexone and buprenorphine, and recommendations for
the medical management of severe opiate withdrawal within an emergency
setting are outlined.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug therapy)
naltrexone (drug therapy)
narcotic agent (adverse drug reaction)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
opiate addiction (rehabilitation)
substance abuse (rehabilitation)
withdrawal syndrome (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
drug detoxification
female
hospitalization
human
male
review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naltrexone (16590-41-3, 16676-29-2)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
14660133 (http://www.ncbi.nlm.nih.gov/pubmed/14660133)
PUI
L37496017
DOI
10.1080/09595230310001613958
FULL TEXT LINK
http://dx.doi.org/10.1080/09595230310001613958
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1128
TITLE
Do Co-intoxicants Increase Adverse Event Rates in the First 24 Hours in
Patients Resuscitated from Acute Opioid Overdose?
AUTHOR NAMES
Mirakbari S.M.
Innes G.D.
Christenson J.
Tilley J.
Wong H.
AUTHOR ADDRESSES
(Mirakbari S.M., smm@fastmail.ca; Innes G.D.; Christenson J.) Department of
Emergency Medicine, St. Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada.
(Mirakbari S.M., smm@fastmail.ca) Medical Faculty, Department of Forensic
Medicine, Tehran Univ. of Medical Sciences, Tehran, Iran.
(Innes G.D.; Christenson J.; Tilley J.; Wong H.) Ctr. for Hlth.
Eval./Outcome Sci., Vancouver, BC, Canada.
(Mirakbari S.M., smm@fastmail.ca) No. 87, Davood Asadi Ave., Tehran, Iran.
CORRESPONDENCE ADDRESS
S.M. Mirakbari, No. 87, Davood Asadi Ave., Tehran, Iran. Email:
smm@fastmail.ca
SOURCE
Journal of Toxicology - Clinical Toxicology (2003) 41:7 (947-953). Date of
Publication: 2003
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Background: Patients frequently arrive in emergency departments (EDs) after
being resuscitated from opioid overdose. Autopsy studies suggest that
multidrug intoxication is a major risk factor for adverse outcomes after
acute heroin overdose in patients. If this is true, there may be high-risk
drug combinations that identify patients who require more intensive
monitoring and prolonged observation. Our objective was to determine the
impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on
short-term adverse event rates in patients resuscitated from acute opioid
overdose. Methods: Data were extracted from the database of a prospective
opioid overdose cohort study conducted between May 1997 and 1999. Patients
were prospectively enrolled if they received naloxone for presumed opioid
overdose. Investigators gathered clinical, demographic, and other predictor
variables, including cointoxicants used. Patients were followed to identify
prespeeified adverse outcome events occurring within 24 h, and multiple
logistic regression was used to determine the association of concomitant
drug use on short-term adverse event rates. Results: Of 1155 patients
studied, 58 (5%) had pure opioid overdose and 922 (80%) reported
co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall,
out of 1056 patients with known outcome status there were 123 major adverse
events (11.6%) and 194 minor adverse events (18.4%). After adjustment for
age, gender, HIV status, cardiovascular disease, pulmonary disease and
diabetes, we found that coadministration of alcohol, cocaine, or CNS
depressants, alone or in combination, was not associated with increased risk
of death or adverse events during the 24 h follow-up period. Conclusion: In
patients resuscitated from acute opioid overdose, short-term outcomes are
similar for patients with pure opioid overdose and multidrug intoxications.
A history of cointoxieation cannot be used to identify high-risk patients
who require more intensive ED monitoring or prolonged observation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
central depressant agent (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
drug overdose (drug therapy)
resuscitation
EMTREE MEDICAL INDEX TERMS
adult
article
autopsy
controlled study
disease course
disease severity
emergency ward
female
high risk patient
human
intensive care
major clinical study
male
patient monitoring
risk factor
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004006206
MEDLINE PMID
14705840 (http://www.ncbi.nlm.nih.gov/pubmed/14705840)
PUI
L38018485
DOI
10.1081/CLT-120026516
FULL TEXT LINK
http://dx.doi.org/10.1081/CLT-120026516
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1129
TITLE
Acute poisoning in Santiago de Compostela during a four year period
ORIGINAL (NON-ENGLISH) TITLE
Intoxicaciones agudas en Santiago de Compostela, en un período de cuatro
años
AUTHOR NAMES
Fernández P.
Ortega M.
Bermejo A.M.
Tabernero M.J.
López-Rivadulla M.
Concheiro M.E.
AUTHOR ADDRESSES
(Fernández P., imlpuri@usc.es; Bermejo A.M.; Tabernero M.J.; López-Rivadulla
M.) Instituto de Medicina Legal, Facultad de Medicina, Univ. de Santiago de
Compostela, Santiago de Compostela, Spain.
(Ortega M.; Concheiro M.E.) Servicio de Farmacia, Hos. Clin. Univ. Santiago
Compostela, Santiago de Compostela, Spain.
(Fernández P., imlpuri@usc.es) Servicio de Toxicologia Forense, Instituto de
Medicina Legal, Facultad de Medicina, C/ San Francisco, S/N, 15782-Santiago
de Compostela, Spain.
CORRESPONDENCE ADDRESS
P. Fernández, Servicio de Toxicologia Forense, Instituto de Medicina Legal,
Facultad de Medicina, C/ San Francisco, S/N, 15782-Santiago de Compostela,
Spain. Email: imlpuri@usc.es
SOURCE
Revista de Toxicologia (2003) 20:3 (216-220). Date of Publication: 2003
ISSN
0212-7113
ABSTRACT
The objective of this work was to evaluate the characteristics of a group of
cases of poisoning in patients at the sanitary area of Santiago de
Compostela. An overall of 1192 cases of acute poisonings were examined in
both the Emergency Room and Intensive Care Unit of the Clinical University
Hospital of this city from January 1, 1993 to December 31, 1996. We have
studied only those cases in which toxicological analyses were requested from
this Institute of Legal Medicine; the cases which were excluded from this
study are not know to us. A clinical record including all of the parameters
studied was designed and then distributed to the physicians for them to fill
out at the time of patient admission. Male patients (61.4%) were found to
predominate, and the average patient age was 32.3±12.5 years (range 15-93
years). The more frequently involved substances in the cases of poisoning
studied were related to drug abuse (681 cases), followed by medicine
overdose (545 cases) and "other agents" (88 cases). The factors of voluntary
poisoning and medicine overdose was largely associated to females, whereas
accidental poisoning and drug abuse was mainly related to males. An overall
of 332 individuals had a psychiatric history, 219 were under some treatment,
189 were alcoholics and 144 used drugs via parenteral route. Of the patients
studied, 76% had some clinical symptom on arrival, with a prevalence of
neurological symptoms (682 cases). A specific treatment was used in 574
individuals, with emphasis on gastric lavage (444 cases) and the
administration of antidotes (358 cases). The majority of the patients
evolved favorably, with a mortality rate of only 2%. This information
reflects the existing abuse pattern and the efficiency of treatment, helping
us in our effort to improve poisoned patient control.
EMTREE DRUG INDEX TERMS
acetylcysteine
activated carbon
alcohol (drug toxicity)
analgesic agent (drug dose, drug toxicity, pharmacology)
anticonvulsive agent (drug dose, drug toxicity, pharmacology)
antidepressant agent (drug dose, drug toxicity, pharmacology)
antidote (drug therapy, pharmacology)
antihistaminic agent (drug dose, drug toxicity, pharmacology)
benzodiazepine derivative (drug dose, drug toxicity)
cannabis (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
flumazenil (drug therapy, pharmacology)
methadone (drug toxicity)
naloxone (drug therapy, pharmacology)
neuroleptic agent (drug dose, drug toxicity, pharmacology)
opiate (drug dose, drug toxicity)
oral contraceptive agent (drug dose, drug toxicity, oral drug
administration, pharmacology)
paracetamol
paraquat (drug toxicity)
pentachlorophenol (drug toxicity)
pesticide (drug toxicity)
pethidine (drug toxicity)
psychotropic agent (drug dose, drug toxicity)
zolpidem (drug dose, drug toxicity)
zopiclone (drug dose, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, epidemiology, etiology, therapy)
drug overdose (drug therapy, epidemiology, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
accident
adolescent
adult
aged
alcohol abuse
alcoholism
anamnesis
article
clinical feature
controlled study
correlation analysis
drug abuse
drug efficacy
emergency ward
female
forensic medicine
hospital admission
human
intensive care unit
major clinical study
male
medical record
mental disease
mortality
neurologic disease
sex ratio
Spain
stomach lavage
toxicological parameters
treatment outcome
university hospital
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
flumazenil (78755-81-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
pentachlorophenol (87-86-5)
pethidine (28097-96-3, 50-13-5, 57-42-1)
zolpidem (82626-48-0)
zopiclone (43200-80-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2004033183
PUI
L38089753
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1130
TITLE
Isopropanol intoxication mimicking basilar artery thrombosis
AUTHOR NAMES
Mueller-Kronast N.
Rabinstein A.A.
Voung L.
Forteza A.M.
AUTHOR ADDRESSES
(Mueller-Kronast N.; Rabinstein A.A., arabinstein@med.miami.edu; Forteza
A.M.) Department of Neurology, Jackson Memorial Hospital, Univ. of Miami
School of Medicine, Miami, FL, United States.
(Voung L.) Department of Medicine, Jackson Memorial Hospital, Univ. of Miami
School of Medicine, Miami, FL, United States.
(Rabinstein A.A., arabinstein@med.miami.edu) 1150 MW 14th Street, Miami, FL
33101, United States.
CORRESPONDENCE ADDRESS
A.A. Rabinstein, 1150 MW 14th Street, Miami, FL 33101, United States. Email:
arabinstein@med.miami.edu
SOURCE
Neurology (2003) 61:10 (1456-1457). Date of Publication: 25 Nov 2003
ISSN
0028-3878
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2 propanol (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
flumazenil (drug therapy)
glucose (drug therapy)
naloxone (drug therapy)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
artery thrombosis (diagnosis)
basilar artery
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
acute disease
adult
article
blood pressure
body temperature
breathing rate
case report
clinical examination
coma
emergency ward
follow up
gas chromatography
human
image analysis
imaging system
ingestion
intubation
laboratory test
male
priority journal
reflex
serum osmolality
suicide attempt
CAS REGISTRY NUMBERS
2 propanol (67-63-0)
alcohol (64-17-5)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2003485316
MEDLINE PMID
14638985 (http://www.ncbi.nlm.nih.gov/pubmed/14638985)
PUI
L37463400
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1131
TITLE
Recommendations for good practice for sedation in assisted conception
AUTHOR NAMES
Elkington N.M.
Kehoe J.
Acharya U.
AUTHOR ADDRESSES
(Elkington N.M.; Acharya U.) Centre for Reproductive Medicine, Derriford
Hospital, Plymouth PL6 8DH, United Kingdom.
(Kehoe J.) Department of Anaesthesia, Derriford Hospital, Plymouth PL6 8DH,
United Kingdom.
CORRESPONDENCE ADDRESS
N.M. Elkington, Centre for Reproductive Medicine, Derriford Hospital,
Plymouth PL6 8DH, United Kingdom.
SOURCE
Human Fertility (2003) 6:2 (77-80). Date of Publication: 2003
ISSN
1464-7273
BOOK PUBLISHER
Taylor and Francis Ltd., 4 Park Square, Milton Park, Abingdon, Oxfordshire,
United Kingdom.
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (adverse drug reaction, drug combination, drug
dose, intravenous drug administration)
fentanyl (adverse drug reaction, drug comparison, pharmacology)
flumazenil
midazolam (adverse drug reaction, intravenous drug administration,
pharmacokinetics, pharmacology)
morphine (adverse drug reaction, drug comparison, pharmacology)
naloxone
narcotic analgesic agent (adverse drug reaction, drug combination, drug
comparison, pharmacokinetics, pharmacology)
oxygen
pethidine (adverse drug reaction, drug comparison, pharmacokinetics,
pharmacology)
propofol (pharmacoeconomics)
sedative agent (adverse drug reaction, drug dose, intravenous drug
administration, pharmacoeconomics, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
good clinical practice
infertility therapy
sedation
EMTREE MEDICAL INDEX TERMS
anesthesia induction
anesthesia mechanism
anesthesist
anesthetic equipment
anesthetic recovery
cardiovascular disease (side effect)
clinical audit
clinical protocol
consciousness
dose calculation
drug cost
drug elimination
drug half life
drug response
emergency treatment
hemodynamic monitoring
human
infertility (disease management, therapy)
medical education
medical society
note
oocyte transport
oxygen therapy
patient care
patient guidance
patient monitoring
practice guideline
process optimization
questionnaire
respiration depression (side effect)
respiratory tract disease (side effect)
resuscitation
risk assessment
risk benefit analysis
safety
side effect (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
flumazenil (78755-81-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Health Policy, Economics and Management (36)
Clinical and Experimental Pharmacology (30)
Adverse Reactions Titles (38)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Obstetrics and Gynecology (10)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2003439192
MEDLINE PMID
12869789 (http://www.ncbi.nlm.nih.gov/pubmed/12869789)
PUI
L37336641
DOI
10.1080/1464770312331369093
FULL TEXT LINK
http://dx.doi.org/10.1080/1464770312331369093
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1132
TITLE
Emergency Medical Technician/Paramedic's Role in Prehospital Drug Delivery
AUTHOR NAMES
Pearson R.M.
AUTHOR ADDRESSES
(Pearson R.M., ricksusanp@att.net) Medical Programs, Bidwell Training
Center, Inc., .
(Pearson R.M., ricksusanp@att.net) A-K Pulser Paramedic Response Team,
Alle-Kiski Medical Center, Allegheny Valley Hospital, Pittsburgh, PA, United
States.
(Pearson R.M., ricksusanp@att.net) A-K Pulser Paramedic Response Team, 1301
Carlisle St., Natrona Heights, PA 15065-1152, United States.
CORRESPONDENCE ADDRESS
R.M. Pearson, A-K Pulser Paramedic Response Team, 1301 Carlisle St., Natrona
Heights, PA 15065-1152, United States. Email: ricksusanp@att.net
SOURCE
Journal of Pharmacy Technology (2003) 19:6 (361-364). Date of Publication:
November/December 2003
ISSN
8755-1225
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
Objective: To describe the role of the medical technician/paramedic and
review 2 types of drug storage: the emergency department and prehospital
emergency medical services (EMS). Data Sources: Information was obtained
from personal experience, personal communication with hospitals, prehospital
healthcare providers, pharmacy technicians, and pharmacists. Searches of the
Internet were conducted for sites reviewing traditional drug storage
systems, as well as those utilized specifically for prehospital EMS. Key
words used were advanced cardiac life support, crash cart, drug security,
drug storage, emergency department, and emergency medical services. Study
Selection and Data Extraction: All articles identified from the data sources
were evaluated and all information deemed relevant was included for this
review. Data Synthesis: Emergency departments traditionally utilize crash
carts for their ease of maneuverability over tiled floors and massive
storage capabilities. Prehospital EMS are unable to use crash carts for drug
storage and transport. Smaller, more compact types of securable and
transportable drug storage units are required for prehospital EMS.
Conclusions: The concept of bringing the emergency department to the injured
is still a relatively young science. With time and experience come
innovations that tailor themselves to the needed specialties. The drug box
used by the emergency medical technicians/paramedics bridges that gap
between the emergency department and the street.
EMTREE DRUG INDEX TERMS
abciximab (pharmaceutics)
acetylsalicylic acid (pharmaceutics)
adenosine (pharmaceutics)
amiodarone (pharmaceutics)
atropine (pharmaceutics)
benzocaine (drug administration, pharmaceutics, topical drug administration)
bretylium (pharmaceutics)
calcium chloride (pharmaceutics)
dexamethasone sodium phosphate (pharmaceutics)
diazepam (pharmaceutics)
diltiazem (pharmaceutics)
diphenhydramine (pharmaceutics)
dobutamine (pharmaceutics)
dopamine (pharmaceutics)
epinephrine (pharmaceutics)
eptifibatide (pharmaceutics)
fibrinogen receptor antagonist (pharmaceutics)
furosemide (pharmaceutics)
glucagon (pharmaceutics)
hydrocortisone sodium succinate (pharmaceutics)
isoprenaline (pharmaceutics)
lidocaine (pharmaceutics)
lorazepam (pharmaceutics)
midazolam (pharmaceutics)
morphine sulfate (pharmaceutics)
naloxone (pharmaceutics)
salbutamol (pharmaceutics)
tetracaine (drug administration, pharmaceutics, topical drug administration)
tirofiban (pharmaceutics)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
paramedical personnel
patient transport
EMTREE MEDICAL INDEX TERMS
ambulance
drug safety
drug stability
emergency treatment
emergency ward
human
paramedical education
resuscitation
review
CAS REGISTRY NUMBERS
abciximab (143653-53-6)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
benzocaine (1333-08-0, 94-09-7)
bretylium (59-41-6)
calcium chloride (10043-52-4)
dexamethasone sodium phosphate (2392-39-4, 312-93-6)
diazepam (439-14-5)
diltiazem (33286-22-5, 42399-41-7)
diphenhydramine (147-24-0, 58-73-1)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
eptifibatide (148031-34-9)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9, 35763-26-9)
tetracaine (136-47-0, 94-24-6)
tirofiban (142373-60-2, 144494-65-5, 150915-40-5)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004006107
PUI
L38018386
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1133
TITLE
The Effect of Race/Ethnicity and Desirable Social Characteristics on
Physicians' Decisions to Prescribe Opioid Analgesics
AUTHOR NAMES
Tamayo-Sarver J.H.
Dawson N.V.
Hinze S.W.
Cydulka R.K.
Wigton R.S.
Albert J.M.
Ibrahim S.A.
Baker D.W.
AUTHOR ADDRESSES
(Tamayo-Sarver J.H., sarver@po.cwru.edu; Albert J.M.) Dept. of Epidemiol.
and Biostatist., Case W. Reserve Univ. Sch. of Med., Cleveland, OH, United
States.
(Dawson N.V.) Ctr. for Hlth. Care Res. and Policy, Department of Medicine,
Case W. Reserve Univ. Sch. of Med., Cleveland, OH, United States.
(Hinze S.W.) Department of Sociology, Case Western Reserve University,
Cleveland, OH, United States.
(Cydulka R.K.) Department of Emergency Medicine, MetroHealth Medical Center,
Case W. Reserve Univ. Sch. of Med., Cleveland, OH, United States.
(Wigton R.S.) Department of Internal Medicine, Univ. of Nebraska Medical
Center, College of Medicine, Omaha, NE, United States.
(Ibrahim S.A.) University of Pittsburgh, Ctr. for Hlth. Equity Res. and
Prom., VA Pittsburgh Health Care System, Pittsburgh, PA, United States.
(Baker D.W.) Department of Medicine, Feinberg Sch. of Med. NW Univ.,
Chicago, IL, United States.
(Tamayo-Sarver J.H., sarver@po.cwru.edu) 4009 Cullen Drive, Cleveland, OH
44105, United States.
CORRESPONDENCE ADDRESS
J.H. Tamayo-Sarver, 4009 Cullen Drive, Cleveland, OH 44105, United States.
Email: sarver@po.cwru.edu
SOURCE
Academic Emergency Medicine (2003) 10:11 (1239-1248). Date of Publication:
November 2003
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objective: Racial/ethnic disparities in physician treatment have been
documented in multiple areas, including emergency department (ED) analgesia.
The purpose of this study was to determine if physicians were predisposed to
different treatment decisions based on patient race/ethnicity and if
physicians' treatment predispositions changed when socially desirable
information about the patient (occupation, socioeconomic status, and
relationship with a primary care physician) was made explicit. Methods: The
authors developed three clinical vignettes designed to engage physicians'
decision-making processes. The patient's race/ethnicity was included. Each
vignette randomly included or omitted explicit socially desirable
information. The authors mailed 5,750 practicing emergency physicians three
clinical vignettes and a one-page questionnaire about demographic and
practice characteristics. Chi-square tests of significance for bivariate
analyses and multiple logistic regression were used for multivariate
analyses. Results: A total of 2,872 (53%) of the 5,398 potential physician
subjects participated. Patient race/ethnicity had no effect on physician
prescription of opioids at discharge for African Americans, Hispanics, and
whites: absolute differences in rates of prescribing opioids at discharge
were less than 2% for all three conditions presented. Making socially
desirable information explicit increased the prescribing rates by 4% (95% CI
= 0.1% to 8%) for the migraine vignette and 6% (95% CI = 3% to 8%) for the
back pain vignette. Conclusions: Patient race/ethnicity did not influence
physicians' predispositions to treatment plans in clinical vignettes. Even
knowing that the patient had a high-prestige occupation and a primary care
provider only minimally increased prescribing of opioid analgesics for
conditions with few objective findings.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ethnic difference
medical decision making
prescription
race difference
social desirability
EMTREE MEDICAL INDEX TERMS
adult
article
backache (drug therapy)
bivariate analysis
Black person
Caucasian
chi square distribution
clinical practice
clinical protocol
clinical trial
controlled clinical trial
controlled study
demography
disease predisposition
doctor patient relation
emergency health service
emergency treatment
emergency ward
ethnic group
female
health care quality
human
human experiment
interpersonal communication
male
migraine (drug therapy)
multiple regression
multivariate analysis
multivariate logistic regression analysis
normal human
occupation
patient care
primary medical care
priority journal
questionnaire
randomized controlled trial
social status
treatment planning
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003455278
MEDLINE PMID
14597500 (http://www.ncbi.nlm.nih.gov/pubmed/14597500)
PUI
L37377281
DOI
10.1197/S1069-6563(03)00494-9
FULL TEXT LINK
http://dx.doi.org/10.1197/S1069-6563(03)00494-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1134
TITLE
Cardiorespiratory Effects of Naloxone in Children
AUTHOR NAMES
Hasan R.A.
Benko A.S.
Nolan B.M.
Campe J.
Duff J.
Zureikat G.Y.
AUTHOR ADDRESSES
(Hasan R.A., Rhasan1@hurleymc.com; Nolan B.M.; Zureikat G.Y.) Department of
Pediatrics, Michigan State University, Hurley Medical Center, Flint, MI,
United States.
(Benko A.S.; Campe J.; Duff J.) Hurley Medical Center, Flint, MI, United
States.
(Hasan R.A., Rhasan1@hurleymc.com) Hurley Medical Center, One Hurley Plaza,
Flint, MI 48503-5993, United States.
CORRESPONDENCE ADDRESS
R.A. Hasan, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503-5993,
United States. Email: Rhasan1@hurleymc.com
SOURCE
Annals of Pharmacotherapy (2003) 37:11 (1587-1592). Date of Publication:
November 2003
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
BACKGROUND: Data on the cardiorespiratory changes and complications
following administration of naloxone in children are limited. OBJECTIVE: To
evaluate the cardiorespiratory changes and complications following naloxone
treatment in children. METHODS: The maximal changes in respiratory rate
(RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure,
and any complications within 1 and 2 hours following naloxone were
tabulated. RESULTS: One hundred ninety-five children received naloxone over
3 years. The mean ± SD age was 9.7 ± 6 years. The total doses of naloxone
ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose
of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were
postoperative and had been given naloxone by an anesthesiologist; group 2
patients consisted of 79 (40%) children who received naloxone in the
emergency department or pediatric intensive care unit. Patients in group 1
were older: 10.6 ± 5.3 versus 8.2 ± 6.7 years (p < 0.006), but received
significantly lower doses of naloxone (0.09 ± 0.2 vs. 1.1 ± 0.76 mg; p <
0.001). When the entire cohort was evaluated, a significant increase in RR
(15 ± 7 vs. 21 ± 8 breaths/min; p < 0.001), HR (102 ± 29 vs. 107 ± 29
beats/min; p < 0.001), SBP (109 ± 17 vs. 115 ± 15 mm Hg; p < 0.001), and DBP
(56 ± 10 vs. 60 ± 13 mm Hg; p < 0.001) within 1 hour following naloxone was
noted. When the 2 groups were compared, only the changes in RR were greater
in group 2 patients (6.8 ± 7.9 vs. 4.7 ± 5 breaths/min; p < 0.001) following
naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all
patients, while diastolic hypertension occurred in 13 (6.6%) of all patients
after naloxone. Only the incidence of diastolic hypertension was higher in
group 2 compared with group 1 patients following naloxone (16% vs. 2%; p <
0.001). Hypertension resolved spontaneously. One child developed pulmonary
edema and required positive pressure ventilation for 22 hours. CONCLUSIONS:
Moderate increases in RR, HR, and BP occur after naloxone administration to
children, but development of more serious complications is rare.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration, pharmacology)
opiate antagonist (adverse drug reaction, drug dose, drug therapy,
pharmacology)
EMTREE DRUG INDEX TERMS
antidote
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular effect
lung parenchyma
respiratory function
EMTREE MEDICAL INDEX TERMS
adolescent
anesthesia complication
article
blood pressure regulation
catecholamine release
child
drug effect
female
heart arrest (side effect)
heart arrhythmia (side effect)
heroin dependence (drug therapy)
human
hypertension (side effect)
hypotension (side effect)
lung edema (side effect)
major clinical study
male
positive end expiratory pressure
priority journal
respiration depression (drug therapy)
seizure (side effect)
side effect (side effect)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
2003432387
MEDLINE PMID
14565809 (http://www.ncbi.nlm.nih.gov/pubmed/14565809)
PUI
L37315095
DOI
10.1345/aph.1C521
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.1C521
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1135
TITLE
Safe and Efficacious Use of Procedural Sedation and Analgesia by
Nonanesthesiologists in a Pediatric Emergency Department
AUTHOR NAMES
Pitetti R.D.
Singh S.
Pierce M.C.
AUTHOR ADDRESSES
(Pitetti R.D., piterd@chp.edu; Singh S.; Pierce M.C.) Div. of Pediatric
Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA,
United States.
(Pitetti R.D., piterd@chp.edu) Div. of Pediatric Emergency Medicine,
Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213,
United States.
CORRESPONDENCE ADDRESS
R.D. Pitetti, Div. of Pediatric Emergency Medicine, Children's Hospital of
Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213, United States. Email:
piterd@chp.edu
SOURCE
Archives of Pediatrics and Adolescent Medicine (2003) 157:11 (1090-1096).
Date of Publication: November 2003
ISSN
1072-4710
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Background: Children often require relief of pain and anxiety when
undergoing diagnostic or therapeutic procedures in the emergency department
(ED). Procedural sedation and analgesia (PSA) has become standard practice
in the outpatient setting for such procedures. Few studies have looked at
the overall success and incidence of complications of PSA as performed by
nonanesthesiologists. Objectives: To prospectively describe PSA as performed
in a pediatric ED and to report the success of sedation and incidence of
complications. Design: Prospective descriptive study. Setting and
Population: Subjects aged 0 to 21 years presenting to the ED of an urban,
tertiary care, children's hospital between May 1, 1997, and April 30, 1999,
requiring PSA for a diagnostic or therapeutic procedure. Methods: A PSA form
was designed and used by ED personnel to record pertinent clinical and
demographic characteristics of patients, information related to the
procedure, vital signs, and occurrence of complications. Success of sedation
was defined a priori as successful completion of the procedure in a
minimally responsive subject. Complications were defined as apnea, hypoxia
(sustained pulse oximetry, <93%), seizure, arrhythmia, laryngospasm,
stridor, hypotension, rash, vomiting, disinhibition, or aspiration.
Follow-up telephone calls were made to families within 24 to 48 hours of
discharge from the ED to document further complications. Main Outcome
Measures: Rate of success of sedation and incidence of complications.
Results: Procedural sedation and analgesia was performed 1244 times in 1215
patients during the study. The median age of the patients was 5.9 years
(mean age, 6.9 years; range, 2 months to 19.4 years). There were 791 boys
(65.1%) and 424 girls (34.9%). A little more than half of the patients (643
or 52.9%) required PSA for fracture reduction and 396 (32.6%) for laceration
repair. Intravenous (IV) fentanyl citrate and midazolam hydrochloride was
provided in 734 sedation events (59.0%); IV ketamine hydrochloride,
midazolam, and atropine sulfate in 293 (23.6%); and intramuscular ketamine,
midazolam, and atropine in 82 (6.6%). Procedural sedation and analgesia was
successfully provided in 1177 (98.6%) of 1194 sedation events. Complications
occurred in 207 (17.8%) of 1161 events. The most common complication was
hypoxia (79.1% of patients), followed by vomiting (6.2% of patients). No
patient required intubation. One patient had an oral airway placed, 3
patients received flumazenil, 3 patients received naloxone hydrochloride,
and 1 patient received naloxone and bag-valve-mask ventilation. Seventy
(9.8%) of 717 patients, following discharge from the ED, reported minor
complications related to PSA. The most common complication was vomiting
(76.7% of patients), followed by persistent dizziness (6.8% of patients).
Patients who received IV fentanyl and midazolam were significantly more
likely to experience a complication during PSA (P<.001), while patients
sedated using IV ketamine, midazolam, and atropine (P=.006) or IV midazolam
alone (P=.005) were less likely. No difference in success of sedation or
incidence of complications at follow-up was found between the types of PSA
provided. Conclusions: Complications related to PSA occurred in 17.9% of
patients, but most commonly consisted of hypoxia that was easily treated.
Sedation was successful in 98.6% of patients. Procedural sedation and
analgesia can be safely and effectively provided by nonanesthesiologists in
a pediatric ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (adverse drug reaction, drug administration, drug combination,
intramuscular drug administration, intravenous drug administration,
pharmacology)
fentanyl citrate (adverse drug reaction, drug combination, drug dose,
intravenous drug administration, pharmacology)
ketamine (adverse drug reaction, drug administration, drug combination, drug
dose, intramuscular drug administration, intravenous drug administration,
pharmacology)
lorazepam (adverse drug reaction, drug combination, intravenous drug
administration, pharmacology)
midazolam (adverse drug reaction, drug administration, drug combination,
drug dose, intramuscular drug administration, intravenous drug
administration, pharmacology)
nitrous oxide (adverse drug reaction, pharmacology)
EMTREE DRUG INDEX TERMS
dexamethasone sodium phosphate (drug therapy, intramuscular drug
administration, pharmacology)
diphenhydramine (drug therapy, pharmacology)
flumazenil (drug therapy, pharmacology)
metoclopramide (drug therapy, intravenous drug administration, pharmacology)
morphine (adverse drug reaction, drug combination, drug therapy, intravenous
drug administration, pharmacology)
naloxone (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
sedation
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
adolescent
adult
agitation
anesthesist
apnea (side effect)
article
artificial ventilation
aspiration
bronchospasm (side effect)
child
controlled study
demography
diagnostic procedure
drug efficacy
drug safety
dysphoria (side effect)
dystonia (side effect)
emergency ward
female
follow up
fracture reduction
headache (side effect)
heart arrhythmia (side effect)
hiccup (side effect)
hospital discharge
human
hypotension (side effect)
hypoxia (drug therapy, side effect)
incidence
infant
laceration (surgery)
larynx spasm (side effect)
major clinical study
male
medical record
nausea (side effect)
pediatric hospital
priority journal
pulse oximetry
rash (side effect)
seizure (side effect)
side effect (side effect)
stridor (drug therapy, side effect)
tissue repair
urban area
urticaria (drug therapy, side effect)
vertigo (side effect)
vomiting (drug therapy, side effect)
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
dexamethasone sodium phosphate (2392-39-4, 312-93-6)
diphenhydramine (147-24-0, 58-73-1)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003475233
MEDLINE PMID
14609900 (http://www.ncbi.nlm.nih.gov/pubmed/14609900)
PUI
L37433175
DOI
10.1001/archpedi.157.11.1090
FULL TEXT LINK
http://dx.doi.org/10.1001/archpedi.157.11.1090
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1136
TITLE
Procedural sedation and analgesia for paediatric patients in the emergency
department
AUTHOR NAMES
Evered L.M.
AUTHOR ADDRESSES
(Evered L.M., lisaevered@shaw.ca) Department of Pediatrics, 2C3.00 WMC
Health Sciences Building, University of Alberta, Edmonton, Alta. T6G 2R7,
Canada.
CORRESPONDENCE ADDRESS
L.M. Evered, Department of Pediatrics, 2C3.00 WMC Health Sciences Building,
University of Alberta, Edmonton, Alta. T6G 2R7, Canada. Email:
lisaevered@shaw.ca
SOURCE
Paediatrics and Child Health (2003) 8:8 (503-508+528). Date of Publication:
Oct 2003
ISSN
1205-7088
ABSTRACT
Children presenting to the emergency department (ED) often require sedation
for brief procedures such as fracture and dislocation reductions, laceration
repairs, and imaging procedures that are painful, anxiety provoking or both.
This article presents three cases of paediatric patients who require
sedation and/or analgesia, and summarizes important aspects of procedural
sedation for the primary care practitioner in the emergency setting.
Presedation assessment and monitoring equipment are detailed. Discussion of
routes of administration and different agents including barbiturates,
opiates, benzodiaxepines, the 'cardiac coctail', ketamine, propofol, nitrous
oxide, and etomidate follow. Emphasis is placed on indications,
contraindications, dosing, timing and advantages and disadvantages of each.
Reversal agents are mentioned, and discharge criteria are outlined.
EMTREE DRUG INDEX TERMS
barbituric acid derivative (adverse drug reaction, drug therapy)
benzodiazepine derivative (adverse drug reaction, drug therapy)
chloral hydrate (drug dose, drug therapy, oral drug administration,
pharmacokinetics, rectal drug administration)
chlorpromazine (adverse drug reaction, drug combination, drug therapy,
intramuscular drug administration)
diamorphine (drug therapy, pharmacokinetics)
diazepam (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration, pharmacokinetics, rectal drug administration)
etomidate (adverse drug reaction, drug dose, drug therapy, pharmacokinetics)
fentanyl (adverse drug reaction, drug combination, drug dose, drug
interaction, drug therapy, intravenous drug administration,
pharmacokinetics)
flumazenil (drug dose, intravenous drug administration, pharmacokinetics,
pharmacology)
ketamine (adverse drug reaction, drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration, oral drug administration,
pharmacokinetics)
lorazepam (adverse drug reaction, drug dose, drug therapy, intramuscular
drug administration, intravenous drug administration, oral drug
administration, pharmacokinetics)
methohexital (drug dose, drug therapy, intravenous drug administration,
pharmacokinetics, rectal drug administration)
midazolam (drug combination, drug dose, drug interaction, drug therapy,
intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, pharmacokinetics,
rectal drug administration)
morphine (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration, pharmacokinetics)
naloxone (drug dose, intramuscular drug administration, intravenous drug
administration, pharmacokinetics, pharmacology)
narcotic agent (adverse drug reaction, drug therapy)
nitrous oxide (drug dose, drug therapy, inhalational drug administration,
pharmacokinetics)
pentobarbital (adverse drug reaction, drug dose, drug therapy, intramuscular
drug administration, intravenous drug administration, oral drug
administration, pharmacokinetics)
pethidine (adverse drug reaction, drug combination, drug therapy,
intramuscular drug administration)
promethazine (adverse drug reaction, drug combination, drug therapy,
intramuscular drug administration)
propofol (adverse drug reaction, drug combination, drug dose, drug therapy,
pharmacokinetics)
thiopental (adverse drug reaction, drug dose, drug therapy,
pharmacokinetics, rectal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
sedation
EMTREE MEDICAL INDEX TERMS
agitation
anxiety disorder (drug therapy)
apnea (side effect)
bronchospasm (side effect)
child
coughing (side effect)
drug effect
drug half life
drug metabolism
dystonia (side effect)
emergency ward
focal epilepsy
fracture (surgery)
hemodynamics
human
hypertension (side effect)
hypotension (side effect)
infant
intracranial hypertension (side effect)
laceration (surgery)
larynx spasm (side effect)
monitoring
muscle rigidity (side effect)
myocardial disease (side effect)
pain (drug therapy)
pediatrics
pruritus (side effect)
respiration depression (side effect)
review
seizure (side effect)
thorax wall
treatment contraindication
treatment indication
vomiting (side effect)
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
chlorpromazine (50-53-3, 69-09-0)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2003484499
PUI
L37462322
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1137
TITLE
A prospective before-and-after trial of a medical emergency team
AUTHOR NAMES
Bellomo R.
Goldsmith D.
Uchino S.
Buckmaster J.
Hart G.K.
Opdam H.
Silvester W.
Doolan L.
Gutteridge G.
AUTHOR ADDRESSES
(Bellomo R., Rinaldo.Bellomo@austin.org.au; Goldsmith D.; Uchino S.;
Buckmaster J.; Hart G.K.; Opdam H.; Silvester W.; Doolan L.; Gutteridge G.)
Austin and Repatriation Medical Ctr., Studley Road, Heidelberg, Vic. 3084,
Australia.
CORRESPONDENCE ADDRESS
R. Bellomo, Austin and Repatriation Medical Ctr., Studley Road, Heidelberg,
Vic. 3084, Australia. Email: Rinaldo.Bellomo@austin.org.au
SOURCE
Medical Journal of Australia (2003) 179:6 (283-287). Date of Publication: 15
Sep 2003
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
ABSTRACT
Objective: To determine the effect on cardiac arrests and overall hospital
mortality of an intensive care-based medical emergency team. Design and
setting: Prospective before-and-after trial in a tertiary referral hospital.
Patients: Consecutive patients admitted to hospital during a 4-month
"before" period (May - August 1999) (n=21 090) and a 4-month intervention
period (November 2000 - February 2001) (n=20 921). Main outcome measures:
Number of cardiac arrests, number of patients dying after cardiac arrest,
number of postcardiac-arrest bed-days and overall number of in-hospital
deaths. Results: There were 63 cardiac arrests in the "before" period and 22
in the intervention period (relative risk reduction, RRR: 65%; P<0.001).
Thirty-seven deaths were attributed to cardiac arrests in the "before"
period and 16 in the intervention period (RRR: 56%; P=0.005). Survivors of
cardiac arrest in the "before" period required 163 ICU bed-days versus 33 in
the intervention period (RRR: 80%; P<0.001), and 1353 hospital bed-days
versus 159 in the intervention period (RRR: 88%; P<0.001). There were 302
deaths in the "before" period and 222 in the intervention period (RRR: 26%;
P=0.004). Conclusions: The incidence of in-hospital cardiac arrest and death
following cardiac arrest, bed occupancy related to cardiac arrest, and
overall in-hospital mortality decreased after introducing an intensive
care-based medical emergency team.
EMTREE DRUG INDEX TERMS
anticonvulsive agent (drug therapy, intravenous drug administration)
atropine (drug therapy)
beta adrenergic receptor blocking agent (drug therapy, intravenous drug
administration)
dexamethasone (drug therapy)
digoxin (drug therapy, intravenous drug administration)
furosemide (drug therapy, intravenous drug administration)
glucose (drug therapy, intravenous drug administration)
glyceryl trinitrate (drug therapy, intravenous drug administration)
hypertensive agent (drug therapy, intravenous drug administration)
infusion fluid (drug therapy, intravenous drug administration)
insulin (drug therapy, intravenous drug administration)
magnesium (drug therapy, intravenous drug administration)
metoclopramide (drug therapy, intravenous drug administration)
morphine (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
oxygen
ranitidine (drug therapy, intravenous drug administration)
salbutamol (drug therapy, inhalational drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
heart arrest (drug therapy, epidemiology, surgery, therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
assisted ventilation
cardioversion
catheterization
clinical practice
controlled study
epidemiological data
erythrocyte transfusion
female
health care delivery
health care quality
hospital personnel
hospital service
hospitalization
human
incidence
intensive care unit
intubation
laboratory test
length of stay
major clinical study
male
mortality
outcomes research
oxygen therapy
prospective study
resuscitation
risk management
statistical analysis
surgical technique
survival
tracheostomy
treatment outcome
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
dexamethasone (50-02-2)
digoxin (20830-75-5, 57285-89-9)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
insulin (9004-10-8)
magnesium (7439-95-4)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
ranitidine (66357-35-5, 66357-59-3)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Health Policy, Economics and Management (36)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003380278
MEDLINE PMID
12964909 (http://www.ncbi.nlm.nih.gov/pubmed/12964909)
PUI
L37150532
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1138
TITLE
Prehospital treatment of opioid overdose in Copenhagen 1995-1998
ORIGINAL (NON-ENGLISH) TITLE
Præhospital behandling af opioidoverdosering i København 1995-1998
AUTHOR NAMES
Ishøy T.
Høgskilde S.Å.
Haastrup L.
AUTHOR ADDRESSES
(Ishøy T., ti@dgma.dk) DGMA, Amager Hospital, DK-2300 København S., Denmark.
(Høgskilde S.Å.; Haastrup L.)
CORRESPONDENCE ADDRESS
T. Ishøy, DGMA, Amager Hospital, DK-2300 København S., Denmark. Email:
ti@dgma.dk
SOURCE
Ugeskrift for Laeger (2003) 165:38 (3624-3627). Date of Publication: 15 Sep
2003
ISSN
0041-5782
BOOK PUBLISHER
Almindelige Danske Laegeforening, Tromdhjemsgade 9, Copenhagen, Denmark.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug therapy, intravenous drug
administration, subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine
diamorphine (drug toxicity)
methadone
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
addiction
ambulance
article
Denmark
drug abuse
emergency treatment
human
major clinical study
patient transport
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
Danish
LANGUAGE OF SUMMARY
Danish
EMBASE ACCESSION NUMBER
2004037475
MEDLINE PMID
14556395 (http://www.ncbi.nlm.nih.gov/pubmed/14556395)
PUI
L38101074
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1139
TITLE
Emergency treatment of opiate overdose and withdrawal syndrome
ORIGINAL (NON-ENGLISH) TITLE
Terapia d'urgenza nell'overdose e nella sindrome di astinenza da oppioidi
AUTHOR NAMES
Lambiase W.M.
Colabella L.
AUTHOR ADDRESSES
(Lambiase W.M.; Colabella L.) U.O. Pronto Soccorso e Accettazione, IRCCS,
Osp. Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
CORRESPONDENCE ADDRESS
W.M. Lambiase, U.O. Pronto Soccorso e Accettazione, IRCCS, Osp. Casa
Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
SOURCE
Impegno Ospedaliero, Sezione Scientifica (2003) 24:2 (35-39). Date of
Publication: Sep 2003
ISSN
0393-0394
ABSTRACT
In our work, we have tried to show certainties and contradictions that the
physician after finds in the daily clinical practice. We will analyze,
because of the high number of morbility and mortality, the urgencies related
to the cases of acute poisoning by opium. We will also evaluate the teraphy
in the abstinence's syndrome caused by opium.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug dose, drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
withdrawal syndrome (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
clinical practice
drug effect
drug overdose
drug screening
human
morbidity
mortality
urinary urgency
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
2003417839
PUI
L37267407
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1140
TITLE
Serious overdoses involving buprenorphine in Helsinki
AUTHOR NAMES
Boyd J.
Randell T.
Luurila H.
Kuisma M.
AUTHOR ADDRESSES
(Boyd J., james.boyd@hel.fi; Luurila H.; Kuisma M.) Helsinki Emergency
Medical Service, Helsinki University Central Hospital, Helsinki, Finland.
(Randell T.) Dept. of Anesth./Intensive Care Med., Helsinki University
Central Hospital, Helsinki, Finland.
(Boyd J., james.boyd@hel.fi) Helsinki Emergency Medical Service, Helsinki
University Central Hospital, PO Box 112, FIN-00099 Helsinki, Finland.
CORRESPONDENCE ADDRESS
J. Boyd, Helsinki Emergency Medical Service, Helsinki University Central
Hospital, PO Box 112, FIN-00099 Helsinki, Finland. Email: james.boyd@hel.fi
SOURCE
Acta Anaesthesiologica Scandinavica (2003) 47:8 (1031-1033). Date of
Publication: September 2003
ISSN
0001-5172
BOOK PUBLISHER
Blackwell Munksgaard, 1 Rosenorns Alle, P.O. Box 227, Copenhagen V, Denmark.
ABSTRACT
Background: Buprenorphine is used as maintenance therapy for
opioid-dependent patients. In comparison with other opioids it is thought to
be safer because it is less likely to cause serious respiratory depression.
However, concomitant use of psychotropics, especially benzodiazepines, and
intravenous injection of dissolved buprenorphine tablets increase the risk
of a serious overdose. Methods: As part of a larger retrospective study of
opioid overdoses in Helsinki, the emergency medical services (EMS) records
from January 1995 to April 2002 were reviewed for overdoses involving
buprenorphine. Hospital records were reviewed when available. Results: We
report 11 overdoses in which buprenorphine was involved. The classic
symptoms and signs of an opioid overdose (respiratory depression, miosis and
central nervous system depression) were present in most of the cases. At
least eight of the patients had an overdose that was potentially fatal. One
of the patients had a heroin overdose and was reportedly 'treated' by his
friends with intravenously administered buprenorphine. Conclusion: The
high-dosage formulation of buprenorphine used for opioid-dependent patients
might have caused several dangerous and potentially fatal overdoses in
Helsinki. However, it does cause considerably less serious overdoses than
heroin. Drug abusers might be intravenously administering buprenorphine
themselves to treat heroin overdoses. © Acta Anaesthesiologica Scandinavica
47 (2003).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug dose, drug interaction, drug therapy, drug toxicity,
intravenous drug administration, oral drug administration, pharmaceutics)
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine derivative (drug interaction)
diamorphine (drug dose, drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
article
central nervous system depression
clinical article
clinical feature
drug fatality
drug formulation
Finland
human
medical record
miosis
opiate addiction (drug therapy)
priority journal
respiration depression
retrospective study
DRUG TRADE NAMES
subutex
temgesic
CAS REGISTRY NUMBERS
alcohol (64-17-5)
buprenorphine (52485-79-7, 53152-21-9)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003340897
MEDLINE PMID
12904197 (http://www.ncbi.nlm.nih.gov/pubmed/12904197)
PUI
L37013780
DOI
10.1034/j.1399-6576.2003.00201.x
FULL TEXT LINK
http://dx.doi.org/10.1034/j.1399-6576.2003.00201.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1141
TITLE
Intravenous fentanyl for cancer pain: A "fast titration" protocol for the
emergency room
AUTHOR NAMES
Soares L.G.L.
Martins M.
Uchoa R.
AUTHOR ADDRESSES
(Soares L.G.L.; Martins M.; Uchoa R.) Ctro. de Suporte Terap. Oncologico,
Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
(Soares L.G.L.) Rua Marques de Pinedo 97/402, Laranjeiras 22231100, Rio de
Janeiro, Brazil.
CORRESPONDENCE ADDRESS
L.G.L. Soares, Rua Marques de Pinedo 97/402, Laranjeiras 22231100, Rio de
Janeiro, Brazil.
SOURCE
Journal of Pain and Symptom Management (2003) 26:3 (876-881). Date of
Publication: 1 Sep 2003
ISSN
0885-3924
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
Patients with cancer sometimes are admitted to the emergency room due to
severe pain. Despite the fact that morphine's hydrophilicity can delay its
peak effects after intravenous administration up to 30 minutes, it is still
the most commonly used opioid during cancer pain emergencies. Fentanyl is a
synthetic, lipophilic opioid, more potent than morphine, and achieves peak
effects after intravenous administration in 5 minutes. According to our
observations, intravenous fentanyl could be safely used in the emergency
room to treat patients who need fast titration of an opioid to control their
pain. In our study, fentanyl was employed in a four-step protocol to treat
patients admitted to our palliative care emergency room due to severe pain,
regardless of the previous use of morphine at home. Titration with
intravenous fentanyl was successfully employed in 18/18 (100%) patients,
with an average time for pain control at about 11 minutes, and without
relevant adverse effects. We conclude that intravenous fentanyl could be
safely used for severe cancer pain when rapid titration is being considered.
© 2003 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All
rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, clinical trial, drug dose, drug therapy,
intravenous drug administration, pharmacology)
EMTREE DRUG INDEX TERMS
morphine (clinical trial, drug administration, drug dose, drug therapy,
intravenous drug administration, oral drug administration, pharmacology)
naloxone (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
cancer pain (drug therapy)
cancer palliative therapy
emergency treatment
EMTREE MEDICAL INDEX TERMS
adult
aged
article
bradycardia (side effect)
clinical article
clinical protocol
clinical trial
controlled clinical trial
controlled study
disease severity
drowsiness (side effect)
drug safety
emergency medicine
emergency ward
female
hallucination (side effect)
human
hypotension (side effect)
male
rigidity
side effect (side effect)
thorax
time
titrimetry
vomiting (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Cancer (16)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003369852
MEDLINE PMID
14528871 (http://www.ncbi.nlm.nih.gov/pubmed/14528871)
PUI
L37101235
DOI
10.1016/S0885-3924(03)00314-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0885-3924(03)00314-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1142
TITLE
Assessment for deaths in out-of-hospital heroin overdose patients treated
with naloxone who refuse transport
AUTHOR NAMES
Vilke G.M.
Sloane C.
Smith A.M.
Chan T.C.
AUTHOR ADDRESSES
(Vilke G.M., gmvilke@ucsd.edu; Sloane C.; Chan T.C.) Department of Emergency
Medicine, University of California, San Diego Medical Center, San Diego, CA,
United States.
(Vilke G.M., gmvilke@ucsd.edu; Smith A.M.) S. Diego Co. Div. Emergency Med.
S., San Diego, CA, United States.
(Vilke G.M., gmvilke@ucsd.edu) Department of Emergency Medicine, UC San
Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, United
States.
CORRESPONDENCE ADDRESS
G.M. Vilke, Department of Emergency Medicine, UC San Diego Medical Center,
200 West Arbor Drive, San Diego, CA 92103, United States. Email:
gmvilke@ucsd.edu
SOURCE
Academic Emergency Medicine (2003) 10:8 (893-896). Date of Publication: 1
Aug 2003
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Naloxone frequently is used to treat suspected heroin and opioid overdoses
in the out-of-hospital setting. The authors' emergency medical services
system has operated a policy of allowing these patients, when successfully
treated, to sign out against medical advice (AMA) in the field. Objectives:
To evaluate the safety of this AMA policy. Methods: This is a retrospective
review of out-of-hospital and medical examiner (ME) databases over a
five-year period. The authors reviewed all ME cases in which opioid
overdoses were listed as contributing to the cause of death. These cases
were cross-compared with all patients who received naloxone by field
paramedics and then refused transport. The charts were reviewed by dates,
times, age, sex, location, and ethnicity when available. Results: There were
998 out-of-hospital patients who received naloxone and refused further
treatment and 601 ME cases of opioid overdose deaths. When compared by age,
time, date, sex, location, and ethnicity, there were no cases in which a
patient was treated by paramedics with naloxone within 12 hours of being
found dead of an opioid overdose. Conclusions: Giving naloxone to patients
with heroin overdoses in the field and then allowing them to sign out AMA
resulted in no identifiable deaths within this study population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
patient transport
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
cause of death
death
emergency health service
ethnology
female
health care policy
human
major clinical study
male
medical decision making
paramedical disciplines
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003347821
MEDLINE PMID
12896894 (http://www.ncbi.nlm.nih.gov/pubmed/12896894)
PUI
L37040537
DOI
10.1197/aemj.10.8.893
FULL TEXT LINK
http://dx.doi.org/10.1197/aemj.10.8.893
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1143
TITLE
Emergency department presentations of naltrexone-accelerated detoxification
AUTHOR NAMES
Armstrong J.
Little M.
Murray L.
AUTHOR ADDRESSES
(Armstrong J.; Little M.; Murray L., lindsay.murray@health.wa.gov.au)
Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, WA,
Australia.
(Murray L., lindsay.murray@health.wa.gov.au) Department of Emergency
Medicine, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009,
Australia.
CORRESPONDENCE ADDRESS
L. Murray, Department of Emergency Medicine, Sir Charles Gairdner Hospital,
Hospital Avenue, Nedlands, WA 6009, Australia. Email:
lindsay.murray@health.wa.gov.au
SOURCE
Academic Emergency Medicine (2003) 10:8 (860-866). Date of Publication: 1
Aug 2003
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: To analyze emergency department (ED) presentations after
naltrexone-accelerated detoxification. Methods: This was a retrospective
cohort analysis of patient presentations to Sir Charles Gairdner Hospital
Emergency Department over a six-month period (November 2000 to April 2001).
Results: During the six-month study period, 42 patients presented to the ED
after naltrexone-accelerated detoxification. This represented 7% of patients
treated at a single clinic over the same period. Presentation occurred
within 24 hours in 40% of cases and within 48 hours in 74%. Clinical
features on presentation included gastrointestinal (GI) symptoms (vomiting,
60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS]
symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and
respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%).
Gastrointestinal symptoms were managed adequately with supportive therapy in
most cases (intravenous fluids; antiemetics). Agitation sometimes required
large doses of intravenous benzodiazepines (up to 730 mg in 44 hours),
one-to-one nursing, and security staff. Two of 14 patients presenting with
predominantly CNS disturbance required intubation (14%). Mean in-hospital
stay for all patients was 18 hours (range 1 to 92 hours). Conclusions: A few
patients undergoing outpatient naltrexone-accelerated detoxification during
a six-month period subsequently required ED management. The clinical
features encountered in this group of patients can be subdivided into GI or
CNS predominance, with different management strategies. Most presentations
can be managed in the ED or an associated observation ward, but departmental
resources must be available for one-to-one nursing and security personnel.
Patients presenting with agitation should be sedated with benzodiazepines;
large doses may be required. Close monitoring of respiratory function is
mandatory, and advanced airway management may be required.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naltrexone (oral drug administration, subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid (endogenous compound)
4 aminobutyric acid receptor stimulating agent (drug therapy)
alpha adrenergic receptor stimulating agent (drug therapy)
antidiarrheal agent (drug therapy)
antiemetic agent (drug therapy)
benzodiazepine derivative (drug therapy, intravenous drug administration)
celecoxib (drug therapy)
chlorpromazine (drug therapy)
clonidine (drug therapy, intravenous drug administration, oral drug
administration)
dopamine receptor blocking agent (drug therapy)
flunitrazepam (drug therapy)
haloperidol (drug therapy)
loperamide (drug therapy, oral drug administration)
metoclopramide (drug therapy, intravenous drug administration)
midazolam (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
neuroleptic agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
noradrenalin (endogenous compound)
octreotide (drug therapy, subcutaneous drug administration)
ondansetron (drug therapy)
opiate antagonist (drug therapy)
quinine sulfate (drug therapy)
scopolamine butyl bromide (drug therapy, intravenous drug administration)
sedative agent (drug therapy)
serotonin 3 antagonist (drug therapy, intravenous drug administration)
somatostatin derivative (drug therapy)
spasmolytic agent (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical feature
drug detoxification
emergency ward
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
adolescent
adult
agitation
article
central nervous system disease (drug therapy)
clinical article
cohort analysis
conservative treatment
diarrhea (drug therapy)
drowsiness (drug therapy)
endotracheal intubation
female
gastrointestinal symptom
hospitalization
human
intravenous drug administration
length of stay
male
nursing
patient care
patient monitoring
practice guideline
priority journal
respiratory distress
respiratory tract disease
retrospective study
sedation
tachypnea
United States
vomiting (drug therapy)
CAS REGISTRY NUMBERS
4 aminobutyric acid (28805-76-7, 56-12-2)
celecoxib (169590-42-5)
chlorpromazine (50-53-3, 69-09-0)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
flunitrazepam (1622-62-4)
haloperidol (52-86-8)
loperamide (34552-83-5, 53179-11-6)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
noradrenalin (1407-84-7, 51-41-2)
octreotide (83150-76-9)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
quinine sulfate (804-63-7)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003347814
MEDLINE PMID
12896887 (http://www.ncbi.nlm.nih.gov/pubmed/12896887)
PUI
L37040530
DOI
10.1197/aemj.10.8.860
FULL TEXT LINK
http://dx.doi.org/10.1197/aemj.10.8.860
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1144
TITLE
Drug poisoning
ORIGINAL (NON-ENGLISH) TITLE
Intoxicación por drogas
AUTHOR NAMES
Gainza I.
Nogué S.
Martínez Velasco C.
Hoffman R.S.
Burillo-Putze G.
Dueñas A.
Gómez J.
Pinillos M.A.
AUTHOR ADDRESSES
(Gainza I.) Servicio de Psiquiatría, Hospital de Navarra, UHP-II, Pamplona,
Spain.
(Nogué S.) Area de Vigilancia Intensiva, Unidad de Toxicologia Clinica,
Hospital Clínic, Barcelona, Spain.
(Martínez Velasco C.) Medicina Intensiva, Clínica San Miguel, Pamplona,
Spain.
(Burillo-Putze G.) Servicio de Urgencias, Hospital Universitario de
Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
(Dueñas A.) U. Regional de Toxicologia Clinica, Hosp. Universitario del Rio
Ortega, Valladolid, Spain.
(Pinillos M.A., ma.pinillos.echeverria@cfnavarra.es) Servicio de Urgencias,
Hospital de Navarra, Pamplona, Spain.
(Pinillos M.A., ma.pinillos.echeverria@cfnavarra.es) Servicio de Urgencias,
Hospital de Navarra, Irunlarrea 3, 31008 Pamplona, Spain.
(Hoffman R.S.; Gómez J.)
CORRESPONDENCE ADDRESS
M.A. Pinillos, Servicio de Urgencias, Hospital de Navarra, Irunlarrea 3,
31008 Pamplona, Spain. Email: ma.pinillos.echeverria@cfnavarra.es
SOURCE
Anales del Sistema Sanitario de Navarra (2003) 26:SUPPL. 1 (99-128). Date of
Publication: 2003
ISSN
1137-6627
BOOK PUBLISHER
Anales del Sistema Sanitario de Navarra, C/ Irunlarrea 3, Pamplona
(Navarra), Spain.
ABSTRACT
A review is made of acute poisoning by opiates and its treatment in the
emergency services, bearing in mind the progressive decline in the number of
cases presented with the arrival of new forms of their administration, as
well as the presence of new addictive drugs that have resulted in a shift in
consumption habits. Reference is also made to the way in which the different
types of existing substances originated, with the aim of achieving a better
understanding of their use and in order to administer the most suitable
treatment when poisoning occurs. Cocaine poisoning is discussed, with
reference to its clinical picture, diagnosis and treatment. The consumption
of illegal drugs in our country has undergone a notable change in recent
years, with heroin being relegated and the incorporation of cocaine,
amphetamine derivatives such as "ecstasy" (MDMA), "liquid ecstasy" (GHB)
and, to a lesser extent, ketamine. A review is made of cannabis and its
derivates, from the history of its consumption and the preparations employed
to the effects produced in the different bodily systems. A brief explanation
is also given of its metabolites and its principal mechanisms of action.
Finally, we comment on the effects of LSD and hallucinogenic mushrooms.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine (drug toxicity)
illicit drug (drug toxicity)
opiate derivative (drug toxicity)
EMTREE DRUG INDEX TERMS
4 hydroxybutyric acid (drug toxicity)
amphetamine (drug toxicity)
benzodiazepine derivative (drug therapy)
cannabinoid (drug toxicity)
cannabis (drug toxicity)
diamorphine (drug toxicity)
flumazenil (drug therapy)
ketamine (drug toxicity)
lysergide (drug toxicity)
methadone (drug toxicity)
midazolam (drug therapy)
midomafetamine (drug toxicity)
naloxone (drug therapy)
phentolamine (drug therapy)
physostigmine (drug therapy)
propranolol (drug therapy)
psychedelic agent (drug toxicity)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
agitation
algorithm
clinical feature
drug abuse
emergency health service
human
review
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 hydroxybutyric acid (591-81-1)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lysergide (50-37-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
phentolamine (50-60-2, 73-05-2)
physostigmine (57-47-6, 64-47-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
2003250641
MEDLINE PMID
12813480 (http://www.ncbi.nlm.nih.gov/pubmed/12813480)
PUI
L36749809
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1145
TITLE
The History and Evolution of Paediatric Resuscitation
AUTHOR NAMES
Hia C.P.P.
AUTHOR ADDRESSES
(Hia C.P.P.) Children's Medical Institute, National University Hospital,
Lower Kent Ridge Road, Singapore 119074, Singapore.
CORRESPONDENCE ADDRESS
C.P.P. Hia, Children's Medical Institute, National University Hospital,
Lower Kent Ridge Road, Singapore 119074, Singapore.
SOURCE
Singapore Paediatric Journal (2003) 45:1 (6-15). Date of Publication: Jun
2003
ISSN
0218-9941
ABSTRACT
Resuscitation is part and parcel of the practice of medicine today.
Healthcare professionals and laypersons are now well-versed in the technique
of cardiopulmonary resuscitation (CPR) and often apply it without question
to an unconscious victim. There are numerous counts of persons being
successfully revived, some neurologically intact, others neurologically
devastated. What exactly comprises "resuscitation" and how did it all begin?
How has resuscitation evolved through history and what are the new advances
in resuscitation? How is the paediatric patient different? Have new advances
altered the practice of medicine? These issues are explored in this article.
EMTREE DRUG INDEX TERMS
atropine (adverse drug reaction, drug dose)
bicarbonate (drug toxicity)
calcium channel blocking agent (drug dose)
calcium chloride
epinephrine (adverse drug reaction)
gluconate calcium
glucose
lidocaine
naloxone
vasopressin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatrics
resuscitation
EMTREE MEDICAL INDEX TERMS
algorithm
atrioventricular block
bradycardia (side effect)
defibrillation
electric current
electrolyte disturbance
emergency health service
endotracheal intubation
evidence based medicine
family
heart massage
heart ventricle extrasystole (side effect)
heart ventricle fibrillation
human
hypotension
lung ventilation
medical practice
metabolic acidosis
microclimate
mouth breathing
myocardial disease (side effect)
nose breathing
oxygenation
paramedical personnel
practice guideline
respiratory acidosis
review
side effect (side effect)
survival rate
vagus nerve stimulation
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2004177581
PUI
L38508969
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1146
TITLE
Prescritions in psychiatric emergencies
ORIGINAL (NON-ENGLISH) TITLE
Prescriptions dans l'urgence psychiatrique
AUTHOR NAMES
Vaiva G.
Ducrocq F.
Ezzedine M.
AUTHOR ADDRESSES
(Vaiva G., gvaiva@chru-lille.fr; Ducrocq F.; Ezzedine M.) Clinique de
Psychiatrie, Centre d'Accueil et de Crise, CHU de Lille and INSERM U513,
59037 Lille Cedex, France.
CORRESPONDENCE ADDRESS
G. Vaiva, Clinique de Psychiatrie, Centre d'Accueil et de Crise, CHU de
Lille and INSERM U513, 59037 Lille Cedex, France. Email:
gvaiva@chru-lille.fr
SOURCE
Revue du Praticien (2003) 53:11 (1209-1213). Date of Publication: 1 Jun 2003
ISSN
0035-2640
BOOK PUBLISHER
Huveaux France, 114 Avenue Charles de Gaulle, Neuilly sur Seine, France.
ABSTRACT
The two missions of an emergency psychiatric intervention are firstly
diagnostic, and then if possible, therapeutic. The therapeutic aims are thus
dominated by two potential cases, one not exclusive of the other:
hospitalisation and/or the obtainment of anxiolysis, if not sedation. In a
psychiatric emergency, everything comes together in such a way that can
induce serious errors, in terms of prescription, for the outcome for the
patient: 1) not to appreciate the situation of the crisis, and aboveall, 2)
to "over-estimate" the intensity of the problems, in confusing the gravity
of the clinical picture with the intensity of the psychomotor agitation. A
sedative and anxiolytic molecule proves to be necessary when faced with a
patient in whom the agitation doesn't settle, who remains threatening and
oppositional, or in whom the anxious character of the life-like delerium is
manifest. Physical containment may be necessary and is then considered a
prescribed therapeutic act that necessitates the surveillance of the
subject. Therapeutic prescriptions are led by two cases which are not
reciprocally exclusive non exclusive.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug therapy)
neuroleptic agent (drug dose, drug therapy, intramuscular drug
administration)
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
bromazepam (drug therapy)
clonazepam (drug therapy)
clorazepate (drug dose, drug therapy)
clorazepate dipotassium (drug therapy)
cyamemazine (drug dose, drug therapy, intramuscular drug administration,
oral drug administration)
droperidol (drug therapy)
levomepromazine (drug therapy)
lorazepam (drug dose, drug therapy)
naloxone (drug therapy)
olanzapine (drug dose, drug therapy, intramuscular drug administration, oral
drug administration)
zolpidem tartrate (drug therapy)
zuclopenthixol decanoate (drug dose, drug therapy, intramuscular drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
mental disease (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
agitation
delirium
disease severity
drug indication
hospitalization
human
outcomes research
prescription
review
sedation
tranquilizing activity
DRUG TRADE NAMES
clopixol
droleptan
lexomil
narcan
nozinan
rivotril
stilnox
temesta
tercian
tranxene
xanax
zyprexa
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
bromazepam (1812-30-2)
clonazepam (1622-61-3)
clorazepate (20432-69-3, 23887-31-2)
clorazepate dipotassium (57109-90-7)
cyamemazine (3546-03-0)
droperidol (548-73-2)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
zolpidem tartrate (99294-93-6)
zuclopenthixol decanoate (64053-00-5)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2003242396
MEDLINE PMID
15185646 (http://www.ncbi.nlm.nih.gov/pubmed/15185646)
PUI
L36723413
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1147
TITLE
Attitudes about Prescribing Take-Home Naloxone to Injection Drug Users for
the Management of Heroin Overdose: A Survey of Street-Recruited Injectors in
the San Francisco Bay Area
AUTHOR NAMES
Seal K.H.
Downing M.
Kral A.H.
Singleton-Banks S.
Hammond J.-P.
Lorvick J.
Ciccarone D.
Edlin B.R.
AUTHOR ADDRESSES
(Seal K.H., karens@itsa.ucsf.edu; Downing M.; Kral A.H.; Singleton-Banks S.;
Hammond J.-P.; Lorvick J.; Ciccarone D.; Edlin B.R.) Urban Health Study,
Dept. of Fam. and Community Medicine, University of California, San
Francisco, CA, United States.
(Seal K.H., karens@itsa.ucsf.edu) Urban Health Study, University of
California, 3180 18th Street, San Francisco, CA 94110, United States.
CORRESPONDENCE ADDRESS
K.H. Seal, Urban Health Study, University of California, 3180 18th Street,
San Francisco, CA 94110, United States. Email: karens@itsa.ucsf.edu
SOURCE
Journal of Urban Health (2003) 80:2 (291-301). Date of Publication: June
2003
ISSN
1099-3460
BOOK PUBLISHER
Springer Science and Business Media Deutschland GmbH, Heidelberger Platz 3,
Berlin, Germany.
ABSTRACT
Naloxone, an injectable opiate antagonist, can immediately reverse an opiate
overdose and prevent overdose death. We sought to determine injection drug
users' (ID Us) attitudes about being prescribed take-home naloxone. During
November 1999 to February 2000, we surveyed 82 street-recruited IDUs from
the San Francisco Bay Area of California who had experienced one or more
heroin overdose events. We used a questionnaire that included structured and
open-ended questions. Most respondents (89%) had witnessed an overdose, and
90% reported initially attempting lay remedies in an effort to help
companions survive. Only 51% reported soliciting emergency assistance
(calling 911) for the last witnessed overdose, with most hesitating due to
fear of police involvement. Of ID Us surveyed, 87% were strongly in favor of
participating in an overdose management training program to receive
take-home naloxone and training in resuscitation techniques. Nevertheless,
respondents expressed a variety of concerning attitudes. If provided
naloxone, 35% predicted that they might feel comfortable using greater
amounts of heroin, 62% might be less inclined to call 911 for an overdose,
30% might leave an overdose victim after naloxone resuscitation, and 46%
might not be able to dissuade the victim from using heroin again to
alleviate withdrawal symptoms induced by naloxone. Prescribing take-home
naloxone to ID Us with training in its use and in resuscitation techniques
may represent a life-saving, peer-based adjunct to accessing emergency
services. Nevertheless, strategies for overcoming potential risks associated
with the use of take-home naloxone would need to be emphasized in an
overdose management training program.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug misuse
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
human
injection
intravenous drug abuse
mortality
patient attitude
priority journal
resuscitation
review
United States
withdrawal syndrome
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003494603
MEDLINE PMID
12791805 (http://www.ncbi.nlm.nih.gov/pubmed/12791805)
PUI
L37486665
DOI
10.1093/jurban/jtg032
FULL TEXT LINK
http://dx.doi.org/10.1093/jurban/jtg032
COPYRIGHT
Copyright 2010 Elsevier B.V., All rights reserved.
RECORD 1148
TITLE
Pain management in children with sickle cell disease
AUTHOR NAMES
Stinson J.
Naser B.
AUTHOR ADDRESSES
(Stinson J., jennifer.stinson@sickkids.ca; Naser B.) Department of
Anaesthesia, Hospital for Sick Children, Toronto, Ont., Canada.
(Stinson J., jennifer.stinson@sickkids.ca) Department of Anaesthesia,
Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8,
Canada.
CORRESPONDENCE ADDRESS
J. Stinson, Department of Anaesthesia, Hospital for Sick Children, 555
University Avenue, Toronto, Ont. M5G 1X8, Canada. Email:
jennifer.stinson@sickkids.ca
SOURCE
Pediatric Drugs (2003) 5:4 (229-241). Date of Publication: 2003
ISSN
1174-5878
BOOK PUBLISHER
Adis International Ltd, 41 Centorian Drive, Private Bag 65901, Mairangi Bay,
Auckland 10, New Zealand.
ABSTRACT
Sickle cell disease (SCD) is one of the most common inherited diseases
worldwide. The disease is characterized by chronic hemolytic anemia, as well
as acute and chronic complications. One of the most intractable problems
encountered by children with SCD is the painful episode that results from
tissue ischemia due to vaso-occlusion. Pain related to SCD is unique among
pain syndromes due to the unpredictable, recurrent, and often persistent
nature of the disease, as well as the recurring and essential need for the
use of opioids. Painful vaso-occlusive episodes (VOE) are a principal cause
of morbidity and account for a significant number of emergency department
and hospital admissions. When untreated or inadequately managed, the pain of
VOE may cause both short- and long-term consequences. Despite the fact that
pain is an almost universal feature of the disease, children with SCD may
form one of the most undertreated and understudied populations. One of the
factors contributing to poor pain management is conflicting perceptions
between patients, their families, and healthcare professionals about pain
that is reported and analgesia that is required. Pain management guidelines
have recently been published in an effort to overcome barriers in the
assessment and management of pain related to SCD. Although there is
considerable variability in the way SCD pain is managed, the standard
treatment protocol for painful episodes has been rest, rehydration, and
analgesia. However, pain control for children with SCD is often a difficult
and complex process, and one that requires frequent systematic pain
assessments and continuous adjustment of comfort measures, especially
analgesics. There are a variety of analgesic agents to choose from, such as
acetaminophen (paracetamol), oral or parenteral nonsteroidal
anti-inflammatory drugs, and oral or parenteral opioids. Each of these
options has advantages and disadvantages to their use. Continuous infusions
of analgesics and patient controlled analgesia have been shown to be
effective and widely used in hospital settings to manage severe pain.
However, the opioid dose required to achieve pain relief varies considerably
within each painful episode, from one episode to another, and between
individual patients. Although not yet curable in humans, pain related to SCD
can be effectively managed in most patients by using a comprehensive
approach that incorporates pharmacologic, psychologic, behavioral, and
physical pain management strategies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, drug combination, drug dose, drug
therapy, intravenous drug administration, oral drug administration,
parenteral drug administration, pharmaceutics, pharmacology, rectal drug
administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, drug therapy, pharmacology)
antiemetic agent (drug therapy)
antipruritic agent (drug therapy)
cocodamol (adverse drug reaction, drug therapy, oral drug administration,
pharmacology)
codeine (adverse drug reaction, drug combination, drug therapy, oral drug
administration, pharmacology)
corticosteroid (drug therapy)
cyclooxygenase 2 inhibitor (adverse drug reaction, drug therapy,
pharmacology)
diclofenac (adverse drug reaction, drug therapy, rectal drug administration)
diphenhydramine (drug therapy)
fentanyl (adverse drug reaction, drug therapy, pharmacology)
hydrocodone (adverse drug reaction, drug therapy, pharmacology)
hydromorphone (adverse drug reaction, drug dose, drug therapy, intravenous
drug administration, pharmacology)
ibuprofen (drug dose, drug therapy)
ketorolac (adverse drug reaction, drug dose, drug therapy, intravenous drug
administration, oral drug administration, parenteral drug administration)
laxative (drug dose, drug therapy)
methadone (adverse drug reaction, drug therapy, pharmacology)
morphine (adverse drug reaction, drug combination, drug dose, drug therapy,
intravenous drug administration, oral drug administration, pharmaceutics,
pharmacology)
nalbuphine (adverse drug reaction, drug therapy, pharmacology)
naloxone (drug therapy)
naproxen (adverse drug reaction, drug therapy, rectal drug administration)
nonsteroid antiinflammatory agent (adverse drug reaction, drug combination,
drug dose, drug therapy, oral drug administration, parenteral drug
administration, pharmacology, rectal drug administration)
opiate agonist (adverse drug reaction, drug combination, drug dose, drug
therapy, intravenous drug administration, oral drug administration,
parenteral drug administration, pharmaceutics, pharmacology)
opiate antagonist (adverse drug reaction, drug therapy, pharmacology)
oxycodone (adverse drug reaction, drug therapy, pharmacology)
paracetamol (adverse drug reaction, drug combination, drug dose, drug
therapy, pharmacology)
pethidine (adverse drug reaction, drug therapy, intravenous drug
administration)
prostaglandin inhibitor (adverse drug reaction, drug therapy, pharmacology)
prostaglandin synthase inhibitor (adverse drug reaction, drug therapy,
pharmacology)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (complication, drug therapy, epidemiology, etiology, therapy)
sickle cell anemia (etiology)
EMTREE MEDICAL INDEX TERMS
addiction (side effect)
analgesia
artery occlusion (complication)
child
childhood disease
clinical feature
constipation (drug therapy, side effect)
disease course
dose response
drug dependence (side effect)
drug efficacy
drug hypersensitivity (side effect)
drug infusion
hemolytic anemia (complication)
hospital admission
human
ischemia
morbidity
nausea (side effect)
nephrotoxicity (side effect)
neurotoxicity (side effect)
pain assessment
patient controlled analgesia
practice guideline
priority journal
pruritus (drug therapy, side effect)
rehydration
respiration depression (side effect)
rest
review
Reye syndrome (side effect)
seizure, epilepsy and convulsion (drug therapy, side effect)
side effect (side effect)
sustained release preparation
treatment outcome
vomiting (drug therapy, side effect)
withdrawal syndrome (drug therapy, side effect)
DRUG TRADE NAMES
aspirin
naprosyn
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
codeine (76-57-3)
diclofenac (15307-79-6, 15307-86-5)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1)
ketorolac (74103-06-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
oxycodone (124-90-3, 76-42-6)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Hematology (25)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003167408
MEDLINE PMID
12662119 (http://www.ncbi.nlm.nih.gov/pubmed/12662119)
PUI
L36469931
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1149
TITLE
Heroin addicts to receive CPR training and Narcan.
AUTHOR NAMES
Lindstrom A.M.
AUTHOR ADDRESSES
(Lindstrom A.M.)
CORRESPONDENCE ADDRESS
A.M. Lindstrom,
SOURCE
JEMS : a journal of emergency medical services (2003) 28:5 (142-144). Date
of Publication: May 2003
ISSN
0197-2510
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug therapy)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
community care
emergency health service
heroin dependence (drug therapy)
intoxication (drug therapy)
resuscitation
EMTREE MEDICAL INDEX TERMS
article
education
health care quality
human
mortality
organization and management
United States (epidemiology)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
12774790 (http://www.ncbi.nlm.nih.gov/pubmed/12774790)
PUI
L36696863
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1150
TITLE
Pediatric emergencies in hemato-oncology
ORIGINAL (NON-ENGLISH) TITLE
Les urgences en hémato-oncologie pédiatrique
AUTHOR NAMES
Aerts I.
Brisse H.
Orbach D.
AUTHOR ADDRESSES
(Aerts I.; Orbach D., daniel.orbach@curie.net) Departement de Pediatrie,
Institut Curie, Paris, France.
(Brisse H.) Département d'Imagerie, Institut Curie, Paris, France.
CORRESPONDENCE ADDRESS
D. Orbach, Departement de Pediatrie, Institut Curie, Paris, France. Email:
daniel.orbach@curie.net
SOURCE
Medecine Therapeutique Pediatrie (2003) 6:3 (117-128). Date of Publication:
May 2003
ISSN
1286-5494
EMTREE DRUG INDEX TERMS
carbamazepine
cyclophosphamide (adverse drug reaction, drug therapy)
cytarabine (adverse drug reaction, drug therapy)
dexamethasone (intravenous drug administration)
diazepam (intravenous drug administration)
enalapril maleate (drug therapy)
furosemide (drug therapy, intravenous drug administration)
ifosfamide (adverse drug reaction, drug therapy)
indometacin
lidocaine
lidocaine plus prilocaine
methotrexate
morphine
naloxone
nifedipine (drug therapy)
pamidronic acid
paracetamol
phenobarbital (intravenous drug administration)
phenytoin (drug therapy, intravenous drug administration)
prednisone
rasburicase (drug therapy, intravenous drug administration)
uricozyme (drug therapy)
vinblastine sulfate
vincristine (adverse drug reaction, drug therapy)
vincristine sulfate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood cancer
hematologic malignancy (drug therapy)
EMTREE MEDICAL INDEX TERMS
child
disseminated intravascular clotting (complication)
human
hydration
hyperkalemia (complication, drug therapy, prevention, therapy)
hyperphosphatemia (complication, drug therapy, prevention, therapy)
hypertension (complication, drug therapy)
hyperuricemia (complication, drug therapy, prevention, therapy)
inappropriate vasopressin secretion (complication, side effect)
review
thrombosis (complication)
DRUG TRADE NAMES
adalate
aracytine
aredia
dihydan
dilantin
EMLA
endoxan
fasturtec
gardenal
holoxan
indocid
lasix
narcan
oncovin
renitec
tegretol
uricozyme
valium
velbe
xylocaine
CAS REGISTRY NUMBERS
carbamazepine (298-46-4, 8047-84-5)
cyclophosphamide (50-18-0)
cytarabine (147-94-4, 69-74-9)
dexamethasone (50-02-2)
diazepam (439-14-5)
EMLA (101362-25-8)
enalapril maleate (76095-16-4)
furosemide (54-31-9)
ifosfamide (3778-73-2)
indometacin (53-86-1, 74252-25-8, 7681-54-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methotrexate (15475-56-6, 59-05-2, 7413-34-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
pamidronic acid (40391-99-9, 57248-88-1)
paracetamol (103-90-2)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
prednisone (53-03-2)
rasburicase (352311-12-7)
vinblastine sulfate (143-67-9)
vincristine sulfate (2068-78-2)
vincristine (57-22-7)
EMBASE CLASSIFICATIONS
Cancer (16)
Hematology (25)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2003465473
PUI
L37410458
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1151
TITLE
Nitrous oxide in emergency medicine
AUTHOR NAMES
O'Sullivan Í.
Benger J.
AUTHOR ADDRESSES
(O'Sullivan Í., Iomhar.O'Sullivan@ubht.swest.nhs.uk) Bristol Emergency
Department, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW,
United Kingdom.
(Benger J.) Emergency Department, Bristol Royal Infirmary, Marlborough
Street, Bristol BS2 8HW, United Kingdom.
CORRESPONDENCE ADDRESS
Í. O'Sullivan, Bristol Emergency Department, Bristol Royal Infirmary,
Marlborough Street, Bristol BS2 8HW, United Kingdom. Email:
Iomhar.O'Sullivan@ubht.swest.nhs.uk
SOURCE
Emergency Medicine Journal (2003) 20:3 (214-217). Date of Publication: May
2003
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Safe and predictable analgesia is required for the potentially painful or
uncomfortable procedures often undertaken in an emergency department. The
characteristics of an ideal analgesic agent are safety, predictability,
non-invasive delivery, freedom from side effects, simplicity of use, and a
rapid onset and offset. Newer approaches have threatened the widespread use
of nitrous oxide, but despite its long history this simple gas still has
much to offer.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nitrous oxide (adverse drug reaction, clinical trial, drug combination, drug
comparison, drug interaction, drug therapy, drug toxicity, inhalational drug
administration, pharmacology)
EMTREE DRUG INDEX TERMS
analgesic agent (adverse drug reaction, clinical trial, drug combination,
drug comparison, drug interaction, drug therapy, drug toxicity, inhalational
drug administration, pharmacology)
cyanocobalamin (endogenous compound)
lidocaine (drug combination, drug therapy)
midazolam (adverse drug reaction, drug combination, drug comparison, drug
therapy, oral drug administration)
morphine (drug comparison, intramuscular drug administration)
naloxone (drug interaction)
nitrous oxide plus oxygen (adverse drug reaction, drug therapy, inhalational
drug administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency medicine
EMTREE MEDICAL INDEX TERMS
analgesic activity
anemia (side effect)
anesthesia level
anesthesia mechanism
anesthetic equipment
apnea (side effect)
bone marrow disease (side effect)
cardiovascular disease (side effect)
cardiovascular effect
central nervous system depression
clinical trial
cyanocobalamin deficiency (side effect)
disease exacerbation (side effect)
drug contraindication
drug delivery system
drug efficacy
drug indication
drug inhibition
drug safety
drug use
emergency ward
evidence based medicine
gastrointestinal symptom (side effect)
human
hypoxia (side effect)
infertility
kidney colic (drug therapy)
long term exposure
lung vascular resistance
megaloblastic anemia (side effect)
meta analysis
migraine (drug therapy)
myeloneuropathy (side effect)
nausea and vomiting (side effect)
neurologic disease (side effect)
neuropathy (side effect)
nonhuman
pain (drug therapy)
pernicious anemia (side effect)
physical chemistry
postoperative vomiting (side effect)
prediction
pregnancy
priority journal
respiratory tract disease (side effect)
resuscitation
review
side effect (side effect)
spontaneous abortion
stereospecificity
teratogenicity
thorax pain (drug therapy)
DRUG TRADE NAMES
entonox
CAS REGISTRY NUMBERS
cyanocobalamin (53570-76-6, 68-19-9, 8064-09-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
nitrous oxide plus oxygen (54510-89-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Public Health, Social Medicine and Epidemiology (17)
Toxicology (52)
Clinical and Experimental Pharmacology (30)
Adverse Reactions Titles (38)
Anesthesiology (24)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003212654
MEDLINE PMID
12748131 (http://www.ncbi.nlm.nih.gov/pubmed/12748131)
PUI
L36617310
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1152
TITLE
Incidence and Preventability of Adverse Drug Events among Older Persons in
the Ambulatory Setting
AUTHOR NAMES
Gurwitz J.H.
Field T.S.
Harrold L.R.
Rothschild J.
Debellis K.
Seger A.C.
Cadoret C.
Fish L.S.
Garber L.
Kelleher M.
Bates D.W.
AUTHOR ADDRESSES
(Gurwitz J.H., jgurwitz@meyersprimary.org) Meyers Primary Care Institute,
630 Plantation St, Worcester, MA 01605, United States.
(Gurwitz J.H., jgurwitz@meyersprimary.org; Field T.S.; Harrold L.R.;
Debellis K.; Seger A.C.; Cadoret C.; Fish L.S.; Garber L.; Kelleher M.)
Meyers Primary Care Institute, Univ. of Massachusetts Med. School,
Worcester, MA, United States.
(Rothschild J.; Bates D.W.) Brigham and Women's Hospital, Partners
Health-Care System, Boston, MA, United States.
CORRESPONDENCE ADDRESS
J.H. Gurwitz, Meyers Primary Care Institute, 630 Plantation St, Worcester,
MA 01605, United States. Email: jgurwitz@meyersprimary.org
SOURCE
Journal of the American Medical Association (2003) 289:9 (1107-1116). Date
of Publication: 5 Mar 2003
ISSN
0098-7484
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Context: Adverse drug events, especially those that may be preventable, are
among the most serious concerns about medication use in older persons cared
for in the ambulatory clinical setting. Objective: To assess the incidence
and preventability of adverse drug events among older persons in the
ambulatory clinical setting. Design, Setting, and Patients: Cohort study of
all Medicare enrollees (30 397 person-years of observation) cared for by a
multispecialty group practice during a 12-month study period (July 1, 1999,
through June 30, 2000), in which possible drug-related incidents occurring
in the ambulatory clinical setting were detected using multiple methods,
including reports from health care providers; review of hospital discharge
summaries; review of emergency department notes; computer-generated signals;
automated free-text review of electronic clinic notes; and review of
administrative incident reports concerning medication errors. Main Outcome
Measures: Number of adverse drug events, severity of the events (classified
as significant, serious, life-threatening, or fatal), and whether the events
were preventable. Results: There were 1523 identified adverse drug events,
of which 27.6% (421) were considered preventable. The overall rate of
adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8
preventable adverse drug events per 1000 person-years. Of the adverse drug
events, 578 (38.0%) were categorized as serious, life-threatening, or fatal;
244 (42.2%) of these more severe events were deemed preventable compared
with 177 (18.7%) of the 945 significant adverse drug events. Errors
associated with preventable adverse drug events occurred most often at the
stages of prescribing (n =246, 58.4%) and monitoring (n =256, 60.8%), and
errors involving patient adherence (n =89, 21.1%) also were common.
Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid
analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were
the most common medication categories associated with preventable adverse
drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%),
hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric
(8.6%) events were the most common types of preventable adverse drug events.
Conclusions: Adverse drug events are common and often preventable among
older persons in the ambulatory clinical setting. More serious adverse drug
events are more likely to be preventable. Prevention strategies should
target the prescribing and monitoring stages of pharmaceutical care.
Interventions focused on improving patient adherence with prescribed
regimens and monitoring of prescribed medications also may be beneficial.
EMTREE DRUG INDEX TERMS
analgesic agent (adverse drug reaction)
anticoagulant agent (adverse drug reaction)
anticonvulsive agent (adverse drug reaction)
antidiabetic agent (adverse drug reaction)
antiparkinson agent (adverse drug reaction)
antipyretic analgesic agent (adverse drug reaction)
carbamazepine (adverse drug reaction)
cardiovascular agent (adverse drug reaction)
central depressant agent (adverse drug reaction)
cyclosporine (adverse drug reaction)
digoxin (adverse drug reaction)
diphenhydramine
diuretic agent (adverse drug reaction)
gastrointestinal agent (adverse drug reaction)
hormone (adverse drug reaction)
hypnotic sedative agent (adverse drug reaction)
naloxone
phenobarbital (adverse drug reaction)
phenytoin (adverse drug reaction)
phytomenadione
polystyrene
prednisone
procainamide (adverse drug reaction)
protamine sulfate
psychotropic agent (adverse drug reaction)
quinidine (adverse drug reaction)
theophylline (adverse drug reaction)
topical agent (adverse drug reaction)
unindexed drug
valproic acid (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory care
drug induced disease (epidemiology, prevention, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (epidemiology, prevention, side effect)
aged
allergy (epidemiology, prevention, side effect)
anaphylaxis (epidemiology, prevention, side effect)
anorexia (epidemiology, prevention, side effect)
article
ataxia (epidemiology, prevention, side effect)
bleeding (epidemiology, prevention, side effect)
body weight loss
brain hemorrhage (epidemiology, prevention, side effect)
cardiovascular disease (epidemiology, prevention, side effect)
cerebrovascular accident (epidemiology, prevention, side effect)
constipation (epidemiology, prevention, side effect)
dermatitis (epidemiology, prevention, side effect)
diarrhea (epidemiology, prevention, side effect)
disease severity
drug blood level
drug fatality (epidemiology, prevention, side effect)
drug monitoring
drug toxicity
edema (epidemiology, prevention, side effect)
electrolyte disturbance (epidemiology, prevention, side effect)
endocrine disease (epidemiology, prevention, side effect)
extrapyramidal symptom (epidemiology, prevention, side effect)
faintness (epidemiology, prevention, side effect)
falling
fatality
female
gait disorder (epidemiology, prevention, side effect)
gastritis (epidemiology, prevention, side effect)
gastrointestinal disease (epidemiology, prevention, side effect)
human
hypoglycemia (epidemiology, prevention, side effect)
iatrogenic disease
incidence
incontinence (epidemiology, prevention, side effect)
infection (epidemiology, prevention, side effect)
intraocular hemorrhage (epidemiology, prevention, side effect)
kidney disease (epidemiology, prevention, side effect)
liver disease (epidemiology, prevention, side effect)
lung injury (epidemiology, prevention, side effect)
major clinical study
male
metabolic disorder (epidemiology, prevention, side effect)
musculoskeletal disease (epidemiology, prevention, side effect)
nausea (epidemiology, prevention, side effect)
neuropathy (epidemiology, prevention, side effect)
neutropenia (epidemiology, prevention, side effect)
patient compliance
peptic ulcer (epidemiology, prevention, side effect)
pharmaceutical care
prescription
priority journal
prophylaxis
psychopathy (epidemiology, prevention, side effect)
respiratory tract disease (epidemiology, prevention, side effect)
skin allergy (epidemiology, prevention, side effect)
skin disease (epidemiology, prevention, side effect)
tardive dyskinesia (epidemiology, prevention, side effect)
urticaria (epidemiology, prevention, side effect)
vertigo (epidemiology, prevention, side effect)
vomiting (epidemiology, prevention, side effect)
CAS REGISTRY NUMBERS
carbamazepine (298-46-4, 8047-84-5)
cyclosporin (79217-60-0)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
phytomenadione (11104-38-4, 84-80-0)
polystyrene (9003-53-6)
prednisone (53-03-2)
procainamide (51-06-9, 614-39-1)
protamine sulfate (9009-65-8)
quinidine (56-54-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003473561
MEDLINE PMID
12622580 (http://www.ncbi.nlm.nih.gov/pubmed/12622580)
PUI
L37430324
DOI
10.1001/jama.289.9.1107
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.289.9.1107
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1153
TITLE
Anesthesia-assisted opiate detoxification
AUTHOR NAMES
Gevirtz C.
AUTHOR ADDRESSES
(Gevirtz C.) 627 West Street, Harrison, NY 10528, United States.
CORRESPONDENCE ADDRESS
C. Gevirtz, 627 West Street, Harrison, NY 10528, United States.
SOURCE
International Anesthesiology Clinics (2003) 41:2 (79-93). Date of
Publication: Spring 2003
ISSN
0020-5907
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction)
EMTREE DRUG INDEX TERMS
cyclooxygenase 2 inhibitor (drug therapy)
diamorphine (adverse drug reaction)
famotidine (drug therapy)
methadone (adverse drug reaction)
mu opiate receptor antagonist (adverse drug reaction)
nonsteroid antiinflammatory agent (drug therapy)
octreotide (drug therapy)
ondansetron (drug therapy)
opiate agonist (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
EMTREE MEDICAL INDEX TERMS
abdominal cramp (drug therapy, side effect)
backache (drug therapy, side effect)
diaphoresis
diarrhea (drug therapy, side effect)
drug dependence (side effect)
drug detoxification
emergency treatment
health program
health visitor
hospital
human
hypertension (side effect)
myalgia (drug therapy, side effect)
nausea (drug therapy, side effect)
priority journal
review
tachycardia (side effect)
vomiting (drug therapy, side effect)
withdrawal syndrome (side effect)
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
famotidine (76824-35-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
octreotide (83150-76-9)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2003164446
MEDLINE PMID
12711916 (http://www.ncbi.nlm.nih.gov/pubmed/12711916)
PUI
L36459061
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1154
TITLE
Poisoned child: Emergency room management
AUTHOR NAMES
Gupta S.
Taneja V.
AUTHOR ADDRESSES
(Gupta S., drguptasuresh@yahoo.co.in) Pediatric Emergency Medicine, Sir
Ganga Ram Hospital, Rajinder Nagar, New Delhi-110060, India.
(Taneja V.) Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi,
India.
CORRESPONDENCE ADDRESS
S. Gupta, Pediatric Emergency Medicine, Sir Ganga Ram Hospital, Rajinder
Nagar, New Delhi-110060, India. Email: drguptasuresh@yahoo.co.in
SOURCE
Indian Journal of Pediatrics (2003) 70:SUPPL. 1 (S2-S8). Date of
Publication: 1 Mar 2003
ISSN
0019-5456
BOOK PUBLISHER
Springer India, Barakhamba Road 110001, New Delhi, India.
ABSTRACT
Poisoning is one of the commonest pediatric emergencies. Most of poisonings
in children below 5 years of age, are accidental and fortunately trivial,
related to their exploratory nature. However a poisoned child may present as
an acute emergency with or without multisystem involvement. The initial
phase of management focuses on support of airways, breathing and cardiac
function (ABCD of Resuscitation). The second phase includes Evaluation and
Detoxification phase. The Evaluation phase involves identification and
severity of toxic exposure. Recognizing a Toxidrome (constellation of the
signs and symptoms seen with the ingestion of a particular poison) is
particularly very helpful when the child presents with an unknown poisoning.
Detoxification should proceed simultaneously. The current literature
suggests that activated charcoal is the mainstay of GI decontamination.
Whole bowel Irrigation is a new addition to the armamentarium of GI
decontamination. At present antidotes are available for few toxins only so
the management remains supportive for most poisons.
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy, intravenous drug administration)
acetylcysteine (drug therapy, oral drug administration)
activated carbon (drug therapy)
alcohol derivative (drug therapy, intravenous drug administration, oral drug
administration)
antidote (drug therapy)
arsenic (drug therapy, intramuscular drug administration, oral drug
administration)
atropine (drug therapy, intravenous drug administration)
bicarbonate (drug therapy, intravenous drug administration)
calcium chloride (drug therapy, intravenous drug administration)
deferoxamine (drug therapy, intravenous drug administration)
digoxin (drug therapy, intravenous drug administration)
dimercaprol (drug therapy, intramuscular drug administration, oral drug
administration)
edetate calcium disodium (intravenous drug administration)
flumazenil (drug therapy, intravenous drug administration)
fresh frozen plasma (drug therapy)
glucagon (drug therapy, intravenous drug administration)
methanol (drug therapy, intravenous drug administration, oral drug
administration)
methylene blue (drug therapy, intravenous drug administration)
naloxone (intravenous drug administration)
physostigmine salicylate (drug therapy, intravenous drug administration)
phytomenadione (drug therapy)
pralidoxime (drug therapy, intravenous drug administration)
pyridoxine (drug therapy, intravenous drug administration)
sodium nitrite (drug therapy, intravenous drug administration)
sodium thiosulfate (drug therapy, intravenous drug administration)
succimer (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
intoxication (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
airway
breathing
child
detoxification
disease severity
evaluation study
heart function
human
intestine
medical literature
resuscitation
review
support group
symptom
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
arsenic (7440-38-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
deferoxamine (70-51-9)
digoxin (20830-75-5, 57285-89-9)
dimercaprol (59-52-9)
edetate calcium disodium (62-33-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
methanol (67-56-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
physostigmine salicylate (57-64-7, 71214-04-5)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003193070
MEDLINE PMID
12785275 (http://www.ncbi.nlm.nih.gov/pubmed/12785275)
PUI
L36560305
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1155
TITLE
Pediatric advanced life support (PALS): The current guidelines
AUTHOR NAMES
Janakiraman L.
AUTHOR ADDRESSES
(Janakiraman L., jlalitha54@hotmail.com) Kanchi Kamakoti Childs Trust Hosp.,
Chennai, India.
(Janakiraman L., jlalitha54@hotmail.com) Kanchi Kamakoti Childs Trust Hosp.,
12-A, Nageswara Road, Nungambakkam, Chennai-600034, India.
CORRESPONDENCE ADDRESS
L. Janakiraman, Kanchi Kamakoti Childs Trust Hosp., 12-A, Nageswara Road,
Nungambakkam, Chennai-600034, India. Email: jlalitha54@hotmail.com
SOURCE
Indian Journal of Pediatrics (2003) 70:SUPPL. 1 (S34-S38). Date of
Publication: 1 Mar 2003
ISSN
0019-5456
BOOK PUBLISHER
Springer India, Barakhamba Road 110001, New Delhi, India.
ABSTRACT
Every 5 years the American Heart Association (AHA) updates the Guidelines
for CPR and Emergency Cardiovascular Care (ECC). The ECC Guidelines 2000
incorporates all the current consensus of experts, from not only a variety
of disciplines, but also a variety of countries and cultures and is evidence
based. The new Guidelines emphasize interventions to reduce the risk of
sudden deaths, early identification of respiratory failure and shock and
implementation of Advanced Life Support (ALS) to treat respiratory and
cardiac arrest.
EMTREE DRUG INDEX TERMS
adenosine (drug therapy, intravenous drug administration)
amiodarone (drug therapy, intraosseous drug administration, intravenous drug
administration)
atropine (drug therapy, intraosseous drug administration, intratracheal drug
administration, intravenous drug administration)
epinephrine (drug therapy, intraosseous drug administration, intratracheal
drug administration, intravenous drug administration)
lidocaine (drug therapy, intraosseous drug administration, intratracheal
drug administration, intravenous drug administration)
magnesium sulfate (drug therapy, intraosseous drug administration,
intravenous drug administration)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
long term care
pediatrics
respiratory failure (disease management, drug therapy)
shock (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
cardiovascular system
cell culture
disciplines relating to biomedicine
emergency treatment
evidence based medicine
functional assessment
heart arrest
human
medical society
practice guideline
resuscitation
review
risk factor
sudden death
tachycardia (drug therapy)
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003193075
MEDLINE PMID
12785280 (http://www.ncbi.nlm.nih.gov/pubmed/12785280)
PUI
L36560310
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1156
TITLE
Strategies for preventing heroin overdose
AUTHOR NAMES
Sporer K.A.
AUTHOR ADDRESSES
(Sporer K.A., ksporer@itsa.ucsf.edu) Department of Medicine, University of
California, San Francisco, CA 94143, United States.
(Sporer K.A., ksporer@itsa.ucsf.edu) Emergency Services, San Francisco
General Hospital, San Francisco, CA 94110, United States.
CORRESPONDENCE ADDRESS
K.A. Sporer, Emergency Services, San Francisco General Hospital, San
Francisco, CA 94110, United States. Email: ksporer@itsa.ucsf.edu
SOURCE
British Medical Journal (2003) 326:7386 (442-444). Date of Publication: 22
Feb 2003
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Making naloxone available in addicts' homes is one of several official or
unofficial ways that are being tried out to reduce the rising toll of
fatalities from heroin overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity, intravenous drug administration)
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine
buprenorphine (drug therapy)
cocaine
methadone (clinical trial, drug therapy, pharmacology)
methamphetamine
naloxone (adverse drug reaction, drug dose, drug therapy, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, pharmacokinetics, pharmacology, subconjunctival drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, epidemiology, etiology, prevention, therapy)
heroin dependence (diagnosis, epidemiology)
EMTREE MEDICAL INDEX TERMS
agitation
Australia
clinical feature
clinical trial
controlled clinical trial
controlled study
disease transmission
drug efficacy
drug safety
drug tolerance
education
emergency health service
Germany
heart arrest (side effect)
heart arrhythmia (side effect)
home
human
interview
lung edema (side effect)
meta analysis
morbidity
mortality
prescription
priority journal
randomized controlled trial
respiration depression (side effect)
resuscitation
sedation
seizure (side effect)
short survey
side effect (side effect)
support group
treatment indication
United Kingdom
violence
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003089795
MEDLINE PMID
12595388 (http://www.ncbi.nlm.nih.gov/pubmed/12595388)
PUI
L36246323
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1157
TITLE
Pediatric "body packing"
AUTHOR NAMES
Traub S.J.
Kohn G.L.
Hoffman R.S.
Nelson L.S.
AUTHOR ADDRESSES
(Traub S.J., straub@caregroup.harvard.edu; Hoffman R.S.; Nelson L.S.)
Department of Emergency Medicine, New York University, Bellevue Hospital and
Medical Center, New York, NY, United States.
(Traub S.J., straub@caregroup.harvard.edu; Hoffman R.S.; Nelson L.S.) New
York City Poison Control Center, New York, NY, United States.
(Kohn G.L.) Department of Pediatrics, Schneider Children's Hospital, Long
Island Jewish Medical Center, New Hyde Park, NY, United States.
(Traub S.J., straub@caregroup.harvard.edu) Division of Toxicology,
Department of Emergency Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States.
(Kohn G.L.) Division of Pediatric Critical Care, Morristown Memorial
Hospital, Morristown, NJ, United States.
(Traub S.J., straub@caregroup.harvard.edu) Department of Emergency Medicine,
Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215,
United States.
CORRESPONDENCE ADDRESS
S.J. Traub, Department of Emergency Medicine, Beth Israel Deaconess Medical
Center, One Deaconess Road, Boston, MA 02215, United States. Email:
straub@caregroup.harvard.edu
SOURCE
Archives of Pediatrics and Adolescent Medicine (2003) 157:2 (174-177). Date
of Publication: 1 Feb 2003
ISSN
1072-4710
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Background: Recent events in the United States have led to increased
security at national borders, resulting in an unexpected increase in drug
seizures. In response, drug smugglers may begin using children as couriers,
including using them as "body packers." Objective: To look at the occurrence
of body packing, the concealing of contraband within the human body, which
is well documented in adults, in the pediatric literature. Patient Reports:
Two cases of pediatric body packing, in boys aged 16 years and 12 years.
Patient 1, a 16-year-old boy, presented with findings consistent with opioid
intoxication after arriving in the United States on a transcontinental
flight. His mental status improved after he received naloxone hydrochloride,
and he subsequently confessed to body packing heroin. He was treated with a
naloxone infusion and aggressive gastrointestinal decontamination. He
ultimately passed 53 packets of heroin, one of which had ruptured. He
recovered uneventfully. Patient 2, a 12-year-old boy, presented to the
emergency department with rectal bleeding. He had recently arrived in the
United States from Europe, and he confessed to body packing heroin. He was
treated with whole-bowel irrigation and activated charcoal, and he
subsequently passed 84 packets. He also recovered uneventfully. Conclusions:
We report the first 2 cases of body packing in the pediatric literature and
review the diagnosis and management of this clinical entity. Pediatricians
should be aware that body packing, regrettably, is not confined to the adult
population.
EMTREE DRUG INDEX TERMS
diamorphine
naloxone (intravenous drug administration, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
adolescent
aggression
article
case report
drug infusion
emergency ward
gastrointestinal tract
human
male
medical literature
mental health
pediatrician
priority journal
rectum hemorrhage
rupture
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003123731
MEDLINE PMID
12580688 (http://www.ncbi.nlm.nih.gov/pubmed/12580688)
PUI
L36343402
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1158
TITLE
Unraveling the mysteries of mechanical ventilation: A helpful step-by-step
guide
AUTHOR NAMES
Spritzer C.J.
AUTHOR ADDRESSES
(Spritzer C.J., Spritzer@erols.com) Medical/Interventional Cardiology,
Washington Adventist Hospital, Takoma Park, Washington, MD, United States.
CORRESPONDENCE ADDRESS
C.J. Spritzer, 1300 Arbor View Rd., Silver Spring, MD 20902, United States.
Email: Spritzer@erols.com
SOURCE
Journal of Emergency Nursing (2003) 29:1 (29-36). Date of Publication:
February 2003
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
ABSTRACT
Knowing why a particular ventilator mode has been chosen for a patient, the
advantages and disadvantages of that mode, and monitoring parameters,
alarms, and troubleshooting strategies for each alarm will increase the ED
nurse's comfort level with mechanical ventilation.
EMTREE DRUG INDEX TERMS
bicarbonate
fentanyl citrate (intravenous drug administration)
flumazenil
midazolam (intravenous drug administration)
naloxone
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
artificial ventilation (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
acute respiratory failure (therapy)
adolescent
adult
aged
alarm monitoring
apnea
arterial gas
article
awareness
barotrauma
blood gas analysis
breathing rate
case report
communicable disease
consciousness disorder
controlled study
devices
devices
education
emergency ward
endotracheal intubation
female
fever
heart output
heart stroke volume
hospital service
human
hyperventilation
hypoventilation
hypoxemia
inspiratory capacity
intensive care unit
intermittent mandatory ventilation
lung perfusion
male
medical parameters
metabolism
methodology
monitoring
near drowning
nurse
nursing
oxygen concentration
patient monitoring
pneumonia
positive end expiratory pressure
respiratory distress syndrome (therapy)
respiratory failure (diagnosis, etiology, therapy)
thorax pressure
tidal volume
ventilator
DRUG TRADE NAMES
narcan
romazicon
sublimaze
versed
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
12556826 (http://www.ncbi.nlm.nih.gov/pubmed/12556826)
PUI
L36231079
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1159
TITLE
GHB poisoning: Three recent cases reflect the continuing danger
AUTHOR NAMES
Muller A.A.
AUTHOR ADDRESSES
(Muller A.A., mullera@email.chop.edu) The Poison Control Center, The
Children's Hosp. of Philadelphia, 34th and Civic Center Blvd., Philadelphia,
PA 19104, United States.
CORRESPONDENCE ADDRESS
A.A. Muller, The Children's Hosp. of Philadelphia, The Poison Control
Center, 34th and Civic Center Blvd., Philadelphia, PA 19104, United States.
Email: mullera@email.chop.edu
SOURCE
Journal of Emergency Nursing (2003) 29:1 (72-74). Date of Publication:
February 2003
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 hydroxybutyric acid (drug toxicity)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid derivative (drug toxicity)
4 hydroxybutyric acid
activated carbon (drug therapy)
alcohol
anesthetic agent (drug toxicity)
antidote (adverse drug reaction, drug therapy)
benzodiazepine
cannabis
cocaine
flumazenil (drug therapy)
gamma butyrolactone
hydroxybutyric acid (drug toxicity)
lorazepam (drug therapy)
methamphetamine
midomafetamine (drug toxicity)
naloxone (drug therapy)
oxybate sodium
oxygen (drug therapy)
paracetamol
physostigmine (adverse drug reaction, drug therapy)
salicylic acid derivative
street drug (drug toxicity)
vecuronium (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
addiction (complication, diagnosis, epidemiology, therapy)
adolescent
adult
apnea
article
artificial ventilation
bradycardia (side effect)
breathing disorder
burn
case report
central nervous system depression
coma
controlled study
diaphoresis
drug abuse
drug screening
emergency treatment
emergency ward
endotracheal intubation
female
heart arrest (side effect)
hospital
human
hypothermia
intensive care unit
lethargy
male
methodology
nausea
nursing
poison center
seizure (side effect)
stomach lavage
symptomatology
United States (epidemiology)
vomiting
DRUG TRADE NAMES
xyrem
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 hydroxybutyric acid (591-81-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
benzodiazepine (12794-10-4)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
flumazenil (78755-81-4)
gamma butyrolactone (96-48-0)
hydroxybutyric acid (1320-61-2, 35054-79-6)
lorazepam (846-49-1)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
oxybate sodium (502-85-2)
oxygen (7782-44-7)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
vecuronium (50700-72-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
12556839 (http://www.ncbi.nlm.nih.gov/pubmed/12556839)
PUI
L36231089
DOI
10.1067/men.2003.11
FULL TEXT LINK
http://dx.doi.org/10.1067/men.2003.11
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1160
TITLE
Hypotension and bradycardia in infants after the use of topical brimonidine
and beta-blockers
AUTHOR NAMES
Mungan N.K.
Wilson T.W.
Nischal K.K.
Koren G.
Levin A.V.
AUTHOR ADDRESSES
(Mungan N.K.; Nischal K.K.; Levin A.V.) Department of Ophthalmology,
Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada.
(Wilson T.W.) Geisinger Medical Center, Danville, PA, United States.
(Koren G.) Div. of Clin. Pharmacol./Toxicology, Hospital for Sick Children,
University of Toronto, Toronto, Ont., Canada.
(Levin A.V.) Department of Ophthalmology, Hospital for Sick Children, 555
University Ave, Toronto, Ont. M5G 1X8, Canada.
CORRESPONDENCE ADDRESS
A.V. Levin, Department of Ophthalmology, Hospital for Sick Children, 555
University Ave, Toronto, Ont. M5G 1X8, Canada.
SOURCE
Journal of AAPOS (2003) 7:1 (69-70). Date of Publication: February 2003
ISSN
1091-8531
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Brimonidine is a selective alpha-2 adrenergic agonist used to treat
glaucoma. There have been several reports of central nervous system
depression after its use in infants.(1-4)We observed rapid-onset bradycardia
and decreased blood pressure in addition to central nervous system
depression in 2 infants who received concomitant topical brimonidine and
beta-blockers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
beta adrenergic receptor blocking agent (adverse drug reaction, drug
therapy, topical drug administration)
brimonidine (adverse drug reaction, drug therapy, topical drug
administration)
EMTREE DRUG INDEX TERMS
alpha 2 adrenergic receptor stimulating agent (adverse drug reaction, drug
therapy, topical drug administration)
betaxolol (adverse drug reaction, drug therapy, topical drug administration)
dipivefrine (drug therapy, topical drug administration)
dorzolamide (adverse drug reaction, drug therapy, topical drug
administration)
naloxone (drug therapy)
noradrenalin (drug therapy, intravenous drug administration)
timolol (adverse drug reaction, drug therapy, topical drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bradycardia (side effect)
glaucoma (drug therapy, surgery)
hypotension (drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
apnea (side effect)
article
blood examination
brain scintiscanning
breathing disorder (side effect)
case report
computer assisted tomography
electroencephalography
emergency ward
female
human
hypothermia (side effect)
hypoventilation (side effect)
hypoxemia (side effect)
intraocular pressure
lensectomy
newborn
physical examination
priority journal
vitrectomy
CAS REGISTRY NUMBERS
betaxolol (63659-18-7, 72424-72-7)
brimonidine (59803-98-4)
dipivefrine (52365-63-6, 56298-24-9)
dorzolamide (130693-82-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
timolol (26839-75-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Ophthalmology (12)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003478054
MEDLINE PMID
12690374 (http://www.ncbi.nlm.nih.gov/pubmed/12690374)
PUI
L37443358
DOI
10.1016/S1091-8531(02)42013-7
FULL TEXT LINK
http://dx.doi.org/10.1016/S1091-8531(02)42013-7
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1161
TITLE
Nebulized naloxone gently and effectively reverses methadone intoxication
AUTHOR NAMES
Mycyk M.B.
Szyszko A.L.
Aks S.E.
AUTHOR ADDRESSES
(Mycyk M.B.; Aks S.E.) Toxikon Consortium/Cook Co. Hospital, Chicago, IL,
United States.
(Mycyk M.B.; Szyszko A.L.; Aks S.E.) Univ. of Illinois Hosp. and Clinics,
Chicago, IL, United States.
(Mycyk M.B.) Northwestern Univ. Medical School, Chicago, IL, United States.
(Aks S.E.) Mercy Hospital Medical Center, Chicago, IL, United States.
(Mycyk M.B.) Division of Emergency Medicine, 676 N. St. Clair, Chicago, IL
60611, United States.
CORRESPONDENCE ADDRESS
M.B. Mycyk, Division of Emergency Medicine, 676 N. St. Clair, Chicago, IL
60611, United States.
SOURCE
Journal of Emergency Medicine (2003) 24:2 (185-187). Date of Publication:
February 2003
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
A 46-year-old woman presented to the Emergency Department with lethargy and
respiratory depression after ingesting methadone. Initial oxygen saturation
of 61% on room air did not improve with supplemental oxygenation. As venous
access was initially unobtainable, naloxone was administered by nebulizer.
Within 5 min oxygen saturation was 100% and mental status was normal. The
patient did not develop severe withdrawal symptoms. Naloxone hydrochloride
has been administered by various routes to treat opioid toxicity. Our report
describes the successful use of nebulized naloxone for methadone toxicity. ©
2003 Elsevier Science Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
naloxone (adverse drug reaction, drug dose, drug therapy, inhalational drug
administration, intravenous drug administration)
EMTREE DRUG INDEX TERMS
alcohol
cocaine
opiate
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
anamnesis
article
case report
drug overdose
female
hospital admission
human
intubation
laboratory test
lacrimation
lethargy (drug therapy)
lung auscultation
lung edema (side effect)
nebulizer
neurologic examination
oxygen saturation
oxygenation
physical disability
physical examination
priority journal
pupil
respiration depression (drug therapy)
withdrawal syndrome
yawning
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003098507
MEDLINE PMID
12609650 (http://www.ncbi.nlm.nih.gov/pubmed/12609650)
PUI
L36269246
DOI
10.1016/S0736-4679(02)00723-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(02)00723-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1162
TITLE
Non-opiate analgesia: level I and II emergency drugs (indications,
undesirable effects and evaluation of their efficacity)
ORIGINAL (NON-ENGLISH) TITLE
Analgésie non morphinique: médications de niveaux I et II utilisables en
urgence (indications, effets indésirables, évaluation de leur efficacité).
AUTHOR NAMES
Attard N.
Baraton S.
Pistre E.
Aboukrat C.
Visigny S.
Bertuzzi M.C.
Moraly J.
Alazia M.
AUTHOR ADDRESSES
(Attard N.; Baraton S.; Pistre E.; Aboukrat C.; Visigny S.; Bertuzzi M.C.;
Moraly J.; Alazia M.) Sau des hôpitaux Sud, 270, bd Sainte-Marguerite, BP
29, 13274 Marseille, France.
CORRESPONDENCE ADDRESS
N. Attard, Sau des hôpitaux Sud, 270, bd Sainte-Marguerite, BP 29, 13274
Marseille, France.
SOURCE
Revue de l'infirmière (2003) :88 (36-38). Date of Publication: Feb 2003
ISSN
1293-8505
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
pain (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
classification
drug monitoring
hospitalization
human
methodology
pain assessment
patient selection
treatment outcome
LANGUAGE OF ARTICLE
French
MEDLINE PMID
12696355 (http://www.ncbi.nlm.nih.gov/pubmed/12696355)
PUI
L36642462
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1163
TITLE
Patterns of presentation in heroin overdose resulting in pulmonary edema
AUTHOR NAMES
Sterrett C.
Brownfield J.
Korn C.S.
Hollinger M.
Henderson S.O.
AUTHOR ADDRESSES
(Sterrett C.; Brownfield J.; Korn C.S.; Henderson S.O.,
sohender@hsc.usc.edu) Department of Emergency Medicine, Keck School of
Medicine, University of Southern California, Los Angeles, CA, United States.
(Hollinger M.) Univ. of S. California Med. Center, Los Angeles, CA, United
States.
(Henderson S.O., sohender@hsc.usc.edu) Department of Emergency Medicine,
LAC/USC Medical Center, Unit #1, 1200 N. State St., Los Angeles, CA 90033,
United States.
CORRESPONDENCE ADDRESS
S.O. Henderson, Department of Emergency Medicine, LAC/USC Medical Center,
Unit #1, 1200 N. State St., Los Angeles, CA 90033, United States. Email:
sohender@hsc.usc.edu
SOURCE
American Journal of Emergency Medicine (2003) 21:1 (32-34). Date of
Publication: January 2003
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The study objective was to describe the morbidity of patients presenting
with heroin overdose (HOD)-induced noncardiogenic pulmonary edema (NCPE) at
an urban ED. A retrospective chart review of patients presenting between
1996 and 1999 with the diagnosis of HOD was conducted. Using a standardized
data abstraction form, information on prehospital care, ED care,
demographics, and cointoxications was collected. One hundred twenty-five
charts (78%) were available for review. Of these, 13 (10%) were diagnosed
with NCPE and all were male. In the field, NCPE patients had an average
relative risk of 6, a Glasgow Coma Scale of 4, and all needed naloxone. The
average admitted duration of use was 2.9 years for those who developed NCPE
compared with 13.2 years for those who did not. Five (42%) NCPE patients
tested positive for cocaine use and 7 (58%) tested positive for alcohol. In
this cohort, the NCPE patients were male and less experienced users with
initial low relative risk and Glasgow Coma Scale which demanded prehospital
naloxone use. Copyright 2003, Elsevier Science (USA). All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy, epidemiology)
heroin dependence (diagnosis, drug therapy, epidemiology)
lung edema (etiology)
EMTREE MEDICAL INDEX TERMS
adult
alcoholism (diagnosis, epidemiology)
article
clinical feature
cocaine dependence (diagnosis, epidemiology)
emergency ward
female
Glasgow coma scale
human
major clinical study
male
morbidity
priority journal
risk
urban area
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003067925
MEDLINE PMID
12563576 (http://www.ncbi.nlm.nih.gov/pubmed/12563576)
PUI
L36176127
DOI
10.1053/ajem.2003.50006
FULL TEXT LINK
http://dx.doi.org/10.1053/ajem.2003.50006
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1164
TITLE
Procedural sedation and analgesia for children in the emergency department
AUTHOR NAMES
Flood R.G.
Krauss B.
AUTHOR ADDRESSES
(Flood R.G., Robert.Flood@tch.harvard.edu; Krauss B.) Division of Emergency
Medicine, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United
States.
CORRESPONDENCE ADDRESS
R.G. Flood, Division of Emergency Medicine, Children's Hospital, 300
Longwood Avenue, Boston, MA 02115, United States. Email:
Robert.Flood@tch.harvard.edu
SOURCE
Emergency Medicine Clinics of North America (2003) 21:1 (121-139). Date of
Publication: February 2003
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
PSA for children continues to be an integral part of the practice of
emergency medicine. The advancement of knowledge for all health care
professionals must continue so that pain and anxiety in children may be
minimized during their visits to EDs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (adverse drug reaction, drug dose, drug therapy,
intravenous drug administration, oral drug administration)
hypnotic sedative agent (adverse drug reaction, drug dose, intravenous drug
administration, oral drug administration)
narcotic analgesic agent (adverse drug reaction, drug dose, intravenous drug
administration)
sedative agent (adverse drug reaction, drug dose, intravenous drug
administration, oral drug administration)
EMTREE DRUG INDEX TERMS
chloral hydrate (adverse drug reaction, drug dose, oral drug administration)
fentanyl (adverse drug reaction, drug dose, intravenous drug administration)
flumazenil (drug dose, intravenous drug administration)
ibuprofen (adverse drug reaction, drug dose, drug therapy)
ketamine (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration)
ketorolac (adverse drug reaction, drug dose, drug therapy)
lidocaine plus prilocaine (adverse drug reaction, drug dose, drug therapy,
topical drug administration)
methohexital (adverse drug reaction, drug dose, rectal drug administration)
midazolam (adverse drug reaction, drug dose, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, oral drug administration, rectal drug administration)
nalmefene (drug dose, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
naloxone (drug dose, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
nitrous oxide (adverse drug reaction, drug dose, inhalational drug
administration)
pentobarbital (adverse drug reaction, drug dose, intravenous drug
administration, oral drug administration, rectal drug administration)
pethidine (adverse drug reaction, drug dose, drug therapy)
thiopental (adverse drug reaction, drug dose, rectal drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency health service
pain (drug therapy)
sedation
EMTREE MEDICAL INDEX TERMS
anxiety
bleeding (side effect)
clinical examination
drug choice
drug contraindication
drug hypersensitivity (side effect)
emergency treatment
heart arrhythmia (side effect)
human
hypersalivation (side effect)
hypotension (side effect)
intracranial hypertension (side effect)
intraocular hypertension (side effect)
larynx spasm (side effect)
methemoglobinemia (side effect)
muscle rigidity (side effect)
myoclonus (side effect)
patient monitoring
practice guideline
priority journal
pruritus (side effect)
respiration depression (side effect)
review
seizure (side effect)
topical anesthesia
vomiting (side effect)
DRUG MANUFACTURERS
(United States)Astra Zeneca
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
EMLA (101362-25-8)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ibuprofen (15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003097733
MEDLINE PMID
12630735 (http://www.ncbi.nlm.nih.gov/pubmed/12630735)
PUI
L36268472
DOI
10.1016/S0733-8627(02)00084-6
FULL TEXT LINK
http://dx.doi.org/10.1016/S0733-8627(02)00084-6
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1165
TITLE
Fentanyl-induced rigidity during emergence from general anesthesia
potentiated by venlafexine
AUTHOR NAMES
Roy S.
Fortier L.-P.
AUTHOR ADDRESSES
(Roy S.; Fortier L.-P., hmranest@odyssee.net) Departement d'Anesthesiologie,
Université de Montréal, 5415 boul. de l'Assomption, Montréal, Qué. H1T 2M4,
Canada.
CORRESPONDENCE ADDRESS
L.-P. Fortier, Departement d'Anesthesiologie, Hôpital Maisonneuve- Rosemont,
5415 boul. de l'Assomption, Montréal, Qué. H1T 2M4, Canada. Email:
hmranest@odyssee.net
SOURCE
Canadian Journal of Anesthesia (2003) 50:1 (32-35). Date of Publication:
January 2003
ISSN
0832-610X
BOOK PUBLISHER
Canadian Anaesthetists' Society, 1 Eglinton Avenue East, Suite 208, Toronto,
Canada.
ABSTRACT
Purpose: To present and discuss a case of opioid-induced rigidity with
low-dose fentanyl during recovery from anesthesia. Clinical features: A
41-yr-old woman underwent laparotomy for total abdominal hysterectomy and
bilateral salpingo- oophorectomy under general anesthesia. She received a
total of 500 μg of fentanyl by iv intermittent boluses during the three-hour
anesthetic. During emergence from anesthesia, while intubated, the patient
presented with rigidity. No changes in ventilatory parameters were measured
during the episode. The only notable predisposing factor was treatment with
venlafexine, an antidepressant that modifies serotonin and norepinephrine
levels. She was successfully treated with iv naloxone 20 μg. The rest of the
postoperative period was uneventful. Conclusion: We observed an atypical
case of opioid-induced rigidity in contrast to the classical syndrome, which
presents at induction with high-dose opioids. This syndrome has many
clinical presentations with neurologic and ventilatory signs of varying
intensity. Early recognition of the syndrome and adequate treatment is
crucial. If treated adequately, opioid-induced rigidity is self-limited with
few complications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, drug combination, drug dose, drug
interaction, intravenous drug administration)
venlafaxine (adverse drug reaction, drug combination, drug dose, drug
interaction, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
desflurane (adverse drug reaction, drug combination)
enflurane (adverse drug reaction)
etomidate (adverse drug reaction)
glycopyrronium (drug combination)
halide (adverse drug reaction)
haloperidol (drug combination, drug interaction)
halothane (adverse drug reaction)
isoflurane (adverse drug reaction)
ketamine (adverse drug reaction)
morphine (intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
neostigmine (drug combination, intravenous drug administration)
noradrenalin (endogenous compound)
opiate (adverse drug reaction, drug combination, drug dose, drug
interaction, intravenous drug administration)
oxygen (drug combination)
propofol (adverse drug reaction, drug combination)
remifentanil (adverse drug reaction, drug combination)
rocuronium (drug combination, intravenous drug administration)
serotonin (endogenous compound)
sevoflurane (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
general anesthesia
muscle rigidity (drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal hysterectomy
adult
agitation
anesthetic recovery
article
artificial ventilation
case report
clinical feature
depression (drug therapy)
dose response
drug megadose
drug potentiation
female
human
laparotomy
neurologic disease (side effect)
priority journal
respiratory tract parameters
treatment outcome
CAS REGISTRY NUMBERS
desflurane (57041-67-5)
enflurane (13838-16-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
glycopyrronium bromide (596-51-0)
haloperidol (52-86-8)
halothane (151-67-7, 66524-48-9)
isoflurane (26675-46-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
propofol (2078-54-8)
remifentanil (132539-07-2)
rocuronium (119302-91-9)
serotonin (50-67-9)
sevoflurane (28523-86-6)
venlafaxine (93413-69-5)
EMBASE CLASSIFICATIONS
Surgery (9)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2003096637
MEDLINE PMID
12514147 (http://www.ncbi.nlm.nih.gov/pubmed/12514147)
PUI
L36267269
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1166
TITLE
Rethinking coma cocktails.
AUTHOR NAMES
Pore C.
AUTHOR ADDRESSES
(Pore C.)
CORRESPONDENCE ADDRESS
C. Pore,
SOURCE
JEMS : a journal of emergency medical services (2003) 28:1 (14; author reply
14). Date of Publication: Jan 2003
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
glucose (drug administration)
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (drug therapy)
emergency health service
EMTREE MEDICAL INDEX TERMS
health care quality
human
note
standard
United States
CAS REGISTRY NUMBERS
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
12564425 (http://www.ncbi.nlm.nih.gov/pubmed/12564425)
PUI
L36490072
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1167
TITLE
Opiate overdose in Dublin [1]
AUTHOR NAMES
Cullen W.
Griffin S.
Bury G.
Plunkett P.K.
AUTHOR ADDRESSES
(Cullen W.; Bury G.) Department of General Practice, University College
Dublin, Dublin, Ireland.
(Griffin S.; Plunkett P.K.) Department of Emergency Med., St James's
Hospital, Dublin, Ireland.
CORRESPONDENCE ADDRESS
W. Cullen, Department of General Practice, University College Dublin,
Dublin, Ireland.
SOURCE
Irish Journal of Medical Science (2003) 172:1 (46). Date of Publication:
January/February/March 2003
ISSN
0021-1265
BOOK PUBLISHER
Springer London Ltd, The Guildway, Old Portsmouth Road, Artington,
Guildford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
methadone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
clinical audit
clinical study
critical illness
death
drug use
emergency treatment
female
hospital department
hospital discharge
human
Ireland
law
letter
major clinical study
male
mortality
patient attitude
patient care
patient monitoring
prescription
prospective study
workload
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2003216102
MEDLINE PMID
12760466 (http://www.ncbi.nlm.nih.gov/pubmed/12760466)
PUI
L36626537
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1168
TITLE
Systematic evaluation of complications related to endoscopy in a training
setting: A prospective 30-day outcomes study
AUTHOR NAMES
Bini E.J.
Firoozi B.
Choung R.J.
Ali E.M.
Osman M.
Weinshel E.H.
AUTHOR ADDRESSES
(Bini E.J.; Firoozi B.; Choung R.J.; Ali E.M.; Osman M.; Weinshel E.H.)
Division of Gastroenterology, VA New York Harbor Healthcare System, NYU
School of Medicine, New York, NY, United States.
(Bini E.J.) Division of Gastroenterology (111D), VA New York Harbor
Healthcare System, 423 East 23rd St., New York, NY 10010, United States.
CORRESPONDENCE ADDRESS
E.J. Bini, Division of Gastroenterology (111D), VA New York Harbor
Healthcare System, 423 East 23rd St., New York, NY 10010, United States.
SOURCE
Gastrointestinal Endoscopy (2003) 57:1 (8-16). Date of Publication: January
2003
ISSN
0016-5107
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Background: The 30-day frequency of negative outcomes after outpatient
endoscopy performed by gastroenterology fellows is unknown. Methods:
Questionnaires were mailed to 1000 consecutive patients 30 days after
endoscopy to evaluate procedure-related negative outcomes (serious and minor
adverse events) and patient satisfaction. Serious adverse events were
defined as follows: oversedation requiring administration of a reversal
agent, and those that resulted in a physician visit, emergency department
visit, admission to the hospital, or death. Minor adverse events were
defined as all problems other than serious adverse events that patients
related to their endoscopic procedure. Results: The 30-day frequency of
negative outcomes in the 869 patients who responded was 14.3%, of which 0.6%
were serious and 13.7% were minor adverse events. The frequency of negative
outcomes was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for combined EGD
and colonoscopy, and 7.8% for flexible sigmoidoscopy. One hundred percent of
the serious adverse events were known to us, but only 16.0% of minor adverse
events (p < 0.001). Multiple logistic regression identified midazolam dose
(OR for each 1 mg increase in dose 4.5; 95% CI [2.7, 7.3]; p < 0.001),
treatment with warfarin (OR 3.0; 95% CI [1.4, 6.2]; p = 0.003), comorbid
disease (OR 2.1; 95% CI [1.3, 3.4]; p = 0.001), endoscopy performed in July
or August (OR 2.0; 95% CI [1.1,3.7]; p = 0.02), and age (OR for each 1 year
increase in age 1.03; 95% CI [1.01, 1.05]; p = 0.01) as independent
predictors of negative outcomes. There was a significant association between
negative outcomes and decreased patient satisfaction, and patients who
reported negative outcomes were less likely to agree to endoscopy in the
future. Conclusions: Serious adverse events were rare after endoscopy
performed by gastroenterology fellows. Contacting patients 30 days after
outpatient endoscopy significantly improved the detection of negative
outcomes. Although the majority of negative outcomes were minor, these
adverse events were associated with decreased patient satisfaction.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
midazolam (adverse drug reaction, drug dose)
naloxone (drug therapy)
nonsteroid antiinflammatory agent
pethidine (adverse drug reaction, drug dose)
warfarin (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical education
endoscopy
training
EMTREE MEDICAL INDEX TERMS
abdominal discomfort (complication)
adult
aged
appetite disorder (complication)
article
colon perforation (complication)
comorbidity
controlled study
death
dose response
drowsiness (side effect)
drug induced disease (side effect)
emergency treatment
epistaxis (complication)
evaluation study
fatigue (complication)
female
fever (complication)
headache (complication)
hoarseness (complication)
hospital admission
human
injection pain (complication)
logistic regression analysis
major clinical study
male
medical specialist
myalgia (complication)
nausea (complication)
nocturia (complication)
outpatient
patient satisfaction
priority journal
questionnaire
rash (complication)
rectum hemorrhage (complication, side effect)
respiratory distress (complication, drug therapy)
sedation
sigmoidoscopy
sore throat (complication)
thorax pain (complication)
treatment outcome
vertigo (complication)
vomiting (complication)
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2003086136
MEDLINE PMID
12518123 (http://www.ncbi.nlm.nih.gov/pubmed/12518123)
PUI
L36236792
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1169
TITLE
Hemodynamic instability and delayed emergence from general anesthesia
associated with inadvertent intrathecal baclofen overdose
AUTHOR NAMES
Lyew M.A.
Mondy C.
Eagle S.
Chernich S.E.
AUTHOR ADDRESSES
(Lyew M.A., mlyew@mail.mcg.edu; Mondy C.; Eagle S.) Department of
Anesthesiology, Children's Medical Center, 1446 Harper Street, Augusta, GA
30912, United States.
(Chernich S.E.) Department of Neurosurgery, Medical College of Georgia, 1446
Harper Street, Augusta, GA 30912, United States.
(Lyew M.A., mlyew@mail.mcg.edu) Dept. of Pediatric Anesthesiology,
Children's Medical Center, Medical College of Georgia, 1446 Harper Street,
Augusta, GA 30912, United States.
CORRESPONDENCE ADDRESS
M.A. Lyew, Dept. of Pediatric Anesthesiology, Children's Medical Center,
Medical College of Georgia, 1446 Harper Street, Augusta, GA 30912, United
States. Email: mlyew@mail.mcg.edu
SOURCE
Anesthesiology (2003) 98:1 (265-268). Date of Publication: 1 Jan 2003
ISSN
0003-3022
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
baclofen (drug dose, drug therapy, drug toxicity, intrathecal drug
administration, pharmaceutics)
EMTREE DRUG INDEX TERMS
atropine (drug dose, pharmacology)
fentanyl (pharmacology)
glucose (endogenous compound, pharmacology)
glycopyrronium (intravenous drug administration, pharmacology)
isoflurane (drug dose, pharmacology)
naloxone (drug dose, intravenous drug administration, pharmacology)
nitrous oxide (drug dose, pharmacology)
oxygen
ranitidine (drug therapy, oral drug administration)
rocuronium (pharmacology)
scopolamine (drug therapy, transdermal drug administration)
thiopental (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary hemodynamics
drug overdose
general anesthesia
EMTREE MEDICAL INDEX TERMS
anamnesis
article
blood pressure monitoring
bradycardia
breathing rate
case report
catheter
catheterization
cerebral palsy
cerebrospinal fluid drainage
coma
device removal
drowsiness
drug infusion
drug solution
endotracheal intubation
extubation
glucose blood level
human
hypotension
infusion pump
inhalation anesthesia
maintenance drug dose
male
medical device
muscle spasm (drug therapy)
neuromuscular blocking
oxygen breathing
oxygen saturation
pediatric anesthesia
priority journal
pulse oximetry
pupil
school child
unconsciousness
venous blood
X ray picture
DEVICE TRADE NAMES
SynchroMed , United StatesMedtronic
DEVICE MANUFACTURERS
(United States)Medtronic
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
baclofen (1134-47-0)
fentanyl (437-38-7)
glucose (50-99-7, 84778-64-3)
glycopyrronium bromide (596-51-0)
isoflurane (26675-46-7)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
oxygen (7782-44-7)
ranitidine (66357-35-5, 66357-59-3)
rocuronium (119302-91-9)
scopolamine (138-12-5, 51-34-3, 55-16-3)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2003016372
MEDLINE PMID
12503007 (http://www.ncbi.nlm.nih.gov/pubmed/12503007)
PUI
L36043436
DOI
10.1097/00000542-200301000-00040
FULL TEXT LINK
http://dx.doi.org/10.1097/00000542-200301000-00040
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1170
TITLE
Paediatric resuscitation
AUTHOR NAMES
McKee L.A.
Zideman D.A.
AUTHOR ADDRESSES
(McKee L.A.; Zideman D.A.) Department of Anaesthesia, Hammersmith Hospital,
Du Cane Road, London W12 0HS, United Kingdom.
CORRESPONDENCE ADDRESS
D.A. Zideman, Department of Anaesthesia, Hammersmith Hospital, Du Cane Road,
London W12 0HS, United Kingdom.
SOURCE
CPD Anaesthesia (2002) 4:3 (99-105). Date of Publication: 2002
ISSN
1466-2922
ABSTRACT
In 2000 the European Resuscitation Council issued the latest guidelines on
paediatric basic and advanced life support. These included several changes
from pre-existing guidelines, which were made in response to new scientific
evidence and where possible to simplify and aid teaching and retention. This
article reviews the new guidelines and outlines current paediatric
resuscitation practice.
EMTREE DRUG INDEX TERMS
amiodarone (drug therapy, intravenous drug administration)
antiarrhythmic agent (drug therapy, intravenous drug administration)
atropine (drug therapy, intraosseous drug administration, intravenous drug
administration, pharmacology)
bicarbonate (drug therapy, intratracheal drug administration)
epinephrine (adverse drug reaction, drug dose, drug therapy, intraosseous
drug administration, intravenous drug administration, pharmacology)
lidocaine (drug therapy, intraosseous drug administration, intravenous drug
administration)
magnesium (drug therapy)
naloxone (drug therapy, intraosseous drug administration, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatrics
resuscitation
EMTREE MEDICAL INDEX TERMS
age
airway
airway obstruction
algorithm
bradycardia (drug therapy)
breathing
child
circulation
clinical practice
clinical protocol
compartment syndrome (complication)
defibrillation
dose response
drug extravasation
drug mechanism
emergency health service
endotracheal intubation
Europe
evidence based medicine
fracture (complication)
head tilting
heart arrest (drug therapy, therapy)
heart fibrillation
heart ventricle fibrillation (drug therapy)
heart ventricle tachycardia (drug therapy)
hemodynamic monitoring
human
hypertension (side effect)
hypoxia
laryngeal mask
lung ventilation
metabolic acidosis (complication, drug therapy)
osteomyelitis (complication)
oxygenation
practice guideline
pulse rate
review
stimulus response
tachycardia (side effect)
teaching
torsade des pointes (drug therapy)
vascular access
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium (7439-95-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002449131
PUI
L35446481
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1171
TITLE
Physostigmine as a treatment for gamma-hydroxybutyrate toxicity: A review
AUTHOR NAMES
Traub S.J.
Nelson L.S.
Hoffman R.S.
AUTHOR ADDRESSES
(Traub S.J., stevetraub@yahoo.com; Nelson L.S.; Hoffman R.S.) New York City
Poison Control Center, New York, NY, United States.
CORRESPONDENCE ADDRESS
S.J. Traub, New York City Poison Control Center, New York, NY, United
States. Email: stevetraub@yahoo.com
SOURCE
Journal of Toxicology - Clinical Toxicology (2002) 40:6 (781-787). Date of
Publication: 2002
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Introduction: Gamma-hydroxybutyrate is a potent sedative -hypnotic agent and
a popular drug of abuse. In the United States, gamma-hydroxybutyrate is a
Schedule I controlled substance (sodium oxybate) with orphan drug status for
the treatment of narcolepsy within approved clinical studies. Physostigmine
is a carbamate inhibitor of acetylcholinesterase that is reported to
attenuate the sedative effects of a number of drugs, including
gamma-hydroxybutyrate. We reviewed the literature that pertains to the use
of physostigmine to treat gamma-hydroxybutyrate-induced sedation. Methods: A
structured literature search was performed to identify articles in which
physostigmine and gamma-hydroxybutyrate were mentioned. Keywords were used
to identify relevant articles in the Medline database, and the reference
sections of articles identified by this method were hand-checked to identify
additional articles. Those articles that presented original evidence
pertaining to the use of physostigmine to treat
gamma-hydroxybutyrate-induced sedation were included in this review; those
that did not were rejected. Results: The literature search identified 22
articles, six of which did not pertain to the subject matter. Of the 16
articles which remained, 12 were rejected because they offered opinions
without presenting original evidence. Of the four articles that presented
original evidence, there were no in vitro studies and no animal studies.
There were two small case series in which physostigmine was given to treat
acute gamma-hydroxybutyrate toxicity in an emergency department setting, and
two larger series in which stevetraub@yahoo.com physostigmine was given to
attenuate the sedation induced by gamma- hydroxybutyrate in a more
structured anesthesia setting. Although these references report that
physostigmine attenuates gamma-hydroxybutyrate-induced sedation, there are
methodological flaws and confounding factors that limit the scope of the
conclusions that can be drawn from them. Conclusions: There is currently
insufficient scientific evidence to support the routine use of physostigmine
in the treatment of gamma-hydroxybutyrate toxicity. Further studies are
needed to determine the role, if any, for physostigmine in this setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 hydroxybutyric acid (drug toxicity)
physostigmine (drug therapy, intravenous drug administration, pharmacology)
EMTREE DRUG INDEX TERMS
flumazenil (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
toxicity (drug therapy)
EMTREE MEDICAL INDEX TERMS
anesthesia
arousal
data base
disease course
drug effect
emergency ward
human
medical literature
Medline
premedication
review
sedation
unconsciousness
CAS REGISTRY NUMBERS
4 hydroxybutyric acid (591-81-1)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002441780
MEDLINE PMID
12475191 (http://www.ncbi.nlm.nih.gov/pubmed/12475191)
PUI
L35423413
DOI
10.1081/CLT-120015839
FULL TEXT LINK
http://dx.doi.org/10.1081/CLT-120015839
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1172
TITLE
The challenge of drug shortages for emergency medicine
AUTHOR NAMES
Tyler L.S.
Fox E.R.
Caravati E.M.
AUTHOR ADDRESSES
(Tyler L.S., Linda.Tyler@hsc.utah.edu; Fox E.R.) Drug Information Service,
Univ. of Utah Health Sciences Center, Salt Lake City, UT, United States.
(Caravati E.M.) Division of Emergency Medicine, Univ. of Utah Health
Sciences Center, Salt Lake City, UT, United States.
(Tyler L.S., Linda.Tyler@hsc.utah.edu) Dept. of Pharmacy Services A-050,
Univ. of Utah Hospitals and Clinics, 50 North Medical Drive, Salt Lake City,
UT 84132, United States.
CORRESPONDENCE ADDRESS
L.S. Tyler, Dept. of Pharmacy Services A-050, Univ. of Utah Hospitals and
Clinics, 50 North Medical Drive, Salt Lake City, UT 84132, United States.
Email: Linda.Tyler@hsc.utah.edu
SOURCE
Annals of Emergency Medicine (2002) 40:6 (598-602). Date of Publication: 1
Dec 2002
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS
diphenhydramine
diphtheria pertussis tetanus vaccine
etomidate
fentanyl
naloxone
prochlorperazine
snake venom
suxamethonium
tetanus toxoid
venom antiserum
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug manufacture
emergency medicine
EMTREE MEDICAL INDEX TERMS
editorial
food and drug administration
health care delivery
health care management
human
inventory control
patient care
pharmacy
priority journal
CAS REGISTRY NUMBERS
diphenhydramine (147-24-0, 58-73-1)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
prochlorperazine (58-38-8)
snake venom (55230-69-8)
suxamethonium (306-40-1, 71-27-2)
tetanus toxoid (57425-69-1, 93384-51-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002440370
MEDLINE PMID
12447336 (http://www.ncbi.nlm.nih.gov/pubmed/12447336)
PUI
L35417482
DOI
10.1067/mem.2002.129127
FULL TEXT LINK
http://dx.doi.org/10.1067/mem.2002.129127
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1173
TITLE
Potential impacts on the incidence of fatal heroin-related overdose in
Western Australia: A time-series analysis
AUTHOR NAMES
Hargreaves K.
Lenton S.
Phillips M.
Swensen G.
AUTHOR ADDRESSES
(Hargreaves K.; Lenton S.) National Drug Research Institute, Curtin
University of Technology, Health Dept. of Western Australia, Perth, WA,
Australia.
(Phillips M.) School of Public Health, Curtin University of Technology,
Health Dept. of Western Australia, Perth, WA, Australia.
(Swensen G.) Drug and Alcohol Office, Health Dept. of Western Australia,
Perth, WA, Australia.
CORRESPONDENCE ADDRESS
S. Lenton, National Drug Research Institute, GPO Box U1987, Perth, WA 6845,
Australia.
SOURCE
Drug and Alcohol Review (2002) 21:4 (321-327). Date of Publication: December
2002
ISSN
0959-5236
BOOK PUBLISHER
Routledge
ABSTRACT
In response to the rising concerns about the rate of heroin-related
fatalities, overdose prevention campaigns, run by both users' organizations
and government agencies, have been implemented in a number of states across
Australia. In Western Australia (WA) in mid-1997, various overdose
prevention initiatives were implemented. These included the implementation
of a protocol limiting police presence at overdose events; the commencement
of naloxone administration by ambulance staff; and the establishment of the
Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for
individuals treated for overdose in emergency departments. This paper
reports the results of a multiple linear regression analysis of 60 months of
time-series data, both prior to and following the implementation of these
interventions, to determine their impact on the number of fatal heroin
overdoses in WA. The model employed in the analysis controlled for changes
over time in proxy indicators of use and community concerns about heroin, as
well as market indicators. The results suggest that, although the
interventions implemented have managed to reduce the expected number of
fatalities, they have become less successful in doing so as time passes.
This has implications for both existing and potential interventions to
reduce fatal heroin-related overdose. [Hargreaves K. Lenton S., Phillips M.,
Swensen G. Potential impacts on the incidence of fatal heroin-related
overdose in Western Australia: a time-series analysis. Drug Alcohol Rev.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heroin dependence (epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
Australia (epidemiology)
human
intoxication (epidemiology)
mortality
review
time
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
12537700 (http://www.ncbi.nlm.nih.gov/pubmed/12537700)
PUI
L35464687
DOI
10.1080/0959523021000023162
FULL TEXT LINK
http://dx.doi.org/10.1080/0959523021000023162
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1174
TITLE
Methanol poisoning: Speed in the initiation of specific treatment
ORIGINAL (NON-ENGLISH) TITLE
Intoxicación por metanol: Rapidez en el inicio del tratamiento específico
AUTHOR NAMES
Escudero Cuadrillero E.
Bartual Lobato E.
Medina García P.
Merino De Cos P.
AUTHOR ADDRESSES
(Escudero Cuadrillero E.; Bartual Lobato E.; Medina García P.; Merino De Cos
P.) Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, Spain.
CORRESPONDENCE ADDRESS
E. Escudero Cuadrillero, Servicio de Medicina Intensiva, Hospital Can
Misses, Ibiza, Spain.
SOURCE
Medicina Intensiva (2002) 26:10 (508). Date of Publication: Dec 2002
ISSN
0210-5691
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methanol (drug toxicity)
EMTREE DRUG INDEX TERMS
flumazenil (drug therapy)
glucose
naloxone (drug therapy)
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
methanol poisoning (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
case report
coma (complication)
computer assisted tomography
emergency treatment
female
Glasgow coma scale
hemodialysis
human
intoxication (diagnosis, drug therapy, therapy)
letter
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
Spanish
EMBASE ACCESSION NUMBER
2003169842
PUI
L36505530
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1175
TITLE
Fatal intravenous misuse of transdermal fentanyl
AUTHOR NAMES
Reeves M.D.
Ginifer C.J.
AUTHOR ADDRESSES
(Reeves M.D., corinne.ginifer@dhhs.tas.gov.au; Ginifer C.J.,
corinne.ginifer@dhhs.tas.gov.au) Department of Anaesthesia, North West
Regional Hospital, Brickport Road, Burnie, Tas. 7316, Australia.
CORRESPONDENCE ADDRESS
M.D. Reeves, Department of Anaesthesia, North West Regional Hospital,
Brickport Road, Burnie, Tas. 7316, Australia. Email:
corinne.ginifer@dhhs.tas.gov.au
SOURCE
Medical Journal of Australia (2002) 177:10 (552-553). Date of Publication:
18 Nov 2002
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
ABSTRACT
The introduction of a transdermal delivery system for fentanyl means that it
is now more readily available. We present the first documented fatality
after intravenous injection of the contents of a transdermal fentanyl patch.
Prescribers need to be aware of the potential for misuse of fentanyl
patches.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug dose, drug toxicity, intravenous drug administration,
transdermal drug administration)
EMTREE DRUG INDEX TERMS
alcohol
atropine (drug therapy, intravenous drug administration, pharmacology)
bicarbonate (endogenous compound)
epinephrine (drug therapy, intravenous drug administration, pharmacology)
hemoglobin (endogenous compound)
naloxone (drug therapy, intravenous drug administration, pharmacology)
narcotic agent (drug dose, drug toxicity, intravenous drug administration,
transdermal drug administration)
noradrenalin (drug therapy, pharmacology)
oxygen
polygeline (drug therapy, pharmacology)
sugar (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug fatality
drug misuse (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
ambulance
article
artificial ventilation
basal ganglion
cardiopulmonary arrest (therapy)
case report
Cheyne Stokes breathing
clinical feature
computer assisted tomography
diabetes insipidus
disease severity
documentation
drug delivery system
drug effect
drug overdose (drug therapy)
emergency ward
encephalitis (diagnosis)
female
Glasgow coma scale
glucose blood level
health care availability
heart arrest
heart rate
heart ventricle fibrillation
hemodynamic parameters
human
hypoxia
injection
intensive care unit
intestine necrosis (diagnosis)
laboratory test
liver dysfunction
lung aspiration
male
oxygen saturation
prescription
respiratory tract intubation
resuscitation
sinus rhythm
systolic blood pressure
tachycardia
thorax radiography
transdermal patch
DRUG TRADE NAMES
hemacell
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
fentanyl (437-38-7)
hemoglobin (9008-02-0)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
oxygen (7782-44-7)
polygeline (66455-30-9)
EMBASE CLASSIFICATIONS
Toxicology (52)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Clinical and Experimental Biochemistry (29)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002441185
MEDLINE PMID
12429004 (http://www.ncbi.nlm.nih.gov/pubmed/12429004)
PUI
L35422818
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1176
TITLE
Moscow theatre siege: A deadley gamble that nearly paid off
AUTHOR NAMES
Van Damme B.
AUTHOR ADDRESSES
(Van Damme B.)
SOURCE
Pharmaceutical Journal (2002) 269:7224 (723). Date of Publication: 16 Nov
2002
ISSN
0031-6873
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug dose, drug toxicity, pharmacology)
halothane (adverse drug reaction, drug dose, drug toxicity, pharmacology)
EMTREE DRUG INDEX TERMS
acetylcholine (endogenous compound)
antidote
benzilic acid derivative (drug dose, pharmacology)
lysergide (drug dose, pharmacology)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chemical warfare
terrorism
EMTREE MEDICAL INDEX TERMS
aerosol
anesthesist
army
asphyxia
cardiovascular disease
central nervous system
coma
drug administration
drug potency
drug safety
emergency treatment
health care access
health care delivery
health care planning
human
liver toxicity (side effect)
medical specialist
note
protective clothing
rescue personnel
respiration depression
respiratory failure
Russian Federation
soldier
syringe
unconsciousness
ventilator
CAS REGISTRY NUMBERS
acetylcholine (51-84-3, 60-31-1, 66-23-9)
fentanyl (437-38-7)
halothane (151-67-7, 66524-48-9)
lysergide (50-37-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002428703
PUI
L35378917
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1177
TITLE
Emergencies at home: Emergency material and drugs
ORIGINAL (NON-ENGLISH) TITLE
Le matériel et les médicaments de l'urgence
AUTHOR NAMES
Dubas J.
Higelin F.
AUTHOR ADDRESSES
(Dubas J.; Higelin F.) Case postale 2861, 1211 Genève 2, Switzerland.
CORRESPONDENCE ADDRESS
J. Dubas, Case postale 2861, 1211 Genève 2, Switzerland. Email:
jdubas@sos-medecins.ch
SOURCE
Medecine et Hygiene (2002) 60:2412 (2069-2074). Date of Publication: 6 Nov
2002
ISSN
0025-6749
EMTREE DRUG INDEX TERMS
acetalgine
acetazolamide (intramuscular drug administration, intravenous drug
administration)
acetylsalicylic acid (oral drug administration)
adenosine (intravenous drug administration)
adenosine
alprazolam (oral drug administration)
amiodarone (intravenous drug administration)
amoxi mepha
amoxicillin (oral drug administration)
amoxicillin plus clavulanic acid (oral drug administration)
atropine (intramuscular drug administration, intratracheal drug
administration, intravenous drug administration, subcutaneous drug
administration)
aziclav
betamethasone dipropionate (intraarticular drug administration,
intramuscular drug administration)
biperiden (intramuscular drug administration, intravenous drug
administration)
bromazepam (oral drug administration)
budesonide (inhalational drug administration)
cefpodoxime proxetil (oral drug administration)
ceftriaxone (intramuscular drug administration, intravenous drug
administration)
ciprofloxacin (oral drug administration)
clarithromycin (oral drug administration)
clemastine fumarate (intramuscular drug administration, intravenous drug
administration)
clonazepam (intravenous drug administration)
co amoxi mepha
cotrimoxazole (oral drug administration)
diazepam (intramuscular drug administration, intravenous drug
administration, rectal drug administration)
diclofenac (intramuscular drug administration, intravenous drug
administration)
digoxin (intravenous drug administration)
dipyrone
domperidone (oral drug administration)
epinephrine (intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
etomidate (intravenous drug administration)
flumazenil
fluticasone propionate
fraxiforte
furosemide
fusidic acid
greffen
haloperidol
ibuprofen
ipratropium bromide (inhalational drug administration)
isophane insulin
ketorolac trometamol
levofloxacin
lidocaine
loperamide
lysine acetylsalicylate
mefe basan
mefenacide
mefenamic acid (oral drug administration)
metoclopramide
naloxone
neutral insulin
nifedipine
omeprazole
oxytocin
paracetamol
paracetamol
penimox
promazine
recombinant glucagon
salbutamol
scopolamine butyl bromide
sucralfate (oral drug administration)
sumatriptan succinate
suxamethonium
tramadol
tramadol melpha
ultracortene
unindexed drug
valaciclovir
verapamil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
EMTREE MEDICAL INDEX TERMS
diagnostic test
home care
medical device
plaster cast
short survey
DRUG TRADE NAMES
acetalgine
actrapid
adalat retard
akineton
amoxi mepha
anexate
antra
aspegic
aspirine
atrovent
augmentin
axotide
aziclav
bactrim
ben u ron
brufen
buscopan
ciproxine
clamoxyl
clavamox
co amoxi mepha
cordarone
cotrim
dafalgan
diamox
diclo basan
diprophos
escoprim
etomidate
fraxiforte
fucithalmic
gastrosil
glucagen
greffen
haldol
imigran
imodium
insulatard
irfen
isoptin
klacid
krenosine
lasix
lexotanil
lysthenon
mefe basan
mefenacide
midarine
motilium
narcan
novalgine
orelox
panadol
penimox
podomexef
ponstan
prazine
primperan
pulmicort
rivotril
rocephine
stesolid
succinolin
supracombin forte
syntocinon
tavanic
tavegyl
tora dol
tramadol melpha
tramal
tylenol
ulcogant
ultracortene
valium
valtrex
ventolin
voltarene
xanax
xylocaine
DEVICE TRADE NAMES
ACE-MDI-Spacer
Ambu
Babyhaler
Butterfly
Combibag
Combur-Test
Glucotrend Plus
Instillagel
Keto-Diabur-Test
Nebunette
Nephur-Test
Opsite
Practo-Clyss
Practomil
Rhena-Alginat
Spongostan
Steri-Strips
Uriflac
Venflon
DEVICE MANUFACTURERS
Laerdal
CAS REGISTRY NUMBERS
acetazolamide (1424-27-7, 59-66-5)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alprazolam (28981-97-7)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1)
amoxicillin (26787-78-0, 34642-77-8, 61336-70-7)
atropine (51-55-8, 55-48-1)
betamethasone dipropionate (5593-20-4)
biperiden (1235-82-1, 514-65-8)
bromazepam (1812-30-2)
budesonide (51333-22-3)
cefpodoxime proxetil (87239-81-4)
ceftriaxone (73384-59-5, 74578-69-1)
ciprofloxacin (85721-33-1)
clarithromycin (81103-11-9)
clemastine fumarate (14976-57-9)
clonazepam (1622-61-3)
cotrimoxazole (8064-90-2)
diazepam (439-14-5)
diclofenac (15307-79-6, 15307-86-5)
digoxin (20830-75-5, 57285-89-9)
domperidone (57808-66-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
flumazenil (78755-81-4)
fluticasone propionate (80474-14-2)
furosemide (54-31-9)
fusidic acid (6990-06-3)
haloperidol (52-86-8)
ibuprofen (15687-27-1)
ipratropium bromide (22254-24-6)
isophane insulin (9004-17-5)
levofloxacin (100986-85-4, 138199-71-0)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
loperamide (34552-83-5, 53179-11-6)
lysine acetylsalicylate (34220-70-7, 37933-78-1, 62952-06-1, 77337-52-1)
mefenamic acid (61-68-7)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
neutral insulin (9004-14-2)
nifedipine (21829-25-4)
omeprazole (73590-58-6, 95510-70-6)
oxytocin (50-56-6, 54577-94-5)
paracetamol (103-90-2)
promazine (53-60-1, 58-40-2)
salbutamol (18559-94-9)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
sucralfate (54182-58-0)
sumatriptan succinate (103628-48-4)
suxamethonium (306-40-1, 71-27-2)
tramadol (27203-92-5, 36282-47-0)
valaciclovir (124832-26-4)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2002424854
PUI
L35364266
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1178
TITLE
No more coma cocktails. Using science to dispel myths & improve patient
care.
AUTHOR NAMES
Bledsoe B.E.
AUTHOR ADDRESSES
(Bledsoe B.E.)
CORRESPONDENCE ADDRESS
B.E. Bledsoe, Email: bbledsoe@earthlink.net
SOURCE
JEMS : a journal of emergency medical services (2002) 27:11 (54-60). Date of
Publication: Nov 2002
ISSN
0197-2510
ABSTRACT
It should be clear from this discussion that coma cocktails are a bad idea
and should be immediately abandoned. In fact, the indiscriminate use of the
coma cocktail may indeed harm patients, EMS has evolved to a point where any
EMS provider should be able to reasonably determine the most likely cause of
coma, or, in a worst-case scenario, narrow the cause to but a few
possibilities. Certainly, patients with bona fide hypoglycemia should
receive IV glucose. Because the consequences of prolonged hypoglycemia are
severe, if there's a doubt about whether hypoglycemia is present, then
glucose should be empirically administered. Naloxone should be used only for
those cases in which a narcotic overdose appears likely. Similarly thiamine
administration should be limited to patients suspected of chronic alcohol
abuse and who exhibit at least one of the three symptoms of WE described
above. Flumazenil has no role in the routine treatment of coma unless the
patient is known to not be benzodiazepine dependent and the overdose is
known to result only from benzos--two very difficult requirements to verify
in the back of an ambulance at 2 a.m. Coma cocktails are bad medicine. Let's
banish them from our EMS armamentarium.
EMTREE DRUG INDEX TERMS
benzodiazepine receptor affecting agent (drug administration)
flumazenil (drug administration)
glucose (drug administration)
naloxone (drug administration)
narcotic antagonist (drug administration)
thiamine (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (drug therapy)
emergency health service
evidence based medicine
health care quality
EMTREE MEDICAL INDEX TERMS
article
drug combination
human
hypoglycemia (drug therapy)
methodology
standard
United States
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
12483195 (http://www.ncbi.nlm.nih.gov/pubmed/12483195)
PUI
L35521802
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1179
TITLE
Low incidence of nausea and vomiting with intravenous opiate analgesia in
the ED
AUTHOR NAMES
Paoloni R.
Talbot-Stern J.
AUTHOR ADDRESSES
(Paoloni R.; Talbot-Stern J.) Department of Emergency Medicine, Royal Prince
Alfred Hospital, Sydney, Australia.
CORRESPONDENCE ADDRESS
R. Paoloni, Emergency Department, Royal Prince Alfred Hospital, Missenden
Rd, Sydney, NSW, Australia.
SOURCE
American Journal of Emergency Medicine (2002) 20:7 (604-608). Date of
Publication: November 2002
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Two double-blind, placebo-controlled, prospective randomized trials in the
emergency department (ED) setting have examined the use of metoclopramide
for the prevention of opiate-induced nausea and vomiting. Both showed a low
incidence of vomiting in the control group. This prospective observational
study in 205 unselected ED patients with acute pain syndromes measured
nausea and vomiting before intravenous opiate administration and 30 and 60
minutes posttreatment. Cumulative incidence of vomiting was 1.5% at 30
minutes and 2.4% at 60 minutes. Corresponding figures for nausea were 4.9%
at 30 minutes and 9.3% at 60 minutes, with more than 75% of patients rating
their nausea as mild. Prevalence of both nausea and vomiting were higher at
baseline than after analgesia. These data support the findings of previous
randomized trials that the incidence of nausea and vomiting after
intravenous opiate analgesia in the ED is low and argues against routine use
of prophylactic antiemetic administration in combination with opiate
analgesia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antiemetic agent (clinical trial, drug therapy)
metoclopramide (clinical trial, drug therapy)
morphine (adverse drug reaction, drug administration, drug dose, drug
therapy, intramuscular drug administration, intravenous drug administration,
subcutaneous drug administration)
narcotic analgesic agent (adverse drug reaction, drug administration, drug
dose, drug therapy, intramuscular drug administration, intravenous drug
administration, subcutaneous drug administration)
opiate (adverse drug reaction, drug administration, drug dose, drug therapy,
intramuscular drug administration, intravenous drug administration,
subcutaneous drug administration)
pethidine (adverse drug reaction, drug administration, drug dose, drug
therapy, intramuscular drug administration, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
nausea (drug therapy, prevention, side effect)
opioid induced emesis (drug therapy, prevention, side effect)
pain (drug therapy)
vomiting (drug therapy, prevention, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (drug therapy)
acute heart infarction (drug therapy)
adolescent
adult
aged
analgesia
article
clinical trial
controlled clinical trial
controlled study
double blind procedure
emergency ward
female
human
incidence
major clinical study
male
musculoskeletal disease (drug therapy)
prevalence
priority journal
randomized controlled trial
treatment outcome
CAS REGISTRY NUMBERS
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002425314
MEDLINE PMID
12442238 (http://www.ncbi.nlm.nih.gov/pubmed/12442238)
PUI
L35364814
DOI
10.1053/ajem.2002.35457
FULL TEXT LINK
http://dx.doi.org/10.1053/ajem.2002.35457
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1180
TITLE
Pharmacotherapeutic options for chemical restraint
AUTHOR NAMES
Rose S.R.
Ward K.R.
Giorgi-Guarnieri D.
AUTHOR ADDRESSES
(Rose S.R.; Ward K.R.; Giorgi-Guarnieri D.) Department of Emergency
Medicine, Virginia Cmw. Univ. Medical College, Richmond, VA, United States.
CORRESPONDENCE ADDRESS
S.R. Rose, Department of Emergency Medicine, Virginia Cmw. Univ. Medical
College, Richmond, VA, United States.
SOURCE
Journal of Critical Illness (2002) 17:11 (446-450). Date of Publication: 1
Nov 2002
ISSN
1040-0257
ABSTRACT
In the emergent setting, it is sometimes necessary to use pharmacotherapy to
gain control of violent or aggressive patients. Here, the authors explain
which agents are most appropriate and why.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
barbituric acid derivative
benzodiazepine derivative (adverse drug reaction, drug combination,
intravenous drug administration)
neuroleptic agent
opiate (adverse drug reaction)
sedative agent
EMTREE DRUG INDEX TERMS
amobarbital (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacokinetics)
butyrophenone derivative (adverse drug reaction, drug combination,
intravenous drug administration, pharmacokinetics)
cholinergic receptor blocking agent (drug therapy, intramuscular drug
administration, intravenous drug administration)
diazepam (adverse drug reaction, intravenous drug administration,
pharmacokinetics)
diphenhydramine (drug therapy, intramuscular drug administration,
intravenous drug administration)
droperidol (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacokinetics)
etomidate (adverse drug reaction)
fentanyl citrate (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, pharmacokinetics)
glycopyrronium
haloperidol (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacokinetics)
ketamine (adverse drug reaction, drug combination, intramuscular drug
administration, intravenous drug administration, pharmacokinetics)
lorazepam (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, pharmacokinetics)
methohexital (intramuscular drug administration, intravenous drug
administration)
midazolam (adverse drug reaction, drug combination, intravenous drug
administration)
morphine (adverse drug reaction)
naloxone
olanzapine (adverse drug reaction, intramuscular drug administration)
pethidine (adverse drug reaction)
propofol (adverse drug reaction)
thiopental (intravenous drug administration, pharmacokinetics)
ziprasidone (adverse drug reaction, intramuscular drug administration,
pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aggression
sedation
violence
EMTREE MEDICAL INDEX TERMS
agitation
behavior
catatonia (side effect)
central nervous system depression
delirium (side effect)
drug safety
drug tolerability
dystonia (drug therapy, side effect)
emergency treatment
extrapyramidal symptom (side effect)
hallucination (side effect)
human
hypersalivation (side effect)
hypotension (side effect)
larynx spasm (side effect)
long QT syndrome (side effect)
muscle rigidity (side effect)
nausea (side effect)
pruritus (side effect)
respiration depression (side effect)
review
seizure (side effect)
side effect (side effect)
vomiting (side effect)
DRUG TRADE NAMES
amytal
ativan
brevital
geodon
haldol
inapsine
ketalar
pentothal
sublimaze
valium
versed
CAS REGISTRY NUMBERS
amobarbital (57-43-2, 64-43-7)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
droperidol (548-73-2)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl citrate (990-73-8)
glycopyrronium bromide (596-51-0)
haloperidol (52-86-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
olanzapine (132539-06-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
thiopental (71-73-8, 76-75-5)
ziprasidone (118289-78-4, 122883-93-6, 138982-67-9, 199191-69-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002411757
PUI
L35316022
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1181
TITLE
Pharmacologic therapies for acutely decompensated heart failure
AUTHOR NAMES
Fonarow G.C.
AUTHOR ADDRESSES
(Fonarow G.C.) Division of Cardiology, UCLA School of Medicine, Los Angeles,
CA, United States.
CORRESPONDENCE ADDRESS
G.C. Fonarow, Division of Cardiology, UCLA School of Medicine, Los Angeles,
CA, United States.
SOURCE
Reviews in Cardiovascular Medicine (2002) 3:SUPPL. 4 (S18-S27). Date of
Publication: 2002
ISSN
1530-6550
BOOK PUBLISHER
MedReviews LLC, 1333 Broadway, Suite 1120, New York, United States.
ABSTRACT
The management of acutely decompensated heart failure in the emergency
medical setting poses a major clinical challenge. Acutely decompensated
heart failure is characterized by hemodynamic abnormalities and
neuroendocrine activation that contribute to heart failure symptoms,
end-organ dysfunction, arrhythmias, and progressive cardiac failure. The
therapeutic goals in patients presenting with acutely decompensated heart
failure are to stabilize the patient, reverse acute hemodynamic
abnormalities, rapidly reverse dyspnea and/or hypoxemia caused by pulmonary
edema, and initiate treatments that will decrease disease progression and
improve survival. Pharmacologic therapies to impact the hemodynamic
abnormalities and symptoms in patients with acutely decompensated heart
failure include diuretics, inotropic agents, vasodilators, and natriuretic
peptides. In patients with acutely decompensated heart failure, it has
recently been demonstrated that elevation in left ventricular filling
pressure is the hemodynamic abnormality that most directly impacts heart
failure symptoms and is highly predictive of increased risk of fatal
decompensation and sudden death. Measures of systemic perfusion, arterial
pressure, and vascular resistance have not been predictive of symptoms or
clinical outcomes. An ideal agent for acute decompensated heart failure
would be one that rapidly reduces pulmonary wedge pressure, results in
balanced arterial and venous dilation, promotes natriuresis, lacks direct
positive inotropic effects, and does not result in reflex neuroendocrine
activation. © 2002 MedReviews, LLC.
EMTREE DRUG INDEX TERMS
aldosterone antagonist (drug therapy, pharmacology)
beta adrenergic receptor blocking agent (drug therapy, pharmacology)
brain natriuretic peptide (adverse drug reaction, drug combination, drug
comparison, drug dose, drug therapy, intravenous drug administration,
pharmacokinetics, pharmacology)
dipeptidyl carboxypeptidase inhibitor (drug combination, drug comparison,
drug therapy, oral drug administration, pharmacology)
diuretic agent (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration, parenteral drug
administration, pharmacology)
dobutamine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intravenous drug administration, pharmacology)
dopamine (adverse drug reaction, drug combination, drug comparison, drug
therapy, intravenous drug administration, pharmacology)
enoximone (drug therapy, pharmacology)
epinephrine (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration, pharmacology)
furosemide (drug combination, drug dose, drug therapy, intravenous drug
administration, pharmacology)
glyceryl trinitrate (adverse drug reaction, drug comparison, drug dose, drug
therapy, intravenous drug administration, pharmacology)
hydralazine (drug combination, drug therapy, oral drug administration,
pharmacology)
inotropic agent (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration, oral drug administration,
pharmacology)
isoprenaline (adverse drug reaction, drug combination, drug comparison, drug
therapy, intravenous drug administration, pharmacology)
milrinone (adverse drug reaction, drug comparison, drug therapy, intravenous
drug administration, pharmacology)
morphine sulfate (adverse drug reaction, drug therapy, intravenous drug
administration, pharmacology)
naloxone (drug therapy)
nesiritide (adverse drug reaction, drug combination, drug comparison, drug
therapy, intravenous drug administration, pharmacokinetics, pharmacology)
nitroprusside sodium (adverse drug reaction, drug combination, drug
comparison, drug therapy, intravenous drug administration, pharmacology)
noradrenalin (adverse drug reaction, drug comparison, drug therapy,
intravenous drug administration, pharmacology)
piperanometozine (drug therapy, pharmacology)
vasodilator agent (adverse drug reaction, drug combination, drug comparison,
drug therapy, intravenous drug administration, pharmacology)
xamoterol (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute heart failure (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
arterial pressure
article
bradycardia (drug therapy, side effect)
cardiovascular risk
controlled study
disease course
dose response
drug half life
drug mechanism
dyspnea
emergency ward
fatality
headache (side effect)
heart arrhythmia (side effect)
heart left ventricle filling pressure
heart muscle ischemia (side effect)
hemodynamics
hormonal regulation
human
hypotension (drug therapy, side effect)
hypoxemia
inotropism
lung edema
lung wedge pressure
pathophysiology
prediction
sudden death
survival
symptomatology
tachyphylaxis
tissue perfusion
treatment outcome
vascular resistance
vasodilatation
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
brain natriuretic peptide (114471-18-0)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
enoximone (77671-31-9)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
hydralazine (304-20-1, 86-54-4)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
milrinone (78415-72-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
nesiritide (124584-08-3, 189032-40-4)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
piperanometozine (81840-15-5)
xamoterol (81801-12-9)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002349492
MEDLINE PMID
12439427 (http://www.ncbi.nlm.nih.gov/pubmed/12439427)
PUI
L35100410
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1182
TITLE
Accident or suicide attempt: Specific measures in poisoning emergencies
ORIGINAL (NON-ENGLISH) TITLE
Unfall oder suizidversuch: Gezielte maßnahmen bei vergiftungsnotfállen
AUTHOR NAMES
Hermanns-Clausen M.
Stedtler U.
AUTHOR ADDRESSES
(Hermanns-Clausen M.; Stedtler U.) Vergiftungs-Informations-Zentrale,
Mathildenstr. 1, 79106 Freiburg, Germany.
CORRESPONDENCE ADDRESS
M. Hermanns-Clausen, Vergiftungs-Informations-Zentrale, Mathildenstr. 1,
79106 Freiburg, Germany.
SOURCE
Notfall Medizin (2002) 28:7-8 (364-369). Date of Publication: 2002
ISSN
0341-2903
ABSTRACT
Most cases of poisoning seen in Germany are attempted suicides or industrial
accidents. In childhood, in contrast, accidents involving poisons rarely
result in severe poisoning. The severity and the temporal course of the
clinical symptoms can vary greatly, and the mortality rate is usually low.
Since the prognosis is generally good, overtreatment should be avoided.
Consultation with a poisons centre is recommended with the aim of initiating
specific measures and to obtain information on possible complications.
EMTREE DRUG INDEX TERMS
3,4 methylenedioxyamphetamine (drug toxicity)
4 diphenylacetoxy 1 methylpiperidine (drug therapy)
4 methylpyrazole (drug therapy)
acetylcysteine (drug therapy)
antidepressant agent (drug toxicity)
atropine (drug therapy)
beta adrenergic receptor blocking agent (drug toxicity)
calcium antagonist (drug toxicity)
chloroquine (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
deferoxamine (drug therapy)
diazepam (drug therapy)
digitalis (drug therapy)
ethylene glycol (drug toxicity)
glucagon (drug therapy)
hydroxocobalamin (drug therapy)
methanol (drug toxicity)
midomafetamine (drug toxicity)
n ethyl 3,4 methylenedioxyamphetamine (drug toxicity)
naloxone (drug therapy)
organophosphate insecticide (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy)
silibinin (drug therapy)
sodium thiosulfate (drug therapy)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
zaleplon (drug toxicity)
zolpidem (drug toxicity)
zopiclone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
accident
intoxication (drug therapy)
suicide attempt
EMTREE MEDICAL INDEX TERMS
clinical feature
disease severity
drug intoxication (drug therapy)
Germany
human
mortality
poison center
prognosis
short survey
CAS REGISTRY NUMBERS
3,4 methylenedioxyamphetamine (4764-17-4)
3,4 methylenedioxymethamphetamine (42542-10-9)
4 diphenylacetoxy 1 methylpiperidine (1952-15-4)
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
atropine (51-55-8, 55-48-1)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
deferoxamine (70-51-9)
diazepam (439-14-5)
digitalis (8031-42-3, 8053-83-6)
ethylene glycol (107-21-1)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
methanol (67-56-1)
n ethyl 3,4 methylenedioxyamphetamine (14089-52-2)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
silibinin (22888-70-6)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
zaleplon (151319-34-5)
zolpidem (82626-48-0)
zopiclone (43200-80-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2002342907
PUI
L35078460
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1183
TITLE
Emergency drugs.
AUTHOR NAMES
Haas D.A.
AUTHOR ADDRESSES
(Haas D.A.) Department of Clinical Sciences, Discipline of Anesthesia,
Faculty of Dentistry, Department of Pharmacology, Faculty of Medicine,
University of Toronto, Toronto, Ontario, Canada.
CORRESPONDENCE ADDRESS
D.A. Haas, Department of Clinical Sciences, Discipline of Anesthesia,
Faculty of Dentistry, Department of Pharmacology, Faculty of Medicine,
University of Toronto, Toronto, Ontario, Canada. Email:
daniel.haas@utoronto.ca
SOURCE
Dental clinics of North America (2002) 46:4 (815-830). Date of Publication:
Oct 2002
ISSN
0011-8532
ABSTRACT
There is universal agreement that dentists require emergency drugs to be
readily available. Opinions differ as to the specific drugs that should
comprise an emergency kit. This article has provided one opinion. Oxygen,
epinephrine, nitroglycerin, injectable diphenhydramine or chlorpheniramine,
albuterol, and aspirin should be readily available in a dental office. Other
drugs such as glucagon, atropine, ephedrine, hydrocortisone, morphine or
nitrous oxide, naloxone, midazolam or lorazepam, and flumazenil should also
be considered. There are differences in the level of training of dentists in
the management of medical emergencies [25]. Therefore the final decision
should be made by the individual dentist who is in the best position to
determine the appropriateness of these agents for the particular practice.
Despite the best efforts at prevention, emergencies may still arise. Plans
to manage these events are needed and there is the possibility that the
drugs discussed above may be required. Their presence may save a life.
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent (drug therapy)
antiallergic agent (drug therapy)
antidiabetic agent (drug therapy)
antiinflammatory agent (drug therapy)
antithrombocytic agent (drug therapy)
bronchodilating agent (drug therapy)
cholinergic receptor blocking agent (drug therapy)
histamine H1 receptor antagonist (drug therapy)
hypnotic sedative agent (drug therapy)
narcotic analgesic agent (drug therapy)
narcotic antagonist (drug therapy)
steroid
vasodilator agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dental procedure
drug therapy
emergency treatment
EMTREE MEDICAL INDEX TERMS
adult
child
emergency
human
oxygen therapy
review
LANGUAGE OF ARTICLE
English
MEDLINE PMID
12442734 (http://www.ncbi.nlm.nih.gov/pubmed/12442734)
PUI
L35516103
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1184
TITLE
Opioids prolong nuclear hepatobiliary imaging when given prior to scanning
AUTHOR NAMES
Barlas D.
Margouleff D.
Vignogna-Barlas L.
Lesser M.L.
AUTHOR ADDRESSES
(Barlas D.; Vignogna-Barlas L.) Department of Emergency Medicine, North
Shore University Hospital, New York University School of Medicine,
Manhasset, NY, United States.
(Margouleff D.) Department of Medicine, North Shore University Hospital, New
York University School of Medicine, Manhasset, NY, United States.
(Lesser M.L.) Department of Research, North Shore University Hospital, New
York University School of Medicine, Manhasset, NY, United States.
(Barlas D.) North Shore University Hospital, Department of Emergency
Medicine, 300 Community Drive, Manhasset, NY 11030, United States.
CORRESPONDENCE ADDRESS
D. Barlas, North Shore University Hospital, Department of Emergency
Medicine, 300 Community Drive, Manhasset, NY 11030, United States.
SOURCE
Journal of Emergency Medicine (2002) 23:3 (231-236). Date of Publication:
October 2002
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Opioid-mediated contraction of the distal common bile duct (CBD) may delay
tracer passage during nuclear hepatobiliary imaging (NHI), mimicking
pathologic obstruction. We sought to determine if opioid administration
before NHI delays CBD visualization and prolongs imaging. The records of 198
Emergency Department patients who underwent NHI were reviewed (after
excluding those with evidence for pathologic CBD obstruction). Opioids were
administered before NHI in 56 cases. Delayed CBD visualization occurred in
28.6% of subjects who had received opioids and in 12.0% of those who had not
(p < 0.01). Delayed imaging was performed in 77.8% of those who had received
opioids and in 53.5% of those who had not (p < 0.01). The relative risk of
delayed CBD visualization was 1.46 [95%CI 0.65-3.28] for meperidine, 4.18
[95%CI 2.00-8.82] for morphine, and 2.38 [95%CI 1.29-4.39] for any opioid.
We conclude that opioids given before NHI are associated with delayed CBD
visualization and more imaging sessions. © 2002 Elsevier Science Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
disofenin tc 99m (pharmacology)
opiate (drug comparison, pharmacology)
tracer (pharmacology)
EMTREE DRUG INDEX TERMS
morphine (drug comparison, pharmacology)
pethidine (drug comparison, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
common bile duct
imaging
nuclear medicine
EMTREE MEDICAL INDEX TERMS
adult
aged
article
common bile duct obstruction (diagnosis)
controlled study
echography
emergency ward
female
human
major clinical study
male
priority journal
retrospective study
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Nuclear Medicine (23)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002407384
MEDLINE PMID
12426012 (http://www.ncbi.nlm.nih.gov/pubmed/12426012)
PUI
L35300242
DOI
10.1016/S0736-4679(02)00523-1
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(02)00523-1
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1185
TITLE
Trends in opiate and opioid poisonings in addicts in north-east Paris and
suburbs, 1995-99
AUTHOR NAMES
Gueye P.N.
Megarbane B.
Borron S.W.
Adnet F.
Galliot-Guilley M.
Ricordel I.
Tourneau J.
Goldgran-Toledano D.
Baud F.J.
AUTHOR ADDRESSES
(Gueye P.N., p.gueye@wanadoo.fr; Megarbane B.; Borron S.W.;
Goldgran-Toledano D.; Baud F.J.) Réanimation Médicale et Toxicologique,
Groupe Hospitalier Lariboisière, Fernand Widal Assistance Publique-Hôpitaux
de Paris, Paris, France.
(Borron S.W.) Department of Emergency Medicine, George Washington
University, School of Medicine, Washington, DC, United States.
(Adnet F.) Service d'Aide Médicale Urgente, 93 UPRES VA 34-09 Hôpital
Avicenne, Bobigny, France.
(Galliot-Guilley M.) Laboratoire de Biochimie et Toxicologie, Hôpital
Fernand, Widal, Paris, France.
(Ricordel I.; Tourneau J.) Laboratoire de Toxicologie, Préfecture de Police
de Paris, Paris, France.
(Gueye P.N., p.gueye@wanadoo.fr) Réanimation Médicale et Toxicologique,
Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.
CORRESPONDENCE ADDRESS
P.N. Gueye, Reanimation Medicale/Toxicologique, Hôpital Lariboisière 2, rue
Ambroise Paré, 75010 Paris, France. Email: p.gueye@wanadoo.fr
SOURCE
Addiction (2002) 97:10 (1295-1304). Date of Publication: 1 Oct 2002
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Aims: (1) To assess the trends in the number, mortality and the nature of
severe opiate/opioid poisonings from 1995 to 1999 in north-east Paris and
adjacent suburbs and (2) to examine the effects of the introduction of
high-dose buprenorphine on these parameters. Design: Retrospective. 5-year
study with review of pre-hospital, hospital and post-mortem data. Setting
and participants: Eighty patients from the toxicological intensive care unit
(TICU) in north-east Paris. 421 patients from the pre-hospital emergency
medical service in a north-east suburb of Paris (SAMU 93) and 40 deaths from
the coroner's office in Paris. Measurements and results: We found that the
number of pre-hospital opiate/opioid poisonings and deaths decreased over 5
years. During the same time frame, opiate/opioid poisoning admissions to our
TICU remained steady. but the number of deaths declined. From 1995 to 1999,
the detection of buprenorphine among opiate/opioid-poisoned TICU patients
increased from two to eight occurrences per year while detection of opiates
diminished from 17 to 10 occurrences per year. Increased buprenorphine
detection correlated directly with increasing sales over this time period.
In spite of the increased use of buprenorphine, the mortality associated
with opiate/opioid poisonings has diminished in the pre-hospital environment
from 9% in 1995 to 0% in 1999. and in the TICU from 12% in 1995 to 0% in
1997 and thereafter. We found a high frequency of multiple opiate/opioid use
in severe poisonings, as well as the frequent association of other
psychoactive drugs including ethanol. Conclusions: The number and the
mortality of opiate/opioid poisonings appear to be stable or decreasing in
our region. The association of multiple opiates/ opioids appears nearly as
common as the association with other psychoactive drugs. The introduction of
high-dose buprenorphine coincides with a decrease in opiate/opioid poisoning
mortality. Further study will be necessary to clarify this observation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
buprenorphine (drug toxicity)
dextropropoxyphene (drug toxicity)
diamorphine (drug toxicity)
methadone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (etiology)
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
age distribution
article
female
France
human
major clinical study
male
mortality
multiple drug abuse (etiology)
sex ratio
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002363321
MEDLINE PMID
12359034 (http://www.ncbi.nlm.nih.gov/pubmed/12359034)
PUI
L35147501
DOI
10.1046/j.1360-0443.2002.00189.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1360-0443.2002.00189.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1186
TITLE
Rapid opioid detoxification in Australia [1]
AUTHOR NAMES
O'Neil G.
Hulse G.
Armstrong J.
Little M.
Murray L.
Reece S.
AUTHOR ADDRESSES
(O'Neil G.; Hulse G.; Armstrong J.; Little M.; Murray L.; Reece S.)
Australian Med. Research Foundation, Subiaco, WA, Australia.
CORRESPONDENCE ADDRESS
G. O'Neil, Australian Med. Research Foundation, Subiaco, WA, Australia.
SOURCE
Academic Emergency Medicine (2002) 9:9 (960-962). Date of Publication: Sep
2002
ISSN
1069-6563
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
naloxone (drug dose, intravenous drug administration)
naltrexone (drug dose, subcutaneous drug administration)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
baclofen
enflurane
fluoxetine
halothane
phenothiazine derivative
prochlorperazine
propofol
sevoflurane
trazodone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug detoxification
emergency treatment
EMTREE MEDICAL INDEX TERMS
anesthesia induction
Australia
drug infusion
human
implantation
letter
medical practice
neuromodulation
neurotransmission
patient counseling
patient referral
priority journal
procedures
safety
survival rate
treatment outcome
CAS REGISTRY NUMBERS
baclofen (1134-47-0)
enflurane (13838-16-9)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
halothane (151-67-7, 66524-48-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
prochlorperazine (58-38-8)
propofol (2078-54-8)
sevoflurane (28523-86-6)
trazodone (19794-93-5, 25332-39-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002325299
PUI
L35006768
DOI
10.1197/aemj.9.9.960
FULL TEXT LINK
http://dx.doi.org/10.1197/aemj.9.9.960
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1187
TITLE
Induced hypothermia for drug overdose [2]
AUTHOR NAMES
Osterhoudt K.C.
Perrone J.
AUTHOR ADDRESSES
(Osterhoudt K.C.; Perrone J.) Poison Control Center, Philadelphia, PA,
United States.
CORRESPONDENCE ADDRESS
K.C. Osterhoudt, Poison Control Center, Philadelphia, PA, United States.
Email: oserhoudtk@email.chop.edu
SOURCE
Academic Emergency Medicine (2002) 9:9 (962). Date of Publication: September
2002
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS
alcohol
antibiotic agent
diazepam (drug toxicity)
naloxone
oxycodone (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (therapy)
hypothermia
EMTREE MEDICAL INDEX TERMS
arterial carbon dioxide tension
artificial ventilation
case report
drug urine level
emergency treatment
female
gas chromatography
heart arrest
human
letter
male
neurologic examination
priority journal
resuscitation
school child
treatment outcome
CAS REGISTRY NUMBERS
alcohol (64-17-5)
diazepam (439-14-5)
naloxone (357-08-4, 465-65-6)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002325300
MEDLINE PMID
12208689 (http://www.ncbi.nlm.nih.gov/pubmed/12208689)
PUI
L35006769
DOI
10.1197/aemj.9.9.962
FULL TEXT LINK
http://dx.doi.org/10.1197/aemj.9.9.962
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1188
TITLE
Morbidity associated with non-fatal heroin overdose
AUTHOR NAMES
Warner-Smith M.
Darke S.
Day C.
AUTHOR ADDRESSES
(Warner-Smith M.; Darke S., s.darke@unsw.edu.au; Day C.) National Drug and
Alcohol Research Centre, University of New South Wales, Australia.
(Darke S., s.darke@unsw.edu.au) National Drug and Alcohol Research Centre,
University of New South Wales, NSW 2052, Australia.
CORRESPONDENCE ADDRESS
S. Darke, Natl. Drug and Alcohol Res. Centre, University of New South Wales,
Sydney, NSW 2052, Australia. Email: s.darke@unsw.edu.au
SOURCE
Addiction (2002) 97:8 (963-967). Date of Publication: 2002
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Aims: To estimate the range and severity of heroin overdose related
morbidity. Design: Cross-sectional survey. Setting: Sydney, Australia.
Participants: 198 heroin users. Findings Sixty-nine per cent had experienced
a heroin overdose, 28% in the preceding 12 months. Of those who had
overdosed, 79% had experien0ced at least one overdose-related morbidity
symptom. An ambulance had attended overdoses for 59% of subjects, 33% had
required hospital treatment for overdose, and 14% had experienced
overdose-related complications of sufficient severity to be admitted to a
hospital ward. Indirect overdose-related morbidity included: physical injury
sustained when falling at overdose (40%), burns (24%) and assault while
unconscious (14%). Direct overdose-related morbidity included: peripheral
neuropathy (49%), vomiting (33%), temporary paralysis of limbs (26%), chest
infections (13%) and seizure (2%). Conclusions: There appears to be
extensive morbidity associated with non-fatal overdose. This is clearly an
area that requires more research to document the prevalence and nature of
these harms, and factors associated with them.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
methadone (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, epidemiology)
morbidity
EMTREE MEDICAL INDEX TERMS
adolescent
adult
anamnesis
article
assault
Australia
burn
consciousness
controlled study
disease severity
emergency treatment
falling
female
heart arrhythmia (complication, etiology)
hospital admission
human
length of stay
lung edema (complication, etiology)
major clinical study
male
nerve paralysis (complication, etiology)
peripheral neuropathy (complication, etiology)
pneumonia (complication, etiology)
respiratory tract infection (complication, etiology)
rhabdomyolysis (complication, etiology)
seizure (complication, etiology)
sex ratio
treatment indication
vomiting (complication, etiology)
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002293193
MEDLINE PMID
12144598 (http://www.ncbi.nlm.nih.gov/pubmed/12144598)
PUI
L34888483
DOI
10.1046/j.1360-0443.2002.00132.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1360-0443.2002.00132.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1189
TITLE
Intranasal naloxone for life threatening opioid toxicity
AUTHOR NAMES
Kelly A.-M.
Koutsogiannis Z.
AUTHOR ADDRESSES
(Kelly A.-M.; Koutsogiannis Z.) Joseph Epstein Ctr. Emerg. Med. Res.,
Western Hospital, Private Bag, Footscray, Vic. 3011, Australia.
CORRESPONDENCE ADDRESS
A.-M. Kelly, Joseph Epstein Ctr. Emerg. Med. Res., Western Hospital, Private
Bag, Footscray, Vic. 3011, Australia. Email: Anne-Maree.Kelly@wh.org.au
SOURCE
Emergency Medicine Journal (2002) 19:4 (375). Date of Publication: 2002
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug dose, drug therapy, intramuscular drug
administration, intranasal drug administration, parenteral drug
administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
assisted ventilation
breathing
clinical article
dose response
drug efficacy
drug overdose
drug toxicity
emergency ward
heroin dependence (drug therapy, therapy)
human
injection
letter
medical decision making
needlestick injury (complication)
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Drug Literature Index (37)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002274194
MEDLINE PMID
12101174 (http://www.ncbi.nlm.nih.gov/pubmed/12101174)
PUI
L34830509
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1190
TITLE
Methadone poisoning in an one-year-old child treated by continuous infusion
of naloxone
ORIGINAL (NON-ENGLISH) TITLE
Intoxication par la méthadone chez un enfant d'un an traité par perfusion
continue de naloxone
AUTHOR NAMES
Leblanc A.
Benbrick N.
Moreau M.H.
AUTHOR ADDRESSES
(Leblanc A., antoine.leblanc@easynet.fr; Benbrick N.) Service de
Pédiatrie-néonatologie, Centre Hospitalier Sud-francilien, 91014 Évry Cedex,
France.
(Moreau M.H.) Laboratoire de Biologie, Centre Hospitalier Sud-francilien,
91014 Évry Cedex, France.
CORRESPONDENCE ADDRESS
A. Leblanc, Service de Pediatrie-Neonatologie, Centre Hospitalier
Sud-Francilien, 91014 Évry Cedex, France. Email: antoine.leblanc@easynet.fr
SOURCE
Archives de Pediatrie (2002) 9:7 (694-696). Date of Publication: 2002
ISSN
0929-693X
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
Methadone is a synthetic narcotic used in opioid dependant situations. Child
intoxications are harmful, sometimes responsible for death. Case report. -
An one-year-old infant was seen in the emergency room, two hours after
accidental methadone ingestion. He presented with coma, myosis and
respiratory depression. After intubation, symptoms disappeared with naloxone
injection. For maintaining this child safe, naloxone was given by continuous
infusion during 48 hours. Conclusion. - Patients, families and professionals
should be informed of the risks of methadone intoxication. Owing to
methadone long duration of action, initial injection of naloxone, the
specific opioid antagonist, must be followed by continuous infusion. © 2002
Éditions scientifiques et médicales Elsevier SAS.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
opiate antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
continuous infusion
drug intoxication (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
case report
clinical feature
disease course
emergency treatment
human
preschool child
risk assessment
treatment outcome
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2002265919
MEDLINE PMID
12162157 (http://www.ncbi.nlm.nih.gov/pubmed/12162157)
PUI
L34803364
DOI
10.1016/S0929-693X(01)00967-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0929-693X(01)00967-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1191
TITLE
A young woman with altered mental status
AUTHOR NAMES
Liu S.W.
Kumar A.M.
Nadel E.S.
Brown D.F.M.
AUTHOR ADDRESSES
(Liu S.W.; Kumar A.M.; Nadel E.S.; Brown D.F.M.) Division of Emergency
Medicine, Harvard Medical School, Boston, MA, United States.
(Nadel E.S.; Brown D.F.M.) Department of Emergency Medicine, Brigham and
Women's Hospital, Boston, MA, United States.
(Nadel E.S.) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, MA, United States.
(Nadel E.S.) Department of Emergency Medicine, Brigham and Women's Hospital,
75 Francis Street, Boston, MA 02115, United States.
CORRESPONDENCE ADDRESS
E.S. Nadel, Department of Emergency Medicine, Brigham and Women's Hospital,
75 Francis Street, Boston, MA 02115, United States.
SOURCE
Journal of Emergency Medicine (2002) 22:4 (405-408). Date of Publication:
2002
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
EMTREE DRUG INDEX TERMS
ceftriaxone
charcoal
glucose (pharmacology)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
mental health
milk alkali syndrome (diagnosis)
syndrome (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
computer assisted tomography
differential diagnosis
disease control
electrocardiography
emergency ward
female
human
laboratory test
medical examination
priority journal
symptom
treatment outcome
CAS REGISTRY NUMBERS
ceftriaxone (73384-59-5, 74578-69-1)
charcoal (16291-96-6)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002251172
MEDLINE PMID
12113853 (http://www.ncbi.nlm.nih.gov/pubmed/12113853)
PUI
L34756315
DOI
10.1016/S0736-4679(02)00450-X
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(02)00450-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1192
TITLE
Introducing a simple, weight-based, color-coded, medication dosing device
AUTHOR NAMES
Slishman S.
Sapien R.
Crandall C.S.
AUTHOR ADDRESSES
(Slishman S.; Sapien R., rsapien@salud.unm.edu; Crandall C.S.) Department of
Emergency Medicine, University of New Mexico Health Sciences Center,
Albuquerque, NM, United States.
(Sapien R., rsapien@salud.unm.edu) University of New Mexico Health Sciences
Center, Department of Emergency Medicine, ACC 4-W, Albuquerque, NM
87131-5246, United States.
CORRESPONDENCE ADDRESS
R. Sapien, Univ. of New Mexico Hlth. Sci. Ctr., Department of Emergency
Medicine, ACC 4-W, Albuquerque, NM 87131-5246, United States. Email:
rsapien@salud.unm.edu
SOURCE
Pediatric Emergency Care (2002) 18:3 (212-215). Date of Publication: 2002
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Objective: To compare the time required to withdraw various pediatric
resuscitation medications using traditional techniques and the Per-Kilo
Doser (PKD), a new weight-based dosing device. Methods: Seven emergency
department nurses were each videotaped as they withdrew medications for four
different pediatric resuscitation scenarios. In random order, each nurse
performed a total of eight timing trials-four with traditional techniques
and four with the PKD. The videotapes were later reviewed and timed by two
reviewers who were unaware of the study purpose. The time to drug withdrawal
(announcement of medication and dose to be withdrawn until the nurse
completed medication withdrawal) was measured in seconds. Nonparametric and
exact techniques were used to determine statistical significance. Results:
Using traditional techniques, the mean time to drug withdrawal was 71.8
seconds; using the PKD, the mean time to drug withdrawal was 43.1 seconds.
The mean time difference between the PKD and traditional techniques was 29.2
seconds (95% CI, 16.7-41.7). Conclusion: The PKD decreases medication
withdrawal time.
EMTREE DRUG INDEX TERMS
adenosine (drug dose)
atropine (drug dose)
epinephrine (drug dose, intratracheal drug administration, intravenous drug
administration, subcutaneous drug administration)
etomidate (drug dose)
fentanyl (drug dose)
ketamine (drug dose)
lidocaine (drug dose)
lorazepam (drug dose)
midazolam (drug dose)
morphine (drug dose)
naloxone (drug dose)
suxamethonium (drug dose)
vecuronium (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dosimetry
resuscitation
EMTREE MEDICAL INDEX TERMS
article
coding
color
devices
emergency ward
intermethod comparison
nurse
weight
DEVICE TRADE NAMES
Broselow tape , United StatesVital Signs
Per-Kilo Doser
DEVICE MANUFACTURERS
(United States)Vital Signs
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
suxamethonium (306-40-1, 71-27-2)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Biophysics, Bioengineering and Medical Instrumentation (27)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002232710
MEDLINE PMID
12066012 (http://www.ncbi.nlm.nih.gov/pubmed/12066012)
PUI
L34694707
DOI
10.1097/00006565-200206000-00016
FULL TEXT LINK
http://dx.doi.org/10.1097/00006565-200206000-00016
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1193
TITLE
Clinical experience with intrathecal bupivacaine in combination with opioid
for the treatment of chronic pain related to failed back surgery syndrome
and metastatic cancer pain of the spine
AUTHOR NAMES
Deer T.R.
Caraway D.L.
Kim C.K.
Dempsey C.D.
Stewart C.D.
McNeil K.F.
AUTHOR ADDRESSES
(Deer T.R., doctdeer@aol.com; Kim C.K.; Dempsey C.D.; Stewart C.D.; McNeil
K.F.) Center for Pain Relief, 1201 Washington Street, Charleston, WV 25301,
United States.
(Deer T.R., doctdeer@aol.com) West Virginia University, Department of Pain
Medicine, Charleston Area Medical Center, 3200 MacCorkle Avenue, SE,
Charleston, WV, 25304, United States.
(Caraway D.L.) Center for Pain Relief, Huntington, WV, United States.
(Deer T.R., doctdeer@aol.com) Center for Pain Relief, 400 Court Street,
Charleston, WV 25301, United States.
CORRESPONDENCE ADDRESS
T.R. Deer, The Center For Pain Relief, 400 Court Street, Charleston, WV
25301, United States. Email: DocTDeer@aol.com
SOURCE
Spine Journal (2002) 2:4 (274-278). Date of Publication: 8 Jul 2002
ISSN
1529-9430
BOOK PUBLISHER
Elsevier Inc.
ABSTRACT
Background context: Bupivacaine is a local anesthetic agent of the amide
class. This drug has been used in many clinical situations including
intrathecal infusion. The literature regarding intrathecal bupivacaine is
limited to small case studies, and anecdotal reports. This article examines
a large patient group receiving bupivacaine with opioids over an extended
period of time and analyzes efficacy and safety. The patients had pain
related to failed back surgery syndrome or metastatic cancer to the spine.
Purpose: The purpose of this study was to determine the efficacy and safety
of intrathecal bupivacaine combined with opioids for treatment of pain of
spinal origin when opioids alone were inadequate. The secondary purpose of
this study was to determine if the combination of bupivacaine and opioids
created a neurological safety risk. Study design/setting: The study design
was retrospective, and involved consecutive medical records review by a
disinterested third party. Patient sample: One hundred nine consecutive
patients were studied for a total of 6,780 patient weeks of
bupivacaine/opioid infusion. These data were compared with a comparable time
in the opioid alone treatment arm. The population included 84 noncancer
patients and 25 cancer patients. Outcome measures: The primary outcome
measure was pain relief obtained by a group of patients with a combination
of bupivacaine and opioids as compared with opioid alone when delivered by
intrathecal infusion. The visual analog scale was used to measure pain
levels. Secondary objectives included measuring the amount of oral and
transdermal medication required (opioid and nonopioid), emergency visits,
routine office visits and patient satisfaction. These secondary objectives
give a measure of health-care utilization. We also reviewed neurological
complications during the combined arm of treatment. Methods: The study was
done retrospectively with 109 consecutive patients. Patient chart reviews
were used to determine the visual analog scales, amount of oral opioids,
oral nonopioid adjuvant and patient safisfaction ratings. Patient
satisfaction and pain rating was measured by a visual analog scale. Other
factors recorded were emergency room visits, doctor's visits (other than the
primary pain physician) and pain center visits. We also reviewed records for
neurological deficits in the opioid arm and the combined arm. The t test was
used to analyze statistical significance. Results: The findings suggested
that in the combination arm the pain relief was significantly better
(p=.008), the number of oral opioids used were significantly less (p=.008),
the number of oral nonopioid adjuvants were reduced, the number of doctor's
visits were less in the combined arm (p=.008), the number of pain clinic
visits were less (p=.03), the number of emergency visits were significantly
less (p=.01) and patient satisfaction was better (p=.003). The total dose of
morphine was reduced by 23% in the combined arm (p=.005). During the course
of treatment with intrathecal bupivacaine, there were no irreversible
complications. Conclusion: Bupivacaine, when used in combination with
opioids, is a helpful and safe method of treatment in a select population of
patients who have not responded to intrathecal opioids alone. © 2002
Elsevier Science Inc. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bupivacaine (adverse drug reaction, drug administration, drug combination,
drug comparison, drug therapy, intrathecal drug administration,
pharmacology)
opiate (adverse drug reaction, drug combination, drug comparison, drug
therapy, intrathecal drug administration, oral drug administration,
pharmacology, transdermal drug administration)
EMTREE DRUG INDEX TERMS
amide (drug administration, drug combination, drug therapy, intrathecal drug
administration, pharmacology)
analgesic agent (drug therapy)
anticonvulsive agent (drug therapy)
antidepressant agent (drug therapy)
barbituric acid derivative (drug therapy)
hydromorphone (drug therapy, intrathecal drug administration)
local anesthetic agent (adverse drug reaction, drug administration, drug
combination, drug comparison, drug therapy, intrathecal drug administration,
pharmacology)
morphine (drug combination, drug dose, drug therapy, intrathecal drug
administration)
narcotic analgesic agent (drug administration, drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
spasmolytic agent (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (complication, drug therapy)
chronic pain (complication, drug therapy)
spine cancer
EMTREE MEDICAL INDEX TERMS
adult
aged
analgesia
article
backache (drug therapy, etiology)
cancer patient
combination chemotherapy
controlled study
dose response
drug combination
drug efficacy
drug infusion
drug safety
edema (side effect)
female
health care utilization
human
infusion pump (adverse drug reaction)
intraspinal drug administration
major clinical study
male
medical record
metastasis
neurological complication (side effect)
outcomes research
pain assessment
patient satisfaction
postoperative pain (drug therapy)
rating scale
retrospective study
risk assessment
spinal cord tumor (complication)
spine (surgery)
spine disease
spine metastasis
visual analog scale
CAS REGISTRY NUMBERS
amide (17655-31-1)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
tramadol (27203-92-5, 36282-47-0)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
MEDLINE PMID
14589479 (http://www.ncbi.nlm.nih.gov/pubmed/14589479)
PUI
L35154356
DOI
10.1016/S1529-9430(02)00199-7
FULL TEXT LINK
http://dx.doi.org/10.1016/S1529-9430(02)00199-7
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1194
TITLE
Intravenous or intramuscular/subcutaneous naloxone in opioid overdose
AUTHOR NAMES
Clarke S.
Dargan P.
AUTHOR ADDRESSES
(Clarke S.; Dargan P.)
SOURCE
Emergency Medicine Journal (2002) 19:3 (249). Date of Publication: 2002
ISSN
1351-0622
ABSTRACT
A short cut review was carried out to establish whether
intramuscular/subcutaneous naloxone is better than intravenous naloxone in
opioid overdose. Altogether 185 papers were found using the reported search,
of which two presented the best evidence to answer the clinical question.
The author, date and country of publication, patient group studied, study
type, relevant outcomes, results and study weaknesses of these best papers
are tabulated. A clinical bottom line is stated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug comparison, drug dose, drug therapy,
intramuscular drug administration, intravenous drug administration,
pharmacology, subcutaneous drug administration)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
opiate agonist (drug administration, drug comparison, drug dose, drug
therapy, intramuscular drug administration, intravenous drug administration,
pharmacology, subcutaneous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
dose response
drug mechanism
emergency ward
evidence based medicine
human
opiate addiction
outcomes research
short survey
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002200759
PUI
L34601156
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1195
TITLE
Intravenous bolus or infusion of naloxone in opioid overdose
AUTHOR NAMES
Clarke S.
Dargan P.
AUTHOR ADDRESSES
(Clarke S.; Dargan P.)
SOURCE
Emergency Medicine Journal (2002) 19:3 (249-250). Date of Publication: 2002
ISSN
1351-0622
ABSTRACT
A short cut review was carried out to establish whether intravenous boluses
of naloxone are better than intravenous influsion in opioid overdose.
Altogether 188 papers were found using the reported search, of which one
presented the best evidence to answer the clinical question. The author,
date and country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses of this best paper is tabulated. A
clinical bottom line is stated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug toxicity)
naloxone (drug administration, drug concentration, drug dose, drug therapy,
intravenous drug administration, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
bolus injection
breathing rate
case report
clinical protocol
dose calculation
drug blood level
drug elimination
drug infusion
drug overdose (drug therapy)
emergency ward
Glasgow coma scale
human
male
Medline
risk management
safety
short survey
withdrawal syndrome
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002200760
PUI
L34601157
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1196
TITLE
Towards evidence based emergency medicine: Best BETs from the Manchester
Royal Infirmary
AUTHOR NAMES
Mackway-Jones K.
AUTHOR ADDRESSES
(Mackway-Jones K.) Department of Emergency Medicine, Manchester Royal
Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
CORRESPONDENCE ADDRESS
K. Mackway-Jones, Department of Emergency Medicine, Manchester Royal
Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. Email:
kevin.mackway-jones@man.ac.uk
SOURCE
Emergency Medicine Journal (2002) 19:3 (247). Date of Publication: 2002
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS
antidote (drug administration, drug therapy, intravenous drug
administration, oral drug administration)
iron (drug toxicity)
naloxone (drug therapy, intramuscular drug administration, intravenous drug
administration)
opiate (drug toxicity)
paracetamol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
evidence based medicine
EMTREE MEDICAL INDEX TERMS
bolus injection
clinical practice
drug infusion
drug overdose (drug therapy)
hospital discharge
human
Internet
iron overload (therapy)
medical information
medical literature
note
opiate addiction (drug therapy)
stomach lavage
vomiting
CAS REGISTRY NUMBERS
iron (14093-02-8, 53858-86-9, 7439-89-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Toxicology (52)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002200756
MEDLINE PMID
11971839 (http://www.ncbi.nlm.nih.gov/pubmed/11971839)
PUI
L34601153
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1197
TITLE
Inventory control for advanced cardiac life support medications [4]
AUTHOR NAMES
Dager W.E.
AUTHOR ADDRESSES
(Dager W.E.) Dept. of Pharmaceutical Services, University of California,
Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817-2201,
United States.
CORRESPONDENCE ADDRESS
W.E. Dager, Dept. of Pharmaceutical Services, University of California,
Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817-2201,
United States. Email: william.dager@ucdmc.ucdavis.edu
SOURCE
Annals of Pharmacotherapy (2002) 36:5 (942-943). Date of Publication: 2002
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
benzocaine
calcium chloride
dopamine
epinephrine
glucose
EMTREE DRUG INDEX TERMS
adenosine
amiodarone
benzodiazepine derivative
bicarbonate
digoxin
dobutamine
furosemide
hydrocortisone
lidocaine
magnesium sulfate
muscle relaxant agent
naloxone
noradrenalin
phenylephrine
phenytoin
procainamide
sodium chloride
vasopressin
verapamil
water
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
resuscitation
EMTREE MEDICAL INDEX TERMS
drug labeling
emergency medicine
first aid
health care availability
hospital pharmacy
human
letter
pharmacist
priority journal
United States
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
benzocaine (1333-08-0, 94-09-7)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
digoxin (20830-75-5, 57285-89-9)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
phenytoin (57-41-0, 630-93-3)
procainamide (51-06-9, 614-39-1)
sodium chloride (7647-14-5)
vasopressin (11000-17-2)
verapamil (152-11-4, 52-53-9)
water (7732-18-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Pharmacy (39)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002175544
MEDLINE PMID
12014356 (http://www.ncbi.nlm.nih.gov/pubmed/12014356)
PUI
L34517432
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1198
TITLE
Altered mental status and agitation
AUTHOR NAMES
Bigal M.E.
Bordini C.A.
Speciali J.G.
AUTHOR ADDRESSES
(Bigal M.E.; Bordini C.A.; Speciali J.G.) Department of Neurology, School of
Medicine at Ribeirão Preto, São Paulo University, Ribeirão Preto, SP,
Brazil.
(Speciali J.G.) Department of Neurology, School of Medicine at Ribeirão
Preto, University of Sao Paulo, Av. Bandeirantes, 3900, 14049-900 Ribeirão
Preto, SP, Brazil.
CORRESPONDENCE ADDRESS
E.S. Nadel, Department of Emergency Medicine, Brigham and Women's Hospital,
75 Francis Street, Boston, MA 02115, United States.
SOURCE
Journal of Emergency Medicine (2002) 23:2 (199-202). Date of Publication:
June 2002
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
EMTREE DRUG INDEX TERMS
aciclovir (drug administration)
antibiotic agent (drug administration)
ceftriaxone (drug administration)
haloperidol (drug administration)
immunosuppressive agent
lorazepam (drug administration)
naloxone (intramuscular drug administration)
penicillin G (pharmacology)
prednisone
steroid
vancomycin (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
resident
symposium
EMTREE MEDICAL INDEX TERMS
agitation
article
asthma
building
confusion
diaphoresis
drug resistance
headache
human
malaise
mental health
nausea
priority journal
psoriasis
substance abuse
transesophageal echocardiography
transthoracic echocardiography
United States
vomiting
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
ceftriaxone (73384-59-5, 74578-69-1)
haloperidol (52-86-8)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
prednisone (53-03-2)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002416336
MEDLINE PMID
12359291 (http://www.ncbi.nlm.nih.gov/pubmed/12359291)
PUI
L35335347
DOI
10.1016/S0736-4679(02)00507-3
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(02)00507-3
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1199
TITLE
Is subcutaneous or intramuscular naloxone as effective as intravenous
naloxone in the treatment of life-threatening heroin overdose?
AUTHOR NAMES
Wasiak J.
Clavisi O.
AUTHOR ADDRESSES
(Wasiak J.; Clavisi O.) Centre for Clinical Effectiveness, Monash Inst. of
Hlth. Serv. Research, Clayton, Vic., Australia.
CORRESPONDENCE ADDRESS
J. Wasiak, Centre for Clinical Effectiveness, Monash Inst. of Hlth. Serv.
Research, Clayton, Vic., Australia. Email: cce@med.monash.edu.au
SOURCE
Medical Journal of Australia (2002) 176:10 (495). Date of Publication: 20
May 2002
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (clinical trial, drug administration, drug therapy, intramuscular
drug administration, intravenous drug administration, pharmacology,
subcutaneous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
artificial ventilation
breathing rate
clinical protocol
clinical trial
Cochrane Library
comparative study
consciousness
controlled clinical trial
controlled study
data base
drug efficacy
emergency health service
emergency ward
evidence based medicine
health care policy
human
medical staff
Medline
needlestick injury
outcomes research
physician
publication
randomization
risk management
short survey
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Toxicology (52)
Clinical and Experimental Pharmacology (30)
Health Policy, Economics and Management (36)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2002193836
MEDLINE PMID
12065016 (http://www.ncbi.nlm.nih.gov/pubmed/12065016)
PUI
L34575466
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1200
TITLE
Opioid intoxication following transdermal application of fentanyl
ORIGINAL (NON-ENGLISH) TITLE
Opioidintoxikation durch transdermales fentanyl
AUTHOR NAMES
Klockgether-Radke A.P.
Gaus P.
Neumann P.
AUTHOR ADDRESSES
(Klockgether-Radke A.P.; Gaus P.; Neumann P.) Zentrum Anaesthesiologie,
Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Germany.
CORRESPONDENCE ADDRESS
A.P. Klockgether-Radke, Zentrum Anaesthesiologie, Rettungs- und
Intensivmedizin, Georg-August-Universitat Gottingen, Robert-Koch-Straße 40,
37075 Göttingen, Germany. Email: Klockgether-Radke@gmx.de
SOURCE
Anaesthesist (2002) 51:4 (269-271). Date of Publication: 2002
ISSN
0003-2417
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
ABSTRACT
The case of a 77-year-old woman is described, who was found unconscious,
with decreased respiration and miotic pupils, having previously experienced
dizziness, nausea and drowsiness before. In the emergency room a fentanyl
patch was detected, which had obviously been mistakenly applied by the
patient the day before. Opioid intoxication was assumed and successfully
treated with naloxon. The patient was supervised in an ICU for 24 h and sent
home the next day without serious sequelae. The consequences following
inappropriate use of transdermal fentanyl are discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug toxicity, transdermal drug administration)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
aged
article
case report
drug misuse (diagnosis)
emergency treatment
female
human
iatrogenic disease (diagnosis, drug therapy, etiology)
intensive care
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2002157809
MEDLINE PMID
12063717 (http://www.ncbi.nlm.nih.gov/pubmed/12063717)
PUI
L34454454
DOI
10.1007/s00101-002-0299-4
FULL TEXT LINK
http://dx.doi.org/10.1007/s00101-002-0299-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1201
TITLE
Towards evidence based emergency medicine: best BETs from the Manchester
Royal Infirmary. Intravenous bolus or infusion of naloxone in opioid
overdose.
AUTHOR NAMES
Clarke S.
Dargan P.
AUTHOR ADDRESSES
(Clarke S.; Dargan P.)
CORRESPONDENCE ADDRESS
S. Clarke,
SOURCE
Emergency medicine journal : EMJ (2002) 19:3 (249-250). Date of Publication:
May 2002
ISSN
1472-0205
ABSTRACT
A short cut review was carried out to establish whether intravenous boluses
of naloxone are better than intravenous infusion in opioid overdose.
Altogether 188 papers were found using the reported search, of which one
presented the best evidence to answer the clinical question. The author,
date and country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses of this best paper is tabulated. A
clinical bottom line is stated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug administration)
methadone (drug toxicity)
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
comparative study
evidence based medicine
heroin dependence (therapy)
human
intoxication (therapy)
intravenous drug administration
male
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11971842 (http://www.ncbi.nlm.nih.gov/pubmed/11971842)
PUI
L35660200
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1202
TITLE
Towards evidence based emergency medicine: best BETs from the Manchester
Royal Infirmary. Intravenous or intramuscular/subcutaneous naloxone in
opioid overdose.
AUTHOR NAMES
Clarke S.
Dargan P.
AUTHOR ADDRESSES
(Clarke S.; Dargan P.)
CORRESPONDENCE ADDRESS
S. Clarke,
SOURCE
Emergency medicine journal : EMJ (2002) 19:3 (249). Date of Publication: May
2002
ISSN
1472-0205
ABSTRACT
A short cut review was carried out to establish whether
intramuscular/subcutaneous naloxone is better than intravenous naloxone in
opioid overdose. Altogether 185 papers were found using the reported search,
of which two presented the best evidence to answer the clinical question.
The author, date and country of publication, patient group studied, study
type, relevant outcomes, results and study weaknesses of these best papers
are tabulated. A clinical bottom line is stated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug administration)
naloxone (drug administration)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
evidence based medicine
heroin dependence (therapy)
human
intramuscular drug administration
intravenous drug administration
male
subcutaneous drug administration
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11971843 (http://www.ncbi.nlm.nih.gov/pubmed/11971843)
PUI
L35660201
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1203
TITLE
Emergency analgesia in the paediatric population. Part II. Pharmacological
methods of pain relief
AUTHOR NAMES
Maurice S.C.
O'Donnell J.J.
Beattie T.F.
AUTHOR ADDRESSES
(Maurice S.C.; O'Donnell J.J.; Beattie T.F.) Accident and Emergency
Department, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester
M23 9LT, United Kingdom.
CORRESPONDENCE ADDRESS
S.C. Maurice, Accident and Emergency Department, Wythenshawe Hospital,
Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom. Email:
sue.maurice@gw.smuht.nwest.nhs.uk
SOURCE
Emergency Medicine Journal (2002) 19:2 (101-105). Date of Publication: 2002
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
The first paper in this series examined some of the reasons for poor
provision of analgesia to children in accident and emergency departments. In
this paper we discuss the pharmacological agents available for systemic and
local administration in the management of children's pain in the emergency
environment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, clinical trial, drug administration,
drug dose, drug interaction, drug therapy, inhalational drug administration,
intramuscular drug administration, intranasal drug administration,
intravenous drug administration, oral drug administration, pharmaceutics,
pharmacoeconomics, pharmacokinetics, pharmacology, rectal drug
administration)
anesthetic agent (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy, inhalational drug administration, pharmaceutics,
pharmacoeconomics, pharmacokinetics, pharmacology, topical drug
administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, drug comparison, drug therapy,
pharmacoeconomics, pharmacology)
alprenolol (adverse drug reaction, drug therapy, pharmaceutics,
pharmacokinetics)
benzodiazepine
bupivacaine (drug comparison, drug therapy, pharmacology)
cocaine (adverse drug reaction, drug combination, drug dose, drug therapy,
pharmaceutics)
codeine (adverse drug reaction, drug administration, drug combination, drug
dose, drug interaction, drug therapy, intravenous drug administration, oral
drug administration)
diamorphine (clinical trial, drug administration, drug therapy, intranasal
drug administration, intravenous drug administration, pharmacokinetics,
pharmacology)
diclofenac (drug therapy, oral drug administration, pharmacoeconomics,
rectal drug administration)
epinephrine (adverse drug reaction, drug combination, drug dose, drug
therapy, pharmaceutics)
fentanyl (adverse drug reaction, drug administration, drug combination, drug
dose, drug therapy, intranasal drug administration, intravenous drug
administration, pharmacokinetics, pharmacology)
ibuprofen (adverse drug reaction, drug comparison, drug therapy, oral drug
administration, pharmaceutics, pharmacoeconomics, pharmacology)
ketamine (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration, pharmacology)
lidocaine (drug comparison, drug dose, drug therapy, subcutaneous drug
administration)
lidocaine plus prilocaine (adverse drug reaction, drug comparison, drug
therapy, pharmaceutics, pharmacokinetics)
morphine (adverse drug reaction, drug administration, drug comparison, drug
therapy, intravenous drug administration, oral drug administration,
pharmacokinetics, pharmacology, rectal drug administration)
naloxone (drug therapy)
nitrous oxide (drug therapy, inhalational drug administration)
nitrous oxide plus oxygen (drug comparison, drug therapy, inhalational drug
administration, pharmaceutics, pharmacology)
nonsteroid antiinflammatory agent (adverse drug reaction, drug comparison,
drug therapy, oral drug administration, pharmaceutics, pharmacology, rectal
drug administration)
opiate (adverse drug reaction, clinical trial, drug administration, drug
combination, drug comparison, drug dose, drug interaction, drug therapy,
intranasal drug administration, intravenous drug administration, oral drug
administration, pharmacokinetics, rectal drug administration)
paracetamol (drug combination, drug comparison, drug dose, drug interaction,
drug therapy, oral drug administration, pharmaceutics, pharmacoeconomics,
pharmacology, rectal drug administration)
pethidine (adverse drug reaction, drug comparison, drug therapy, intravenous
drug administration)
tetracaine (adverse drug reaction, drug combination, drug dose, drug
therapy, pharmaceutics, pharmacokinetics, pharmacology, topical drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (disease management, drug therapy)
pediatric anesthesia
EMTREE MEDICAL INDEX TERMS
anaphylaxis (side effect)
bronchospasm (side effect)
chickenpox (drug therapy)
child
clinical trial
cream
dose response
drug absorption
drug activity
drug bioavailability
drug cost
drug delivery system
drug effect
drug efficacy
drug formulation
drug megadose
drug metabolism
drug potentiation
drug receptor binding
drug safety
drug synthesis
drug tolerability
drug use
emergency treatment
emergency ward
face mask
gastrointestinal disease (side effect)
hallucination (side effect)
hematoma (side effect)
hospital discharge
human
hypotension (side effect)
influenza (drug therapy)
ischemia (side effect)
local anesthesia
maximum permissible dose
nausea and vomiting (side effect)
neuromuscular blocking
patient monitoring
respiratory distress (side effect)
review
Reye syndrome (side effect)
side effect (side effect)
suppository
toxicity (side effect)
DRUG TRADE NAMES
ametop Smith and Nephew
astra
DRUG MANUFACTURERS
Smith and Nephew
CAS REGISTRY NUMBERS
EMLA (101362-25-8)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alprenolol (13655-52-2, 13707-88-5, 39405-98-6, 58615-82-0)
benzodiazepine (12794-10-4)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
diclofenac (15307-79-6, 15307-86-5)
fentanyl (437-38-7)
ibuprofen (15687-27-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
nitrous oxide plus oxygen (54510-89-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tetracaine (136-47-0, 94-24-6)
EMBASE CLASSIFICATIONS
Pharmacy (39)
Drug Literature Index (37)
Health Policy, Economics and Management (36)
Clinical and Experimental Pharmacology (30)
Adverse Reactions Titles (38)
Anesthesiology (24)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002128315
MEDLINE PMID
11904252 (http://www.ncbi.nlm.nih.gov/pubmed/11904252)
PUI
L34279605
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1204
TITLE
Medical service use and financial charges among opioid users at a public
hospital
AUTHOR NAMES
Masson C.L.
Sorensen J.L.
Batki S.L.
Okin R.
Delucchi K.L.
Perlman D.C.
AUTHOR ADDRESSES
(Masson C.L., masson@itsa.ucsf.edu; Sorensen J.L.; Okin R.) Department of
Psychiatry, University of California San Francisco, San Francisco General
Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
(Masson C.L., masson@itsa.ucsf.edu; Sorensen J.L.; Okin R.; Delucchi K.L.)
Department of Psychiatry, University of California San Francisco, 401
Parnassus Avenue, San Francisco, CA 94143, United States.
(Batki S.L.) Department of Psychiatry, SUNY Upstate Medical University, 750
East Adams Street, Syracuse, NY 13210, United States.
(Perlman D.C.) Department of Medicine, Beth Israel Medical Center, First
Avenue at 16th Street, New York, NY 10003, United States.
CORRESPONDENCE ADDRESS
C.L. Masson, Department of Psychiatry, Univ. of California San Francisco,
1001 Potrero Avenue, San Francisco, CA 94110, United States. Email:
masson@itsa.ucsf.edu
SOURCE
Drug and Alcohol Dependence (2002) 66:1 (45-50). Date of Publication: 1 Mar
2002
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
We examined the prevalence of drug use related infectious complications
among opioid using or dependent individuals and service charges associated
with medical care received over a 2-year period at a public hospital. A
computerized medical record review was used to identify 3147 individuals
with diagnoses related to opioid use or dependence. Forty-nine percent of
these patients were treated for bacterial infections and 30% presented for
treatment of medical problems arising from the effects of the drugs
themselves (e.g. drug withdrawal, overdoses, and drug-induced psychiatric
symptoms). Mean charges were $13 393 for these patients, nearly 2.5 times
the average per patient charges for non-opioid using patients during the
study period. Patients with diagnoses related to opioid use or dependence
comprised 2% of the total patient population for this period, yet accounted
for 5% of total charges. Homeless patients were less likely to have used
ambulatory services and were more likely than non-homeless patients to have
used emergency and inpatient services. Early detection of patients with
opioid use or dependence problems, coupled with effective strategies to
engage them in ambulatory preventive services, could allow interventions to
reduce morbidity and associated charges in this patient population. The
findings suggest that health care providers and policy makers consider
polices that promote ambulatory care use among opioid users seeking medical
care through the public health care system. © 2002 Elsevier Science Ireland
Ltd. All rights reserved.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug use
hospital cost
medical service
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
anamnesis
article
automation
bacterial infection (complication, epidemiology)
clinical feature
clinical trial
controlled clinical trial
controlled study
disease association
drug overdose (complication)
drug withdrawal
emergency treatment
health care
health care policy
homelessness
hospital patient
human
major clinical study
medical care
mental disease (complication)
morbidity
opiate addiction (diagnosis, disease management)
prevalence
priority journal
public health service
public hospital
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Public Health, Social Medicine and Epidemiology (17)
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002071131
MEDLINE PMID
11850135 (http://www.ncbi.nlm.nih.gov/pubmed/11850135)
PUI
L34159255
DOI
10.1016/S0376-8716(01)00182-X
FULL TEXT LINK
http://dx.doi.org/10.1016/S0376-8716(01)00182-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1205
TITLE
Intranasal administration of naloxone by paramedics
AUTHOR NAMES
Barton E.D.
Ramos J.
Colwell C.
Benson J.
Baily J.
Dunn W.
AUTHOR ADDRESSES
(Barton E.D.; Ramos J.; Colwell C.; Benson J.; Baily J.; Dunn W.) Division
of Emergency Medicine, University of Utah Health Sciences Center (EDB), Salt
Lake City, UT, United States.
CORRESPONDENCE ADDRESS
E.D. Barton, Univ. of Utah Health Sciences Center, Division of Emergency
Medicine, 1150 Moran Building, 175 North Medical Drive East, Salt Lake City,
UT 84132, United States. Email: edbarton@worldnet.att.net
SOURCE
Prehospital Emergency Care (2002) 6:1 (54-58). Date of Publication: 2002
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Introduction. Naloxone is a medication that is frequently administered in
the field by paramedics for suspected opioid overdoses. Most prehospital
protocols, however, require this medication to be given to patients
intravenously (IV) or intramuscularly (IM). Unfortunately, intravenous line
placement may be problematic and time-consuming in chronic IV drug users.
There may also be a delay in patient response to opioid reversal with IM
absorption of naloxone. Additionally, routine use of needles in high-risk
populations poses an increased risk of occupational blood exposures to
paramedics. Objective. To prospectively test the effectiveness of intranasal
(IN) naloxone administration by paramedics. This preliminary report
summarizes the first month's experience in the city of Denver. Methods.
Naloxone was first administered to patients found unconscious in the field
using a nasal mucosal atomizer device (MAD). Patients were then treated
using standard prehospital protocols, which included IV line placement and
medications, if they did not immediately respond to IN naloxone. Time to
patient response was recorded. Results. A total of 30 patients received IN
naloxone in the field over a one-month period. Of these, 11 patients
responded to either IN or IV naloxone. Ten (91%) patients responded to IN
naloxone alone, with an average response time of 3.4 minutes. Seven patients
(64%) did not require an IV in the field after response to IN naloxone.
Conclusions. Intranasal naloxone may provide a safe, rapid, effective way to
manage suspected opioid overdoses in the field. Use of this route may
decrease paramedic exposures to blood-borne diseases. The addition of IN
naloxone administration to prehospital protocols should be considered as an
initial therapy for suspected opioid abusers.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug comparison, drug dose, drug therapy,
intranasal drug administration, intravenous drug administration,
pharmacokinetics)
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
clinical article
clinical protocol
emergency health service
high risk population
human
nebulizer
occupational exposure
paramedical personnel
DRUG TRADE NAMES
narcan
DEVICE TRADE NAMES
Mucosal Atomizer Device , United StatesWolfe Tory
DEVICE MANUFACTURERS
(United States)Wolfe Tory
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Psychiatry (32)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002018438
MEDLINE PMID
11789651 (http://www.ncbi.nlm.nih.gov/pubmed/11789651)
PUI
L34041913
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1206
TITLE
GHB: An important pharmacologic and clinical update
AUTHOR NAMES
Okun M.S.
Boothby L.A.
Bartfield R.B.
Doering P.L.
AUTHOR ADDRESSES
(Okun M.S., msokun@dnamail.com; Boothby L.A.) Emory University, Department
of Neurology, Atlanta, GA, United States.
(Okun M.S., msokun@dnamail.com; Bartfield R.B.; Doering P.L.) University of
Florida, Department of Neurology, Brain Institute, Gainesville, GA, United
States.
CORRESPONDENCE ADDRESS
M.S. Okun, Emory University, Department of Neurology, Wesley Woods Health
Center, 1841 Clifton Road NE, Atlanta, GA, United States. Email:
msokun@dnamail.com
SOURCE
Journal of Pharmacy and Pharmaceutical Sciences (2001) 4:2 (167-175). Date
of Publication: 2001
ISSN
1482-1826
BOOK PUBLISHER
Canadian Society for Pharmaceutical Sciences, 3118 Dentistry/Pharmacy
Centre, Univ. of Alberta Campus, Edmonton, Canada.
ABSTRACT
Gamma-hydroxybutyrate (GHB) intoxication is a significant cause of morbidity
and mortality in patients taking the drug for recreational purposes. Due to
the recent increase in emergency room visits, hospital admissions, and
deaths, it has become necessary to re-examine the pharmacology,
pharmacokinetics, pharmacodynamics, clinical manifestations, and potential
adverse effects associated with GHB use. We present an important
pharmacologic and clinical update on GHB.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 hydroxybutyric acid (adverse drug reaction, drug comparison, drug
interaction, drug therapy, oral drug administration, pharmacokinetics,
pharmacology)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid (endogenous compound)
4 aminobutyric acid A receptor (endogenous compound)
4 aminobutyric acid B receptor (endogenous compound)
alcohol
amphetamine (pharmacology)
anticonvulsive agent (drug therapy)
benzodiazepine (adverse drug reaction, drug therapy)
clonazepam (drug therapy)
cocaine
cyclic GMP (endogenous compound)
diamorphine
diazepam (drug comparison, drug therapy)
dopamine (endogenous compound)
dopamine receptor stimulating agent (pharmacology)
ethosuximide (drug therapy)
growth hormone (endogenous compound)
methamphetamine
midomafetamine
naloxone (drug interaction, drug therapy)
neurotransmitter (endogenous compound)
noradrenalin (endogenous compound)
opiate (adverse drug reaction, drug comparison)
opiate receptor (endogenous compound)
oxybate sodium (drug therapy)
physostigmine (adverse drug reaction, drug therapy, intravenous drug
administration)
placebo
serotonin (endogenous compound)
unindexed drug
valproic acid (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS
alcohol withdrawal syndrome (drug therapy)
amnesia (side effect)
animal experiment
animal model
arousal
bradycardia (side effect)
clinical feature
coma (side effect)
confusion (side effect)
controlled study
dopaminergic system
drug abuse
drug antagonism
drug dependence treatment
drug elimination
drug intoxication (drug therapy)
drug mechanism
drug use
epilepsy (drug therapy, side effect)
hospital admission
human
hyperpolarization
hypotension (side effect)
morbidity
mortality
muscle hypotonia (side effect)
narcolepsy (drug therapy)
nausea and vomiting (side effect)
nonhuman
recreation
respiration depression (side effect)
review
risk benefit analysis
sleep stage
somnolence (side effect)
unconsciousness (side effect)
vertigo (side effect)
DRUG TRADE NAMES
xyrem Orphan
DRUG MANUFACTURERS
Orphan
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 aminobutyric acid (28805-76-7, 56-12-2)
4 hydroxybutyric acid (591-81-1)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
benzodiazepine (12794-10-4)
clonazepam (1622-61-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
cyclic GMP (7665-99-8)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
ethosuximide (77-67-8)
growth hormone (36992-73-1, 37267-05-3, 66419-50-9, 9002-72-6)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxybate sodium (502-85-2)
physostigmine (57-47-6, 64-47-1)
serotonin (50-67-9)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002139333
MEDLINE PMID
11466174 (http://www.ncbi.nlm.nih.gov/pubmed/11466174)
PUI
L34305608
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1207
TITLE
Acute drug intoxication
ORIGINAL (NON-ENGLISH) TITLE
Akute drogenintoxikatinen
AUTHOR NAMES
Poser W.
Tönnies E.
AUTHOR ADDRESSES
(Poser W.; Tönnies E.) Klin. fur Psychiat./Psychother., Klinikum der
Universitat Gottingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany.
CORRESPONDENCE ADDRESS
W. Poser, Klin. fur Psychiat./Psychother., Klinikum der Universitat
Gottingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany. Email:
wposer@gwdg.de
SOURCE
Notfall Medizin (2001) 27:10 (472-476). Date of Publication: 2001
ISSN
0341-2903
ABSTRACT
The term "drug emergency" covers numerous differ conditions, degrees of
intoxication and withdrawal symptoms. As a result, a concrete case requires
a certain diagnostic effort. History-taking is not always possible, for
example, when the patient is comatose, confused or psychotic. In such a case
information from friends/relations and the situation itself provide initial
clues. Pupil size, pulse rate, blood pressure, hyperactivity and bowel
sounds together enable good differentiation of the individual pathological
states. On account of its depressive effect on respiration, opioid
intoxication is the most threatening situation, and often makes artificial
ventilation or administration of antagonists (naloxone) necessary. Grand mal
seizures are mostly due to alcohol or benzodiazepine withdrawal, but
occasionally point to cocaine intoxication.
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
barbituric acid derivative
benzodiazepine derivative (drug toxicity)
biperiden
cannabis (drug toxicity)
cholinergic receptor blocking agent
clomethiazole
cocaine (drug toxicity)
codeine
diamorphine
diazepam
dihydrocodeine
flunitrazepam
levomethadone
lorazepam
midomafetamine (drug toxicity)
morphine
naloxone (drug therapy)
opiate (drug toxicity)
oxazepam
psychostimulant agent (drug toxicity)
tilidine
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
anamnesis
artificial ventilation
blood pressure
coma (complication)
confusion (complication)
diagnostic procedure
drug withdrawal
emergency health service
human
hyperactivity (complication)
intestine motility
panic
psychosis (complication)
pulse rate
pupil
respiration depression (complication)
short survey
tonic clonic seizure (complication, etiology)
withdrawal syndrome
DRUG TRADE NAMES
akineton
distraneurin
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
alcohol (64-17-5)
biperiden (1235-82-1, 514-65-8)
cannabis (8001-45-4, 8063-14-7)
clomethiazole (1867-58-9, 533-45-9)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
flunitrazepam (1622-62-4)
levomethadone (125-58-6)
lorazepam (846-49-1)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
tilidine (20380-58-9, 27107-79-5)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001390807
PUI
L33031759
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1208
TITLE
Drug self-help - Prevention of drug-related emergencies?
ORIGINAL (NON-ENGLISH) TITLE
Drogenselbsthilfe - Prävention von drogennotfällen?
AUTHOR NAMES
Korporal J.
Dangel B.
AUTHOR ADDRESSES
(Korporal J.; Dangel B.) Alice-Salomon-Fachhochschule, Alice-Salomon-Platz
5, 12627 Berlin, Germany.
CORRESPONDENCE ADDRESS
J. Korporal, Alice-Salomon-Fachhochschule, Alice-Salomon-Platz 5, 12627
Berlin, Germany. Email: korporal@asfh-berlin.de
SOURCE
Notfall Medizin (2001) 27:10 (488-491). Date of Publication: 2001
ISSN
0341-2903
ABSTRACT
Against the background of the continuing high incidence of drug-related
deaths reflecting the fatal outcome of frequent drug-induced emergencies, an
approach is discussed that aims to help prevent such events by providing
support and lay-medical qualification of drug self-aiders. This exploratory
approach reflects the fact that drug consumption is increasingly withdrawing
into "private" areas that are less readily accessible to medical rescue
services. As a rule, drug users have experience with emergency situation,
are motivated to provide help, are rarely alone in the event of an
emergency, and, in such a case, are more ready to take on the responsibility
of providing immediate first-aid measures and tiding over the time elapsing
until professional help is available. In a model project involving mobile
training units, drug users were given training in first-aid measures and in
the criterion-directed application the antidote, naloxone. The results and
experience gained during this project confirmed this approach to be both
effective and feasible.
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, epidemiology, prevention, therapy)
self help
EMTREE MEDICAL INDEX TERMS
drug use
emergency health service
feasibility study
first aid
incidence
medical education
mortality
patient education
short survey
social support
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001390810
PUI
L33031762
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1209
TITLE
Acute intoxications in children
ORIGINAL (NON-ENGLISH) TITLE
Intoxications aiguës de l'enfant
AUTHOR NAMES
Lavaud J.
Chouakri O.A.
AUTHOR ADDRESSES
(Lavaud J.; Chouakri O.A.) SMUR Pédiatrique, Hôpital Necker-Enfants malades,
SAMU de Paris, Pr P. Carli, 75743 Paris Cedex 15, France.
CORRESPONDENCE ADDRESS
J. Lavaud, SMUR Pédiatrique, Hôpital Necker-Enfants malades, SAMU de Paris,
Pr P. Carli, 75743 Paris Cedex 15, France.
SOURCE
Revue du Praticien (2001) 51:17 (1909-1913). Date of Publication: 1 Nov 2001
ISSN
0035-2640
BOOK PUBLISHER
Huveaux France, 114 Avenue Charles de Gaulle, Neuilly sur Seine, France.
ABSTRACT
Acute intoxications of children remain too frequents, despite of an open
decrease of mortality and a regression of morbidity in less than 20 years.
Medicaments are in the majority, but their gravity concern the house
caustic, industrial products (White spirit, oil, antifreeze), fertilizers
and herbicides, the carbon monoxyde intoxication. Many parents are careless
or make several behaviour's mistakes, which mislead youngers of less 4 or 5
years. Quick help to regional CAP, or 15 by failure, good medical advice,
early arrival to emergency unit, or the displacement, very exceptional, of
SMUR's team, at last, now well systematize therapeutics indications have
allowed to realize very great progress since the eighties.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
acid anhydride (drug toxicity)
alcohol (drug toxicity)
antidepressant agent (drug toxicity)
antidote (drug therapy)
atropine (drug toxicity)
barbituric acid derivative (drug toxicity)
benzodiazepine derivative (drug toxicity)
carbamic acid derivative (drug toxicity)
carbon monoxide (drug toxicity)
charcoal (drug therapy)
colchicine (drug toxicity)
digitalis (drug toxicity)
domestic chemical (drug toxicity)
fertilizer (drug toxicity)
flumazenil (drug therapy)
herbicide (drug toxicity)
hydroxocobalamin (drug therapy)
industrial chemical (drug toxicity)
naloxone (drug therapy)
opiate (drug toxicity)
osmotic diuretic agent (drug therapy)
oxygen
paracetamol (drug therapy, drug toxicity, rectal drug administration)
phenothiazine derivative (drug toxicity)
quinine (drug toxicity)
salicylic acid derivative (drug toxicity)
sodium chloride
theophylline (drug toxicity)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
alcohol intoxication (epidemiology, therapy)
carbon monoxide intoxication (epidemiology, therapy)
child
diuresis
drug intoxication (drug therapy, epidemiology, therapy)
emergency treatment
food poisoning (epidemiology)
human
morbidity
mortality
poison center
review
stomach lavage
DRUG TRADE NAMES
anexate
carbomix
doliprane
narcan
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
charcoal (16291-96-6)
colchicine (64-86-8)
digitalis (8031-42-3, 8053-83-6)
flumazenil (78755-81-4)
hydroxocobalamin (13422-51-0, 13422-52-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
paracetamol (103-90-2)
quinine (130-89-2, 130-95-0, 14358-44-2, 549-48-4, 549-49-5, 60-93-5,
7549-43-1)
sodium chloride (7647-14-5)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2001396590
MEDLINE PMID
11787223 (http://www.ncbi.nlm.nih.gov/pubmed/11787223)
PUI
L33042246
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1210
TITLE
Delayed awakening or emergence from anaesthesia
AUTHOR NAMES
Radhakrishnan J.
Jesudasan S.
Jacob R.
AUTHOR ADDRESSES
(Radhakrishnan J.; Jesudasan S.; Jacob R.)
SOURCE
Update in Anaesthesia (2001) :13 (4-6). Date of Publication: 2001
ISSN
1353-4882
ABSTRACT
Delayed awakening of varying degrees is not uncommon after anaesthesia, and
may have a number of different causes, individual or combined, which may be
both drug or non - drug related. The primary management is always support of
airway, breathing and circulation, whilst the cause is sought and treated as
outlined above.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent (drug dose, drug interaction, intravenous drug
administration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
atracurium besilate (drug dose)
benzodiazepine derivative (drug interaction, oral drug administration)
diazepam (drug interaction)
midazolam (drug interaction)
mivacurium (drug dose)
muscle relaxant agent (drug dose)
naloxone (intravenous drug administration)
propofol (drug interaction, intravenous drug administration,
pharmacokinetics)
suxamethonium (drug dose)
vecuronium (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
anesthetic recovery
EMTREE MEDICAL INDEX TERMS
airway conductance
anesthesia level
arousal
brain hypoxia (complication)
breathing
cerebrovascular disease (complication)
circulation
drug overdose
metabolic disorder
neuromuscular blocking
respiratory failure
short survey
CAS REGISTRY NUMBERS
atracurium (64228-79-1)
diazepam (439-14-5)
midazolam (59467-70-8)
mivacurium (106791-40-6, 106861-44-3)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
propofol (2078-54-8)
suxamethonium (306-40-1, 71-27-2)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001371702
PUI
L32979587
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1211
TITLE
Seizures with intravenous codeine phosphate
AUTHOR NAMES
Zolezzi M.
Al Mohaimeed S.A.
AUTHOR ADDRESSES
(Zolezzi M.; Al Mohaimeed S.A.) L-532 MODA, PO Box 7897, Riyadh 11159, Saudi
Arabia.
CORRESPONDENCE ADDRESS
M. Zolezzi, L-532 MODA, PO Box 7897, Riyadh 11159, Saudi Arabia. Email:
monizolezzi@yahoo.com
SOURCE
Annals of Pharmacotherapy (2001) 35:10 (1211-1213). Date of Publication:
2001
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
OBJECTIVE: To describe an adverse effect with intravenous codeine in a child
diagnosed with sickle cell anemia. CASE SUMMARY: A seven-year-old boy with
sickle cell anemia was admitted to the emergency department with severe pain
unresponsive to high doses of oral acetaminophen; subsequently, intravenous
codeine phosphate was administered. The patient immediately developed a
tonic-clonic seizure, which was treated with intravenous diazepam and
naloxone. DISCUSSION: Seizures associated with the intravenous
administration of codeine phosphate have not been extensively reported in
the literature, and special precautions for using the parenteral route for
this drug have been vague and limited. Because of the frequent need for
acute pain control in children with sickle cell crisis, they may be exposed
to this type of reaction when intravenous narcotics are administered. The
need for clear guidelines regarding the drug's appropriate parenteral dosing
and administration is essential. CONCLUSIONS: Codeine phosphate-induced
seizures are not common. The need for special instructions for its
intravenous administration may prevent this type of reaction, especially in
patients in need of acute pain control requiring intravenous narcotics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine phosphate (adverse drug reaction, drug therapy, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
diazepam (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
paracetamol (drug therapy, oral drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
tonic clonic seizure (side effect)
EMTREE MEDICAL INDEX TERMS
apnea (side effect)
article
case report
coma (side effect)
cyanosis (side effect)
human
hypotension (side effect)
hypoxemia (side effect)
male
pain (drug therapy)
priority journal
school child
sickle cell anemia
tachycardia (side effect)
CAS REGISTRY NUMBERS
codeine phosphate (52-28-8)
diazepam (439-14-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
2001363368
MEDLINE PMID
11675848 (http://www.ncbi.nlm.nih.gov/pubmed/11675848)
PUI
L32959190
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1212
TITLE
An analysis of the drug emergencies of the years 1996-1999 in the Rural
District of Tübingen
ORIGINAL (NON-ENGLISH) TITLE
Eine analyse der drogennotfälle im landkreis Tübingen der jahre 1996-1999
AUTHOR NAMES
Dinse H.
Reinl H.
AUTHOR ADDRESSES
(Dinse H.; Reinl H.) Berufsgenossenschaftl. Unfallklin., Abt. fur
Anasthesie/Intensivmedizin, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
CORRESPONDENCE ADDRESS
H. Dinse, Berufsgenossenschaftl. Unfallklin., Abt. fur
Anasthesie/Intensivmedizin, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
Email: heidi.reinl@uni-tuebingen.de
SOURCE
Sucht (2001) 47:4 (275-285). Date of Publication: 2001
ISSN
0939-5911
ABSTRACT
The topic of the research was the analysis of standardized protocols of the
prehospital emergency medical system of the years 1996 through 1999
according to the primary diagnosis »drug intoxication)«, completed by
interviews with affected persons and professionals. A drug emergency was
defined as a clinically relevant, possibly lifethreatening condition after
intake of illegal drugs, their substitutes or the withdrawals of these
substances. 191 emergencies of 135 persons could be analysed (35 females, 99
males, 3 gender), i.e. 1,9% of 9842 runs of the prehospital emergency unit.
The Glasgow-Coma-Scale indicated a comatous state in 42% of the cases. The
patients had to be intubated and ventilated in 21% of the cases. Heroin was
the most frequent named substance of intoxication (54%). Alcohol and
benzodiazepines could be identified as the most frequent additional
substances. A withdrawal syndrome was present in 11,5% of the cases. Among
the males most emergencies had happened in public (58,8%), among the females
in privacy (50,9%). More than half of the emergencies had been classified as
lifethreatening. 81,1% of the intoxicated patients had to be treated in
hospitals. Naloxone, a specific antidote of opiates, had been delivered in
only one third of all heroin intoxications. In order to decrease the
quantity of drug emergencies and fatalities we need to establish a better
cooperation of the different helping systems, a more elaborate psychosocial
treatment system for fesysteme, eine differenziertere psychosoziale
Begleitung von Substituierten sowie eine Verbesserung des Wissens der
KonsumentInnen über Notfälle, Gefahren des Beikonsums und über mögliche
Erste-Hilfe-Maβnahmen anzustreben. Des Weiteren sollte der Mut zur
schnelleren Information des Hilfesystems bei Notfällen gestärkt werden. Eine
Take-home-Gabe von Naloxon könnte unter bestimmten Voraussetzungen ebenfalls
sinnvoll sein. patients in the maintenance treatment as well as an
improvement of the knowledge about drug emergencies, the risk of additional
substance abuse and praticable measures in first aid. Furthermore we should
encourage a faster information of the emergency system in case of emergency.
On certain premises the take-home naloxone may be useful.
EMTREE DRUG INDEX TERMS
alcohol
amphetamine
benzodiazepine derivative (drug toxicity)
cannabis
cocaine
codeine
diamorphine (drug toxicity)
illicit drug
methadone
midomafetamine
morphine
naloxone (drug therapy)
opiate (drug toxicity)
psychedelic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical protocol
emergency
emergency health service
female
human
major clinical study
male
mortality
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001352669
PUI
L32928826
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1213
TITLE
Acute opioid withdrawal in the emergency department: Inadvertent naltrexone
abuse?
AUTHOR NAMES
Bristow K.
Meek R.
Clark N.
AUTHOR ADDRESSES
(Bristow K.; Meek R., rmeek@mailcity.com) Emergency Department, Dandenong
Hospital, Dandenong, Vic., Australia.
(Clark N.) Turning Point Alcohol and Drug Centre, Melbourne, Vic.,
Australia.
(Meek R., rmeek@mailcity.com) Emergency Department, Dandenong Hospital,
David Street, Dandenong, Vic. 3175, Australia.
CORRESPONDENCE ADDRESS
R. Meek, Emergency Department, Dandenong Hospital, David Street, Dandenong,
Vic. 3175, Australia. Email: rmeek@mailcity.com
SOURCE
Emergency Medicine (2001) 13:3 (359-363). Date of Publication: 2001
ISSN
1035-6851
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
From July 1999 it became evident that a rising number of heroin users were
presenting to the Dandenong Hospital Emergency Department with a rapid
onset, florid opioid withdrawal syndrome following the intravenous injection
of what they had believed to be heroin. We suspect that the injected
substance was in fact naltrexone. This paper describes two such cases and
reviews the literature on naltrexone. Recommendations regarding the
management of the acute opioid withdrawal syndrome are made.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naltrexone (drug toxicity)
opiate (drug toxicity)
propofol (drug therapy)
EMTREE DRUG INDEX TERMS
clonidine (drug dose, drug therapy)
diazepam (drug therapy, oral drug administration)
methadone (drug dose, drug therapy)
metoclopramide (drug dose, drug therapy, intravenous drug administration)
midazolam (drug dose, drug therapy, intravenous drug administration)
ondansetron (drug dose, drug therapy, intravenous drug administration)
prochlorperazine (drug dose, drug therapy, intravenous drug administration)
scopolamine butyl bromide (drug dose, drug therapy, intravenous drug
administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
withdrawal syndrome (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
abdominal pain
adult
agitation
article
Australia
case report
clinical feature
emergency medicine
emergency treatment
emergency ward
female
heroin dependence
human
medical literature
practice guideline
priority journal
symptom
treatment planning
vomiting (drug therapy)
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
naltrexone (16590-41-3, 16676-29-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
prochlorperazine (58-38-8)
propofol (2078-54-8)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001341500
MEDLINE PMID
11554869 (http://www.ncbi.nlm.nih.gov/pubmed/11554869)
PUI
L32905781
DOI
10.1046/j.1035-6851.2001.00240.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1035-6851.2001.00240.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1214
TITLE
Managing acute pain and anxiety in children undergoing procedures in the
emergency department
AUTHOR NAMES
Krauss B.
AUTHOR ADDRESSES
(Krauss B., baruch.krauss@tch.harvard.edu) Department of Paediatrics,
Harvard Medical School, Boston, MA, United States.
(Krauss B., baruch.krauss@tch.harvard.edu) Division of Emergency Medicine,
Children's Hospital, Boston, MA, United States.
(Krauss B., baruch.krauss@tch.harvard.edu) Division of Emergency Medicine,
Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
CORRESPONDENCE ADDRESS
B. Krauss, Division of Emergency Medicine, Children's Hospital, 300 Longwood
Avenue, Boston, MA 02115, United States. Email:
baruch.krauss@tch.harvard.edu
SOURCE
Emergency Medicine (2001) 13:3 (293-304). Date of Publication: 2001
ISSN
1035-6851
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug combination, drug dose, drug therapy, inhalational
drug administration, intramuscular drug administration, intravenous drug
administration, oral drug administration, rectal drug administration)
benzodiazepine derivative (drug combination, drug dose, drug therapy,
intravenous drug administration, rectal drug administration)
flumazenil (drug therapy, intravenous drug administration)
hypnotic sedative agent (drug combination, drug dose, drug therapy,
intravenous drug administration, oral drug administration, rectal drug
administration)
inhalation anesthetic agent (drug therapy, inhalational drug administration)
naloxone (drug therapy, intravenous drug administration)
nonsteroid antiinflammatory agent (drug dose, drug therapy, intramuscular
drug administration, intravenous drug administration)
opiate agonist (drug combination, drug dose, drug therapy, intravenous drug
administration)
sedative agent (drug combination, drug dose, drug therapy, intravenous drug
administration, rectal drug administration)
thiopental (drug therapy, rectal drug administration)
EMTREE DRUG INDEX TERMS
barbituric acid derivative (drug therapy, intravenous drug administration,
rectal drug administration)
chloral hydrate (drug dose, drug therapy, oral drug administration, rectal
drug administration)
diazepam (drug therapy)
epinephrine (drug combination, drug dose, drug therapy, topical drug
administration)
etomidate (drug therapy)
fentanyl (drug dose, drug therapy, intravenous drug administration, oral
drug administration)
ketamine (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration, oral drug administration)
ketorolac (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration)
lidocaine plus prilocaine (drug therapy, topical drug administration)
methohexital (drug therapy, rectal drug administration)
midazolam (drug therapy, intranasal drug administration, oral drug
administration)
morphine (drug therapy)
nitrous oxide (drug therapy, inhalational drug administration)
pentobarbital (drug therapy, intravenous drug administration, oral drug
administration)
pethidine (drug therapy, intravenous drug administration)
propofol (drug therapy, intravenous drug administration)
remifentanil (drug therapy)
sufentanil (drug therapy)
tetracaine (drug combination, drug therapy, topical drug administration)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
anxiety
emergency medicine
pain (drug therapy)
sedation
EMTREE MEDICAL INDEX TERMS
algorithm
child
child health care
dental anesthesia
drug indication
emergency treatment
emergency ward
general anesthesia
history of medicine
human
patient care
patient monitoring
practice guideline
priority journal
review
treatment indication
CAS REGISTRY NUMBERS
EMLA (101362-25-8)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
chloral hydrate (302-17-0)
diazepam (439-14-5)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
remifentanil (132539-07-2)
sufentanil (56030-54-7)
tetracaine (136-47-0, 94-24-6)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2001341491
MEDLINE PMID
11554860 (http://www.ncbi.nlm.nih.gov/pubmed/11554860)
PUI
L32905772
DOI
10.1046/j.1035-6851.2001.00232.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1035-6851.2001.00232.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1215
TITLE
Harm reduction: Closing the distance
ORIGINAL (NON-ENGLISH) TITLE
La réduction des dommages: Refermer l'écart
AUTHOR ADDRESSES
SOURCE
Canadian Medical Association Journal (2001) 165:4 (389-391). Date of
Publication: 2001
ISSN
0820-3946
BOOK PUBLISHER
Canadian Association of Radiologists, 1740 boul.Cote-Vertu Blvd, St-Laurent,
Canada.
EMTREE DRUG INDEX TERMS
cocaine
diamorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health program
EMTREE MEDICAL INDEX TERMS
Canada
cause of death
drug abuse
drug overdose
drug use
editorial
emergency ward
health service
hepatitis C
human
Human immunodeficiency virus infection
instrument sterilization
medical care
medical education
methadone treatment
needle
poverty
prevention
unemployment
vaccination
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
French, English
EMBASE ACCESSION NUMBER
2001333746
MEDLINE PMID
11531042 (http://www.ncbi.nlm.nih.gov/pubmed/11531042)
PUI
L32885410
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1216
TITLE
Laboratory investigations of acute drug intoxications diagnosed and treated
by prehospital emergency doctors
ORIGINAL (NON-ENGLISH) TITLE
Laborchemische überprüfung von notarztdiagnosen bei akuten intoxikationen
mit rauschmitteln
AUTHOR NAMES
Schmidbauer S.
Mayr N.P.
Drasch G.
Roider G.
Schneider K.
Hallfeldt K.
AUTHOR ADDRESSES
(Schmidbauer S.; Mayr N.P.; Drasch G.; Roider G.; Schneider K.; Hallfeldt
K.) Chirurgische Klinik und Poliklinik, Klin. Inne.
Ludwig-Maximilians-Univ., Nußbaumstraße 20, 80336 München, Germany.
CORRESPONDENCE ADDRESS
S. Schmidbauer, Chirurgische Klinik und Poliklinik, Klin. Inne.
Ludwig-Maximilians-Univ., Nußbaumstraße 20, 80336 München, Germany.
SOURCE
Notarzt (2001) 17:4 (120-123). Date of Publication: 2001
ISSN
0177-2309
ABSTRACT
In Germany have been registrated 1501 deaths by acute drug intoxications in
1997. Prehospital emergency doctors have to treat patients with different
disturbances of consciousness caused by commonly unknown narcotic
poisioning. In this prospective study we analysed quality and quantity of
acute drug intoxications treated in the supply district of the Munich
downtown emergency physician from 10/1995 to 4/1996. Prehospital
documentation was done by independent study assistants, blood samples were
analysed by HPLC, immunochemical methods and gaschromatography. 53% of our
patients had an acute alcohol intoxication with lowered values of the
Glasgow-Coma-Scale between 4 and 14 points, the median value of blood
alcohol concentration was 2.54%. 29% of the patients suffered from an acute
opiate-intoxication, 45% of them were found in a public toilet, in 64%
injection utensils lead to the prehospital diagnosis. 7 of 11 opiate
intoxicated have been treated with naloxon for antagonising without
complications, four of them showed additional drug abuse. Polyintoxication
later proved by blood analysis wasn't recognized prehospital in a third of
our cases. In the supply district of the Munich downtown emergency physician
every tenth emergency call is caused by drug intoxications, 76% of these
patients are admitted to emergency departments. According to the high
incidence of polyintoxicated patients and the shown underestimation of
clinical symptoms drugscreening should immediately be performed in the
emergency department. The education of the emergency physicians should be
more intensive.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
naloxone (drug toxicity)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis)
emergency medicine
EMTREE MEDICAL INDEX TERMS
article
blood sampling
consciousness
diagnostic approach route
Germany
Glasgow coma scale
high performance liquid chromatography
human
immunochemistry
laboratory diagnosis
medical documentation
medical education
medical practice
physician
prospective study
CAS REGISTRY NUMBERS
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001316119
PUI
L32830633
DOI
10.1055/s-2001-16339
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2001-16339
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1217
TITLE
Relief by naloxone of morphine-induced spasm of the sphincter of Oddi in a
post-cholecystectomy patient
AUTHOR NAMES
Butler K.C.
Selden B.
Pollack Jr. C.V.
AUTHOR ADDRESSES
(Butler K.C.; Selden B.; Pollack Jr. C.V.) Department of Emergency Medicine,
Maricopa Medical Center, Phoenix, AZ, United States.
(Butler K.C.) Department of Emergency Medicine, Maricopa Medical Center,
P.O. Box 5008, Phoenix, AZ 85008, United States.
CORRESPONDENCE ADDRESS
K.C. Butler, Department of Emergency Medicine, Maricopa Medical Center, P.O.
Box 5008, Phoenix, AZ 85008, United States.
SOURCE
Journal of Emergency Medicine (2001) 21:2 (129-131). Date of Publication:
2001
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Spasm of the sphincter of Oddi is a well-recognized effect of the narcotic
class of drugs. Although it is usually clinically silent, such spasm
occasionally causes debilitating pain that may be mistaken for more serious
disorders. We present the case of a patient who had undergone
cholecystectomy previously, but in whom morphine given in the Emergency
Department precipitated pain consistent with biliary colic; the pain
resolved promptly after administration of naloxone. This entity may
considered in the differential diagnosis of acute onset of colicky abdominal
pain in the patient given narcotics. © 2001 Elsevier Science Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (adverse drug reaction, intramuscular drug administration)
naloxone (drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
hydroxyzine (intramuscular drug administration)
ibuprofen (drug therapy)
narcotic agent (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
smooth muscle spasm (drug therapy, side effect)
EMTREE MEDICAL INDEX TERMS
abdominal pain (side effect)
adult
article
biliary colic (drug therapy, side effect)
case report
cholecystectomy
colic (diagnosis)
controlled study
diagnostic value
differential diagnosis
drug induced disease (drug therapy, side effect)
emergency ward
female
human
Oddi sphincter
priority journal
treatment outcome
CAS REGISTRY NUMBERS
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ibuprofen (15687-27-1)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001279276
MEDLINE PMID
11489400 (http://www.ncbi.nlm.nih.gov/pubmed/11489400)
PUI
L32727908
DOI
10.1016/S0736-4679(01)00355-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(01)00355-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1218
TITLE
Poisoning and primary approachs to the poisoned patient
ORIGINAL (NON-ENGLISH) TITLE
Zehirlenme ve zehirlenen hastaya temel yaklaşim
AUTHOR NAMES
Satar S.
Gökel Y.
AUTHOR ADDRESSES
(Satar S.; Gökel Y.) Ilk Yardim ve Acil Anabilin Dali, Tip Fakültesi,
Çukurova Üniversitesi, Adana, Turkey.
CORRESPONDENCE ADDRESS
S. Satar, Ilk Yardim ve Acil Anabilin Dali, Tip Fakültesi, Çukurova
Üniversitesi, Adana, Turkey.
SOURCE
SENDROM (2001) 13:4 (20-29). Date of Publication: 2001
ISSN
1016-5134
ABSTRACT
Poison and its therapy is old as human history. Manuscripts dating back to
15th century BC had been found and still today detailed investigations are
continued. Due to the fact the patient population in this group is large
5-30 % of multidiciplinary intensive care units are used for poisoning
treatment. Poisoned cases may attend to the emergency units for various
reasons and because of this fact emergency doctors need to work like a
dedective using a multidiciplinary approach. With appropriate symptomatic
and supportive therapy the morbidity and mortality of patients who has taken
large doses of drugs, decrease. Specific antidotes can be found for a small
number of substances and quick stabilization, resusication and evaluation of
toxic syndrome, with the aid of laboratory tests may guide the emergency
doctor for the management of these patients. Fifty percent of the patients
admitted to emergency room in comatose state without a known cause are
poisoned cases. Primary approach to patients with acute poisoning is to
collect the poison or eliminate the toxic substrates and to stabilize the
vital functions. In the management of the patients, with high intake of
drugs the most important factors are ventilation and the aggressive support
of cardiovascular, metabolic and neurologic functions. In serious cases the
emergency service personnel need to protect to themselves against toxic
substance contamination. In this article we reviewed the pertinent
literature for the general management of poisoning. Here we present the
recent therapy protocols and managements for poisoning and what the
emergency doctor has to consider in the management of these cases.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
alcohol (drug therapy)
antidote (drug therapy)
ascorbic acid (drug therapy)
atropine (drug therapy)
benzodiazepine derivative (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
bicarbonate (drug therapy)
calcium (drug therapy)
calcium channel blocking agent (drug toxicity)
carbamate insecticide (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
digitalis glycoside (drug toxicity)
digoxin (drug toxicity)
ethylene glycol (drug toxicity)
flumazenil (drug therapy)
glucagon (drug therapy)
glucose (drug therapy)
guanidine (drug therapy)
hydrazine (drug toxicity)
isoniazid (drug toxicity)
isoprenaline (drug therapy)
methanol (drug toxicity)
methionine (drug therapy)
naloxone (drug therapy)
opiate (drug toxicity)
organophosphate insecticide (drug toxicity)
physostigmine (drug therapy)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
assisted ventilation
cardiovascular function
clinical protocol
coma
contamination
detoxification
drug overdose (drug therapy)
emergency ward
history
intensive care unit
laboratory test
metabolism
nervous system function
palliative therapy
resuscitation
review
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
ascorbic acid (134-03-2, 15421-15-5, 50-81-7)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
digoxin (20830-75-5, 57285-89-9)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
guanidine (113-00-8, 25215-10-5, 50-01-1)
hydrazine (10217-52-4, 13775-80-9, 18500-32-8, 302-01-2, 7803-57-8)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
methanol (67-56-1)
methionine (59-51-8, 63-68-3, 7005-18-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Turkish
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001254500
PUI
L32661865
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1219
TITLE
Implementation of standing field treatment protocols in an urban EMS system
AUTHOR NAMES
Eckstein M.
AUTHOR ADDRESSES
(Eckstein M.) Department of Emergency Medicine, University of Southern
California School of Medicine, Los Angeles City Fire Department, Los
Angeles, CA, United States.
CORRESPONDENCE ADDRESS
M. Eckstein, Department of Emergency Medicine, LAC/USC Medical Center, 1200
North State Street, Los Angeles, CA 90033, United States. Email:
eckstein@hsc.usc.edu
SOURCE
American Journal of Emergency Medicine (2001) 19:4 (280-283). Date of
Publication: 2001
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The objective was to describe our experience with implementation of standing
field treatment protocols (SFTP) in a large, urban EMS system. A
prospective, consecutive observational study examining the first 21 days of
implementation of SFTPs in the City of Los Angeles, California. SFTPs were
developed for 7 medical chief complaints and all major trauma patients.
There were 13,586 EMS incidents, of which 4,037 (30%) received ALS
treatment. SFTPs were used on 2,177 of these incidents, representing 54% of
all ALS runs and 16% of all EMS incidents. The most frequently used SFTPs
were for altered level of consciousness (29%), and chest pain (25%). The
most common errors found were failure to document reassessment of the
patient after each medication administration (45% fallout rate), and failure
to document and attach a copy of the ECG to the EMS report (40%). The mean
fallout rate for failure to establish or attempt IV access, administer
oxygen, or provide cardiac monitoring was 7%. Out of 1,450 incidents with
outcome data provided by the receiving hospitals, only 3 cases (2%) involved
incorrect treatment, with an additional 2 involving the unnecessary use of
lidocaine. None of these instances resulted in adverse effects or
complications. SFTPs were integrated into a large EMS system with few
procedural errors or adverse outcomes. Copyright © 2001 by W.B. Saunders
Company.
EMTREE DRUG INDEX TERMS
diazepam
glucose (endogenous compound)
lidocaine
naloxone
oxygen
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical protocol
emergency health service
EMTREE MEDICAL INDEX TERMS
article
consciousness
documentation
electrocardiography
error
human
major clinical study
monitoring
patient care
priority journal
respiratory distress
seizure
thorax pain
urban area
vascular access
CAS REGISTRY NUMBERS
diazepam (439-14-5)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001248641
MEDLINE PMID
11447512 (http://www.ncbi.nlm.nih.gov/pubmed/11447512)
PUI
L32642153
DOI
10.1053/ajem.2001.22666
FULL TEXT LINK
http://dx.doi.org/10.1053/ajem.2001.22666
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1220
TITLE
A 39-year-old man with an overdose of β-blockers
AUTHOR NAMES
Slater T.W.
AUTHOR ADDRESSES
(Slater T.W.) PO Box 470424, Aurora, CO 80047, United States.
CORRESPONDENCE ADDRESS
T.W. Slater, PO Box 470424, Aurora, CO 80047, United States. Email:
tamslater@home.com
SOURCE
Journal of Emergency Nursing (2001) 27:4 (323-326). Date of Publication:
2001
ISSN
0099-1767
BOOK PUBLISHER
Mosby Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atenolol (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity, oral drug
administration)
EMTREE DRUG INDEX TERMS
activated carbon
atenolol (drug toxicity, oral drug administration)
atropine (drug therapy, intravenous drug administration)
beta adrenergic receptor blocking agent
beta adrenergic receptor stimulating agent
beta adrenergic receptor stimulating agent (drug therapy)
dopamine (drug combination, drug therapy, intravenous drug administration)
glucagon (drug combination, drug therapy, intravenous drug administration)
glucose
isoprenaline (drug therapy, intravenous drug administration)
naloxone (drug therapy, intravenous drug administration)
noradrenalin (drug combination, drug therapy, intravenous drug
administration)
thiamine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, therapy)
emergency treatment
heart arrest (diagnosis, drug therapy, diagnosis, therapy)
respiratory failure (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
adult
blood pressure
case report
clinical feature
drug overdose
electrocardiogram
electrocardiography
heart rate
human
iatrogenic disease
intoxication
intubation
male
methodology
nursing
review
stomach lavage
suicide attempt
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atenolol (29122-68-7)
atropine (51-55-8, 55-48-1)
dopamine (51-61-6, 62-31-7)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
thiamine (59-43-8, 67-03-8)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11468625 (http://www.ncbi.nlm.nih.gov/pubmed/11468625)
PUI
L33077535
DOI
10.1067/men.2001.116541
FULL TEXT LINK
http://dx.doi.org/10.1067/men.2001.116541
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1221
TITLE
Emergency drug availability for the cardiac arrest team: A national audit
AUTHOR NAMES
Jowett N.I.
Turner A.M.
Hawkings D.
Denham N.
AUTHOR ADDRESSES
(Jowett N.I., nigel.jowett@pdt-tr.wales.nhs.uk; Turner A.M.; Hawkings D.;
Denham N.) Department of Cardiovascular Medicine, Pembrokeshire and Derwen
NHS Trust, Pembrokeshire, Wales SA61 2PZ, United Kingdom.
CORRESPONDENCE ADDRESS
N.I. Jowett, Dept. of Cardiovascular Medicine, Pembrokeshire and Derwen NHS
Trust, Pembrokeshire, Wales SA61 2PZ, United Kingdom. Email:
nigel.jowett@pdt-tr.wales.nhs.uk
SOURCE
Resuscitation (2001) 49:2 (179-181). Date of Publication: 2001
ISSN
0300-9572
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
Cardiac arrest teams are called upon to deal with many different acute
medical emergencies, including cardiac arrest. However, the drugs that are
supplied for them to perform their role differs vastly from hospital to
hospital. We have confirmed this in an audit of adult cardiac arrest teams
from all the acute hospitals within Wales. The rational use of
defibrillation and drugs during cardiopulmonary resuscitation has been
standardised according to International guidelines, and there is no reason
why resuscitation kits could not also be standardised. Further
considerations of drug availability is needed for acute management of other
collapsed patients without cardiac arrest, most commonly vaso-vagal syncope,
anaphylaxis, hypoglycaemia, fits and respiratory arrest. Based upon recent
recommendations from the project team of the Resuscitation Council (UK),
augmented by other commonly needed drugs for first aid in the collapsed
patient, we propose a reduced and simplified emergency drug list, employing
a two box system covering immediate and most secondary requirements. A
standardised format of drug kits for use by adult cardiac arrest teams could
speed effective delivery of emergency care. © 2001 Elsevier Science Ireland
Ltd.
EMTREE DRUG INDEX TERMS
adenosine
amiodarone
atropine
bicarbonate
calcium chloride
epinephrine
glucose
hydrocortisone
lidocaine
midazolam
naloxone
sodium chloride
vasopressin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
clinical audit
drug bioavailability
emergency health service
emergency treatment
heart arrest
EMTREE MEDICAL INDEX TERMS
anaphylaxis
article
defibrillation
faintness
first aid
human
hypoglycemia
patient care
priority journal
respiratory arrest
resuscitation
seizure
standardization
United Kingdom
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
sodium chloride (7647-14-5)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Portuguese
EMBASE ACCESSION NUMBER
2001203952
MEDLINE PMID
11382524 (http://www.ncbi.nlm.nih.gov/pubmed/11382524)
PUI
L32520931
DOI
10.1016/S0300-9572(00)00357-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S0300-9572(00)00357-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1222
TITLE
An unusual presentation of opioid-like syndrome in pediatric valproic acid
poisoning
AUTHOR NAMES
Espinoza O.
Maradei I.
Ramírez M.
Pascuzzo-Lima C.
AUTHOR ADDRESSES
(Espinoza O.) Ctro. Toxicologico Regl. C., Barquisimeto, Estado Lara,
Venezuela.
(Maradei I.; Pascuzzo-Lima C.) U. de Farmacoepidemiología, Decanato de
Medicina, Univ. Centroccidental Lisandro A., Barquisimeto, Estado Lara,
Venezuela.
(Ramírez M.) U. de Farmacoepidemiología, Decanato de Medicina, Ctro.
Toxicologico Regl. C., Barquisimeto, Estado Lara, Venezuela.
CORRESPONDENCE ADDRESS
O. Espinoza, Ctro. Toxicol. Reg. Centroccidental, Barquisimeto, Estado Lara,
Venezuela.
SOURCE
Veterinary and Human Toxicology (2001) 43:3 (178-179). Date of Publication:
June 2001
ISSN
0145-6296
BOOK PUBLISHER
Comparative Toxicology Laboratories, Manhattan, United States.
ABSTRACT
We report a 3-y-o boy who accidentally poisoned himself with valproic acid
(VPA). Clinical features included profound coma, depressed respiration and
miosis. Treatment included naloxone, gastric lavage, and activated charcoal
and a saline cathartic. The patient fully recovered and was discharged 24 h
after the admission, Prompt use of naloxone is advised whenever the triad of
coma, pinpoint pupils and depressed respiration concur with the clinical
possibility of VPA intoxication.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug therapy)
naloxone (drug therapy)
valproic acid (drug toxicity)
EMTREE DRUG INDEX TERMS
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
neurotoxicity (complication)
EMTREE MEDICAL INDEX TERMS
article
case report
coma (etiology)
emergency treatment
human
male
miosis (etiology)
preschool child
respiration depression (diagnosis)
stomach lavage
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001177604
MEDLINE PMID
11383666 (http://www.ncbi.nlm.nih.gov/pubmed/11383666)
PUI
L32436294
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1223
TITLE
Pre-clinical psychiatric emergencies in the physician-based emergency system
of a German metropolis
ORIGINAL (NON-ENGLISH) TITLE
Psychiatrische notfälle im notarztdienst einer deutschen großstadt
AUTHOR NAMES
Pajonk F.-G.
Grünberg K.A.S.
Paschen H.-R.
Moecke H.
AUTHOR ADDRESSES
(Pajonk F.-G.; Grünberg K.A.S.; Paschen H.-R.; Moecke H.) Klin. fur
Psychiat. und Psychother., Universitatskrankenhaus Eppendorf, Martinistr.
52, 20246 Hamburg, Germany.
CORRESPONDENCE ADDRESS
F.-G. Pajonk, Klin. fur Psychiat. und Psychother., Universitatskrankenhaus
Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Email:
pajonk@uke.uni-hamburg.de
SOURCE
Fortschritte der Neurologie Psychiatrie (2001) 69:4 (170-174). Date of
Publication: 2001
ISSN
0720-4299
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
ABSTRACT
Objective: Pre-clinical Psychiatric Emergency Situations (PES) gain more
scientific interest. First investigations revealed them to be the third
major cause for emergency physician (EP) calls. However, there is still very
little data concerning prevalence, diagnosis and therapy. Methods: A
retrospective analysis of all anonymised EP protocols of the year 1995 in
the city of Hamburg was performed. Data of each multiple-choice category was
evaluated as well as handwritten and personal notes to determine prevalence,
diagnoses and therapy of PES. Results: 2550 out of 26347 protocols (9.7%)
revealed to have a psychiatric disturbance as a major cause for the call.
The most frequent diagnoses in the overall young (average age: 43.1 ± 17.6
years) and male (60.3%) population were found to be alcoholic intoxication
(34%), state of agitation (23%) and suicide attempts (22%). In 55% the
emergencies could be considered as purely psychiatric; in 35% as a combined
somatic-psychiatric emergency. A specific psychopharmacological treatment
was not performed. Conclusions: Psychiatric patients are a considerable
group in pre-clinical emergency medicine, however, disturbances are much too
rarely documented, diagnosed and treated. Training programs are necessary.
Psychiatry has to play a more active role in planning and performing these
programs.
EMTREE DRUG INDEX TERMS
antidote
benzodiazepine derivative
diazepam
flumazenil
midazolam
naloxone
neuroleptic agent
physostigmine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
mental disease (diagnosis, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
aged
agitation
alcohol intoxication (diagnosis, epidemiology)
article
female
Germany
human
major clinical study
male
psychopharmacotherapy
suicide attempt (diagnosis, epidemiology)
CAS REGISTRY NUMBERS
diazepam (439-14-5)
flumazenil (78755-81-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001157831
MEDLINE PMID
11386122 (http://www.ncbi.nlm.nih.gov/pubmed/11386122)
PUI
L32377790
DOI
10.1055/s-2001-12692
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2001-12692
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1224
TITLE
Essential drugs for pediatric emergency medical services
ORIGINAL (NON-ENGLISH) TITLE
Urgenze
AUTHOR ADDRESSES
SOURCE
Occhio Clinico Pediatria (2001) 5:3 (22-23). Date of Publication: 2001
ISSN
1592-1093
EMTREE DRUG INDEX TERMS
atropine (drug dose, drug therapy)
epinephrine (drug dose, drug therapy)
furosemide (drug dose, drug therapy)
glucagon (drug dose, drug therapy)
insulin (drug dose, drug therapy)
metoclopramide (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
salbutamol (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
emergency treatment
EMTREE MEDICAL INDEX TERMS
anaphylaxis (drug therapy)
bronchospasm (drug therapy)
convulsion (drug therapy)
heart disease (drug therapy)
hypertension (drug therapy)
hypocalcemia (drug therapy)
hypoglycemia (drug therapy)
hypovolemia (drug therapy)
ketoacidosis (drug therapy)
larynx spasm (drug therapy)
lung edema (drug therapy)
paroxysmal tachycardia (drug therapy)
short survey
vomiting (drug therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
insulin (9004-10-8)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Italian
EMBASE ACCESSION NUMBER
2001132265
PUI
L32274504
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1225
TITLE
Prediction rule in opioid overdose [2]
AUTHOR NAMES
Su M.
Hoffman R.S.
Christenson J.
Etherington J.
Innes G.
Grafstein E.
Wanger K.
Fernandez C.
Spinelli J.J.
Gao M.
Pennington S.
AUTHOR ADDRESSES
(Su M.; Hoffman R.S.; Christenson J.; Etherington J.; Innes G.; Grafstein
E.; Wanger K.; Fernandez C.; Spinelli J.J.; Gao M.; Pennington S.) New York
City Poison Control Center, Department of Emergency Services, New York Univ.
School of Medicine, New York, NY, United States.
CORRESPONDENCE ADDRESS
M. Su, New York City Poison Control Center, Department of Emergency
Services, New York Univ. School of Medicine, New York, NY, United States.
Email: marksmd@aol.com
SOURCE
Academic Emergency Medicine (2001) 8:4 (403-404). Date of Publication: 2001
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
methadone
opiate
EMTREE DRUG INDEX TERMS
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, etiology)
opiate addiction (rehabilitation)
EMTREE MEDICAL INDEX TERMS
drug dependence
drug dependence treatment
emergency treatment
heroin dependence
hospital discharge
human
letter
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2001144649
MEDLINE PMID
11282681 (http://www.ncbi.nlm.nih.gov/pubmed/11282681)
PUI
L32303660
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1226
TITLE
Recent development in treating opiate misuse
AUTHOR NAMES
Bellingham C.
AUTHOR ADDRESSES
(Bellingham C.)
SOURCE
Pharmaceutical Journal (2001) 266:7144 (541). Date of Publication: 21 Apr
2001
ISSN
0031-6873
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine (drug comparison, drug therapy, pharmaceutics)
methadone (drug comparison, drug therapy)
naloxone (drug administration, drug therapy, intramuscular drug
administration, intravenous drug administration, subcutaneous drug
administration)
opiate (drug therapy, pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
controlled drug release
drug misuse (diagnosis)
drug overdose (drug therapy)
emergency treatment
human
human tissue
major clinical study
practice guideline
short survey
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Pharmacy (39)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2001171121
PUI
L32422564
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1227
TITLE
Take home naloxone and the prevention of deaths from opiate overdose: Two
pilot schemes
AUTHOR NAMES
Dettmer K.
Saunders B.
Strang J.
AUTHOR ADDRESSES
(Dettmer K.; Saunders B.; Strang J.) National Addiction Centre, Institute of
Psychiatry, Maudsley Hospital, London SE5 8AF, United Kingdom.
CORRESPONDENCE ADDRESS
J. Strang, National Addiction Centre, Institute of Psychiatry, Maudsley
Hospital, London SE5 8AF, United Kingdom. Email: j.strang@iop.kcl.ac.uk
SOURCE
British Medical Journal (2001) 322:7291 (895-896). Date of Publication: 14
Apr 2001
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
naloxone (adverse drug reaction, drug administration, drug therapy,
intramuscular drug administration, intravenous drug administration,
subcutaneous drug administration)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
cocaine dependence
drug dependence
drug withdrawal
emergency treatment
home care
human
major clinical study
priority journal
resuscitation
side effect (side effect)
treatment outcome
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2001149427
MEDLINE PMID
11302902 (http://www.ncbi.nlm.nih.gov/pubmed/11302902)
PUI
L32324312
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1228
TITLE
Pediatric pre-hospital advanced life support care in an urban setting
AUTHOR NAMES
Babl F.E.
Vinci R.J.
Bauchner H.
Mottley L.
AUTHOR ADDRESSES
(Babl F.E., franz.babl@bmc.org; Vinci R.J.; Bauchner H.; Mottley L.)
Divisions of Pediatric Emergency Medicine, Boston Medical Center, Boston
University School of Medicine, Boston, MA, United States.
(Babl F.E., franz.babl@bmc.org; Vinci R.J.; Bauchner H.; Mottley L.)
Divisions of General Pediatrics, Boston Medical Center, Boston University
School of Medicine, Boston, MA, United States.
(Babl F.E., franz.babl@bmc.org; Vinci R.J.; Bauchner H.; Mottley L.)
Emergency Medical Services, Public Health Commission, Boston, MA, United
States.
(Babl F.E., franz.babl@bmc.org; Vinci R.J.; Bauchner H.; Mottley L.)
Department of Emergency Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States.
(Babl F.E., franz.babl@bmc.org) Division of Pediatric Emergency Medicine,
Dowling 3, Boston Medical Center, Boston University School of Medicine, 1
Boston Medical Center Place, Boston, MA 02118, United States.
CORRESPONDENCE ADDRESS
F.E. Babl, Div. of Pediatric Emergency Medicine, Boston Medical Center,
Boston University School of Medicine, 1 Boston Medical Center Place, Boston,
MA 02118, United States. Email: franz.babl@bmc.org
SOURCE
Pediatric Emergency Care (2001) 17:1 (5-9). Date of Publication: 2001
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Objective: To describe pediatric advanced life support (PALS) in a single
urban environment and clarify educational priorities for ALS pre-hospital
providers and pediatric medical control physicians. Methods: Retrospective
observational review of all pediatric pre-hospital PALS transport and
medical control records of the two-tiered, unified, municipal emergency
medical service of the City of Boston (catchment area 590,000) over a 1-year
period. Results: Of the 555 pediatric patients receiving ALS transport, 38%
were for respiratory emergencies, 24% for nonrespiratory medical
emergencies, 19% for traffic-related blunt trauma, and 10% for penetrating
trauma. Two percent involved cardiac arrests. The most frequent procedures
performed were intravenous (IV) cannulation (n = 184, 33%), bag-mask
ventilation (n = 28, 5%) and intubation (n = 15, 3%). Intraosseous access
was only performed in three patients (0.5 %). Fifty ALS providers in the EMS
system averaged pediatric IV cannulation 3.7 times, intubation 0.3 times,
and intraosseous access 0.06 times per provider per year. On-line medical
control was requested in 28% of PALS transports. The chief complaints
managed by medical control closely mirrored the distribution of all ALS
transports. The most frequent medication ordered by on-line medical control
was additional nebulized albuterol after standing orders (off-line medical
control) had been exhausted. Conclusions: A limited number of chief
complaints make up the majority of PALS transports. Initial and continuing
education for ALS providers needs to reflect the importance of these
critical entities. Education for urban pre-hospital providers should reflect
that certain procedures will be only executed every few years (eg, pediatric
intubation) or once in the career of an ALS pre-hospital provider (eg,
intraosseous access). With a limited amount of pediatric teaching time,
paramedic education will have to strike a careful balance between teaching
about the chief complaints most frequently encountered and teaching rare,
high-risk procedures that could provide maximal support for the uncommon
critically ill child. On-line medical control physicians need to be prepared
to direct and support the management by ALS pre-hospital providers for the
chief complaints most frequently seen in pediatric patients.
EMTREE DRUG INDEX TERMS
adenosine
atropine
bicarbonate
diazepam
diphenhydramine
epinephrine
glucagon
glucose
ipratropium bromide
naloxone
salbutamol (drug therapy, inhalational drug administration)
sodium chloride
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blunt trauma (epidemiology)
emergency health service
heart arrest (drug therapy, epidemiology)
penetrating trauma (epidemiology)
respiratory failure (drug therapy, epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
allergy (epidemiology)
article
artificial ventilation
child
controlled study
critical illness
female
human
infant
intoxication (epidemiology)
intubation
major clinical study
male
paramedical personnel
patient transport
retrospective study
staff training
traffic accident
urban area
vein catheterization
wheezing (epidemiology)
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
ipratropium bromide (22254-24-6)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9)
sodium chloride (7647-14-5)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001078364
MEDLINE PMID
11265910 (http://www.ncbi.nlm.nih.gov/pubmed/11265910)
PUI
L32172902
DOI
10.1097/00006565-200102000-00002
FULL TEXT LINK
http://dx.doi.org/10.1097/00006565-200102000-00002
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1229
TITLE
Traumatic brain injury outcome: Concepts for emergency care
AUTHOR NAMES
Zink B.J.
AUTHOR ADDRESSES
(Zink B.J.) Department of Emergency Medicine, University of Michigan, Ann
Arbor, MI, United States.
CORRESPONDENCE ADDRESS
B.J. Zink, University of Michigan, Department of Emergency Medicine, TC
B1354, Ann Arbor, MI 48109-0303, United States. Email: bzink@umich.edu
SOURCE
Annals of Emergency Medicine (2001) 37:3 (318-332). Date of Publication:
2001
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Injury to the brain is the leading factor in mortality and morbidity from
traumatic injury. The devastating personal, social, and financial
consequences of traumatic brain injury (TBI) are compounded by the fact that
most people with TBI are young and previously healthy. From the emergency
physician's standpoint, patients with severe TBI are those with a presenting
Glasgow Coma Scale score of less than 9. Over the past 30 years, mortality
from severe traumatic brain injury for those patients who survive to the
hospital has been reduced by half from nearly 50% to approximately 25%.
Because most of the pathologic processes that determine outcome are fully
active during the first hours after TBI, the decisions of emergency care
providers may be crucial. This review addresses new concepts and information
in the pathophysiology of TBI and secondary brain injury and demonstrates
how emergency management may be linked to neurologic outcome.
EMTREE DRUG INDEX TERMS
4 phosphonomethylpipecolic acid (clinical trial, drug therapy)
7 nitroindazole (drug therapy)
aptiganel (clinical trial, drug therapy)
deltibant (clinical trial, drug therapy)
dizocilpine (clinical trial, drug therapy)
excitatory amino acid (clinical trial, drug therapy)
midafotel (clinical trial, drug therapy)
n(g) nitroarginine (drug therapy)
nalmefene (drug therapy)
naloxone (drug therapy)
nimodipine (clinical trial, drug therapy)
scopolamine (clinical trial, drug therapy)
superoxide dismutase (clinical trial, drug therapy)
tirilazad (clinical trial, drug therapy)
triamcinolone (clinical trial, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain injury (drug therapy)
disease severity
EMTREE MEDICAL INDEX TERMS
article
clinical trial
drug efficacy
emergency health service
human
medical decision making
nonhuman
pathophysiology
patient care
phase 2 clinical trial
phase 3 clinical trial
priority journal
treatment outcome
DRUG TRADE NAMES
bradycor
cerestat
eaa 494
mk 801
CAS REGISTRY NUMBERS
4 (3 phosphonoallyl) 2 piperazinecarboxylic acid (117414-74-1)
4 phosphonomethylpipecolic acid (110347-85-8)
7 nitroindazole (2942-42-9)
aptiganel (137159-92-3, 137160-11-3)
deltibant (157967-60-7)
dizocilpine (77086-21-6)
n(g) nitroarginine (2149-70-4)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
nimodipine (66085-59-4)
scopolamine (138-12-5, 51-34-3, 55-16-3)
superoxide dismutase (37294-21-6, 9016-01-7, 9054-89-1)
tirilazad (110101-66-1, 110101-67-2, 111793-42-1)
triamcinolone (124-94-7)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001096706
MEDLINE PMID
11223769 (http://www.ncbi.nlm.nih.gov/pubmed/11223769)
PUI
L32204936
DOI
10.1067/mem.2001.113505
FULL TEXT LINK
http://dx.doi.org/10.1067/mem.2001.113505
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1230
TITLE
Laboratory investigations of acute drug intoxications diagnosed and treated
by prehospital emergency physician
ORIGINAL (NON-ENGLISH) TITLE
Laborchemische überprüfung von notarztdiagnosen bei akuten intoxikationen
mit rauschmitteln
AUTHOR NAMES
Schmidbauer S.
Mayr N.P.
Drasch G.
Roider G.
Schneider K.
Hallfeldt K.
AUTHOR ADDRESSES
(Schmidbauer S.; Mayr N.P.; Drasch G.; Roider G.; Schneider K.; Hallfeldt
K.) Chirurgische Klinik und Poliklinik, Klinikum lnnenstadt,
Ludwig-Maximilians-Universität, Pettenkoferstraße 89, 80336 München,
Germany.
CORRESPONDENCE ADDRESS
S. Schmidbauer, Chirurgische Klinik und Poliklinik, Klinikum lnnenstadt,
Ludwig-Maximilians-Universität, Pettenkoferstraße 89, 80336 München,
Germany.
SOURCE
Notarzt (2001) 17:1 (7-11). Date of Publication: 2001
ISSN
0177-2309
ABSTRACT
In Germany have been registrated 1501 deaths by acute drug intoxications in
1997. Prehospital emergency doctors have to treat patients with different
disturbances of consciousness caused by commonly unknown narcotic
poisioning. In this prospective study we analysed quality and quantity of
acute drug intoxications treated in the supply district of the Munich
downtown emergency physician from 10/1995 to 0411996. Prehospital
documentation was done by independent study assistants, blood samples were
analysed by HPLC, immunochemical methods and gaschromatography. 53 % of our
patients had an acute alcohol intoxication with lowered values of the
Glasgow-Coma-Scale between 4 and 14 points, the median value of blood
alcohol concentration was 2.54 %. 29 % of the patients suffered from an
acute opiate-intoxication, 45 % of them were found in a public toilet, in
64% injection utensils lead to the prehospital diagnosis. 7 of 11 opiate
intoxicated have been treated with naloxon for antagonising without
complications, four of them showed additional drug abuse polyintoxication
later prooved by blood analysis wasn't recognized prehospital in a third of
our cases. In the supply district of the Munich downtown emergency physician
every tenth emergency call is caused by drug-intoxications, 76% of these
patients are admitted to emergency departments. According to the high
incidence of polyintoxicated patients and the shown underestimation of
clinical symptoms drug-screening should immediately be performed in the
emergency department. The education of the emergency physicians should be
more intensive.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
diazepam (drug toxicity)
midomafetamine (drug toxicity)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, epidemiology)
emergency medicine
emergency physician
laboratory diagnosis
physician
EMTREE MEDICAL INDEX TERMS
alcohol intoxication (diagnosis, epidemiology)
article
clinical article
Germany
Glasgow coma scale (diagnosis)
high performance liquid chromatography
human
immunochemistry
medical documentation
multiple drug abuse (diagnosis, epidemiology)
narcotic dependence (diagnosis, epidemiology)
opiate addiction (diagnosis, epidemiology)
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
alcohol (64-17-5)
diazepam (439-14-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Forensic Science Abstracts (49)
General Pathology and Pathological Anatomy (5)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001067406
PUI
L32154375
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1231
TITLE
Availability of antidotes in French emergency medical aid units
ORIGINAL (NON-ENGLISH) TITLE
Disponibilité des antidotes dans l'aide médicale urgente
AUTHOR NAMES
Lapostolle F.
Alayrac L.
Adnet F.
Maistre J.P.
Leseur A.
Lapandry C.
AUTHOR ADDRESSES
(Lapostolle F.; Alayrac L.; Adnet F.; Maistre J.P.; Leseur A.; Lapandry C.)
SAMU 93, Hôpital Avicenne, 125, route de Stalingrad, F93009 Bobigny, France.
CORRESPONDENCE ADDRESS
F. Lapostolle, SAMU 93, Hôpital Avicenne, 125, route de Stalingrad, F93009
Bobigny, France. Email: frederic.lapostolle@avc.ap-hop-paris.fr
SOURCE
Presse Medicale (2001) 30:4 (159-162). Date of Publication: 3 Feb 2001
ISSN
0755-4982
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
OBJECTIVE: To study the availability of antidotes in French emergency
medical aid units (SAMU). METHODS: The physicians or nurses responsible for
antidotes in French emergency medical aid units (SAMU) were interviewed by
phone. The study involved 102 SAMU in metropolitan France. Four answers on
availability of 37 antidotes were possible: the antidote was available in
the emergency vehicle used for interventions; the antidote was available in
the hospital-located SAMU; the antidote was available in the referral
hospital (emergency unit, intensive care unit, operating room, pharmacy);
the antidote was not available or not known to be available. RESULTS:
Adrenaline and atropine were available in all the intervention vehicles.
Nine other antidotes were available in more than two-thirds of the vehicles:
30% glucose (101/102), isoprenaline (100/102), dobutamine (98/112), sodium
bicarbonate (97/102), naloxone (95/102), calcium chloride or bicarbonate
(89/102), flumazénil (83/102), sodium lactate (77/102), and magnesium
sulfate (66/102). Among the other antidotes, hydroxocobalamine and
propranolol were available in 24/102 intervention vehicles and activated
charcoal in 22/102. Antidigitalic antibodies and 4-methylpyrazole were not
available in any vehicle, and were available in less than 25% of the
hospitals. CONCLUSION: There is a great disparity of antidote availability.
Certain essential antidotes, for which there is no alternative, are not
available in emergency intervention vehicles and even in the hospital. The
SAMU should develop an economically acceptable departmental management
scheme for exceptional-use antidotes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole
activated carbon
atropine
bicarbonate
calcium chloride
dobutamine
epinephrine
flumazenil
glucose
hydroxocobalamin
isoprenaline
lactate sodium
magnesium sulfate
naloxone
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
health care availability
EMTREE MEDICAL INDEX TERMS
ambulance
article
emergency ward
France
intensive care unit
operating room
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
dobutamine (34368-04-2, 52663-81-7)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lactate sodium (72-17-3)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2001066146
MEDLINE PMID
11229303 (http://www.ncbi.nlm.nih.gov/pubmed/11229303)
PUI
L32150982
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1232
TITLE
Prehospital management of rapid atrial fibrillation: Recommendations for
treatment protocols
AUTHOR NAMES
Abarbanell N.R.
Marcotte M.A.
Schaible B.A.
Aldinger G.E.
AUTHOR ADDRESSES
(Abarbanell N.R.) Department of Emergency Medicine, Baptist Medical Center,
Jacksonville, FL, United States.
(Marcotte M.A.; Schaible B.A.; Aldinger G.E.) Department of Emergency
Medicine, Saint Francis Hospital, Evanston, IL, United States.
CORRESPONDENCE ADDRESS
N.R. Abarbanell, Baptist Medical Center, Department of Emergency Medicine,
820 Prudential Drive, Jacksonville, FL 32207, United States.
SOURCE
American Journal of Emergency Medicine (2001) 19:1 (6-9). Date of
Publication: 2001
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The present study was completed to establish an epidemiological database
defining prehospital rapid atrial fibrillation (RAF) and interventions given
such patients in the hope of developing recommendations for further
treatment protocols. On review of 4,749 paramedic run reports from a
low-volume urban emergency medical services (EMS) system, 33 persons (0.69%)
presented with RAF. Data collected included vital signs/ventricular rate,
patient age, ambulance field times, patient chief complaint, prehospital
interventions, efficacy of interventions, additional cardiac rhythms,
iatrogenic complications, and patient past medical history. Neither
intravenous (IV) diltiazem or electrical cardioversion were used within the
12-month period of this study. Symptomatic/supportive care consisting of
observation (72.73%) and interventions (27.27%) with nitroglycerine,
furosemide, aspirin, morphine, and/or IV fluid bolus therapy accounted for
all prehospital treatment. Paramedics documented improvement in 100% of
patients. No cases occurred in which RAF resulted in severe hemodynamic
instability. No inappropriate use, point estimate (PE) [(0)/(33) (0.00% to
10.60%)], or unmet need, PE [(0)/(4,716) (0.00% to 0.08%)] of care was
noted. The data presented in this study suggest that given similar EMS
system characteristics, prehospital RAF is an infrequently encountered,
predominantly hemodynamically stable cardiac arrhythmia, readily treatable
with symptomatic/supportive care, and cautious observation. The prehospital
application of adult advanced cardiac life support guidelines utilizing IV
diltiazem and electrical cardioversion for the treatment of RAF may be
unnecessary. Copyright © 2001 by W.B. Saunders Company.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
adenosine (drug dose, drug therapy, intravenous drug administration)
antiarrhythmic agent (drug dose, drug therapy, intravenous drug
administration)
bretylium tosylate (drug dose, drug therapy, intravenous drug
administration)
diltiazem (drug dose, drug therapy, intravenous drug administration)
lidocaine (drug dose, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug dose, drug therapy, oral drug administration)
atropine (drug dose, intravenous drug administration)
diazepam (drug dose, intravenous drug administration)
diphenhydramine (drug dose, intramuscular drug administration, intravenous
drug administration)
dopamine (drug dose, drug therapy, intravenous drug administration)
epinephrine (drug dose, drug therapy, intravenous drug administration,
subcutaneous drug administration)
furosemide (drug dose, drug therapy, intravenous drug administration)
glucagon (drug dose, intramuscular drug administration)
glucose
glyceryl trinitrate (drug dose, drug therapy, sublingual drug
administration)
morphine sulfate (drug dose, intravenous drug administration)
naloxone (drug dose, intravenous drug administration)
salbutamol (drug dose, inhalational drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
atrial fibrillation (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
cardiovascular disease (diagnosis, drug therapy)
child
clinical protocol
electrocardiography monitoring
emergency treatment
endotracheal tube
heart atrium arrhythmia (diagnosis, drug therapy)
human
major clinical study
nebulizer
patient care
patient transport
priority journal
treatment outcome
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bretylium tosylate (61-75-6)
diazepam (439-14-5)
diltiazem (33286-22-5, 42399-41-7)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Pediatrics and Pediatric Surgery (7)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001026384
MEDLINE PMID
11146008 (http://www.ncbi.nlm.nih.gov/pubmed/11146008)
PUI
L32056049
DOI
10.1053/ajem.2001.18124
FULL TEXT LINK
http://dx.doi.org/10.1053/ajem.2001.18124
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1233
TITLE
The Lazarus phenomenon following recreational drug use
AUTHOR NAMES
Walker A.
McClelland H.
Brenchley J.
AUTHOR ADDRESSES
(Walker A., alison.walkerl@virgin.net; McClelland H.; Brenchley J.) Accident
and Emergency Department, Leeds General Infirmary, Great George Street,
Leeds LS1 3EX, United Kingdom.
CORRESPONDENCE ADDRESS
A. Walker, Accident and Emergency Department, Leeds General Infirmary, Gret
George Street, Leeds LS1 3EX, United Kingdom. Email:
alison.walker1@virgin.net
SOURCE
Emergency Medicine Journal (2001) 18:1 (74-75). Date of Publication: January
2001
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
A case is reported of the Lazarus phenomenon (the return of spontaneous
circulation after cardiopulmonary resuscitation had been abandoned) in a
patient following recreational drug use. The implications for management of
cardiac arrest in the emergency department are discussed.
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
bicarbonate (drug therapy)
diamorphine
epinephrine (drug therapy, intravenous drug administration)
illicit drug
midomafetamine
naloxone (drug therapy, intramuscular drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
Lazarus phenomenon
peripheral circulation
resuscitation
EMTREE MEDICAL INDEX TERMS
adult
article
assisted ventilation
cardiopulmonary insufficiency (therapy)
case report
drug abuse
emergency treatment
emergency ward
follow up
heart arrest (drug therapy)
heart arrest
heroin dependence
human
intensive care
male
morphine addiction
recreation
shock (drug therapy, therapy)
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2002028656
MEDLINE PMID
11310473 (http://www.ncbi.nlm.nih.gov/pubmed/11310473)
PUI
L34070849
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1234
TITLE
A descriptive study of an epidemic of poisoning caused by heroin adulterated
with scopolamine
AUTHOR NAMES
Hamilton R.J.
Perrone J.
Hoffman R.
Henretig F.M.
Karkevandian E.H.
Marcus S.
Shih R.D.
Blok B.
Nordenholz K.
AUTHOR ADDRESSES
(Hamilton R.J.; Perrone J.; Hoffman R.; Henretig F.M.; Karkevandian E.H.;
Marcus S.; Shih R.D.; Blok B.; Nordenholz K.) Department of Emergency
Medicine, Med. Coll. of Pennsylvania Hospital, 3300 Henry Avenue,
Philadelphia, PA 19129, United States.
CORRESPONDENCE ADDRESS
R.J. Hamilton, Department of Emergency Medicine, Med. Coll. of Pennsylvania
Hospital, 3300 Henry Avenue, Philadelphia, PA 19129, United States. Email:
richard.hamilton@drexel.edu
SOURCE
Journal of Toxicology - Clinical Toxicology (2000) 38:6 (597-608). Date of
Publication: 2000
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Objective: Adulterants, contaminants, and diluents are all examples of
additives to street drugs. Some of these additives may be pharmacologically
active; however, it is unusual for them to cause toxic side effects. In the
spring of 1995, a new form of heroin appeared in New York City, spreading to
other East Coast cities, that was adulterated with scopolamine. It caused
severe anticholinergic toxicity in heroin users with patients often
presenting to emergency departments in great numbers. This is a report of
the demographics and clinical characteristics of the epidemic. Methods: A
combination of prospective and retrospective data collection from the New
York City, New Jersey, Delaware Valley, and Maryland Poison Centers. The
primary measurements were age, sex, route of drug use, vital signs, signs
and symptoms, disposition, and treatment. Results: Of the 370 cases reported
to the participating poison centers, 129 were excluded from the final
analysis because of insufficient data. Of the patients who used this
product, 55% presented with signs and symptoms of heroin toxicity but then
became severely agitated with anticholinergic symptoms when naloxone was
used to reverse respiratory depression. Nasal insufflation was the route of
administration in 34% of the cases. Seizures were rare (3%). Ninety percent
required admission, and half were admitted to a critical care unit.
Conclusions: Adulteration of street drugs can lead to toxic epidemics.
Poison centers are essential for identification of these trends and are the
primary source of information on diagnosis and treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
scopolamine (drug toxicity)
street drug (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aeration
agitation
anticholinergic effect
article
drug contamination
epidemic
female
human
male
respiration depression
seizure
United States
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
scopolamine (138-12-5, 51-34-3, 55-16-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000424715
MEDLINE PMID
11185966 (http://www.ncbi.nlm.nih.gov/pubmed/11185966)
PUI
L30978638
DOI
10.1081/CLT-100102008
FULL TEXT LINK
http://dx.doi.org/10.1081/CLT-100102008
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1235
TITLE
Peer-initiated overdose resuscitation: Fellow drug users could be mobilised
to implement resuscitation
AUTHOR NAMES
Strang J.
Best D.
Man L.-H.
Noble A.
Gossop M.
AUTHOR ADDRESSES
(Strang J.; Best D.; Man L.-H.; Noble A.; Gossop M.) National Addiction
Centre, Institute of Psychiatry the Maudsley, Denmark Hill, London SE5 8AF,
United Kingdom.
CORRESPONDENCE ADDRESS
J. Strang, National Addiction Centre, Institute of Psychiatry The Maudsley,
Denmark Hill, London SE5 8AF, United Kingdom.
SOURCE
International Journal of Drug Policy (2000) 11:6 (437-445). Date of
Publication: 2000
ISSN
0955-3959
ABSTRACT
Research interviews about overdose experiences were conducted with 115
patients attending a methadone maintenance clinic in south London, UK. While
almost half (49.6%) reported having experienced overdose personally (on an
average of four occasions each), almost all (97.4%) reported that they had
witnessed overdoses (on an average of six occasions each). This represents a
total of 706 overdoses witnessed, of which 106 had resulted in fatalities.
The vast majority of patients (86/97) reported that they had taken actions
when they had witnessed overdoses with those acting taking an average of
nearly threee different actions on the last occasion on which they had seen
someone overdosing. Most respondents reported that they would be willing to
act, even if they did not know the overdose victim personally and that they
had not been deterred from acting by the previous response from the
emergency services. Fear of punishment was not a strong deterrent from
acting certainly not for this sample, with many participants also expressing
an interest in expanding their repertoire of overdose interventions, for
example through training in resuscitation techniques and by keeping naloxone
at home for use in overdose emergency. (C) 2000 Elsevier Science B.V.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (rehabilitation)
opiate addiction (rehabilitation)
EMTREE MEDICAL INDEX TERMS
adult
article
drug abuse
experience
female
human
maintenance therapy
major clinical study
male
peer review
priority journal
procedures
resuscitation
social support
victim
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000420070
PUI
L30953449
DOI
10.1016/S0955-3959(00)00070-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0955-3959(00)00070-0
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1236
TITLE
Antidotes - Inappropriate timely availability
AUTHOR NAMES
Higgins M.A.
Evans R.
AUTHOR ADDRESSES
(Higgins M.A.; Evans R.) Emergency Unit, University Hospital of Wales,
Cardiff CF14 4XW, United Kingdom.
CORRESPONDENCE ADDRESS
M.A. Higgins, Emergency Unit, University Hospital of Wales, Cardiff CF14
4XW, United Kingdom.
SOURCE
Human and Experimental Toxicology (2000) 19:9 (485-488). Date of
Publication: 2000
ISSN
0960-3271
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
The aim of this study was to determine the availability of antidotes to
poisons in Wales and the South West of England. A stocklist of antidotes
that are available to accident and emergency departments was requested and
was compared with recommendations from the International Programme on
Chemical Safety (IPCS). Chief pharmacists were invited to complete a short
questionnaire regarding knowledge of existing guidelines. Thirty-four of 43
centres replied (response rate 77%). No department held all 36 antidotes
(mean 13, range 7-33). All departments held antidotes that were frequently
used. Ninety-one percent of departments held one cyanide antidote.
Eighty-eight percent held one heavy metal chelating agent. The remaining
antidotes were variably stocked. New agents such as 4-methylpyrazole,
hydroxocobalamin and the heavy metal chelating agents DMSA and DMPS were
infrequently held. Twenty of 34 chief pharmacists were unfamiliar with
existing UK guidelines. A trend exists whereby larger departments stocked
more antidotes. Some antidotes to poisons are not available in a timely
fashion in Wales and the South West of England. There is a lack of awareness
of existing guidelines. New recommendations relevant to clinical need and
local practice should ideally be developed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
4 methylpyrazole
acetylcysteine
alcohol
amyl nitrite
atropine
chelating agent
cobalt edetate
cyanide (drug toxicity)
dantrolene
diazepam
flumazenil
glucagon
gluconate calcium
heavy metal (drug toxicity)
hydroxocobalamin
isoprenaline
methionine
methylene blue
naloxone
phentolamine
physostigmine
poison (drug toxicity)
pralidoxime
propranolol
sodium nitrite
sodium thiosulfate
succimer
unindexed drug
unithiol
EMTREE MEDICAL INDEX TERMS
article
controlled study
cyanide poisoning
emergency ward
health care availability
heavy metal poisoning
human
pharmacist
practice guideline
priority journal
questionnaire
United Kingdom
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
alcohol (64-17-5)
amyl nitrite (463-04-7)
atropine (51-55-8, 55-48-1)
cobalt edetate (14931-83-0, 36499-65-7)
cyanide (57-12-5)
dantrolene (14663-23-1, 7261-97-4)
diazepam (439-14-5)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
methionine (59-51-8, 63-68-3, 7005-18-7)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
phentolamine (50-60-2, 73-05-2)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
unithiol (4076-02-2, 74-61-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001046709
MEDLINE PMID
11204549 (http://www.ncbi.nlm.nih.gov/pubmed/11204549)
PUI
L32111949
DOI
10.1191/096032700676333384
FULL TEXT LINK
http://dx.doi.org/10.1191/096032700676333384
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1237
TITLE
Case of the month. The masquerade.
AUTHOR NAMES
Werfel P.
AUTHOR ADDRESSES
(Werfel P.) University Medical Center, State University of New York, Stony
Brooke, USA.
CORRESPONDENCE ADDRESS
P. Werfel, University Medical Center, State University of New York, Stony
Brooke, USA. Email: pwerfel@epo.hsc.sunysb.edu
SOURCE
JEMS : a journal of emergency medical services (2000) 25:12 (20). Date of
Publication: Dec 2000
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain hemorrhage (diagnosis)
emergency treatment
heroin dependence (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
article
case report
diagnostic error
fatality
human
male
social psychology
standard
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11138378 (http://www.ncbi.nlm.nih.gov/pubmed/11138378)
PUI
L33421174
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1238
TITLE
Coma induced by intoxication.
AUTHOR NAMES
Buylaert W.A.
AUTHOR ADDRESSES
(Buylaert W.A.) Department of Emergency Medicine, University Hospital, Gent,
Belgium.
CORRESPONDENCE ADDRESS
W.A. Buylaert, Department of Emergency Medicine, University Hospital, Gent,
Belgium.
SOURCE
Acta neurologica Belgica (2000) 100:4 (221-224). Date of Publication: Dec
2000
ISSN
0300-9009
ABSTRACT
Clinicians in the emergency department are often confronted with coma
patients due to poisoning. A systematic general approach involving early
consultation with a neurologist is of paramount importance. A high index of
suspicion, a systematic first assessment already in the prehospital phase
and early stabilisation of vital functions are the essential first steps.
Specific antidotes like hypertonic glucose and thiamine are part of a "coma
cocktail". The opiate antagonist naloxone should be used only when
clinically indicated and in a titrated way. Flumazenil should only be used
with caution and in restricted cases. Clinical neurological evaluation and
technical investigations like CT-scan and laboratory tests should make part
of a careful diagnostic plan. Toxicological tests deserve their place in the
diagnostic work up of a coma patient with suspected poisoning. Knowledge of
the possibilities of the toxicology lab and optimal communication with the
clinical toxicologist is important for optimal patient care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
glucose (drug therapy)
naloxone (drug therapy)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (complication, diagnosis, therapy)
alcoholism (complication, diagnosis, therapy)
coma (therapy)
EMTREE MEDICAL INDEX TERMS
brain hypoxia (etiology, prevention)
brain injury (diagnosis)
cerebrovascular accident (diagnosis)
chemically induced disorder
diabetic coma (diagnosis)
diagnostic test
differential diagnosis
emergency
falling
first aid
human
hypoglycemia (complication)
intoxication (diagnosis)
monitoring
neurologic examination
review
CAS REGISTRY NUMBERS
alcohol (64-17-5)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11233676 (http://www.ncbi.nlm.nih.gov/pubmed/11233676)
PUI
L33449725
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1239
TITLE
Analgesics in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
Kampf dem schmerz: Analgetika in der notfallmedizin
AUTHOR NAMES
Weiss T.
Zenz M.
AUTHOR ADDRESSES
(Weiss T.; Zenz M.) Universitatsklin. fur Anasthesiol., Intensiv- und
Schmerztherapie, BG-Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789
Bochum, Germany.
CORRESPONDENCE ADDRESS
T. Weiss, Universitatsklin. fur Anasthesiol., Intensiv- und Schmerztherapie,
BG-Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
Email: weiss@anaesthesia.de
SOURCE
Notfall Medizin (2000) 26:12 (558-560). Date of Publication: 2000
ISSN
0341-2903
ABSTRACT
The use of painkilling drugs in emergency medicine is mandatory for humane
reasons. Furthermore, treatment with analgesics is also necessary in order
to avoid such conditions as tachycardia and hypertension triggered by pain
and mental stress. A variety of different classes of painkilling substances
that have proved effective in the practical setting, are presented.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug combination, drug dose, drug therapy, intramuscular
drug administration, intravenous drug administration, pharmaceutics, rectal
drug administration)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug combination, drug therapy)
dipyrone (drug dose, drug therapy, intravenous drug administration,
pharmaceutics, rectal drug administration)
fentanyl (drug dose, drug therapy, pharmaceutics)
ketamine (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration, pharmaceutics)
lysine acetylsalicylate (drug combination, drug dose, drug therapy,
intravenous drug administration)
midazolam (drug therapy)
morphine (drug combination, drug dose, drug therapy, intravenous drug
administration, pharmaceutics)
naloxone (drug dose, drug therapy, intravenous drug administration)
narcotic analgesic agent (drug combination, drug dose, drug therapy,
intravenous drug administration, pharmaceutics)
nonsteroid antiinflammatory agent (drug combination, drug therapy)
opiate antagonist (drug dose, drug therapy, intravenous drug administration)
phencyclidine derivative (drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration, pharmaceutics)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug classification
drug contraindication
drug dosage form
drug efficacy
drug overdose (drug therapy)
hypertension (complication)
mental stress
short survey
tachycardia (complication)
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lysine acetylsalicylate (34220-70-7, 37933-78-1, 62952-06-1, 77337-52-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pharmacy (39)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2001041664
PUI
L32104657
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1240
TITLE
Managing the agitated psychotic patient: A reappraisal of the evidence
AUTHOR NAMES
Allen M.H.
AUTHOR ADDRESSES
(Allen M.H.) Department of Psychiatry, Univ. of Colorado School of Medicine,
MC 0490, 777 Bannock St., Denver, CO 80204, United States.
CORRESPONDENCE ADDRESS
M.H. Allen, Department of Psychiatry, Univ. of Colorado School of Medicine,
MC 0490, 777 Bannock St., Denver, CO 80204, United States. Email:
mallen@dhha.org
SOURCE
Journal of Clinical Psychiatry (2000) 61:SUPPL. 14 (11-20). Date of
Publication: 2000
ISSN
0160-6689
BOOK PUBLISHER
Physicians Postgraduate Press Inc., P.O. Box 752870, Memphis, United States.
ABSTRACT
Under intense public pressure, regulatory agencies have recently defined
circumstances in which medications will be considered a form of restraint,
so-called "chemical restraint". This article proposes that the emergency
management of the agitated patient be viewed as a brief departure from the
usual physician-patient collaboration. Viewed in this way, the goal is
simply to terminate the emergency in the manner most likely to be acceptable
to patients and conducive to a more typical dialogue. To that end, the
author reviews all controlled studies of medication treatment of agitation
that have appeared in English since the advent of the neuroleptic
medications. Issues of diagnosis, relative efficacy, dosage, route, onset,
offset, safety, tolerability, and consumer preference are considered.
EMTREE DRUG INDEX TERMS
alprazolam
amobarbital (drug therapy)
barbituric acid derivative (adverse drug reaction, drug therapy)
benzodiazepine derivative (adverse drug reaction, drug therapy)
chlordiazepoxide
chlorpromazine (adverse drug reaction, drug therapy, intramuscular drug
administration)
clonazepam (drug therapy)
diazepam
droperidol (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration)
flunitrazepam (drug therapy)
haloperidol (drug combination, drug therapy, intramuscular drug
administration, oral drug administration)
lorazepam (drug combination, drug therapy, intramuscular drug
administration, intravenous drug administration, oral drug administration)
loxapine (drug therapy)
loxapine succinate
midazolam (adverse drug reaction, drug therapy)
molindone (drug therapy)
naloxone
neuroleptic agent (adverse drug reaction, drug therapy, intramuscular drug
administration, intravenous drug administration, oral drug administration)
phenobarbital (drug combination, drug therapy)
risperidone
tiotixene (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
psychopharmacotherapy
psychosis (drug therapy)
EMTREE MEDICAL INDEX TERMS
agitation
akathisia (side effect)
article
doctor patient relation
dose response
drug efficacy
drug safety
drug tolerability
emergency health service
emergency treatment
evidence based medicine
extrapyramidal symptom (side effect)
human
hypotension (side effect)
patient compliance
priority journal
psychiatric diagnosis
respiration depression (side effect)
treatment planning
DRUG TRADE NAMES
amytal
ativan
haldol
klonopin
librium
loxitane
moban
narcan
navane
risperdal
valium
versed
xanax
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
amobarbital (57-43-2, 64-43-7)
chlordiazepoxide (438-41-5, 58-25-3)
chlorpromazine (50-53-3, 69-09-0)
clonazepam (1622-61-3)
diazepam (439-14-5)
droperidol (548-73-2)
flunitrazepam (1622-62-4)
haloperidol (52-86-8)
lorazepam (846-49-1)
loxapine (1977-10-2)
loxapine succinate (27833-64-3)
midazolam (59467-70-8)
molindone (15622-65-8, 7416-34-4)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
risperidone (106266-06-2)
tiotixene (5591-45-7)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001033076
MEDLINE PMID
11154012 (http://www.ncbi.nlm.nih.gov/pubmed/11154012)
PUI
L32064772
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1241
TITLE
Pediatric cardiopulmonary resuscitation equipment in the crash cart or
resuscitation trolley
ORIGINAL (NON-ENGLISH) TITLE
Material de reanimación cardiopulmonar pediátrica en el carro de parada o
mesa de reanimación
AUTHOR NAMES
Calvo Macías C.
López-Herce Cid J.
Carrillo Álvarez A.
Burón Martínez E.
Delgado Domínguez M.A.
Domínguez Sampedro P.
Manrique I.
Paisán L.
Rodríguez Núñez A.
Tormo Calandín C.
AUTHOR ADDRESSES
(Calvo Macías C.; López-Herce Cid J.; Carrillo Álvarez A.; Burón Martínez
E.; Delgado Domínguez M.A.; Domínguez Sampedro P.; Manrique I.; Paisán L.;
Rodríguez Núñez A.; Tormo Calandín C.) Servicio Cuidados Criticos/Urgencias,
Departamento de Pediatría, Hospital Materno Infantil, Avda. Arroyo de los
Angeles, s/n, 29011 Málaga, Spain.
CORRESPONDENCE ADDRESS
C. Calvo Macías, Servicio Cuidados Criticos/Urgencias, Departamento de
Pediatría, Hospital Materno Infantil, Avda. Arroyo de los Angeles, s/n,
29011 Málaga, Spain.
SOURCE
Anales Espanoles de Pediatria (2000) 52:3 (258-260). Date of Publication:
2000
ISSN
0302-4342
BOOK PUBLISHER
Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain.
EMTREE DRUG INDEX TERMS
adenosine triphosphate
atropine (drug dose)
bicarbonate (drug dose)
calcium
diazepam (drug dose)
dopamine (drug dose, drug therapy)
epinephrine (drug dose, drug therapy)
fentanyl (drug dose)
flumazenil (drug dose)
furosemide (drug dose, drug therapy)
glucose
lidocaine (drug dose, drug therapy)
mannitol (drug dose)
methylprednisolone (drug dose)
naloxone (drug dose)
nifedipine (drug dose, drug therapy)
phenytoin (drug dose)
Ringer lactate solution
salbutamol (drug administration, drug dose, inhalational drug
administration)
suxamethonium (drug dose)
thiopental (drug dose)
vecuronium (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular disease (diagnosis, drug therapy, therapy)
resuscitation
EMTREE MEDICAL INDEX TERMS
article
defibrillation
electrocardiogram
emergency treatment
human
laryngoscopy
newborn
newborn intensive care
patient monitoring
practice guideline
CAS REGISTRY NUMBERS
Ringer lactate solution (8022-63-7)
adenosine triphosphate (15237-44-2, 56-65-5, 987-65-5)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
fentanyl (437-38-7)
flumazenil (78755-81-4)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
phenytoin (57-41-0, 630-93-3)
salbutamol (18559-94-9)
suxamethonium (306-40-1, 71-27-2)
thiopental (71-73-8, 76-75-5)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Spanish
EMBASE ACCESSION NUMBER
2001165106
MEDLINE PMID
11005749 (http://www.ncbi.nlm.nih.gov/pubmed/11005749)
PUI
L32401709
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1242
TITLE
Inadvertent administration of sufentanil instead of fentanyl during
sedation/analgesia in a community hospital emergency department: A report of
two cases
AUTHOR NAMES
Chisholm C.D.
Klanduch F.
AUTHOR ADDRESSES
(Chisholm C.D.; Klanduch F.) Emergency Medicine and Trauma Center, Methodist
Hospital, I-65 and 21st Street, Indianapolis, IN 46202, United States.
CORRESPONDENCE ADDRESS
C.D. Chisholm, Emergency Medicine and Trauma Center, Methodist Hospital,
I-65 and 21st Street, Indianapolis, IN 46202, United States. Email:
cchisholm@clarian.com
SOURCE
Academic Emergency Medicine (2000) 7:11 (1282-1284). Date of Publication:
2000
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
The authors report two cases of inadvertent administration of sufentanil
instead of fentanyl during patient sedation/analgesia in a community
hospital emergency department (ED). Both cases resuited in reversible
adverse drug events (ADEs) to the respective patients. In tracing the steps
involved in the cause of these errors, the authors discovered several
components common to identified pathways that result in ADEs. These include
similarities in product packaging appearance and names of these two
medications, along with nursing unfamiliarity with the medications.
Medication 'sound-alikes' and 'look-alikes' continue to be a source of
potential error in the ED.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug dose, intravenous drug administration)
sufentanil (drug toxicity)
EMTREE DRUG INDEX TERMS
flumazenil (drug combination, drug therapy)
midazolam (drug dose, intravenous drug administration)
naloxone (drug combination, drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
iatrogenic disease (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
case report
child
clinical feature
community hospital
diagnostic procedure
disease course
emergency ward
human
male
priority journal
resuscitation
sedation
treatment outcome
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
flumazenil (78755-81-4)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000399695
MEDLINE PMID
11073479 (http://www.ncbi.nlm.nih.gov/pubmed/11073479)
PUI
L30829091
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1243
TITLE
Adverse outcomes and opioid analgesic administration in acute abdominal pain
AUTHOR NAMES
Lee J.S.
Stiell I.G.
Wells G.A.
Elder B.R.
Vandemheen K.
Shapiro S.
AUTHOR ADDRESSES
(Lee J.S.; Stiell I.G.; Wells G.A.; Elder B.R.; Vandemheen K.; Shapiro S.)
Clinical Epidemiology Unit, Ottawa Hospital, Civic Campus, 1053 Carling
Avenue, Ottawa, Ont. K1Y 4E9, Canada.
CORRESPONDENCE ADDRESS
J.S. Lee, Clinical Epidemiology Unit, Ottawa Hospital, Civic Campus, 1053
Carling Avenue, Ottawa, Ont. K1Y 4E9, Canada. Email: jslee@ican.ca
SOURCE
Academic Emergency Medicine (2000) 7:9 (980-987). Date of Publication: 2000
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
To the authors' knowledge, no outcome-based, randomized clinical trial of
the safety of opioid analgesics in acute abdominal pain exists. Objectives:
1) To assess the feasibility of a randomized clinical trial of opioid safety
by estimating the adverse outcome rate among patients with abdominal pain
severe enough to necessitate opioid analgesics. 2) To explore the
association of opioid administration with adverse outcomes in acute
abdominal pain. Methods: The authors conducted a prospective observational
study of emergency department (ED) abdominal pain patients, and followed
them by telephone at three weeks to determine whether an adverse outcome
occurred (defined as obstruction, perforation, ischemia, hemorrhage,
peritonitis, sepsis, or death). A logistic regression of factors predicting
adverse outcome was performed. Results: Adverse outcomes occurred in 67 of
860 abdominal pain patients (7.8%, 95% CI = 6.1% to 9.8%), and 252 of 860
(29%) received opioids. The adverse outcome rate was 12.7% (95% CI = 9.0% to
17.0%) among patients who received opioids. Variables predictive of adverse
outcome in logistic regression included: ED diagnosis of adverse outcome (OR
12.4), age (OR 1.6 per decade), fever (OR 4.6), received opioids (OR 2.1),
pain duration (OR 1.5 per day), and leukocytosis (OR 2.0). Conclusions: A
clinical trial would need to randomize more than 1,500 patients to establish
the equivalent adverse outcome rates of opioids and placebo: The sample size
of all existing studies combined is insufficient to make such a conclusion.
Although opioids were associated with a higher adverse outcome rate in this
logistic regression, the authors believe this may be due to confounding by
pain severity. They emphasize that the study's design precludes conclusion
of a causal link. No change in clinical practice is warranted. A randomized
clinical trial of sufficient size to definitively resolve this issue is
needed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (clinical trial, drug therapy, intravenous drug administration)
EMTREE DRUG INDEX TERMS
fentanyl (clinical trial, drug therapy, intravenous drug administration)
morphine (clinical trial, drug therapy, intravenous drug administration)
pethidine (clinical trial, drug therapy, intravenous drug administration)
placebo
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (drug therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
article
bleeding
clinical trial
controlled clinical trial
controlled study
emergency ward
female
human
intestine ischemia
intestine obstruction
intestine perforation
leukocytosis
major clinical study
male
pain
priority journal
randomized controlled trial
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000327710
MEDLINE PMID
11043991 (http://www.ncbi.nlm.nih.gov/pubmed/11043991)
PUI
L30696334
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1244
TITLE
Clonidine toxicity in an adolescent patient.
AUTHOR NAMES
Gitter M.F.
Cox R.
AUTHOR ADDRESSES
(Gitter M.F.; Cox R.) Department of Emergency Medicine, University of
Mississippi Medical Center, Jackson 39216-4505, USA.
CORRESPONDENCE ADDRESS
M.F. Gitter, Department of Emergency Medicine, University of Mississippi
Medical Center, Jackson 39216-4505, USA.
SOURCE
Journal of the Mississippi State Medical Association (2000) 41:10 (757-759).
Date of Publication: Oct 2000
ISSN
0026-6396
ABSTRACT
Clonidine is a central acting a2-agonist used primarily as an
antihypertensive agent. Recently, it has been used for the treatment of
attention deficit hyperactivity disorder in children and adolescents. When
taken in excess, it can produce profound CNS depression, apnea, bradycardia
and hypotension. A transient period of hypertension can sometimes occur.
Treatment is primarily supportive, including respiratory support, atropine
for bradycardia, and fluids and dopamine for hypotension. The CNS depression
sometimes responds to naloxone. Young children are very sensitive to the
toxic effects of clonidine. A case of an 11 year old adolescent who took an
overdose of his clonidine is described to illustrate the toxicity of this
agent.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antihypertensive agent (drug toxicity)
clonidine (drug toxicity)
EMTREE MEDICAL INDEX TERMS
article
case report
child
emergency health service
emergency treatment
home accident
human
intoxication (therapy)
male
methodology
treatment outcome
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
11037697 (http://www.ncbi.nlm.nih.gov/pubmed/11037697)
PUI
L31379034
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1245
TITLE
Combined evidence-based literature analysis and consensus guidelines for
stocking of emergency antidotes in the United States
AUTHOR NAMES
Dart R.C.
Goldfrank L.R.
Chyka P.A.
Lotzer D.
Woolf A.D.
McNally J.
Snodgrass W.R.
Olson K.R.
Scharman E.
Geller R.J.
Spyker D.
Kraft M.
Lipsy R.
AUTHOR ADDRESSES
(Dart R.C.; Goldfrank L.R.; Chyka P.A.; Lotzer D.; Woolf A.D.; McNally J.;
Snodgrass W.R.; Olson K.R.; Scharman E.; Geller R.J.; Spyker D.; Kraft M.;
Lipsy R.) Rocky Mountain Poison and Drug Ctr., 1010 Yosemite Circle, Denver,
CO 80230, United States.
(Dart R.C.; Goldfrank L.R.; Chyka P.A.; Lotzer D.; Woolf A.D.; McNally J.;
Snodgrass W.R.; Olson K.R.; Scharman E.; Geller R.J.; Spyker D.; Kraft M.;
Lipsy R.)
CORRESPONDENCE ADDRESS
R.C. Dart, Rocky Mountain Poison and Drug Ctr., 1010 Yosemite Circle,
Denver, CO 80230, United States.
SOURCE
Annals of Emergency Medicine (2000) 36:2 (126-132). Date of Publication:
2000
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To develop guidelines for the stocking of antidotes at
hospitals that accept emergency admissions using combined evidence-based and
consensus methods. Methods: Study participants were 12 medical care
providers from disciplines that are affected by insufficient stocking of
emergency antidotes (clinical pharmacology, critical care, clinical
pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed
care pharmacy, clinical toxicology, pediatrics, poison control centers,
pulmonary medicine, regulatory medicine). Selection of individuals for the
study panel was based on evidence of previous antidote research or
perspective regarding the purchase and use of antidotes. The literature
regarding each antidote was systematically amassed using pre-1966 literature
files, current MEDLINE searches, the reference lists of major medical
textbooks, and citations solicited from the consensus panel. Articles
relevant to 4 defined core questions were included. These articles formed
the basis of an evidence-based analysis performed by the principal
investigator. After literature analysis, a literature summary and proposed
guidelines for antidote stocking were submitted to the panel. Consensus was
formed by electronic iterative presentation of alternatives to each panel
member using a modified Delphi method. All panel members participated in 5
rounds of guideline analysis of 20 antidotes. Results: Of the 20 antidotes,
16 antidotes were ultimately recommended for stocking (N-acetylcysteine,
atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide
antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol,
fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine,
sodium bicarbonate), 2 were not recommended for stocking (black widow
antivenin, ethylenediamine tetraacetic acid), and consensus could not be
reached for 2 antidotes (flumazenil, physostigmine). Conclusion: These
guidelines provide a tool to be used in revising or creating policies and
procedures with regard to the stocking of antidotes in hospitals that accept
emergency patients.
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy)
acetylcysteine (drug therapy)
arsenic (drug toxicity)
atropine (drug therapy)
bicarbonate (drug therapy)
calcium chloride (drug therapy)
carbamate insecticide (drug toxicity)
cyanide (drug toxicity)
deferoxamine (drug therapy)
digitoxin (drug toxicity)
digoxin (drug toxicity)
digoxin antibody F(ab) fragment (drug therapy)
dimercaprol (drug therapy)
edetic acid (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
gluconate calcium (drug therapy)
lead (drug toxicity)
methylene blue (drug therapy)
naloxone (drug therapy)
organophosphate insecticide (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy)
pralidoxime (drug therapy)
salicylic acid (drug toxicity)
snake venom (drug toxicity)
snake venom antiserum (drug therapy)
spider venom (drug toxicity)
spider venom antiserum (drug therapy)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
emergency treatment
evidence based medicine
hospital pharmacy
human
managed care
poison center
practice guideline
priority journal
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
acetylcysteine (616-91-1)
arsenic (7440-38-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
cyanide (57-12-5)
deferoxamine (70-51-9)
digitoxin (71-63-6)
digoxin (20830-75-5, 57285-89-9)
dimercaprol (59-52-9)
edetic acid (150-43-6, 60-00-4)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
lead (13966-28-4, 7439-92-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
salicylic acid (63-36-5, 69-72-7)
snake venom (55230-69-8)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000309926
MEDLINE PMID
10918103 (http://www.ncbi.nlm.nih.gov/pubmed/10918103)
PUI
L30667017
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1246
TITLE
Trends in treated opiate misuse in Dublin: The emergence of chasing the
dragon
AUTHOR NAMES
Smyth B.P.
O'Brien M.
Barry J.
AUTHOR ADDRESSES
(Smyth B.P.; O'Brien M.; Barry J.) Academic Unit, Pine Lodge, 79 Liverpool
Road, Chester CH2 1AW, United Kingdom.
CORRESPONDENCE ADDRESS
B.P. Smyth, Academic Unit, Pine Lodge, 79 Liverpool Road, Chester CH2 1AW,
United Kingdom. Email: bobbypsmyth@hotmail.com
SOURCE
Addiction (2000) 95:SUPPL. 2 (1217-1223). Date of Publication: 2000
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
To examine trends in treated opiate misuse and identify factors associated
with route of heroin use. Design. Cross-sectional survey. Setting. Services
providing addiction treatment in Dublin. Participants. Individuals making
their first ever contact seeking treatment for current opiate misuse,
between January 1991 and December 1996. Measurements. Data on
socio-demographics and current drug use. Findings. The study population was
3981. Over the 6-year period, there was a 330% increase in the number of new
attenders. The proportion of females increased. The mean age of first opiate
use declined and users began presenting earlier in their opiate-using
careers, causing a decline in the age profile of new attenders. Heroin users
were more likely to smoke (chase) rather than inject after 1994 (odds ratio
3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the
other significant independent predictors of chasing as the preferred route
of heroin use were being in employment, shorter history of use, less
frequent use, younger age, longer period in education and absence of
polydrug use. Gender did not independently predict route of use.
Conclusions. Ireland has joined the growing number of European countries
witnessing a movement towards heroin chasing. This has coincided with a
surge in the number of people entering treatment. We are concerned that the
greater acceptability of this route of use may be drawing increased numbers
of individuals into heroin use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction
EMTREE MEDICAL INDEX TERMS
adult
age
article
drug administration route
education
employment
female
human
male
smoking
United Kingdom
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000299148
MEDLINE PMID
11092069 (http://www.ncbi.nlm.nih.gov/pubmed/11092069)
PUI
L30648797
DOI
10.1046/j.1360-0443.2000.95812178.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1360-0443.2000.95812178.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1247
TITLE
Should we conduct a trial of distributing naloxone to heroin users for peer
administration to prevent fatal overdose?
AUTHOR NAMES
Lenton S.R.
Hargreaves K.M.
AUTHOR ADDRESSES
(Lenton S.R.; Hargreaves K.M.) National Drug Research Institute, GPO Box
U1987, Perth, WA 6845, Australia.
CORRESPONDENCE ADDRESS
S.R. Lenton, National Drug Research Institute, GPO Box U1987, Perth, WA
6845, Australia. Email: simon@ndri.curtin.edu.au
SOURCE
Medical Journal of Australia (2000) 173:5 (260-263). Date of Publication: 4
Sep 2000
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
ABSTRACT
Heroin overdose is a major cause of death among heroin users, and often
occurs in the company of other users. However, sudden death after injection
is rare, giving ample opportunity for intervention. Naloxone hydrochloride,
an injectable opioid antagonist which reverses the respiratory depression,
sedation and hypotension associated with opioids, has long been used to
treat opioid overdose. Experts have suggested that, as part of a
comprehensive overdose prevention strategy, naloxone should be provided to
heroin users for peer administration after an overdose. A trial could be
conducted to determine whether this intervention improves the management of
overdose or results in a net increase in harm (by undermining existing
prevention strategies, precipitating naloxone-related complications, or
resulting in riskier heroin use).
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (drug administration, drug therapy, intramuscular drug
administration, pharmacoeconomics, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
alcohol
benzodiazepine
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, prevention)
EMTREE MEDICAL INDEX TERMS
cause of death
detoxification
drug abuse
drug cost
emergency treatment
human
review
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000317609
MEDLINE PMID
11130352 (http://www.ncbi.nlm.nih.gov/pubmed/11130352)
PUI
L30680670
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1248
TITLE
Heroin and opiate emergencies in Viennaanalysis at the municipal ambulance
service
AUTHOR NAMES
Seidler D.
Schmeiser-Rieder A.
Schlarp O.
Laggner A.N.
AUTHOR ADDRESSES
(Seidler D., dan.seidler@akh-wien.ac.at; Schlarp O.; Laggner A.N.)
Department of Emergency Medicine, AKH, General Hospital, Vienna, Austria.
(Schmeiser-Rieder A.) Institute of Social Medicine, University of Vienna,
Vienna, Austria.
CORRESPONDENCE ADDRESS
D. Seidler, Department of Emergency Medicine, AKH, General Hospital Vienna,
Waehringer Guertel 18-20, A-1090 Vienna, Austria. Email:
dan.seidler@akh-wien.ac.at
SOURCE
Journal of Clinical Epidemiology (2000) 53:7 (734-741). Date of Publication:
July 2000
ISSN
0895-4356
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Vienna suffered an epidemic of heroin abuse in recent years, with
drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The
aim of this study was to make observations about illicit opioid-use with the
ambulance service as a data source. From June 1994 to August 1995, the
structured run records of the ambulance service were reviewed. Those with a
presumptive diagnosis of 'heroin or opiate' overdose were collected,
characteristics of emergencies and patients were analyzed. The run records
demonstrated a large number of non-fatal emergencies due to opioids,
involving 528 men and 179 women in 1087 emergencies. These emergencies were
on the average 6.8 times as prevalent as drug-fatalities. A group of 189
persons could be identified, who caused 52.2% of all emergencies and showed
a threefold mortality rate during the observation period. In Vienna, the
records of the municipal ambulance service provided valuable insights on
opioid-abuse. We suggest local analysis of non-fatal emergencies due to
opioids, as this might lead to a new source of information on illicit abuse
of these drugs. Copyright (C) 2000 Elsevier Science Inc.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
opiate
EMTREE DRUG INDEX TERMS
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (epidemiology)
emergency
EMTREE MEDICAL INDEX TERMS
article
Austria
drug abuse
fatality
female
gender
human
information processing
male
preventive medicine
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000275859
MEDLINE PMID
10941951 (http://www.ncbi.nlm.nih.gov/pubmed/10941951)
PUI
L30609627
DOI
10.1016/S0895-4356(99)00216-4
FULL TEXT LINK
http://dx.doi.org/10.1016/S0895-4356(99)00216-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1249
TITLE
Serious toxicity in a young child due to ibuprofen
AUTHOR NAMES
Öker E.E.
Hermann L.
Baum C.R.
Fentzke K.M.
Sigg T.
Leikin J.B.
AUTHOR ADDRESSES
(Öker E.E., istan_bul@msn.com) Department of Emergency Medicine, University
of Illinois at Chicago, Chicago, IL, United States.
(Hermann L.) Department of Emergency Medicine, Cook County Hospital,
Chicago, IL, United States.
(Baum C.R.; Fentzke K.M.) Department of Pediatrics, NW Univ. Med.
Ctr./Children's M., Chicago, IL, United States.
(Leikin J.B.) Department of Internal Medicine, Rush-Presbyt.-St.-Luke's Med.
Center, Chicago, IL, United States.
(Öker E.E., istan_bul@msn.com; Baum C.R.; Leikin J.B.) Toxikon Consortium,
Chicago, IL, United States.
(Sigg T.) Illinois Poison Center, Chicago, IL, United States.
(Öker E.E., istan_bul@msn.com) Department of Emergency Medicine, University
of Illinois at Chicago, 1740 West Taylor Street, Chicago, IL 60612, United
States.
CORRESPONDENCE ADDRESS
E.E. Oker, Department of Emergency Medicine, University of Illinois at
Chicago, 1740 West Taylor Street, Chicago, IL 60612, United States.
SOURCE
Academic Emergency Medicine (2000) 7:7 (821-823). Date of Publication: July
2000
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
An 18-month-old male presented to the emergency department (ED) for
evaluation of lethargy and apnea. Four hours before presentation, the
patient was found with an empty bottle of ibuprofen, an ingestion of as much
as 7.2 grams (600 mg/kg). The ED course was remarkable for a 30-second
tonic-clonic seizure. Laboratory analysis was notable for metabolic
acidosis. Four-hour and 7.5-hour serum ibuprofen levels were 640 and 39
μg/mL, respectively. Following treatment, the patient improved and was
extubated the next morning. While metabolic acidosis has been frequently
described at doses exceeding 400 mg/kg, seizures occurring early in the
course of ibuprofen toxicity have been rarely noted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ibuprofen (drug concentration, drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon
bicarbonate
lorazepam (drug therapy)
naloxone
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
drug overdose
EMTREE MEDICAL INDEX TERMS
apnea (complication, therapy)
article
case report
computer assisted tomography
drug blood level
endotracheal intubation
human
infant
lethargy (complication)
male
metabolic acidosis (complication)
priority journal
tonic clonic seizure (complication, drug therapy)
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
ibuprofen (15687-27-1)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000241273
MEDLINE PMID
10917334 (http://www.ncbi.nlm.nih.gov/pubmed/10917334)
PUI
L30439334
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1250
TITLE
Postoperative management of the emergency surgery small animal patient
AUTHOR NAMES
Brady C.A.
King L.G.
AUTHOR ADDRESSES
(Brady C.A.; King L.G.) Department of Clinical Studies, Veterinary Hospital,
University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104,
United States.
CORRESPONDENCE ADDRESS
C.A. Brady, Department of Clinical Studies, Veterinary Hospital, University
of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, United
States. Email: cbrady@vet.upenn.edu
SOURCE
Veterinary Clinics of North America - Small Animal Practice (2000) 30:3
(681-698). Date of Publication: 2000
ISSN
0195-5616
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Hypovolemia, hypothermia, and hypotension are common postoperative findings
that predispose the critically ill patient to secondary complications. This
patient population is especially vulnerable to sepsis, hypoxia, and immune
dysfunction. Careful monitoring is essential for early recognition of
potentially life-threatening physiologic derangements. Early and aggressive
intervention may help minimize systemic insult before it progresses to acute
respiratory distress syndrome, acute renal failure, disseminated
intravascular coagulation, or multiple organ failure.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug dose, intramuscular drug administration, intravenous
drug administration, subcutaneous drug administration)
antibiotic agent (drug dose, intravenous drug administration)
antiinflammatory agent (drug dose, intramuscular drug administration,
intravenous drug administration)
catecholamine (drug dose, intravenous drug administration)
opiate (drug dose, intramuscular drug administration, intravenous drug
administration)
EMTREE DRUG INDEX TERMS
amikacin (drug dose, intravenous drug administration)
ampicillin (drug dose, intravenous drug administration)
buprenorphine (drug dose, intramuscular drug administration, intravenous
drug administration)
butorphanol (drug interaction, intramuscular drug administration,
intravenous drug administration, subcutaneous drug administration)
cefotaxime (drug dose, intravenous drug administration)
cefoxitin (drug dose, intravenous drug administration)
clavulanic acid (drug dose, intravenous drug administration)
clindamycin (drug dose, intravenous drug administration)
dexamethasone sodium phosphate (drug dose, intramuscular drug
administration, intravenous drug administration)
diuretic agent
dobutamine (drug dose, intravenous drug administration)
dopamine (drug dose, intravenous drug administration)
enrofloxacin (drug dose, intravenous drug administration)
epinephrine (drug dose, intravenous drug administration)
fentanyl (drug dose, intravenous drug administration)
flumazenil (drug dose, intravenous drug administration)
gentamicin (drug dose, intravenous drug administration)
hydromorphone (drug dose, intramuscular drug administration, intravenous
drug administration)
imipenem (drug dose, intravenous drug administration)
morphine (drug dose, intramuscular drug administration)
naloxone (drug dose, intramuscular drug administration, intravenous drug
administration)
oxymorphone (drug dose, intramuscular drug administration, intravenous drug
administration)
ticarcillin (drug dose, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency surgery
EMTREE MEDICAL INDEX TERMS
fluid therapy
hypoxia (therapy)
kidney failure (therapy)
nonhuman
patient monitoring
postoperative care
respiratory distress syndrome (therapy)
respiratory failure (etiology, therapy)
resuscitation
review
sepsis
shock
systemic inflammatory response syndrome (diagnosis)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amikacin (37517-28-5, 39831-55-5)
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
buprenorphine (52485-79-7, 53152-21-9)
butorphanol (42408-82-2)
cefotaxime (63527-52-6, 64485-93-4)
cefoxitin (33564-30-6, 35607-66-0)
clavulanic acid (58001-44-8)
clindamycin (18323-44-9)
dexamethasone sodium phosphate (2392-39-4, 312-93-6)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
enrofloxacin (93106-60-6)
fentanyl (437-38-7)
flumazenil (78755-81-4)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
hydromorphone (466-99-9, 71-68-1)
imipenem (64221-86-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxymorphone (357-07-3, 76-41-5)
ticarcillin (29457-07-6, 34787-01-4, 4697-14-7)
EMBASE CLASSIFICATIONS
Surgery (9)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000206988
MEDLINE PMID
10853283 (http://www.ncbi.nlm.nih.gov/pubmed/10853283)
PUI
L30366560
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1251
TITLE
Emergency diagnosis of opioid intoxication
AUTHOR NAMES
Williams R.H.
Erickson T.
AUTHOR ADDRESSES
(Williams R.H., rwilliam@uic.edu) University of Illinois, Chicago Medical
Center, Departments of Pathology, Chicago, IL, United States.
(Erickson T.) Emergency Medicine, Chicago, IL, United States.
(Williams R.H., rwilliam@uic.edu) University of Illinois, Chicago Medical
Center, Department of Pathology, 840 S Wood St, 201 G CSB, Chicago, IL
60612, United States.
CORRESPONDENCE ADDRESS
R.H. Williams, University of Illinois, Chicago Medical Center, Department of
Pathology, 840 S Wood St, Chicago, IL 60612, United States. Email:
rwilliam@uic.edu
SOURCE
Laboratory Medicine (2000) 31:6 (334-342). Date of Publication: 2000
ISSN
0007-5027
ABSTRACT
Opioids are widely used for analgesic purposes. If taken as prescribed, they
are safe and effective. Overdosing, however, can cause coma and life-
threatening respiratory depression. In the acute care setting; physicians
often base treatment on the presence of classic 'opioid syndrome'
characteristics - mental status depression, hypoventilation, miosis
(pinpoint pupils), and reduced bowel motility. Rather than identify and
quantify the specific agent, laboratories should confirm opioid intoxication
qualitatively with a urine drug screen. With this information, physicians
may expedite treatment with opioid antagonists (naloxone), which help
patients to resume spontaneous respiration. Because the drug level does not
always correlate with the severity of illness, quantitative drug levels are
rarely needed. Hypoglycemia, hypoxia, and hypothermia are also seen with
opioid overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
opiate (drug toxicity, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
codeine (drug toxicity, pharmacokinetics)
dextromethorphan (drug toxicity, pharmacology)
dextropropoxyphene (drug toxicity, pharmacology)
diamorphine (drug toxicity, pharmacokinetics)
diphenoxylate (drug toxicity, pharmacology)
fentanyl citrate (drug toxicity)
loperamide (drug toxicity)
methadone (drug therapy, drug toxicity)
pentazocine (drug toxicity, pharmacology)
pethidine (drug toxicity, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adult
case report
drug effect
drug excretion
drug mechanism
drug metabolism
human
hypoglycemia
hypothermia
hypoventilation
hypoxia
laboratory test
male
miosis
respiration depression
review
urinalysis
DRUG TRADE NAMES
imodium
sublimaze
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextromethorphan (125-69-9, 125-71-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
diphenoxylate (3810-80-8, 915-30-0)
fentanyl citrate (990-73-8)
loperamide (34552-83-5, 53179-11-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000199642
PUI
L30346698
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1252
TITLE
The management of pain in the emergency department
AUTHOR NAMES
Brent A.St.G.
AUTHOR ADDRESSES
(Brent A.St.G.) Division of Emergency Medicine, All Children's Hospital, 801
Sixth Street South, St. Petersburg, FL 33731-8920, United States.
(St. Germaine Brent A.)
CORRESPONDENCE ADDRESS
A.St.G. Brent, Division of Emergency Medicine, All Children's Hospital, 801
Sixth Street South, St. Petersburg, FL 33731-8920, United States.
SOURCE
Pediatric Clinics of North America (2000) 47:3 (651-679). Date of
Publication: 2000
ISSN
0031-3955
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The challenge for emergency medicine physicians in the new millennium is to
use these drugs and drug combinations to make ED visits pain-free and safe
experiences. With dedication to research, a willingness to take the time to
explore new options, and expansion of pharmacologic and nonpharmacologic
interventions, physicians can make this lofty dream a reality.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, drug dose)
inhalation anesthetic agent (adverse drug reaction, drug dose)
nonsteroid antiinflammatory agent (adverse drug reaction, drug dose)
opiate (adverse drug reaction, drug dose)
sedative agent (adverse drug reaction, drug dose)
EMTREE DRUG INDEX TERMS
atropine (intramuscular drug administration, intravenous drug
administration, oral drug administration)
chloral hydrate (adverse drug reaction, drug dose, oral drug administration,
rectal drug administration)
cocaine (adverse drug reaction, drug dose, topical drug administration)
codeine (adverse drug reaction, drug dose, intramuscular drug
administration, oral drug administration, subcutaneous drug administration)
diazepam (adverse drug reaction, drug dose, intravenous drug administration,
oral drug administration)
epinephrine (adverse drug reaction, drug dose, topical drug administration)
fentanyl (adverse drug reaction, drug dose, intravenous drug administration)
fentanyl citrate (adverse drug reaction, drug dose, oral drug
administration)
flumazenil (adverse drug reaction, drug dose, intravenous drug
administration)
ketamine (intramuscular drug administration, intravenous drug
administration, oral drug administration)
ketorolac (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, oral drug administration)
lidocaine (adverse drug reaction, drug dose, subcutaneous drug
administration, topical drug administration)
lidocaine plus prilocaine (adverse drug reaction, drug dose, intradermal
drug administration)
lorazepam (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, oral drug administration)
metoclopramide
midazolam (adverse drug reaction, drug dose, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, oral drug administration, sublingual drug administration)
morphine (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, subcutaneous drug
administration)
naloxone (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, subcutaneous drug
administration)
nitrous oxide (adverse drug reaction, inhalational drug administration)
pentobarbital (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, oral drug administration,
rectal drug administration)
pethidine (adverse drug reaction, drug dose, intramuscular drug
administration, intravenous drug administration, subcutaneous drug
administration)
propofol (adverse drug reaction, drug dose, intravenous drug administration)
ranitidine
tetracaine (adverse drug reaction, drug dose, topical drug administration)
unindexed drug (adverse drug reaction, drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood injury
emergency ward
pain assessment
EMTREE MEDICAL INDEX TERMS
bleeding (side effect)
child
drug choice
drug induced disease (side effect)
drug safety
erythema (side effect)
general anesthesia
human
hyperkalemia (side effect)
patient monitoring
practice guideline
respiration depression (side effect)
review
sedation
vertigo (side effect)
DRUG TRADE NAMES
ativan
demerol
diprivan
mazicon
narcan
nembutal
oralet
toradol
valium
versed
CAS REGISTRY NUMBERS
EMLA (101362-25-8)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
chloral hydrate (302-17-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diazepam (439-14-5)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
ranitidine (66357-35-5, 66357-59-3)
tetracaine (136-47-0, 94-24-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000174510
MEDLINE PMID
10835996 (http://www.ncbi.nlm.nih.gov/pubmed/10835996)
PUI
L30266190
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1253
TITLE
EMSC partnership for children: National association of EMS physicians model
pediatric protocols
AUTHOR NAMES
Mulligan-Smith D.
O'Connor R.E.
Markenson D.
AUTHOR ADDRESSES
(Mulligan-Smith D.) Department of Community Health and Family Medicine,
University of Florida, North Broward Hospital District, Fort Lauderdale, FL,
United States.
(O'Connor R.E.) National Association of EMS Physicians, Department of
Emergency Medicine, Christiana Care Health System, Newark, DE, United
States.
(Markenson D.) Center for Pediatric Emergency Medicine, Department of
Pediatrics, Bellevue Hospital, New York, NY, United States.
CORRESPONDENCE ADDRESS
D. Markenson, NYU Medical Center, Bellevue Hospital, 462 First Avenue, New
York, NY 10009, United States. Email: dsm1@is2.nyu.edu
SOURCE
Prehospital Emergency Care (2000) 4:2 (111-129). Date of Publication: 2000
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
EMTREE DRUG INDEX TERMS
adenosine (drug dose, drug therapy, intravenous drug administration)
atropine (drug therapy)
bicarbonate (drug therapy)
bretylium (drug dose, drug therapy, intravenous drug administration)
calcium channel blocking agent (drug toxicity)
carbon dioxide (endogenous compound)
diazepam (drug dose, drug therapy, intravenous drug administration)
diphenhydramine (drug therapy)
epinephrine (drug dose, drug therapy, intraosseous drug administration,
intravenous drug administration, subcutaneous drug administration)
fentanyl (drug dose, drug therapy, intravenous drug administration)
fosphenytoin sodium (drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration)
glucagon (drug therapy)
glucose (endogenous compound)
hydrocortisone (drug dose, drug therapy, intravenous drug administration)
lidocaine (drug dose, drug therapy, intravenous drug administration)
lorazepam (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration)
methylprednisolone (drug dose, drug therapy, intramuscular drug
administration, intravenous drug administration)
midazolam (drug dose, drug therapy, intramuscular drug administration,
intravenous drug administration)
morphine (drug dose, drug therapy, intravenous drug administration,
subcutaneous drug administration)
naloxone (drug dose, drug therapy, intramuscular drug administration,
intraosseous drug administration, intravenous drug administration)
narcotic agent (drug toxicity)
nitrous oxide (drug therapy)
oxygen
prednisone (drug dose, drug therapy, oral drug administration)
salbutamol (drug dose, drug therapy, inhalational drug administration)
sedative agent
sodium chloride
terbutaline (drug dose, drug therapy, subcutaneous drug administration)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
allergic reaction (drug therapy, therapy)
anaphylaxis (drug therapy, therapy)
clinical protocol
emergency health service
near drowning (therapy)
pain (drug therapy, therapy)
seizure (drug therapy, therapy)
shock (therapy)
sudden infant death syndrome
toxicity (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
airway obstruction (therapy)
article
artificial ventilation
bradycardia (drug therapy, therapy)
bronchospasm (drug therapy, therapy)
burn (therapy)
cardioversion
defibrillation
heart arrest (drug therapy, therapy)
heart arrest (therapy)
heart ventricle fibrillation (drug therapy, therapy)
human
injury (therapy)
respiratory arrest (therapy)
respiratory distress (therapy)
respiratory failure (therapy)
resuscitation
tachycardia (drug therapy, therapy)
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
carbon dioxide (124-38-9, 58561-67-4)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
fentanyl (437-38-7)
fosphenytoin sodium (92134-98-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
oxygen (7782-44-7)
prednisone (53-03-2)
salbutamol (18559-94-9)
sodium chloride (7647-14-5)
terbutaline (23031-25-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2000140463
MEDLINE PMID
10782600 (http://www.ncbi.nlm.nih.gov/pubmed/10782600)
PUI
L30211215
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1254
TITLE
Appropriateness of intravenous cannulation by paramedics: A London study
AUTHOR NAMES
Snooks H.
Halter M.
Lees-Mlanga S.
Koenig K.L.
Miller K.
AUTHOR ADDRESSES
(Snooks H., h.a.snooks@swan.ac.uk; Halter M.; Lees-Mlanga S.) Clinical Audit
and Research Unit, London Ambulance Service NHS Trust, London, United
Kingdom.
(Koenig K.L.) Department of Emergency Care, Alameda County Medical Center,
Oakland, CA, United States.
(Miller K.) Training Department, London Ambulance Service NHS Trust, London,
United Kingdom.
(Snooks H., h.a.snooks@swan.ac.uk) School of Postgraduate Studies in Medical
and Health Care, Morristown Hospital, Swansea, United Kingdom.
(Snooks H., h.a.snooks@swan.ac.uk) School of Postgraduate Studies in Medical
and Health Care, Maes-y-Gwernen Hall, Morristown Hospital, Swansea SA6 6NL,
United Kingdom.
CORRESPONDENCE ADDRESS
H. Snooks, Postgrad. Stud. Med./Hlth. Care Sch., Maes-y-Gwernen Hall,
Morristown Hospital, Swansea SA6 6NL, United Kingdom. Email:
h.a.snooks@swan.ac.uk
SOURCE
Prehospital Emergency Care (2000) 4:2 (156-163). Date of Publication: 2000
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Introduction. The number of patients undergoing intravenous (IV) cannulation
by paramedics has increased dramatically over recent years in the UK.
Treatment protocols for cannulation in the field are loosely defined.
Variation in practice may lead to patients' receiving differential treatment
according to customary practice, rather than according to their clinical
conditions. Objectives. To explore variations in practice and assess level
of appropriateness of IV cannulation by London Ambulance Service (LAS)
paramedics; to revise treatment protocols and work toward clinical
guidelines, if indicated by study findings. Methods. Skill usage data were
analyzed for all LAS paramedics for 1995-96. All patients who were IV-
cannulated and transported to three hospitals by LAS during March 1996 were
identified. A panel of accident and emergency (AandE) and prehospital
specialists judged each case for appropriateness. Results. Variation during
the year was wide, with a range of 1 to 221 (mean 47) patients cannulated
per paramedic, although the majority showed some consistency in frequency of
skill usage. A sample of 183 cases was reviewed. The majority judged 149
(81.4%) to be appropriate, although there was considerable disagreement
between reviewers (κ = 0.43, p < 0.001). Data suggested that those
paramedics who cannulate more frequently cannulated less appropriately
during the study period (lowest 30%: 73.9% appropriate; highest 30%: 45.8%
appropriate, p = 0.05). Conclusion. Despite wide variation between
paramedics, the panel judged overall appropriateness of cannulation to be
high. The audit advisory group judged that new clinical guidelines might not
achieve an improvement in practice and were not supported by study findings.
It was recommended that variations be addressed through individual practice
review.
EMTREE DRUG INDEX TERMS
antibiotic agent (intravenous drug administration)
atropine (intravenous drug administration)
diamorphine (intravenous drug administration)
diazepam (intravenous drug administration)
epinephrine (intravenous drug administration)
furosemide (intravenous drug administration)
glucagon (intravenous drug administration)
heparin (intravenous drug administration)
hydrocortisone (intravenous drug administration)
lidocaine (intravenous drug administration)
metoclopramide (intravenous drug administration)
nalbuphine (intravenous drug administration)
naloxone (intravenous drug administration)
pethidine (intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cannulation
vein
EMTREE MEDICAL INDEX TERMS
ambulance
article
emergency health service
human
paramedical personnel
practice guideline
skill
United Kingdom
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000140468
MEDLINE PMID
10782605 (http://www.ncbi.nlm.nih.gov/pubmed/10782605)
PUI
L30211220
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1255
TITLE
Poisoning emergency - Diagnosis and therapy of poisoned patients in
emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
Der vergiftungsunfall - Diagnose und therapie vergifteter im rettungsdienst
AUTHOR NAMES
Martens F.
AUTHOR ADDRESSES
(Martens F.) Campus Virchow Klinikum, Med. Fak. der Humboldt-Univ. Berlin,
Klin. Nephrol./Intern. Intensivmed., Augustenburger Platz 1, 13353 Berlin,
Germany.
CORRESPONDENCE ADDRESS
F. Martens, Campus Virchow Klinikum, Med. Fak. der Humboldt-Univ. Berlin,
Klin. Nephrol./Intern. Intensivmed., Augustenburger Platz 1, 13353 Berlin,
Germany. Email: frank.martens@charite.de
SOURCE
Notarzt (2000) 16:1 (35-40). Date of Publication: 2000
ISSN
0177-2309
ABSTRACT
Poisoning is a common event. Approx. 5 to 10% of the patients seen by the
emergency physician on scene are intoxicated. Most of these patients are
adults, who have poisoned themselve in a suicidal attempt. Common are
sedatives, often combined with ethanol, whereas other drugs and chemical
substances are not as frequent. Following the basic check up of vital
functions and emergency procedures it is necessary to inspect the location
where the patient was found, to get the history of the patient from himself
or his relatives. A subtle medical examination as well as collection of
suspicious materials for later toxicological analysis should follow. Therapy
depends on the observed or expected seriousness of the poisoning. Supportive
measures as artificial ventilation, intravenous fluids and/or pressure drugs
are often sufficient. The use of antidotes is required only in a small group
of patients and should be carefully considered due to possible secondary
effects. Because most of the patients have taken the poisons orally,
decontamination procedures of the gitract may be required. The indications
for induced emesis, gastric lavage and activated charcoal have been revised.
Emergency medical procedures should be adopted to the new recommendations
concerning gastric lavage especially.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
amiodarone
antidote
antihistaminic agent
beta adrenergic receptor blocking agent
calcium antagonist
drug
lidocaine
unindexed drug
urapidil
EMTREE DRUG INDEX TERMS
4 dimethylaminophenol
amitriptyline
amphetamine derivative
atropine
benzodiazepine
beta adrenergic receptor stimulating agent
biperiden
caffeine
carbon dioxide
carbon monoxide
clomipramine
cocaine
corticosteroid
cyanide
dimethoate
doxepin
ephedrine
flumazenil
glyceryl trinitrate
hyoscyamine
imipramine
maprotiline
midomafetamine
naloxone
opiate
parathion
physostigmine salicylate
scopolamine
sodium thiosulfate
theophylline
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
intoxication (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
alcohol intoxication
anamnesis
artificial ventilation
drug intoxication
fluid therapy
intravenous drug administration
physical examination
review
stomach lavage
suicide attempt
toxicology
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
4 dimethylaminophenol (5882-48-4, 619-60-3)
activated carbon (64365-11-3, 82228-96-4)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
amitriptyline (50-48-6, 549-18-8)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
biperiden (1235-82-1, 514-65-8)
caffeine (30388-07-9, 58-08-2)
carbon dioxide (124-38-9, 58561-67-4)
carbon monoxide (630-08-0)
clomipramine (17321-77-6, 303-49-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
cyanide (57-12-5)
dimethoate (60-51-5)
doxepin (1229-29-4, 1668-19-5)
ephedrine (299-42-3, 50-98-6)
flumazenil (78755-81-4)
glyceryl trinitrate (55-63-0)
hyoscyamine (101-31-5, 306-03-6)
imipramine (113-52-0, 50-49-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
maprotiline (10262-69-8, 10347-81-6)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
parathion (3270-86-8, 56-38-2, 597-88-6)
physostigmine salicylate (57-64-7, 71214-04-5)
scopolamine (138-12-5, 51-34-3, 55-16-3)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
urapidil (34661-75-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Internal Medicine (6)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2000113870
PUI
L30169360
DOI
10.1055/s-2000-3
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2000-3
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1256
TITLE
Trends in medical use and abuse of opioid analgesics
AUTHOR NAMES
Joranson D.E.
Ryan K.M.
Gilson A.M.
Dahl J.L.
AUTHOR ADDRESSES
(Dahl J.L.) Department of Pharmacology, Univ. of Wisconsin Medical School,
Madison, WI, United States.
(Joranson D.E., joranson@facstaff.wisc.edu; Ryan K.M.; Gilson A.M.) Pain and
Policy Studies Group, Comprehesive Cancer Center, Univ. of Wisconsin Medical
School, Madison, WI, United States.
(Joranson D.E., joranson@facstaff.wisc.edu) MSSW, Pain and Policy Studies
Group, 1900 University Ave, Madison, WI 53705, United States.
CORRESPONDENCE ADDRESS
D.E. Joranson, MSSW, Pain and Policy Studies Group, 1900 University Ave,
Madison, WI 53705, United States. Email: joranson@facstaff.wisc.edu
SOURCE
Journal of the American Medical Association (2000) 283:13 (1710-1714). Date
of Publication: 5 Apr 2000
ISSN
0098-7484
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Context. Pain often is inadequately treated due in part to reluctance about
using opioid analgesics and fear that they will be abused. Although
international and national expert groups have determined that opioid
analgesics are essential for the relief of pain, little information has been
available about the health consequences of the abuse of these drugs.
Objective. To evaluate the proportion of drug abuse related to opioid
analgesics and the trends in medical use and abuse of 5 opioid analgesics
used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine,
and oxycodone. Design and Setting. Retrospective survey of medical records
from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network
(source of abuse data) and the Automation of Reports and Consolidated Orders
System (source of medical use data). Patients. Nationally representative
sample of hospital emergency department admissions resulting from drug
abuse. Main Outcome Measures. Medical use in grams and grams per 100 000
population and mentions of drug abuse by number and percentage of the
population. Results. From 1990 to 1996, there were increases in medical use
of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41 371 g),
oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118455 to 141
325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4
million g). During the same period, the total number of drug abuse mentions
per year due to opioid analgesics increased from 32 430 to 34 563 (6.6%),
although the proportion of mentions for opioid abuse relative to total drug
abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for
meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%;
59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine
(3%; 838 to 865). Conclusions. The trend of increasing medical use of opioid
analgesics to treat pain does not appear to contribute to increases in the
health consequences of opioid analgesic abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug therapy)
hydromorphone (drug therapy)
morphine (drug therapy)
opiate (drug therapy)
oxycodone (drug therapy)
pethidine (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
clinical practice
data analysis
disease severity
drug use
human
pain assessment
priority journal
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000131371
MEDLINE PMID
10755497 (http://www.ncbi.nlm.nih.gov/pubmed/10755497)
PUI
L30196211
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1257
TITLE
Self-reported substance abuse related emergencies: Frequency and nature
ORIGINAL (NON-ENGLISH) TITLE
Drogennotfalle: Haufigkeit und umstande aus der sicht der betroffenen
AUTHOR NAMES
Schäfer G.
Smoltczyk H.
Dengler W.
Buchkremer G.
AUTHOR ADDRESSES
(Schäfer G., gerd.schaefer@med-uni-tuebingen.de; Smoltczyk H.; Dengler W.;
Buchkremer G.) Drogenentgiftungs- M., Universitätsklinik für Psychiatrie und
Psychotherapie Tübingen, Osianderstraße 24, 72076 Tübingen, Germany.
CORRESPONDENCE ADDRESS
G. Schafer, Drogenentgiftungs- und Motiv. A6, Universitat. Psy./Psycho.
Tubingen, Osianderstrasse 24, 72076 Tubingen, Germany. Email:
gerd.schaefer@med-uni-tuebingen.de
SOURCE
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (2000) 35:4
(237-242). Date of Publication: April 2000
ISSN
0939-2661
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
ABSTRACT
Objective: The aim of this study was to estimate the frequency and nature of
self-reported and drug-related emergencies. Methods: 47 patients of a ward
for opiate detoxification were interviewed about their experiences with
drug-related emergencies. Typical categories had to be found like overdose,
seizures, accidents and suicide attempts respectively. Results: 68% had own
experience with drug-related emergency. A majority suffered opiate overdose
with different extensions as unconsciousness or breath-depression. Alcohol
and polydrug use was associated with overdose. Drug-related accidents were
only reported by men. Half the number of drug-related emergencies were
treated in hospital. Most emergencies occurred alone either in a home
environment or outside. Conclusion: Harm reduction interventions like
observed user rooms should be established. Furthermore other strategies to
reduce the number of emergencies as sharing naloxon or resuscitation
programs in wards for detoxification could also be an effective method to
prevent near fatal or fatal overdoses in dependent subjects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
antidote
methadone
morphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency medicine
substance abuse
EMTREE MEDICAL INDEX TERMS
accident
article
clinical article
detoxification
fatality
human
mortality
multiple trauma
risk factor
seizure
self report
suicide
unconsciousness
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
2000175513
MEDLINE PMID
10830076 (http://www.ncbi.nlm.nih.gov/pubmed/10830076)
PUI
L30304044
DOI
10.1055/s-2000-11989
FULL TEXT LINK
http://dx.doi.org/10.1055/s-2000-11989
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1258
TITLE
The use of conscious sedation for outpatient dermatologic surgical
procedures
AUTHOR NAMES
Abeles G.
Warmuth I.P.
Sequeira M.
Swensen R.D.
Bisaccia E.
Scarborough D.A.
AUTHOR ADDRESSES
(Abeles G.; Bisaccia E.) Wright State University and Kettering Anesthesia
Associates, Dayton, OH, United States.
(Warmuth I.P.; Scarborough D.A.) Columbia University College of Physicians
and Surgeons, New York, NY, United States.
(Sequeira M.) Division of Dermatology, Ohio State University Hospitals,
Columbus, OH, United States.
(Swensen R.D.) 182 South St, Morrison, NJ 07960, United States.
CORRESPONDENCE ADDRESS
E. Bisaccia, 182 South St., Morrison, NJ 07960, United States.
SOURCE
Dermatologic Surgery (2000) 26:2 (121-126). Date of Publication: 2000
ISSN
1076-0512
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
BACKGROUND. Dermatologic surgery has undergone increasing levels of
sophistication over the past few decades. Commensurate with this demand, an
established anesthesia technique called conscious sedation has been
employed. OBJECTIVES. Methods for performing office-based conscious sedation
are described. Recommendations are made regarding prerequisites for
conscious sedation in an office setting, patient selection, complications
management, and postoperative discharge requirements. CONCLUSION. The goals
of anesthesia are to provide for patient safety and comfort, to increase
patient acceptance of the procedure, and to enhance the surgeon's efficiency
and satisfaction.
EMTREE DRUG INDEX TERMS
aminophylline
atropine
bicarbonate
diphenhydramine
dopamine
epinephrine
fentanyl (adverse drug reaction, intravenous drug administration)
flumazenil (drug therapy, intravenous drug administration)
gluconate calcium
hydrocortisone
isoprenaline
lidocaine
methohexital (adverse drug reaction)
methylprednisolone
midazolam (adverse drug reaction, intravenous drug administration)
naloxone (drug therapy)
pethidine (adverse drug reaction)
phenylephrine
propofol (adverse drug reaction, intravenous drug administration)
salbutamol
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory surgery
sedation
skin surgery
EMTREE MEDICAL INDEX TERMS
anesthetic recovery
article
bradycardia (drug therapy, side effect)
consciousness
drug efficacy
drug safety
dysphoria (side effect)
emergency treatment
hallucination (side effect)
human
informed consent
muscle rigidity (side effect)
nausea (side effect)
preoperative evaluation
priority journal
respiratory arrest (drug therapy, side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
fentanyl (437-38-7)
flumazenil (78755-81-4)
gluconate calcium (299-28-5)
hydrocortisone (50-23-7)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methohexital (151-83-7, 309-36-4)
methylprednisolone (6923-42-8, 83-43-2)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
propofol (2078-54-8)
salbutamol (18559-94-9)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000070891
MEDLINE PMID
10691939 (http://www.ncbi.nlm.nih.gov/pubmed/10691939)
PUI
L30104337
DOI
10.1046/j.1524-4725.2000.98224.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1524-4725.2000.98224.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1259
TITLE
Development of rhabdomyolysis after rapid opioid detoxification with
subcutaneous naltrexone maintenance therapy
AUTHOR NAMES
Chanmugan A.S.
Hengeller M.
Ezenkwele U.Ugo
AUTHOR ADDRESSES
(Chanmugan A.S., achanmug@jhmi.edu; Hengeller M.; Ezenkwele U.Ugo)
Department of Emergency Medicine, John Hopkins Univ. Sch. of Medicine,
Baltimore, MD, United States.
CORRESPONDENCE ADDRESS
A.S. Chanmugam, Department of Emergency Medicine, Johns Hopkins Univ. Sch.
of Medicine, Baltimore, MD, United States. Email: achanmug@jhmi.edu
SOURCE
Academic Emergency Medicine (2000) 7:3 (303-305). Date of Publication: March
2000
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naltrexone (subcutaneous drug administration)
EMTREE DRUG INDEX TERMS
ketamine (intramuscular drug administration)
octreotide
oxacillin
prochlorperazine
ranitidine (drug therapy, intravenous drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug detoxification
rhabdomyolysis
EMTREE MEDICAL INDEX TERMS
acute kidney failure (complication)
adolescent
article
case report
diarrhea
emergency ward
gastritis (diagnosis, drug therapy)
gastrointestinal endoscopy
general anesthesia
human
intravenous drug abuse
male
Mallory Weiss syndrome (diagnosis, drug therapy)
nausea
priority journal
vomiting
withdrawal syndrome
CAS REGISTRY NUMBERS
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naltrexone (16590-41-3, 16676-29-2)
octreotide (83150-76-9)
oxacillin (1173-88-2, 66-79-5, 7240-38-2)
prochlorperazine (58-38-8)
ranitidine (66357-35-5, 66357-59-3)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2000091034
MEDLINE PMID
10730843 (http://www.ncbi.nlm.nih.gov/pubmed/10730843)
PUI
L30133949
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1260
TITLE
Antidote availability in Quebec hospital pharmacies: Impact of
N-acetylcysteine and naloxone consumption
AUTHOR NAMES
Bailey B.
Bussières J.-F.
AUTHOR ADDRESSES
(Bailey B.; Bussières J.-F.) Hôpital Sainte Justine, 3175
Côte-Saint-Catherine, Montréal, Que. H3T 1C5, Canada.
CORRESPONDENCE ADDRESS
B. Bailey, Hôpital Sainte Justine, 3175 Côte-Saint-Catherine, Montréal, Que.
H3T 1C5, Canada. Email: baileyb@med.umontreal.ca
SOURCE
Canadian Journal of Clinical Pharmacology (2000) 7:4 (198-204). Date of
Publication: 2000
ISSN
1198-581X
BOOK PUBLISHER
Pulsus Group Inc.
ABSTRACT
OBJECTIVES: To study the availability of 13 specific antidotes in hospitals
and correlate the availability of those antidotes to the number of
poisonings seen in hospitals using N-acetylcysteine and naloxone consumption
as a surrogate. METHODS: Pharmacy directors of hospitals with an emergency
department were surveyed for number of adequately stocked antidotes
(N-acetylcysteine, ethanol, cyanide antidote kit or hydroxycobalamine,
deferoxamine, digoxin-immune FAB, dimercaprol, flumazenil, glucagon,
methylene blue, naloxone, physostigmine, pralidoxime and pyridoxine).
RESULTS: Data were obtained from 96 of 112 (86%) of the pharmacies surveyed.
Number of adequately stocked antidotes per hospital ranged from zero to nine
of 13. There was a correlation between all hospital characteristics
evaluated and the number of adequately stocked antidotes (P<0.05).
Correlations between the number of adequately stocked antidotes and the
amount of N-acetylcysteine and naloxone consumed were significant
(r(s)=0.58, P<0.001; r(s)=0.53, P<0.001). The amount of N-acetylcysteine
consumed, the number of annual visits to the emergency department and the
number of hours of pharmacy coverage on weekends independently predicted the
presence of adequately stocked antidotes. CONCLUSIONS: Larger hospitals are
more likely to have adequate stocks of antidotes. Adequate stocking of
antidotes is significantly correlated with the amount of N-acetylcysteine
and naloxone consumed. This suggests that hospitals more likely to see
serious acetaminophen and opiate poisonings are more likely to maintain
adequate stocks of antidotes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine (drug therapy, pharmacoeconomics)
antidote (drug therapy, pharmacoeconomics)
naloxone (drug therapy, pharmacoeconomics)
EMTREE DRUG INDEX TERMS
alcohol (drug therapy, pharmacoeconomics)
deferoxamine (drug therapy, pharmacoeconomics)
digoxin antibody F(ab) fragment (drug therapy, pharmacoeconomics)
dimercaprol (drug therapy, pharmacoeconomics)
flumazenil (drug therapy, pharmacoeconomics)
glucagon (drug therapy, pharmacoeconomics)
hydroxocobalamin (drug therapy, pharmacoeconomics)
methylene blue (drug therapy, pharmacoeconomics)
opiate derivative (drug toxicity)
paracetamol (drug toxicity)
physostigmine (drug therapy, pharmacoeconomics)
pralidoxime (drug therapy, pharmacoeconomics)
pyridoxine (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
drug cost
drug use
emergency treatment
emergency ward
hospital management
hospital pharmacy
human
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
2001046239
MEDLINE PMID
11118966 (http://www.ncbi.nlm.nih.gov/pubmed/11118966)
PUI
L32110733
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 1261
TITLE
Opioid tolerance and the emergence of new opioid receptor-coupled signaling
AUTHOR NAMES
Gintzler A.R.
Chakrabarti S.
AUTHOR ADDRESSES
(Gintzler A.R.; Chakrabarti S.) Department of Biochemistry, State Univ. New
York Hlth. Sci. Ctr., Brooklyn, NY 11203, United States.
CORRESPONDENCE ADDRESS
A.R. Gintzler, Department of Biochemistry, State Univ. New York Hlth. Sci.
Ctr., Brooklyn, NY 11203, United States. Email:
agintzler@netmail.hscbklyn.edu
SOURCE
Molecular Neurobiology (2000) 21:1-2 (21-33). Date of Publication: 2000
ISSN
0893-7648
BOOK PUBLISHER
Humana Press
ABSTRACT
Multiple cellular adaptations are elicited by chronic exposure to opioids.
These include diminution of spare opioid receptors, decreased opioid
receptor density, and G-protein content and coupling thereof. All imply that
opioid tolerance is a manifestation of a loss of opioid function, i.e.,
desensitization. Recent observations challenge the exclusiveness of this
formulation and indicate that opioid tolerance also results from qualitative
changes in opioid signaling. In this article, Gintzler and Chakrabarti
discuss the evidence that suggests that opioid tolerance results not only
from impaired opioid receptor functionality, but also from altered
consequences of coupling. Underlying the latter are fundamental changes in
the nature of effectors that are coupled to the opioid receptor/G-protein
signaling pathway. These molecular changes include the upregulation of
adenylyl cyclase isoforms of the type II family as well as a substantial
increase in their phosphorylation state. As a result, there is a shift in
opioid receptor/G-protein signaling from predominantly G(iα) inhibitory to
G(βγ) stimulatory following chronic in vivo morphine exposure. These
adaptations to chronic morphine indicate the plasticity of opioid-signal
transduction mechanisms and the ability of chronic morphine to augment new
signaling strategies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine
opiate
opiate receptor (endogenous compound)
EMTREE DRUG INDEX TERMS
adenylate cyclase (endogenous compound)
guanine nucleotide binding protein (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug tolerance
EMTREE MEDICAL INDEX TERMS
article
desensitization
enzyme phosphorylation
nerve cell plasticity
nonhuman
protein content
receptor intrinsic activity
signal transduction
CAS REGISTRY NUMBERS
adenylate cyclase (9012-42-4)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2001137465
MEDLINE PMID
11327148 (http://www.ncbi.nlm.nih.gov/pubmed/11327148)
PUI
L32289467
COPYRIGHT
Copyright 2018 Elsevier B.V., All rights reserved.
RECORD 1262
TITLE
Modification of screening immunoassays to detect sub-threshold
concentrations of cocaine, cannabinoids, and opiates in urine: Use for
detecting maternal and neonatal drug exposures
AUTHOR NAMES
Hattab E.M.
Goldberger B.A.
Johannsen L.M.
Kindland P.W.
Ticino F.
Chronister C.W.
Bertholf R.L.
AUTHOR ADDRESSES
(Hattab E.M.; Bertholf R.L., roger.bertholf@jax.ufl.edu) Department of
Pathology, Univ. of Florida Hlth. Sci. Center, Jacksonville, FL, United
States.
(Goldberger B.A.; Chronister C.W.) Dept. Pathol., Immunol., Lab. Med., Univ.
of Florida College of Medicine, Gainesville, FL, United States.
(Johannsen L.M.; Kindland P.W.; Ticino F.) Shands Jacksonville Core
Laboratory, Jacksonville, FL, United States.
(Hattab E.M.) Department of Pathology, Stanford University Medical Center,
Stanford, CA, United States.
(Bertholf R.L., roger.bertholf@jax.ufl.edu) Department of Pathology,
UFHSC/Jax, 655 West 8th Street, Jacksonville, FL 32209, United States.
CORRESPONDENCE ADDRESS
R.L. Bertholf, Department of Pathology, UFHSC/Jax, 655 West 8th Street,
Jacksonville, FL 32209, United States. Email: roger.bertholf@jax.ufl.edu
SOURCE
Annals of Clinical and Laboratory Science (2000) 30:1 (85-91). Date of
Publication: January 2000
ISSN
0091-7370
BOOK PUBLISHER
Association of Clinical Scientists, P.O. Box 1287, Middlebury, United
States.
ABSTRACT
Testing for drugs of abuse in urine is commonplace in emergency departments
and neonatal units. However, the clinical sensitivity of immunochemical
screening methods is limited by the threshold concentrations used to
distinguish between positive and negative specimens. Immunochemical
screening methods for cocaine metabolite (benzoylecgonine), cannabinoids,
and opiates in urine were recalibrated to detect drugs at lower threshold
concentrations. The precision and linearity of the signals at the modified
thresholds were verified by diluting drug-positive urine specimens to
concentrations below the conventional cutoff concentration and measuring the
rate signals in triplicate. To assess the clinical performance of the
modified methods, specimens that tested negative using the unmodified assays
were re-screened at the lower threshold, and specimens that re-screened
positive were submitted for gas chromatographic/mass spectrometric (GC/MS)
confirmation. Reproducibility of sub-threshold measurements was comparable
to the unmodified assays, and rate separations between successive dilutions
were sufficient to give semi-quantitative results. Using the lower
thresholds, drugs were detected in 4-5% of the subjects that had screened
negative at the conventional threshold concentration. GC/MS analysis
confirmed the presence of cannabinoids and cocaine metabolite in 74% and
84%, respectively, of urine specimens that re-screened positive. Morphine,
codeine, hydromorphone, or hydrocodone was detected by GC/MS analysis in 31%
of opiate-positive re- screens.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzoylecgonine (drug concentration)
cannabinoid derivative (drug concentration)
cocaine (drug concentration)
cocaine derivative (drug concentration)
opiate derivative (drug concentration)
EMTREE DRUG INDEX TERMS
codeine (drug concentration)
hydrocodone (drug concentration)
hydromorphone (drug concentration)
morphine (drug concentration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
congenital drug dependence (congenital disorder)
drug determination
immunoassay
prenatal drug exposure
EMTREE MEDICAL INDEX TERMS
accuracy
article
drug urine level
gas chromatography
human
mass spectrometry
priority journal
reproducibility
CAS REGISTRY NUMBERS
benzoylecgonine (519-09-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000053505
MEDLINE PMID
10678589 (http://www.ncbi.nlm.nih.gov/pubmed/10678589)
PUI
L30078310
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1263
TITLE
Systemic analgesia and sedation in managing orthopedic emergencies
AUTHOR NAMES
Ward K.R.
Yealy D.M.
AUTHOR ADDRESSES
(Ward K.R.) Department of Emergency Medicine, Virginia Commonwealth
University, Medical College of Virginia, Richmond, VA, United States.
(Yealy D.M.) Department of Emergency Medicine, University of Pittsburgh,
Pittsburgh, PA, United States.
CORRESPONDENCE ADDRESS
K.R. Ward, Department of Emergency Medicine, Virginia Commonwealth
University, Medical College of Virginia, 401 North 12th Street, Richmond, VA
23298, United States. Email: krward@hsc.vcu.edu
SOURCE
Emergency Medicine Clinics of North America (2000) 18:1 (141-166). Date of
Publication: 2000
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Many potent agents have become available in the emergency department for
providing systemic analgesia and sedation for painful orthopedic procedures.
This article details the pharmacology and principles of systemic analgesia
and sedation, which will help the emergency physician provide maximal
patient comfort with minimal complications during painful procedures. The
use of an appropriate agent in these situations will optimize the outcome of
the procedure itself and result in greater patient satisfaction.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (adverse drug reaction, pharmacology)
nonsteroid antiinflammatory agent (adverse drug reaction, pharmacology)
sedative agent (adverse drug reaction, pharmacology)
EMTREE DRUG INDEX TERMS
chlorpromazine (drug combination)
etomidate (adverse drug reaction, intravenous drug administration,
pharmacology)
fentanyl (drug combination, intravenous drug administration, oral drug
administration)
ketamine (adverse drug reaction, drug combination, intramuscular drug
administration, intravenous drug administration, oral drug administration,
pharmacology, rectal drug administration)
methohexital (adverse drug reaction, intravenous drug administration,
pharmacology)
midazolam (adverse drug reaction, drug combination, intramuscular drug
administration, intranasal drug administration, intravenous drug
administration, oral drug administration)
morphine (adverse drug reaction, intravenous drug administration,
pharmacology)
nalmefene (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, sublingual drug administration)
naloxone (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, sublingual drug administration)
nitrous oxide (drug combination, inhalational drug administration,
pharmacology)
pethidine (adverse drug reaction, drug combination, intravenous drug
administration, pharmacology)
promethazine (drug combination)
propofol (adverse drug reaction, intravenous drug administration,
pharmacology)
sufentanil (intranasal drug administration)
thiopental (adverse drug reaction, intravenous drug administration,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
orthopedic surgery
sedation
EMTREE MEDICAL INDEX TERMS
drug potency
human
outcomes research
patient monitoring
patient satisfaction
practice guideline
priority journal
review
side effect
DRUG TRADE NAMES
demerol
phenergan
thorazine
CAS REGISTRY NUMBERS
chlorpromazine (50-53-3, 69-09-0)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
sufentanil (56030-54-7)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Orthopedic Surgery (33)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000057958
MEDLINE PMID
10678163 (http://www.ncbi.nlm.nih.gov/pubmed/10678163)
PUI
L30084600
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1264
TITLE
Toxicology cart for stocking sufficient supplies of poisoning antidotes
AUTHOR NAMES
Pettit H.E.
McKinney P.E.
Achusim L.E.
Lindsey D.C.
AUTHOR ADDRESSES
(Pettit H.E., hpettit@unm.edu) Inpatient Pharmacy, University Hospital, 2211
Lomas Boulevard, N.E., Albuquerque, NM 87106, United States.
(Lindsey D.C.) Emergency Department, Saint Joseph Hospital, Albuquerque, NM,
United States.
(Pettit H.E., hpettit@unm.edu) College of Pharmacy, University of New
Mexico, Univ. of New Mexico Hlth. Sci. Ctr., Albuquerque, NM, United States.
(McKinney P.E.; Achusim L.E.)
CORRESPONDENCE ADDRESS
H.E. Pettit, Inpatient Pharmacy, University Hospital, 2211 Lomas Boulevard,
N.E., Albuquerque, NM 87106, United States. Email: hpettit@unm.edu
SOURCE
American Journal of Health-System Pharmacy (1999) 56:24 (2537-2539). Date of
Publication: 15 Dec 1999
ISSN
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy, 7272 Wisconsin Ave., Bethesda,
United States.
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
charcoal
citric acid
ethylene glycol (drug toxicity)
flumazenil
ipecac
magnesium
naloxone
organophosphate (drug toxicity)
pralidoxime (drug therapy)
snake venom
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
article
emergency ward
human
pharmacy
priority journal
CAS REGISTRY NUMBERS
charcoal (16291-96-6)
citric acid (126-44-3, 5949-29-1, 77-92-9, 8002-14-0)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
ipecac (8012-96-2)
magnesium (7439-95-4)
naloxone (357-08-4, 465-65-6)
pralidoxime (6735-59-7)
snake venom (55230-69-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
2000010136
MEDLINE PMID
10613372 (http://www.ncbi.nlm.nih.gov/pubmed/10613372)
PUI
L30013947
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1265
TITLE
Sedation and analgesia at the emergency room
ORIGINAL (NON-ENGLISH) TITLE
Sedacao e analgesia no pronto socorro
AUTHOR NAMES
De Carvalho W.B.
Troster E.J.
AUTHOR ADDRESSES
(De Carvalho W.B.; Troster E.J.) Rua Sao Paolo Antigo, 145, Morumbi - Sao
Paulo - CEP 05684-010, Brazil.
CORRESPONDENCE ADDRESS
W.B. De Carvalho, Rua Sao Paolo Antigo, 145, Morumbi - Sao Paulo - CEP
05684-010, Brazil. Email: wertherbru.dped@epm.br
SOURCE
Jornal de Pediatria (1999) 75:SUPPL. 2 (S294-S306). Date of Publication:
1999
ISSN
0021-7557
ABSTRACT
Objectives: To present research data about the adverse effects of pain and
agitation in the emergency room with the best therapeutic options. Methods:
Review of the literature, covering some of the most important studies about
analgesia and sedation in the emergency room, and pharmacokinetics and
pharmacodynamics of the most important drugs. Results: The metabolic
responses, scales of evaluation of pain and anxiety and the different
clinical situations in the emergency room are presented, including also the
main drugs to be used. Conclusions: In the situations of stress in the
emergency room we should not underestimate the clinical situations that
cause pain and anxiety.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction)
sedative agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
aceclofenac
acetylsalicylic acid (adverse drug reaction, oral drug administration,
rectal drug administration)
actiprofen
artril
belacodid
chloral hydrate (adverse drug reaction)
codeine (adverse drug reaction, oral drug administration)
diazepam (adverse drug reaction, intramuscular drug administration,
intravenous drug administration)
diclofenac (adverse drug reaction, oral drug administration)
diclofenac potassium
diempax
dimorf
dipyrone (adverse drug reaction)
dipyrone
doretrim
fentanyl (adverse drug reaction, intradermal drug administration,
intramuscular drug administration, intravenous drug administration)
flanay
flumazenil (adverse drug reaction, intravenous drug administration)
ibuprofen (adverse drug reaction, oral drug administration)
inflamax
ketamine (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, oral drug administration)
lidocaine
lorazepam (adverse drug reaction)
magnopirol
midazolam (adverse drug reaction)
morphine (adverse drug reaction, epidural drug administration, intramuscular
drug administration, intrathecal drug administration, intravenous drug
administration, oral drug administration, subcutaneous drug administration)
naloxone (adverse drug reaction, intramuscular drug administration,
intravenous drug administration)
naproxen (adverse drug reaction, oral drug administration)
nitrous oxide
ortoflan
paracetamol (adverse drug reaction, oral drug administration)
paracetamol
pethidine
pethidine (adverse drug reaction, intramuscular drug administration,
intravenous drug administration, subcutaneous drug administration)
propofol (adverse drug reaction)
sintofenac
suxibuzone
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
sedation
EMTREE MEDICAL INDEX TERMS
agitation
anxiety
drug induced disease (side effect)
emergency ward
human
pain
pain assessment
review
DRUG TRADE NAMES
actiprofen
artril
belacodid
biofenac
calpol
cataflam
danilon
diempax
dimorf
dolantina
dolosal
doretrim
dormonid
flanay
flogan
inflamax
ketalar
lanexat
magnopirol
naprosyn
narcan
novalgina
ortoflan
sintofenac
tylenol
tylex
valium
voltaren
CAS REGISTRY NUMBERS
aceclofenac (89796-99-6)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
chloral hydrate (302-17-0)
codeine (76-57-3)
diazepam (439-14-5)
diclofenac potassium (15307-81-0)
diclofenac (15307-79-6, 15307-86-5)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ibuprofen (15687-27-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
nitrous oxide (10024-97-2)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Portuguese
LANGUAGE OF SUMMARY
English, Portuguese
EMBASE ACCESSION NUMBER
2000054458
PUI
L30079871
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1266
TITLE
Lethal single dose ingestions in pediatrics: A selected review
AUTHOR NAMES
Cisneros L.
AUTHOR ADDRESSES
(Cisneros L.) Department of Emergency Medicine, Albert Einstein College of
Medicine, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
L. Cisneros, Department of Emergency Medicine, Albert Einstein College of
Medicine, Bronx, NY, United States.
SOURCE
Emergency and Office Pediatrics (1999) 12:5-6 (172-175). Date of
Publication: 1999
ISSN
1073-7782
ABSTRACT
The aforementioned drugs are selective examples of commonly used medications
that are potentially as emergency physicians, we must recognize and be
prepared to aggressively treat children in a timely manner.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
non prescription drug (drug toxicity, oral drug administration)
EMTREE DRUG INDEX TERMS
acetonitrile (drug toxicity)
activated carbon (drug therapy, oral drug administration)
atropine plus diphenoxylate (drug toxicity, oral drug administration)
ben gay
benzatropine mesilate (drug therapy)
camphor (drug toxicity, oral drug administration)
chloroquine (drug toxicity, oral drug administration)
chlorpromazine (drug toxicity, oral drug administration)
desipramine (drug toxicity, oral drug administration)
diazepam (drug therapy)
diphenhydramine (drug therapy)
imipramine (drug toxicity, oral drug administration)
laxative (drug therapy)
naloxone (drug therapy)
salicylic acid methyl ester (drug toxicity, oral drug administration)
thioridazine (drug toxicity, oral drug administration)
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
clinical feature
drug safety
emergency treatment
hemodialysis
home accident
human
lethal dose
lethality
short survey
DRUG TRADE NAMES
ben gay Pfizer
lomotil
mellaril Sandoz
thorazine SmithKline Beecham
DRUG MANUFACTURERS
Pfizer
Sandoz
SmithKline Beecham
CAS REGISTRY NUMBERS
acetonitrile (75-05-8)
activated carbon (64365-11-3, 82228-96-4)
atropine plus diphenoxylate (55840-97-6)
benzatropine mesilate (132-17-2)
camphor (464-49-3, 76-22-2, 8008-51-3)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
chlorpromazine (50-53-3, 69-09-0)
desipramine (50-47-5, 58-28-6)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
imipramine (113-52-0, 50-49-7)
naloxone (357-08-4, 465-65-6)
salicylic acid methyl ester (119-36-8)
thioridazine (130-61-0, 50-52-2)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2000046344
PUI
L30068718
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1267
TITLE
Pediatric emergency: Abdominal pain and emergency
ORIGINAL (NON-ENGLISH) TITLE
Douleurs abdominales et urgences
AUTHOR NAMES
Soupre D.
AUTHOR ADDRESSES
(Soupre D.) Serv. d'Urgences/de Reanim. Pediat., Hopital Edouard-Herriot,
Place d'Arsonval, 69437 Lyon, France.
CORRESPONDENCE ADDRESS
D. Soupre, Serv. d'Urgences/de Reanim. Pediat., Hopital Edouard-Herriot,
Place d'Arsonval, 69437 Lyon, France.
SOURCE
Medecine Therapeutique Pediatrie (1999) 2:5 (352-358). Date of Publication:
1999
ISSN
1286-5494
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
narcotic agent (drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
spasmolytic agent (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy, intravenous drug administration, oral
drug administration)
cocodamol (drug therapy, oral drug administration)
corticosteroid (drug therapy)
dextropropoxyphene (drug therapy, oral drug administration)
ibuprofen (drug therapy, oral drug administration)
morphine (drug therapy, oral drug administration)
nalbuphine (drug therapy, intravenous drug administration, rectal drug
administration, subcutaneous drug administration)
naloxone
niflumic acid (drug therapy, rectal drug administration)
paracetamol (drug therapy, oral drug administration)
phloroglucinol (drug therapy, intravenous drug administration, oral drug
administration)
phloroglucinol plus trimethylphloroglucinol
prednisone (drug therapy)
tiemonium iodide (drug therapy, intravenous drug administration, oral drug
administration, rectal drug administration)
trimebutine (drug therapy, oral drug administration)
trimebutine maleate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (diagnosis, drug therapy, etiology)
emergency
pediatrics
EMTREE MEDICAL INDEX TERMS
abdominal radiography
abdominal surgery
barium enema
child
dysmenorrhea (drug therapy)
echography
human
intestine intussusception (diagnosis, etiology, surgery)
kidney colic (drug therapy)
rheumatoid arthritis (drug therapy)
short survey
sickle cell crisis
DRUG TRADE NAMES
advil
antalvic
debridat
doliprane
efferalgan
narcan
nifluril
nubain
nureflex
spasfon
visceralgine
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
dextropropoxyphene (1639-60-7, 469-62-5)
ibuprofen (15687-27-1)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
niflumic acid (4394-00-7)
paracetamol (103-90-2)
phloroglucinol (108-73-6)
prednisone (53-03-2)
spasfon (92739-09-8)
tiemonium iodide (144-12-7, 6252-92-2)
trimebutine maleate (34140-59-5)
trimebutine (39133-31-8)
EMBASE CLASSIFICATIONS
Radiology (14)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2000055860
PUI
L30081816
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1268
TITLE
Analgesia in pediatric emergency
ORIGINAL (NON-ENGLISH) TITLE
Analgesie aux urgences pediatriques
AUTHOR NAMES
Fournier-Charriere E.
AUTHOR ADDRESSES
(Fournier-Charriere E.) Unite Douleur, CHU Bicetre, 78, rue du
General-Leclerc, 94275 Le Kremlin Bicetre Cedex, France.
CORRESPONDENCE ADDRESS
E. Fournier-Charriere, Unite Douleur, CHU Bicetre, 78, rue du
General-Leclerc, 94275 Le Kremlin Bicetre Cedex, France.
SOURCE
Medecine Therapeutique Pediatrie (1999) 2:5 (381-394). Date of Publication:
1999
ISSN
1286-5494
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (adverse drug reaction)
local anesthetic agent
narcotic analgesic agent (adverse drug reaction, drug therapy)
nonsteroid antiinflammatory agent (drug therapy)
spasmolytic agent (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy)
bupivacaine
codeine (drug therapy)
ibuprofen (drug therapy)
lidocaine
lidocaine plus prilocaine (topical drug administration)
midazolam (adverse drug reaction, rectal drug administration)
morphine (adverse drug reaction, drug therapy, intravenous drug
administration, oral drug administration, subcutaneous drug administration)
nalbuphine (adverse drug reaction, drug therapy, intravenous drug
administration, rectal drug administration, subcutaneous drug
administration)
naloxone
naproxen (drug therapy)
niflumic acid (drug therapy)
nitrous oxide plus oxygen (inhalational drug administration)
paracetamol (drug therapy, oral drug administration, rectal drug
administration)
phloroglucinol (drug therapy)
phloroglucinol plus trimethylphloroglucinol
placebo
tiaprofenic acid (drug therapy)
tiemonium iodide (drug therapy)
trimebutine (drug therapy)
trimebutine maleate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency medicine
pediatrics
EMTREE MEDICAL INDEX TERMS
anxiety
child
child behavior
fracture (surgery)
hernia strangulation (complication, surgery)
human
inguinal hernia (surgery)
intestine intussusception (surgery)
irritability
local anesthesia
pain (diagnosis, drug therapy, etiology)
pain assessment
phimosis (therapy)
prescription
review
sedation
side effect
DRUG TRADE NAMES
advil
apranax
debridat
efferalgan
entonox
hypnovel
marcaine
naprosyne
narcan
nifluril
nubain
nureflex
nurofen
spasfon
surgam
visceralgine
xylocaine
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
codeine (76-57-3)
EMLA (101362-25-8)
ibuprofen (15687-27-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
naproxen (22204-53-1, 26159-34-2)
niflumic acid (4394-00-7)
nitrous oxide plus oxygen (54510-89-3)
paracetamol (103-90-2)
phloroglucinol (108-73-6)
spasfon (92739-09-8)
tiaprofenic acid (33005-95-7)
tiemonium iodide (144-12-7, 6252-92-2)
trimebutine maleate (34140-59-5)
trimebutine (39133-31-8)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
2000055864
PUI
L30081820
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1269
TITLE
A rural emergency medical technician with selected advanced skills
AUTHOR NAMES
Haynes B.E.
Pritting J.
AUTHOR ADDRESSES
(Haynes B.E.; Pritting J.) 935 Broadway, El Centro, CA 92243, United States.
CORRESPONDENCE ADDRESS
B.E. Haynes, 935 Broadway, El Centro, CA 92243, United States. Email:
behaynes@worldnet.att.net
SOURCE
Prehospital Emergency Care (1999) 3:4 (343-346). Date of Publication: 1999
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Objective. To educate rural emergency medical technician basics (EMTs) in
selected advanced skills, and then evaluate the safety and effectiveness of
practice. Methods. After a minimum 72 hours of training, EMTs employed three
skills (Combitube, glucometry, automated external defibrillation) and seven
medications (albuterol, nitroglycerin, naloxone, epinephrine, glucagon,
activated charcoal, and aspirin). Written patient care records and
audiotapes were reviewed. Congruence between prehospital assessment and
emergency department (ED) diagnosis was assessed, along with correct use of
airway skills (18 of 36 months). The completeness of documentation,
appropriateness of treatment, and patient response (by explicit criteria)
were determined. Errors and complications were recorded. Results. During
three years of the program, 266 patients were treated, primarily for chest
pain and respiratory distress. No significant errors or complications
occurred. Treatment was judged 94% appropriate, with improvement in 60% of
patients. Documentation had major omissions in 3% of cases. Field and ED
diagnostic congruence was present in 97/129 (75%) when evaluated during the
first 18 months. EMT skill levels were maintained. The mean time to
traditional advanced life support (ALS) care was 41 minutes. Conclusions.
Basic-level EMTs in rural areas can be trained in selected advanced skills,
and provide ALS-level care quickly and appropriately. Close medical
oversight involving review of care and follow-up education is an important
part of the program.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
rural area
EMTREE MEDICAL INDEX TERMS
article
defibrillation
medical practice
paramedical personnel
respiratory distress
rural health care
skill
training
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999372768
MEDLINE PMID
10534037 (http://www.ncbi.nlm.nih.gov/pubmed/10534037)
PUI
L29502713
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1270
TITLE
Patient and physician agreement on abdominal pain severity and need for
opioid analgesia
AUTHOR NAMES
Thomas S.H.
Borczuk P.
Shackelford J.
Ostrander J.
Silver D.
Evans M.
Stein J.
AUTHOR ADDRESSES
(Thomas S.H.) Department of Emergency Medicine, Massachusetts General
Hospital, Clinics Building #115, 55 Fruit St, Boston, MA 02114, United
States.
(Borczuk P.; Shackelford J.; Ostrander J.; Silver D.; Evans M.; Stein J.)
CORRESPONDENCE ADDRESS
S.H. Thomas, Department of Emergency Medicine, Massachusetts General
Hospital, Clinics Building 115, 55 Fruit St, Boston, MA 02114, United
States.
SOURCE
American Journal of Emergency Medicine (1999) 17:6 (586-590). Date of
Publication: 1999
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Whereas controversy surrounds emergency department (ED) analgesia
administration to patients with undifferentiated abdominal pain, few studies
have addressed the level of patient-physician agreement on abdominal pain
severity and need for opioid analgesia. This prospective study was
undertaken to assess concordance between emergency physicians and patients
on abdominal pain severity. Study subjects were a convenience sample of 30
adults seen in an urban university-affiliated tertiary care ED (annual
census 65,000) who had undifferentiated abdominal pain meeting an initial
severity threshold of 5 on a 10cm visual analog scale (VAS) marked by the
patient. Patients' and physicians' VAS scores, obtained in blinded fashion
at presentation (t0) and at one (t1) and two (t2) hours into the ED stay,
were compared with t test (VAS scores) and sign-rank (percent change in VAS
scores) analyses. In addition, patients and physicians were asked at each
assessment time, in blinded fashion, 'Is the pain severe enough to warrant
morphine?' The kappa statistic was used to characterize the degree of
agreement between physician and patient assessments as to whether opioids
were indicated. At t0, t1, and t2, patients' mean VAS scores (7.5, 6.7, and
5.1) were significantly (P < .05) higher than the corresponding physicians'
VAS scores (5.3, 4.7, and 3.9). Though VAS scores for physicians started
lower than those of patients, the percentage changes in scores from one
assessment to the next were similar by Wilcoxon sign-rank testing (P > .50
for time intervals t0 - t1 and t1 - t2). Overall, patients and physicians
agreed on the question of whether pain was sufficient to warrant opioids in
71 of 90 (78.9%) assessments; the corresponding kappa statistic of .57
indicated moderate agreement (P < .0001). These results, indicating that
patients and physicians usually agree on whether opioids are warranted for
abdominal pain, have important implications for further research on ED
analgesia in this population.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
antacid agent (drug therapy)
morphine (drug therapy)
opiate (drug therapy)
paracetamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
analgesia
article
clinical article
controlled study
disease severity
doctor patient relation
female
human
male
pain assessment
priority journal
scoring system
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999357196
MEDLINE PMID
10530541 (http://www.ncbi.nlm.nih.gov/pubmed/10530541)
PUI
L29480852
DOI
10.1016/S0735-6757(99)90203-6
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(99)90203-6
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1271
TITLE
Paediatric life support
AUTHOR NAMES
Zideman D.
AUTHOR ADDRESSES
(Zideman D.) Hammersmith Hospital, London, United Kingdom.
CORRESPONDENCE ADDRESS
D. Zideman, Hammersmith Hospital, London, United Kingdom.
SOURCE
Update in Anaesthesia (1999) :10 (34-46). Date of Publication: 1999
ISSN
1353-4882
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
epinephrine
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pediatric anesthesia
resuscitation
EMTREE MEDICAL INDEX TERMS
airway
algorithm
assisted ventilation
child
circulation
clinical protocol
defibrillation
emergency health service
heart arrest (etiology, therapy)
heart massage
heart ventricle fibrillation (etiology, therapy)
heart ventricle tachycardia (etiology, therapy)
human
infant
intramuscular drug administration
intraosseous drug administration
intravenous drug administration
newborn
oxygen therapy
practice guideline
review
sudden death
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1999347040
PUI
L29468177
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1272
TITLE
Adverse events of procedural sedation and analgesia in a pediatric emergency
department
AUTHOR NAMES
Pena B.M.G.
Krauss B.
AUTHOR ADDRESSES
(Pena B.M.G.; Krauss B.) Division of Emergency Medicine, Children's
Hospital, 300 Longwood Avenue, Boston, MA 02215, United States.
CORRESPONDENCE ADDRESS
B.M.G. Pena, Division of Emergency Medicine, Children's Hospital, 300
Longwood Avenue, Boston, MA 02215, United States.
SOURCE
Annals of Emergency Medicine (1999) 34:4 I (483-491). Date of Publication:
1999
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To determine the adverse event and complication rate for
the use of procedural sedation and analgesia for painful procedures and
diagnostic imaging studies performed in a pediatric emergency department.
Methods: This prospective case series was conducted in the ED of a large,
urban pediatric teaching hospital. Subjects were patients younger than 21
years seen between August 1997 and July 1998, who required intravenous,
intramuscular, oral, rectal, intranasal, or inhalational agents for painful
procedures or diagnostic imaging. All patients who underwent procedural
sedation and analgesia were continually monitored. Adverse events and
complications were recorded. The ED controlled substance log was checked
weekly and all sedations were reviewed. Adverse events were defined as
follows: oxygen desaturation less than 90%, apnea, stridor, laryngospasm,
bronchospasm, cardiovascular instability, paradoxical reactions, emergence
reactions, emesis, and aspiration. Complications were defined as adverse
events that negatively affected outcome or delayed recovery. Results: Of
1,180 patients who underwent procedural sedation and analgesia in the ED, 27
(2.3%) experienced adverse events, which included oxygen desaturation less
than 90% requiring intervention (10 patients) [supplemental oxygen (9), bag-
mask ventilation (1)], paradoxical reactions (7), emesis (3), paradoxical
reaction and oxygen desaturation requiring supplemental oxygen (2), apnea
requiring bag-mask ventilation (1), laryngospasm requiring bag-mask
ventilation (1), bradycardia (1), stridor and emesis (1) and oxygen
desaturation requiring bag-mask ventilation with subsequent emesis (1).
There was no statistically significant difference in mean doses for all
procedural sedation and analgesia medication regimens between those children
who experienced adverse events and those who did not. No single drug or drug
regimen was associated with a higher adverse event rate. In addition, there
was no significant difference in the adverse event rate between males and
females, among the different ages, or among the different indications for
procedural sedation and analgesia. No patient required reversal of sedation
with naloxone or flumazenil, endotracheal intubation, or hospital admission
because of complications from procedural sedation and analgesia. Conclusion:
The adverse event rate for procedural sedation and analgesia performed by
pediatric emergency physicians was 2.3% with no serious complications noted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction, drug combination, drug dose,
pharmacology)
sedative agent (adverse drug reaction, drug combination, drug dose,
pharmacology)
EMTREE DRUG INDEX TERMS
chloral hydrate (drug dose, pharmacology)
diazepam (drug dose, pharmacology)
fentanyl (adverse drug reaction, drug combination, drug dose, pharmacology)
ketamine (adverse drug reaction, drug combination, drug dose, pharmacology)
lorazepam (drug dose, pharmacology)
midazolam (adverse drug reaction, drug combination, drug dose, pharmacology)
morphine (drug dose, pharmacology)
nitric oxide (adverse drug reaction, drug dose, pharmacology)
pentobarbital (drug dose, pharmacology)
sufentanil (adverse drug reaction, drug combination, drug dose,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency ward
sedation
EMTREE MEDICAL INDEX TERMS
adolescent
adult
apnea (side effect)
article
bronchospasm (side effect)
cardiovascular disease (side effect)
child
diagnostic imaging
female
human
infant
inhalational drug administration
intramuscular drug administration
intranasal drug administration
intravenous drug administration
larynx spasm (side effect)
major clinical study
male
oral drug administration
oxygen saturation
preschool child
priority journal
school child
stridor (side effect)
teaching hospital
vomiting (side effect)
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
diazepam (439-14-5)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nitric oxide (10102-43-9)
pentobarbital (57-33-0, 76-74-4)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999344163
MEDLINE PMID
10499949 (http://www.ncbi.nlm.nih.gov/pubmed/10499949)
PUI
L29463212
DOI
10.1016/S0196-0644(99)80050-X
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(99)80050-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1273
TITLE
Efficacy of combinated naloxone-nimodipine therapy in acute cerebral infarct
AUTHOR NAMES
Macias-Islas M.A.
Hernandez-Chavez A.
Ramirez-Casillas G.A.
AUTHOR ADDRESSES
(Macias-Islas M.A.; Hernandez-Chavez A.; Ramirez-Casillas G.A.) Depto. de
Neurologia, Belisario Dominguez 1000 Col. Ind., 44320 Guadalajara, Jalisco,
Mexico.
CORRESPONDENCE ADDRESS
M.A. Macias-Islas, Depto. de Neurologia, Belisario Dominguez 1000 Col. Ind.,
44320 Guadalajara, Jalisco, Mexico.
SOURCE
Archivos de Neurociencias (1999) 4:3 (129-132). Date of Publication: 1999
ISSN
0187-4705
ABSTRACT
The rationale for using combinated therapies is supported by the fact that
two or more drugs may show potential synergistic effects. At this time there
is not a single drug capable to arrest the ischemic cascade and most of them
have not shown effect in limiting the 'ischemic penumbra'. We conducted a
randomized clinical trial in order to asses the efficacy of the nimodipine-
naloxone combination in a five day clinical outcome in non recurrent
cerebral infarct. Ninety-five patients with definitive diagnosis of
nonrecurrent cerebral infarction were randomized and distributed into three
treatment groups. The experimental group received intravenous naloxone 1.2
mg, followed by infusion of 0.4 mg/kg in a 500cc saline 0.9% solution twice
a day during a five days period plus nimodipine 30 mg every 6 hours oral or
by nasogastric tube, or intravenous 15-30 micrograms/kg/day infusion when
orally was not possible. Control groups received nimodipine or naloxone
alone in the same doses. No differences among groups were found for basal
demographic and clinical variables (Chi(2) 1fd.a 0.05). Basal severity and
five days outcome in each treatment group showed no differences (ANOVA
p<0.05). The thirteen patients who died were older and most severely
affected and showed no differences among groups (Chi(2) Yates 0.05). The
mean of arrival time to the emergency room since the initial ischemic insult
was 21 DS.12, for all groups. Combinated therapy as used in this study
showed no advantages over monotherapy. The prolonged time elapsed from onset
of the ischemic insult to the arrival to our medical facilities affected our
results.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug combination, drug therapy, pharmacology)
nimodipine (drug combination, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
calcium channel blocking agent (drug combination, drug therapy,
pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain infarction (drug therapy)
cerebrovascular accident (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
clinical trial
controlled study
drug efficacy
human
intragastric drug administration
intravenous drug administration
major clinical study
Mexico
oral drug administration
randomized controlled trial
treatment outcome
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
nimodipine (66085-59-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
1999337782
PUI
L29455033
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1274
TITLE
Are heroin overdose deaths related to patient release after prehospital
treatment with naloxone?
AUTHOR NAMES
Vilke G.M.
Buchanan J.
Dunford J.V.
Chan T.C.
AUTHOR ADDRESSES
(Vilke G.M.; Buchanan J.; Dunford J.V.; Chan T.C.) Department of Emergency
Medicine, UC San Diego Medical Center, 200 West Arbor Drive, San Diego, CA
92103, United States.
CORRESPONDENCE ADDRESS
G.M. Vilke, Department of Emergency Medicine, UC San Diego Medical Center,
200 West Arbor Drive, San Diego, CA 92103, United States. Email:
gmvilke@ucsd.edu
SOURCE
Prehospital Emergency Care (1999) 3:3 (183-186). Date of Publication: 1999
ISSN
1090-3127
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Objective. Naloxone is frequently used by prehospital care providers to
treat suspected heroin and opioid overdoses. The authors' EMS system has
operated a policy of allowing these patients, once successfully treated, to
sign out against medical advice (AMA) in the field. This study was performed
to evaluate the safety of this practice. Methods. The authors
retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME's)
cases in which opioid overdoses contributed to the cause of death. The
records of all patients who were found dead in public or private residences
or died in emergency departments of reasons other than natural causes or
progression of disease, are forwarded to the ME office. ME cases associated
with opiate use as a cause of death were cross-compared with all patients
who received naloxone by field paramedics and then refused transport. The
charts were reviewed by dates, times, age, sex, location, and, when
available, ethnicity. Results. There were 117 ME cases of opiate overdose
deaths and 317 prehospital patients who received naloxone and refused
further treatment. When compared by age, time, date, sex, location, and
ethnicity, there was no case in which a patient was treated by paramedics
with naloxone within 12 hours of being found dead of an opiate overdose.
Conclusions. Giving naloxone to heroin overdoses in the field and then
allowing the patients to sign out AMA resulted in no death in the one-year
period studied. This study did not evaluate for return visits bY paramedics
nor whether patients were later taken to hospitals by private vehicles.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
diamorphine
naloxone (drug therapy, pharmacokinetics)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
breathing rate
death
drug half life
emergency health service
emergency ward
female
human
intramuscular drug administration
intravenous drug administration
major clinical study
male
paramedical personnel
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999265807
MEDLINE PMID
10424852 (http://www.ncbi.nlm.nih.gov/pubmed/10424852)
PUI
L29356339
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1275
TITLE
A small area analysis estimating the prevalence of addiction to opioids in
Barcelona, 1995
AUTHOR NAMES
Brugal M.T.
Domingo-Salvany A.
Maguire A.
Caylà J.A.
Villalbí J.R.
Hartnoll R.
AUTHOR ADDRESSES
(Brugal M.T.; Caylà J.A.; Villalbí J.R.) Servei d'Epidemiologia, Inst.
Munic. Salut Pub. de Barcelona, Spain.
(Domingo-Salvany A.) Inst. Munic. d'Investigacio Medica, Barcelona, Spain.
(Maguire A.) Ctr. d'Estudis Epidemiològics, SIDA de Catalunya, Spain.
(Hartnoll R.) Europ. Monitoring Ctr. Drugs Drug A., .
(Domingo-Salvany A.) Inst. Munic. d'Investigacio Medica, C/ Dr Aiguader, 80,
08003 Barcelona, Spain.
CORRESPONDENCE ADDRESS
A. Domingo-Salvany, Institut Municipal, d'Investigacio Medica, Dr. Aiguader
80, 08003 Barcelona, Spain.
SOURCE
Journal of Epidemiology and Community Health (1999) 53:8 (488-494). Date of
Publication: August 1999
ISSN
0143-005X
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Study objective - To determine the distribution of opioid use prevalence in
small areas and its relation with socioeconomic indicators. Design -
Capture-recapture was applied using data from the Barcelona Drug Information
System for 1993 (treatment demands, hospital emergency room visits, deaths
from heroin acute adverse reaction and pre-trial prison admissions). To
avoid dependence between sources, a log-linear regression model with
interactions was fitted. For small neighbourhoods, where capture-recapture
estimates were not obtainable, the Heroin Problem Index (HPI) was used to
predict prevalence rates from a regression model. The correlation between
estimated opioid use prevalence by neighbourhoods and their socioeconomic
level was computed. Main results - The city's estimated prevalence was 12.9
opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI:10.1, 17.2),
which represents 9176 persons. The highest rate was found in the inner city
neighbourhood. Comparing rates obtained for each neighbourhood with their
unemployment rates, a high correlation coeffcient was obtained (r = 0.80, p
< 0.001). Conclusion - The main contribution of this study is that of
combining capture-recapture with the HPI to produce small area prevalence
estimates, which would not have been possible using only one method. Areas
with higher socioeconomic status showed proportionally low addiction
prevalences, but in depressed areas, prevalences varied widely.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
diamorphine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (epidemiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
correlation function
emergency ward
female
hospital admission
human
major clinical study
male
prediction
prison
socioeconomics
Spain
statistical model
unemployment
urban area
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999267756
MEDLINE PMID
10562867 (http://www.ncbi.nlm.nih.gov/pubmed/10562867)
PUI
L29358778
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1276
TITLE
Double-blind, randomized study of nalmefene and naloxone in emergency
department patients with suspected narcotic overdose
AUTHOR NAMES
Kaplan J.L.
Marx J.A.
Calabro J.J.
Gin-Shaw S.L.
Spiller J.D.
Spivey W.L.
Gaddis G.M.
Zhao N.
Harchelroad F.P. Jr.
AUTHOR ADDRESSES
(Kaplan J.L.; Marx J.A.; Calabro J.J.; Gin-Shaw S.L.; Spiller J.D.; Spivey
W.L.; Gaddis G.M.; Zhao N.; Harchelroad F.P. Jr.) Department of Emergency
Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia,
PA 19141, United States.
CORRESPONDENCE ADDRESS
J.L. Kaplan, Department of Emergency Medicine, Albert Einstein Medical
Center, 5501 Old York Road, Philadelphia, PA 19141, United States. Email:
kaplanj@aehn2.einstein.edu
SOURCE
Annals of Emergency Medicine (1999) 34:1 (42-50). Date of Publication: 1999
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objectives: To compare the efficacy, safety, and withdrawal symptoms
in emergency department patients with suspected narcotic overdose treated
with nalmefene, an opioid antagonist with a 4- to 10-hour duration of
action, with those treated with naloxone. Methods: Adults in 9 centers who
would otherwise receive naloxone for altered consciousness levels were
randomly assigned to receive intravenous study drug (1 mg nalmefene, or 2 mg
nalmefene or 2 mg naloxone, double-blinded) every 5 minutes as needed for up
to 4 doses in a 4-hour study. Outcomes were 20-minute and 4-hour
posttreatment changes in respiratory rates, Neurobehavioral Assessment Scale
scores, Opioid Withdrawal Scale scores, and incidences of adverse events.
Results: Opioid positivity was recorded for 30 of 63 (1-mg nalmefene), 23 of
55 (2-mg nalmefene), and 24 of 58 (naloxone) cases, 75% of whom also had
nonopioid central nervous system depressants. Most patients received only 1
dose of study drug. Similar, clinically meaningful improvements in
respiratory rates and Neurobehavioral Assessment Scale scores were seen with
all treatments. No statistical differences in efficacy or withdrawal
outcomes were seen between treatment groups, and no significant overall
time-treatment interactions occurred, in either the entire patient group or
among opioid- positive cases (P>.21, all comparisons). Adverse events
occurred in 30.9% (2 mg nalmefene), 15.9% (1 mg nalmefene), and 15.5%
(naloxone) of patients (P>.08); none were associated with morbidity.
Conclusion: In this study of patients with varied potential causes of
altered consciousness, nalmefene (1 mg and 2 mg) and naloxone (2 mg)
appeared to be efficacious, safe, and to yield similar clinical outcomes.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (clinical trial, drug administration, drug comparison, drug dose,
drug therapy, pharmacology)
naloxone (clinical trial, drug administration, drug comparison, drug dose,
drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy)
narcotic dependence (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
clinical trial
controlled clinical trial
controlled study
dose time effect relation
double blind procedure
drug efficacy
drug safety
drug withdrawal
human
intravenous drug administration
major clinical study
phase 3 clinical trial
priority journal
randomized controlled trial
scoring system
treatment outcome
withdrawal syndrome (diagnosis)
CAS REGISTRY NUMBERS
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999223228
MEDLINE PMID
10381993 (http://www.ncbi.nlm.nih.gov/pubmed/10381993)
PUI
L29295750
DOI
10.1016/S0196-0644(99)70270-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(99)70270-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1277
TITLE
Drug abuse emergencies with opiates
ORIGINAL (NON-ENGLISH) TITLE
Drogennotfalle mit opiaten
AUTHOR NAMES
Pfab R.
Zilker T.
AUTHOR ADDRESSES
(Pfab R.; Zilker T.) Toxikologische Abteilung, II. Medizinischen Klinik,
Technischen Universität, München, Germany.
(Pfab R.) Toxikologische Abteilung, II. Med. Klinik und Poliklinik,
Technischen Universität, Ismaninger-Straße 22, D-81664 München, Germany.
CORRESPONDENCE ADDRESS
R. Pfab, Toxikologische Abteilung, II. Med. Klin./Poliklin. Tech. Univ.,
Ismaninger-Strasse 22, D-81664 Munchen, Germany.
SOURCE
Internist (1999) 40:6 (611-616). Date of Publication: 1999
ISSN
0020-9554
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE DRUG INDEX TERMS
codeine (drug toxicity)
diamorphine (drug toxicity)
dihydrocodeine (drug toxicity)
methadone (drug toxicity)
morphine (drug toxicity)
noscapine (drug toxicity)
papaverine (drug toxicity)
pentazocine (drug toxicity)
pethidine (drug toxicity)
tilidine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
emergency
EMTREE MEDICAL INDEX TERMS
first aid
Germany
human
intoxication
myoglobinuria
neurotoxicity
peripheral nervous system
review
CAS REGISTRY NUMBERS
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
noscapine (128-62-1)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
papaverine (58-74-2, 61-25-6)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1999212611
MEDLINE PMID
10420314 (http://www.ncbi.nlm.nih.gov/pubmed/10420314)
PUI
L29281738
DOI
10.1007/s001080050378
FULL TEXT LINK
http://dx.doi.org/10.1007/s001080050378
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1278
TITLE
Use of naloxone to reverse symptomatic tetrahydrozoline overdose in a child
AUTHOR NAMES
Holmes J.F.
Berman D.A.
AUTHOR ADDRESSES
(Holmes J.F.; Berman D.A.) Division of Emergency Medicine, PSSB, 2315
Stockton Boulevard, Sacramento, CA 95817-2282, United States.
CORRESPONDENCE ADDRESS
J.F. Holmes, Division of Emergency Medicine, PSSB, 2315 Stockton Boulevard,
Sacramento, CA 95817-2282, United States. Email: jfholmes@ucdavis.edu
SOURCE
Pediatric Emergency Care (1999) 15:3 (193-194). Date of Publication: 1999
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug dose, drug therapy)
tetryzoline (drug toxicity)
EMTREE DRUG INDEX TERMS
alpha adrenergic receptor stimulating agent (drug toxicity)
decongestive agent
eye drops
non prescription drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood injury
drug overdose
EMTREE MEDICAL INDEX TERMS
article
bradycardia
case report
clinical feature
coma
emergency ward
human
hypotension
intensive care unit
intravenous drug administration
lethargy
male
preschool child
respiration depression
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
tetryzoline (522-48-5, 84-22-0)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1999204139
MEDLINE PMID
10389957 (http://www.ncbi.nlm.nih.gov/pubmed/10389957)
PUI
L29268986
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1279
TITLE
Emergency therapeutical approach simulating ultrarapid opioid detoxification
in methadone withdrawal precipitated by erroneous administration of
naltrexone.
AUTHOR NAMES
De Giacomo M.
Gaspari R.
Stefanelli A.
Barelli A.
Mannelli P.
AUTHOR ADDRESSES
(De Giacomo M.; Gaspari R.; Stefanelli A.; Barelli A.; Mannelli P.) Poison
Control Centre, Policlinico Agostino Gemelli, School of Medicine, Catholic
University of Rome, Italy.
CORRESPONDENCE ADDRESS
M. De Giacomo, Poison Control Centre, Policlinico Agostino Gemelli, School
of Medicine, Catholic University of Rome, Italy.
SOURCE
European journal of emergency medicine : official journal of the European
Society for Emergency Medicine (1999) 6:2 (153-155). Date of Publication:
Jun 1999
ISSN
0969-9546
ABSTRACT
We report the case of a 30-year-old male, heroin dependent, receiving
methadone treatment, who, while staying at home, ingested 50 mg of
naltrexone. He immediately developed serious withdrawal symptoms and was
admitted to the hospital. In the emergency department the drugs given to
counteract the agitation were ineffective, and the patient developed
respiratory distress. Anaesthesia with propofol was then started and the
patient was intubated, ventilated and hospitalized in the intensive care
unit. He was then sedated for 48 hours due to persistent withdrawal signs.
When medically stable the patient was transferred to the medical ward where
daily treatment with naltrexone and psychological support where started.
After 4 days the patient was discharged. Afterwards he did not attend his
scheduled outpatient follow-up visits. Treatment with propofol is effective
in the case of a patient with a serious withdrawal syndrome secondary to
naltrexone overdose during methadone therapy. Despite the actual possibility
of getting through the withdrawal symptoms the patient failed to return for
follow-up visits, which might be related to a lack of motivation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
intravenous anesthetic agent (drug therapy)
methadone (adverse drug reaction)
naltrexone (drug toxicity)
narcotic antagonist (drug toxicity)
propofol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
withdrawal syndrome (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
emergency
human
male
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
propofol (2078-54-8)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
10461561 (http://www.ncbi.nlm.nih.gov/pubmed/10461561)
PUI
L129455957
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1280
TITLE
Contamination of antibiotics resulting in severe pediatric methadone
poisoning
AUTHOR NAMES
Lalkin A.
Kapur B.M.
Koren G.
AUTHOR ADDRESSES
(Lalkin A.) Div. Clin. Pharmacol. and Toxicol., Hospital for Sick Children,
Toronto, Ont., Canada.
(Kapur B.M.) Dept. of Lab. Med. and Pathobiology, Faculty of Medicine,
University of Toronto, Toronto, Ont., Canada.
(Koren G.) Div. Clin. Pharmacol. and Toxicol., Hospital for Sick Children,
555 University Ave., Toronto, Ont. M5G 1X8, Canada.
CORRESPONDENCE ADDRESS
G. Koren, Div. of Clinic. Pharmacol./Toxicol., Hospital for Sick Children,
555 University Ave., Toronto, Ont. M5G 1X8, Canada.
SOURCE
Annals of Pharmacotherapy (1999) 33:3 (314-317). Date of Publication: 1999
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
OBJECTIVE: To report an accidental contamination of antibiotic suspension by
methadone that occurred in a retail Canadian pharmacy, leading to severe
poisoning in a young child. CASE SUMMARY: A 4 1/2 -year-old healthy Asian
boy was prescribed amoxicillin suspension for cough and fever. Shortly after
receiving the second dose of 5 mL he became drowsy anti less responsive. On
admission, he was arousable by deep pain, and pinpoint pupils were noted. A
urine sample sent for a toxicology screen revealed the presence of methadone
and its metabolite. Blood methadone concentrations were 0.23 and 0.14 mg/L,
five and nine hours after the second dose of amoxicillin was given,
respectively. The amoxicillin suspension was tested for methadone and was
found to have a concentration of 2.4 g/L. The child gradually improved and
was discharged on day 4 in good condition. The pharmacy in which the
antibiotic was dispensed has been a dispensing center for a local methadone
maintenance program, and methadone was accidentally mixed with the
antibiotics. DISCUSSION: In this case, a near fatal outcome occurred when
methadone was inadvertently mixed with antibiotics in a community pharmacy.
A literature search revealed two previous reports of opiate toxicity in
children following ingestion of oral antibiotic preparations. CONCLUSIONS:
Prompt action is needed in Canadian pharmacies that dispense methadone in
order to minimize such errors in the future. General practitioners,
pediatricians, and emergency department physicians should recognize and
suspect this rare cause of opiate toxicity in a child. In a patient
presenting with a decreased level of consciousness and miosis, with or
without respiratory depression, naloxone administration should be
considered, whether or not a history of opioid ingestion is obtained.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amoxicillin (drug therapy)
antibiotic agent (drug therapy)
methadone (drug concentration, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
EMTREE MEDICAL INDEX TERMS
antibiotic therapy
article
case report
child
contamination
coughing (drug therapy)
disease severity
fever (drug therapy)
human
male
priority journal
suspension
unconsciousness
CAS REGISTRY NUMBERS
amoxicillin (26787-78-0, 34642-77-8, 61336-70-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Italian, French
EMBASE ACCESSION NUMBER
1999121634
MEDLINE PMID
10200857 (http://www.ncbi.nlm.nih.gov/pubmed/10200857)
PUI
L29157743
DOI
10.1345/aph.18132
FULL TEXT LINK
http://dx.doi.org/10.1345/aph.18132
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1281
TITLE
Drugs for pediatric emergency
ORIGINAL (NON-ENGLISH) TITLE
I farmaci utili nelle emergenze
AUTHOR NAMES
Castorina M.
AUTHOR ADDRESSES
(Castorina M.) Istituto di Clinica Pediatrica, Universita Cattolica del
Sacro Cuore, Roma, Italy.
CORRESPONDENCE ADDRESS
M. Castorina, Istituto di Clinica Pediatrica, Universita Cattolica del Sacro
Cuore, Roma, Italy.
SOURCE
Acta Medica Romana (1999) 37:1-2 (35-49). Date of Publication: 1999
ISSN
0001-6098
ABSTRACT
The drugs for the most common pediatric emergencies are there reported: it
is important that the physician carry off only these that he know very well.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anticonvulsive agent (drug therapy)
antihypertensive agent (drug therapy)
bronchodilating agent (drug therapy)
EMTREE DRUG INDEX TERMS
aminophylline (drug therapy)
atropine
aurantiin
betamethasone (drug therapy)
betamethasone sodium phosphate
breva
clotiazepam
corticosteroid (drug therapy)
dexamethasone (drug therapy)
diazepam (drug therapy)
diphenhydramine (drug therapy)
epinephrine (drug therapy)
epinephrine
fast jekt
flumazenil
furosemide (drug therapy)
hydrocortisone sodium succinate (drug therapy)
ipratropium bromide (drug therapy)
ketorolac
limbial
lixidol
lorazepam (drug therapy)
mannitol (drug therapy)
methylprednisolone (drug therapy)
naloxone
nifedipine (drug therapy)
noradrenalin (drug therapy)
oxazepam
pethidine
petid c
phenobarbital
phenobarbital (drug therapy)
phenytoin (drug therapy)
rizen
salbutamol (drug therapy)
spironolactone (drug therapy)
unclassified drug
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
pediatrics
EMTREE MEDICAL INDEX TERMS
allergy (drug therapy)
analgesia
asthma (drug therapy)
child
epilepsy (drug therapy)
heart tamponade (drug therapy)
human
hypertension (drug therapy)
inflammation (drug therapy)
resuscitation
review
vascular access
DRUG TRADE NAMES
adrenalina
aldactone
anexate
atem
atropina solfato
aurantin
benadryl
bentelan
breva
decadron
fast jekt
flebocortid
gardenale
lasix
limbial
lixidol
narcan
nifedicor
noradrec
petid c
rizen
tavor
tefamin
urbason
valium
ventolin
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
aurantiin (10236-47-2, 12619-61-3, 29658-83-1, 82350-96-7)
betamethasone sodium phosphate (151-73-5, 360-63-4)
betamethasone (378-44-9)
clotiazepam (33671-46-4)
dexamethasone (50-02-2)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
furosemide (54-31-9)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
ipratropium bromide (22254-24-6)
ketorolac (74103-06-3)
lorazepam (846-49-1)
mannitol (69-65-8, 87-78-5)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
noradrenalin (1407-84-7, 51-41-2)
oxazepam (604-75-1)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
salbutamol (18559-94-9)
spironolactone (52-01-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
1999132919
PUI
L29173814
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1282
TITLE
Serendipitous rapid detoxification from opiates: The importance of
time-dependent processes
AUTHOR NAMES
Mannelli P.
De Risio S.
Pozzi G.
Janiri L.
De Giacomo M.
AUTHOR ADDRESSES
(Mannelli P., mannelli@itaca.com; De Risio S.; Pozzi G.; Janiri L.) Servizio
Farmacodipendenze, Istituto di Psichiatria, Rome, Italy.
(De Giacomo M.) Centro Antiveleni, Università Cattolica S. Cuore, Rome,
Italy.
(Mannelli P., mannelli@itaca.com) Servizio Farmacodipendenze, Policlinico A.
Gemelli, 8,00168 Roma, Italy.
CORRESPONDENCE ADDRESS
P. Mannelli, Servizio Farmacodipendenze, Policlinico, A. Gemelli 8, 00168
Roma, Italy. Email: mannelli@itaca.com
SOURCE
Addiction (1999) 94:4 (589-591). Date of Publication: 1999
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Opiate detoxification procedures aim to reduce intensity and duration of
withdrawal. Ultra-rapid opiate detoxification (UROD) methods attempt to
obtain this goal by administering naltrexone under deep sedation or
anaesthesia. We present a case study on accidental ingestion of naltrexone
in a methadone maintenance patient, which shows close methodological
similarities with UROD procedures. Naltrexone was effective in reducing
withdrawal duration, but not as much as UROD studies report. The
administration of naloxone after detoxification did not trigger withdrawal
symptoms, even in the presence of methadone, as detected by urinalyses.
These results suggest the importance of further developing detoxification
methods based on protocols of administration of antagonists different from
UROD, in absence of anaesthesia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone (drug concentration, drug therapy)
naltrexone (drug concentration, drug therapy)
opiate (drug concentration)
EMTREE DRUG INDEX TERMS
diamorphine (drug concentration)
ondansetron (drug administration)
opiate antagonist
propofol (drug administration, drug therapy)
ranitidine (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug detoxification
withdrawal syndrome (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
artificial ventilation
case report
disease duration
drug blood level
drug urine level
emergency health service
home accident
human
human cell
intensive care unit
intravenous drug administration
male
methadone treatment
psychiatry
respiratory distress (drug therapy, therapy)
sedation
urinalysis
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
ondansetron (103639-04-9, 116002-70-1, 99614-01-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
propofol (2078-54-8)
ranitidine (66357-35-5, 66357-59-3)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999135728
MEDLINE PMID
10605854 (http://www.ncbi.nlm.nih.gov/pubmed/10605854)
PUI
L29179129
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1283
TITLE
Early metabolic acidosis and coma after acetaminophen ingestion
AUTHOR NAMES
Roth B.
Woo O.
Blanc P.
AUTHOR ADDRESSES
(Roth B.; Woo O.; Blanc P.) University of Texas, Southwestern Medical
Center, 5323 Harry Hines Boulevard, Dallas, TX 75232-8579, United States.
CORRESPONDENCE ADDRESS
B. Roth, University of Texas, Southwestern Medical Center, 5323 Harry Hines
Boulevard, Dallas, TX 75232-8579, United States.
SOURCE
Annals of Emergency Medicine (1999) 33:4 (452-456). Date of Publication:
1999
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Metabolic acidosis and coma may develop in patients who experience severe
hepatic injury after acetaminophen poisoning. The onset of acidosis and coma
soon after acetaminophen overdose, but preceding manifest hepatic injury,
contrasts with the typical course of poisoning. This pattern has been
reported in a limited number of cases. Coingestions and the rare occurrence
of these findings after an overdose have engendered controversy as to
whether acetaminophen alone is the cause of early coma and acidosis. We
describe 4 separate overdoses among 3 patients who arrived at the emergency
department comatose with a metabolic acidosis soon after ingesting large
amounts of acetaminophen without evidence of toxic liver injury. Our cases
support the view that early metabolic acidosis with coma does indeed occur
after acetaminophen poisoning, independent of hepatic failure or its
complications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine (drug therapy)
paracetamol (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon
bicarbonate (drug therapy)
insulin (drug therapy)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (complication, diagnosis, etiology)
metabolic acidosis (complication, diagnosis, drug therapy, etiology,
therapy)
EMTREE MEDICAL INDEX TERMS
acute toxicity (complication, diagnosis, drug therapy, etiology)
adolescent
adult
alanine aminotransferase blood level
arterial gas
article
case report
central nervous system depression
clinical feature
drug blood level
human
hyperglycemia (drug therapy)
ingestion
lactate blood level
liver failure (complication, diagnosis, etiology)
pathophysiology
priority journal
symptom
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
insulin (9004-10-8)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999121464
MEDLINE PMID
10092726 (http://www.ncbi.nlm.nih.gov/pubmed/10092726)
PUI
L29157573
DOI
10.1016/S0196-0644(99)70312-4
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(99)70312-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1284
TITLE
Fatal ingestion of sodium hypochlorite bleach with associated hypernatremia
and hyperchloremic metabolic acidosis
AUTHOR NAMES
Ross M.P.
Spiller H.A.
AUTHOR ADDRESSES
(Ross M.P.) Department of Pediatrics, University of Louisville, 571 Floyd
Street, Louisville, KY 40202, United States.
(Ross M.P.; Spiller H.A.) Kentucky Regional Poison Center, Louisville, KY
40202, United States.
CORRESPONDENCE ADDRESS
M.P. Ross, Department of Pediatrics, University of Louisville, 571 Floyd
Street, Louisville, KY 40202, United States.
SOURCE
Veterinary and Human Toxicology (1999) 41:2 (82-86). Date of Publication:
April 1999
ISSN
0145-6296
BOOK PUBLISHER
Comparative Toxicology Laboratories, Manhattan, United States.
ABSTRACT
Ingestion of sodium hypochlorite bleach is usually benign, leading most
poison centers to advocate conservative, home management. We report a rare,
fatal case of household bleach ingestion. A 66-y-old female ingested an
unknown quantity of regular CLOROX bleach (5.25% sodium hypochlorite, pH =
11.4). Upon discovery, she was vomiting spontaneously, and had slurred
speech and oral mucosal discoloration. On hospital arrival the patient
became unresponsive with shallow respirations. Laboratory studies revealed
hypernatremia (169 mEq Na/L), hyperchloremia (143 mEq C1/L), and metabolic
acidosis (5 mmol total CO(2)/L). Radiographic evaluation showed bilateral
pneumothoraces and pneumoperitoneum. The patient was intubated and
ventilated, hypotension was treated with fluid resuscitation, and metabolic
acidosis corrected with sodium bicarbonate. Naloxone and flumazenil were
given without effect, and thoracostomy tubes were placed. Rapid
deterioration of vital signs and mental status ensued, with
cardiorespiratory arrest from which she was resuscitated. A second cardiac
arrest resulted in death. Autopsy revealed esophageal and gastric mucosal
erosions, perforation at the gastroesophageal junction, and extensive
necrosis of adjacent soft tissue. Stomach contents contained sodium
hypochlorite, and pleural and peritoneal fluid had the aroma of bleach.
Postmortem vitreous humor Na was 187 mEq/L and C1 was 169 mEq/L. Toxicologic
analysis revealed meprobamate metabolites in the urine, and lidocaine in the
blood. The literature regarding fatal bleach ingestion is reviewed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hypochlorite sodium (drug toxicity)
EMTREE DRUG INDEX TERMS
bicarbonate (drug therapy)
flumazenil
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
metabolic acidosis (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
aged
article
case report
cause of death
emergency treatment
female
human
human tissue
hyperchloremia (etiology)
hypernatremia (etiology)
suicide attempt
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
flumazenil (78755-81-4)
hypochlorite sodium (7681-52-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999120085
MEDLINE PMID
10192136 (http://www.ncbi.nlm.nih.gov/pubmed/10192136)
PUI
L29156113
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1285
TITLE
Naloxone in the reversal of coma induced by sodium valproate [6]
AUTHOR NAMES
Javier Montero F.
AUTHOR ADDRESSES
(Javier Montero F.) Hosp. Univ. Reina Soffa de Cordoba, Cordoba, Spain.
CORRESPONDENCE ADDRESS
F. Javier Montero, Hosp. Univ. Reina Soffa de Cordoba, Cordoba, Spain.
SOURCE
Annals of Emergency Medicine (1999) 33:3 (357-358). Date of Publication:
1999
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
valproic acid (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
anticonvulsive agent (drug toxicity)
narcotic antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (complication, drug therapy, etiology, therapy)
drug overdose (diagnosis, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
adult
case report
emergency treatment
epilepsy
female
human
letter
priority journal
stomach lavage
suicide attempt
treatment outcome
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
naloxone (357-08-4, 465-65-6)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1999086112
MEDLINE PMID
10036355 (http://www.ncbi.nlm.nih.gov/pubmed/10036355)
PUI
L29111121
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1286
TITLE
Metabolic acidosis in restraint-associated cardiac arrest: A case series
AUTHOR NAMES
Hick J.L.
Smith S.W.
Lynch M.T.
AUTHOR ADDRESSES
(Hick J.L., john.hick@co.hennepin.mn.us; Smith S.W.) Department of Emergency
Medicine, Hennepin County Medical Center, Univ. of Minnesota Medical School,
Minneapolis, MN, United States.
(Lynch M.T.) Department of Emergency Medicine, Concord Hospital, Concord,
MA, United States.
(Hick J.L., john.hick@co.hennepin.mn.us) Department of Emergency Medicine,
Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN
55415, United States.
CORRESPONDENCE ADDRESS
J.L. Hick, Department of Emergency Medicine, Hennepin County Medical Center,
701 Park Avenue South, Minneapolis, MN 55415, United States. Email:
john.hick@co.hennepin.mn.us
SOURCE
Academic Emergency Medicine (1999) 6:3 (239-243). Date of Publication: March
1999
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
The mechanism of death in patients struggling against restraints remains a
topic of debate. This article presents a series of five patients with
restraint-associated cardiac arrest and profound metabolic acidosis. The
lowest recorded pH was 6.25; this patient and three others died despite
aggressive resuscitation. The survivor's pH was 6.46; this patient
subsequently made a good recovery. Struggling against restraints may produce
a lactic acidosis. Stimulant drugs such as cocaine may promote further
metabolic acidosis and impair normal behavioral regulatory responses.
Restrictive positioning of combative patients may impede appropriate
respiratory compensation for this acidemia. Public safety personnel and
emergency providers must be aware of the life threat to combative patients
and be careful with restraint techniques. Further investigation of sedative
agents and buffering therapy for this select patient group is suggested.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine (drug toxicity)
lactic acid (endogenous compound)
EMTREE DRUG INDEX TERMS
atropine (drug combination, drug therapy)
bicarbonate (drug combination, drug therapy)
creatine kinase (endogenous compound)
creatinine (endogenous compound)
droperidol (drug combination)
epinephrine (drug combination, drug therapy)
ketamine (drug combination)
lorazepam (drug combination)
naloxone (drug combination)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest (drug therapy)
immobilization stress
metabolic acidosis
EMTREE MEDICAL INDEX TERMS
adult
article
assault
blood pH
case report
cause of death
criminal behavior
disease association
drug abuse
emergency health service
human
intravenous drug administration
lactate blood level
lactic acidosis (complication, drug therapy)
male
mental disease
patient compliance
patient positioning
priority journal
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
creatine kinase (9001-15-4)
creatinine (19230-81-0, 60-27-5)
droperidol (548-73-2)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lactic acid (113-21-3, 50-21-5)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999091888
MEDLINE PMID
10192677 (http://www.ncbi.nlm.nih.gov/pubmed/10192677)
PUI
L29118165
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1287
TITLE
The characteristics of opiate users seen in an emergency service
ORIGINAL (NON-ENGLISH) TITLE
Características de los consumidores de opioides visitados en un servicio de
urgencias.
AUTHOR NAMES
Pérez González K.
Domingo-Salvany A.
Hartnoll R.
AUTHOR ADDRESSES
(Pérez González K.; Domingo-Salvany A.; Hartnoll R.) Institut Municipal
d'Investigació Mèdica, Barcelona, 08003, España.
CORRESPONDENCE ADDRESS
K. Pérez González, Institut Municipal d'Investigació Mèdica, Barcelona,
08003, España.
SOURCE
Gaceta sanitaria / S.E.S.P.A.S (1999) 13:2 (88-95). Date of Publication:
1999 Mar-Apr
ISSN
0213-9111
ABSTRACT
INTRODUCTION: Despite of the fact that it was reported for years that
emergency rooms are the first health services where drug users attend, there
are very few direct studies of this population. In most emergency room
studies, the information was obtained from data available in the clinical
records, and in very few drug users were interviewed. With the aim of having
a deeper knowledge of opiate users who attend the emergency room it was
planned to carry out a cross-sectional study interviewing them. The aims of
this paper are to describe demographic characteristics, patterns of drug use
and to know whether they contact first to an emergency room or to a
treatment centre. METHODS: The sample included all patients detected and
referred by the doctor as being current opiate users, defined as any use in
the 30 days prior the interview. A descriptive bivariate analysis with
simple stratification was carried out. RESULTS: Of the subjects referred by
the doctor 383 opiate users were interviewed and 76 were not interviewed.
The male/female ratio for the 383 interviewed opiates users was 2. Women
were younger than men (25.8 vs 28.3, p (3/4) 0.001). Heroin or cocaine ever
injected was reported by 93% and 76% reported injecting in the last 30 days.
The mean age at the first use of heroin was higher for those who started use
during 1989 or after (21.6) than those who started before 1989 (17.9) (p
(3/4) 0.0001). Patients attending the emergency room for organic pathology
were older (28.5) than those who attended for withdrawal (26.2) and those
who attended for overdose (27.3) (p (3/4) 0.05). Thirty eight percent
reported to attend first an emergency room for a drug related problem since
they started drug use, and 47% to contact first with a treatment centre for
drug dependence. CONCLUSION: Drug users interviewed seem to be more heavy
users than those who started drug treatment in the public centres of
Barcelona in 1992. Also, the hypothesis that emergency rooms are for this
population the first contact point with health services is not supported by
this study.
EMTREE DRUG INDEX TERMS
methadone (drug therapy)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cocaine dependence (complication, epidemiology, rehabilitation)
opiate addiction (complication, epidemiology, rehabilitation)
EMTREE MEDICAL INDEX TERMS
adult
article
chi square distribution
cross-sectional study
emergency
female
human
interview
male
socioeconomics
Spain (epidemiology)
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
LANGUAGE OF ARTICLE
Spanish
MEDLINE PMID
10354528 (http://www.ncbi.nlm.nih.gov/pubmed/10354528)
PUI
L129438097
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1288
TITLE
Methylene blue by intraosseous infusion for methemoglobinemia
AUTHOR NAMES
Herman M.I.
Chyka P.A.
Butler A.Y.
Rieger S.E.
AUTHOR ADDRESSES
(Herman M.I.; Chyka P.A.; Butler A.Y.; Rieger S.E.) Southern Poison Center,
875 Monroe Avenue, Memphis, TN 38163, United States.
CORRESPONDENCE ADDRESS
M.I. Herman, Southern Poison Center, 875 Monroe Avenue, Memphis, TN 38163,
United States.
SOURCE
Annals of Emergency Medicine (1999) 33:1 (111-113). Date of Publication:
1999
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Intraosseous administration of methylene blue may be an emergency
alternative to intravascular administration. A 6-week-old female infant [3
kg) presented to the emergency department after a 1-week illness and
appeared cyanotic and listless. Oxygen saturation by oximetry was 86% while
the patient was receiving oxygen. Vital signs were blood pressure, 107/80 mm
Hg; pulse, 190; respirations, 47; temperature, 39.0°C. A metabolic acidosis
and a methemoglobin level of 29.3% were present. After several unsuccessful
attempts to establish intravenous access, an intra- osseous needle was
placed in the infant's left tibia. Methylene blue, 1 mg/kg, normal saline
solution, and sodium bicarbonate were given intraosseously. The patient's
oxygen saturation rose to 98% to 100%, and her cyanosis improved. Three
hours later, her methemoglobin level was 8.2%. The child recovered
uneventfully and was sent home after 3 days. Intraosseous administration of
standard intravenous doses of methylene blue rapidly terminated the effects
of acquired methemoglobinemia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methylene blue (drug administration, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
atropine
bicarbonate
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hemolytic anemia
methemoglobinemia (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
arterial gas
article
case report
clinical feature
cyanosis
diarrhea
female
human
infant
intraosseous drug administration
oxygen saturation
priority journal
pulse oximetry
resuscitation
vomiting
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999022228
MEDLINE PMID
9867898 (http://www.ncbi.nlm.nih.gov/pubmed/9867898)
PUI
L29028791
DOI
10.1016/S0196-0644(99)70427-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(99)70427-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1289
TITLE
Prevalence of human immunodeficiency virus and risk behaviours among opioid
users seen in an emergency room
ORIGINAL (NON-ENGLISH) TITLE
Prevalencia de la infección por el virus de la inmunodeficiencia humana y
conductas de riesgo en consumidores de opioides visitados en un servicio de
urgencias.
AUTHOR NAMES
Pérez González K.
Domingo-Salvany A.
Hartnoll R.
AUTHOR ADDRESSES
(Pérez González K.; Domingo-Salvany A.; Hartnoll R.) Institut Municipal
d'Investigació Mèdica, Barcelona, Barcelona, 08003, España.
CORRESPONDENCE ADDRESS
K. Pérez González, Institut Municipal d'Investigació Mèdica, Barcelona,
Barcelona, 08003, España.
SOURCE
Gaceta sanitaria / S.E.S.P.A.S (1999) 13:1 (7-15). Date of Publication: 1999
Jan-Feb
ISSN
0213-9111
ABSTRACT
INTRODUCTION: As prevalence of HIV-1 among drug users in Spain is high and
it is difficult to contact them because of their hidden behaviors, emergency
rooms are one of the health facilities where they can be located. A
cross-sectional interview study was planned. The aims of the study were to
estimate prevalence of HIV-1 and to describe risk behaviors. METHODS: The
sample included all patients that in spring 1992 were detected and referred
by the doctor as being current opiate users, defined as any use in the 30
days prior the interview. Drug users who did not know their HIV status or
were negative for more than six months were asked to provide a urine sample
to test HIV serology. A descriptive analysis with simple stratification was
carried out. Row and adjusted odds ratio were used to analyse association
between different variables and HIV status. Logistic regression was used to
examine variables associated with HIV infection and risk behaviors
(injecting drug use, sharing needles, and no use of condom). RESULTS: Three
hundred and eighty three opiate users were interviewed. It was possible to
know HIV status of 94% of the subjects. Of them, 61% were positive (219).
The best adjusted logistic model to predict associated variables with HIV
included being female, primary school level, sickness absence, to attend
because of organic pathology, and more years of parenteral use. Seventy five
percent of the sample injected drugs during the past 30 days, and among them
30% shared syringes. The variables associated with a higher probability of
having injected heroin or cocaine in the last 30 days were to have completed
at least primary education, to be unemployed or reliant on illegal
activities, not to be in drug treatment, and a larger number of drugs used
in the last 30 days. A higher probability of sharing syringes was associated
with a lower educational level, not to be in drug treatment, to live alone
and a higher number of drugs used during last 30 days. Twenty one percent of
the subjects who were sexually active always or nearly always used condom
with regular partners and 56% with casual partners. Women were more likely
to use condom than men with casual partners. Subjects who shared syringes
during last 30 days were nearly three times more likely not to use condom
with casual partners. CONCLUSIONS: Although a high prevalence of HIV-1 was
estimated among opioid users seen in an emergency room, it is not higher
than estimates for intravenous drug users recruited from treatment centres,
prison or needles exchange programs. A high frequency of risk behavior was
also observed indicating a need to develop specific prevention programs for
drug users.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
Human immunodeficiency virus infection (epidemiology)
Human immunodeficiency virus prevalence
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
comorbidity
condom
cross-sectional study
disease transmission
drug abuse
female
high risk behavior
human
Human immunodeficiency virus 1
male
middle aged
risk factor
sexual behavior
socioeconomics
Spain (epidemiology)
statistics
substance abuse (epidemiology)
utilization review
LANGUAGE OF ARTICLE
Spanish
MEDLINE PMID
10217672 (http://www.ncbi.nlm.nih.gov/pubmed/10217672)
PUI
L129418651
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1290
TITLE
The drug emergency
ORIGINAL (NON-ENGLISH) TITLE
Der drogennotfall
AUTHOR NAMES
Vollenweider-Scherpenhuyzen M.F.I.
Vollenweider F.X.
AUTHOR ADDRESSES
(Vollenweider-Scherpenhuyzen M.F.I.; Vollenweider F.X.) Klinik Hirslanden,
Arbeitsgemeinschaft Anasthesiologie, Witellikerstrasse 40, CH-8029 Zurich,
Switzerland.
CORRESPONDENCE ADDRESS
M.F.I. Vollenweider-Scherpenhuyzen, Klinik Hirslanden, Arbeitsgemeinschaft
Anasthesiologie, Witellikerstrasse 40, CH-8029 Zurich, Switzerland.
SOURCE
Anaesthesist (1998) 47:11 (946-955). Date of Publication: 1998
ISSN
0003-2417
BOOK PUBLISHER
Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amphetamine (drug toxicity)
cocaine (drug toxicity)
diamorphine (drug toxicity)
midomafetamine (drug toxicity)
EMTREE DRUG INDEX TERMS
alpha adrenergic receptor blocking agent (drug therapy)
barbituric acid derivative (drug therapy)
benzodiazepine derivative (drug therapy)
beta adrenergic receptor blocking agent (drug therapy)
bicarbonate (drug therapy)
diazepam (drug therapy)
diuretic agent (drug therapy)
naloxone (drug therapy)
nitrate (drug therapy)
phentolamine (drug therapy)
psychedelic agent (drug toxicity)
sedative agent (drug therapy)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, epidemiology, etiology, therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
aspiration pneumonia (complication)
cardiotoxicity (drug therapy, etiology, therapy)
conservative treatment
drug abuse
high risk population
human
hyperthermia (etiology, therapy)
lung toxicity (etiology, therapy)
neurotoxicity (drug therapy, etiology)
review
rhabdomyolysis (drug therapy, etiology, therapy)
CAS REGISTRY NUMBERS
3,4 methylenedioxymethamphetamine (42542-10-9)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
bicarbonate (144-55-8, 71-52-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
naloxone (357-08-4, 465-65-6)
nitrate (14797-55-8)
phentolamine (50-60-2, 73-05-2)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1999001376
MEDLINE PMID
9870095 (http://www.ncbi.nlm.nih.gov/pubmed/9870095)
PUI
L29002220
DOI
10.1007/s001010050650
FULL TEXT LINK
http://dx.doi.org/10.1007/s001010050650
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1291
TITLE
Clonidine overdose in childhood: Implications of increased prescribing
AUTHOR NAMES
Kappagoda C.
Schell D.N.
Hanson R.M.
Hutchins P.
AUTHOR ADDRESSES
(Kappagoda C.; Schell D.N.; Hanson R.M.; Hutchins P.) Roy. Alexandra
Hospital for Children, Parramatta, NSW, Australia.
(Kappagoda C.) Paediatric Intensive Care Unit, Roy. Alexandra Hospital for
Children, PO Box 3515, Parramatta, NSW 2124, Australia.
(Kappagoda C.; Schell D.N.) Poisons Information Centre, .
(Hanson R.M.) Accident and Emergency Department, .
CORRESPONDENCE ADDRESS
D.N. Schell, Paediatric Intensive Care Unit, Royal Alexandra Hosp. for
Children, PO Box 3515, Parramatta, NSW 2124, Australia.
SOURCE
Journal of Paediatrics and Child Health (1998) 34:6 (508-512). Date of
Publication: December 1998
ISSN
1034-4810
BOOK PUBLISHER
Blackwell Publishing, 550 Swanston Street, Carlton South, Australia.
ABSTRACT
Objective: To highlight the increase in the number of cases of clonidine
overdose admitted to a specialist paediatric hospital, with particular
reference to the clinical features, clinical course and circumstances
surrounding the incident. Methods: Cases of clonidine overdose were
identified by review of the emergency department attendance register, the
intensive care unit database and inpatient statistics collection. Case notes
were reviewed to determine the clinical features, history and clinical
course in each case. Results: Fifteen patients experienced 16 overdoses
during the period 1990-97 inclusive. Only one case occurred before 1994.
Depressed level of consciousness and bradycardia were the most common
clinical manifestations, and were observed in 75 and 88% of cases
respectively. There were no fatalities. Five patients received naloxone.
Other treatment modalities included gastrointestinal decontamination,
atropine, ventilation and inotropic support. Fourteen cases occurred in
association with medication prescribed for attention-deficit hyperactivity
disorder (ADHD). Conclusion: Clonidine overdose is a potentially serious
condition, often requiring intensive care management. Our experience
suggests that it is a growing problem, related in part to its increased use
in the treatment of ADHD. Preventive strategies, including raising the level
of awareness of risks, changes to packaging and appropriate selection of
patients for treatment, need consideration if further overdoses are to be
prevented.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug therapy)
clonidine (drug therapy, drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
attention deficit disorder (drug therapy)
drug overdose (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
artificial ventilation
bradycardia
child
clinical article
female
human
male
prescription
priority journal
unconsciousness
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1999022123
MEDLINE PMID
9928640 (http://www.ncbi.nlm.nih.gov/pubmed/9928640)
PUI
L29028686
DOI
10.1046/j.1440-1754.1998.00301.x
FULL TEXT LINK
http://dx.doi.org/10.1046/j.1440-1754.1998.00301.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1292
TITLE
Principles regulating the application of opioids to relieve pain in
emergency cases
AUTHOR NAMES
Gaszynski W.
Piotrowski D.
Ulbrich K.
Kaszynski Z.
Skiba P.
AUTHOR ADDRESSES
(Gaszynski W.; Piotrowski D.; Ulbrich K.; Kaszynski Z.; Skiba P.) ul.
Maratonska 63 m. 8, 94-102 Lodz, Poland.
CORRESPONDENCE ADDRESS
D. Piotrowski, ul. Maratonska 63 m. 8, 94-102 Lodz, Poland.
SOURCE
Medical Science Monitor (1998) 4:3 (568-572). Date of Publication: 1998
ISSN
1234-1010
ABSTRACT
Possibilities and conditions of analgesia in trauma patients on accident
site and during transporting have been presented in the study. Administering
procedure, side effect of numerous non-steroid anti-inflammatory drugs,
opioids volatile and intravenous anaesthetics have been discussed. Attention
has been paid to the patient's general condition, basic parameters of
circulatory and respiratory systems before drug administration. It has been
concluded that application of analgetics on accident site is essential but
in low, fractioned doses preserving safety conditions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent (adverse drug reaction, drug combination, drug therapy)
narcotic analgesic agent (drug dose, drug interaction)
EMTREE DRUG INDEX TERMS
alfentanil (drug dose)
atropine (drug interaction)
benzodiazepine (drug interaction)
buprenorphine
diazepam (drug combination)
fentanyl (drug dose)
ketamine (adverse drug reaction, drug combination, drug dose, drug
interaction)
ketorolac (drug dose)
midazolam (drug combination)
morphine (drug dose)
nalbuphine
nitrous oxide (adverse drug reaction)
nonsteroid antiinflammatory agent (drug dose)
opiate (drug dose, drug interaction)
pethidine (drug dose)
sufentanil (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
traumatology
EMTREE MEDICAL INDEX TERMS
accident
analgesic activity
areflexia
delirium (side effect)
dose response
drug efficacy
first aid
hallucination (side effect)
human
hypoventilation
hypoxia
inhalation anesthesia
inhalational drug administration
intravenous anesthesia
intravenous drug administration
nociceptive stimulation
patient transport
review
shock
vomiting
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
atropine (51-55-8, 55-48-1)
benzodiazepine (12794-10-4)
buprenorphine (52485-79-7, 53152-21-9)
diazepam (439-14-5)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
ketorolac (74103-06-3)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998370430
PUI
L28500302
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1293
TITLE
Coincident meningitis and intracerebral hemorrhage in an unresponsive adult
AUTHOR NAMES
Seymour J.J.
Ferrera P.C.
AUTHOR ADDRESSES
(Seymour J.J.; Ferrera P.C.) Department of Emergency Medicine, Albany
Medical Center, Albany, NY, United States.
(Ferrera P.C.) Dept. of Emergency Medicine A-139, Albany Medical Center, 43
New Scotland Ave, Albany, NY 12208, United States.
CORRESPONDENCE ADDRESS
P.C. Ferrera, Dept. of Emergency Medicine A-139, Albany Medical Center, 43
New Scotland Ave, Albany, NY 12208, United States.
SOURCE
American Journal of Emergency Medicine (1998) 16:6 (576-578). Date of
Publication: 1998
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Intracerebral hemorrhage is an unusual complication of central nervous
system infection. A 54-year-old man presented to our emergency department
unresponsive following an acute intracerebral hemorrhage that likely
occurred as a complication of pneumococcal meningitis. Although the
simultaneous presence of meningitis and intracerebral hemorrhage is rare,
prompt identification and treatment of each is essential to maximize the
outcome. The intracranial complications and various presentations of
bacterial meningitis in adults are reviewed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ceftriaxone (drug combination, drug therapy)
penicillin G (drug therapy)
vancomycin (drug combination, drug therapy)
EMTREE DRUG INDEX TERMS
amoxicillin (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterial meningitis (diagnosis, drug therapy, etiology, surgery)
brain hemorrhage (complication, drug therapy, etiology, surgery)
unconsciousness (complication, diagnosis, etiology)
EMTREE MEDICAL INDEX TERMS
adult
anastomosis
antibiotic sensitivity
article
brain tomography
case report
cerebrospinal fluid analysis
clinical feature
diagnostic approach route
differential diagnosis
disease severity
drug choice
emergency ward
human
intravenous drug administration
male
neurologic examination
priority journal
Streptococcus pneumonia (diagnosis, drug therapy, etiology)
treatment planning
CAS REGISTRY NUMBERS
amoxicillin (26787-78-0, 34642-77-8, 61336-70-7)
ceftriaxone (73384-59-5, 74578-69-1)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998343044
MEDLINE PMID
9786541 (http://www.ncbi.nlm.nih.gov/pubmed/9786541)
PUI
L28465581
DOI
10.1016/S0735-6757(98)90222-4
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(98)90222-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1294
TITLE
Management of paediatric neurologic emergencies in intensive care
AUTHOR NAMES
Cardo E.
Pineda M.
AUTHOR ADDRESSES
(Cardo E.; Pineda M.) Department of Neuro-paediatrics, Hospital San Joan de
Deu, Barcelona, Spain.
CORRESPONDENCE ADDRESS
M. Pineda, Department of Neuro-paediatrics, Hospital San Joan de Deu,
Barcelona, Spain.
SOURCE
Care of the Critically Ill (1998) 14:7 (221-227). Date of Publication: 1998
ISSN
0266-0970
ABSTRACT
Neurologic dysfunction, whether caused by primary nervous system damage or
secondary to systemic disease, often results in a life-threatening condition
that requires immediate and adequate management. The quality of care
provided in the first hours of presentation determines the extent of
neurological damage and outcome. In the majority of infants and children who
require intensive care due to acute neurologic dysfunction, the presenting
features are coma or status epilepticus. This article describes the
management and reviews the newer approaches in these areas.
EMTREE DRUG INDEX TERMS
aciclovir (drug therapy)
glucose (drug therapy)
mannitol (drug therapy)
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neurologic disease (drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
anamnesis
body position
body temperature
cardiopulmonary hemodynamics
child
coma (etiology)
consciousness
convulsion (complication)
disease severity
electrolyte balance
emergency treatment
epileptic state (etiology)
eye movement
health care quality
human
infant
infection (drug therapy, etiology)
intensive care
intracranial pressure
motor activity
neurologic examination
physical examination
pupil
review
systemic disease
CAS REGISTRY NUMBERS
aciclovir (59277-89-3)
glucose (50-99-7, 84778-64-3)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998363182
PUI
L28491219
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1295
TITLE
Loss of consciousness from acute quetiapine overdosage
AUTHOR NAMES
Harmon T.J.
Benitez J.G.
Krenzelok E.P.
Cortes-Belen E.
AUTHOR ADDRESSES
(Harmon T.J., HARMONT@CHPLINK.chp.edu; Benitez J.G.; Krenzelok E.P.;
Cortes-Belen E.) Pittsburgh Poison Center, Children's Hospital of
Pittsburgh, Univ. Pittsburgh Med. Ctr. T., Pittsburgh, PA, United States.
(Harmon T.J., HARMONT@CHPLINK.chp.edu) Pittsburgh Poison Center, Children's
Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, United
States.
CORRESPONDENCE ADDRESS
T.J. Harmon, Pittsburgh Poison Center, Children's Hospital of Pittsburgh,
3705 Fifth Avenue, Pittsburgh, PA 15213, United States. Email:
HARMONT@CHPLINK.chp.edu
SOURCE
Journal of Toxicology - Clinical Toxicology (1998) 36:6 (599-602). Date of
Publication: 1998
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Background: Quetiapine (Seroquel®) is a new atypical antipsychotic agent
developed for the treatment of schizophrenia. This dibenzothiazepine
derivative possesses high affinity for 5-HT(2) receptors with lower affinity
for D(1) and D(2) dopamine receptors. In comparison to other antipsychotic
agents, quetiapine has less antimuscarinic and alpha(1) antagonist receptor
activity. Overdose reports outside of clinical trials are limited. We report
an intentional overdose of quetiapine by a schizophrenic. Case Report: A 26-
year-old female presented to the emergency department following an alleged
ingestion of greater than 10,000 mg of quetiapine. At 1 1/4 hours
postingestion, the patient was awake, ambulatory, and responded to verbal
stimuli. At 2 1/4 hours postingestion, the patient experienced a decreased
level of consciousness and responded only to deep pain. Physical findings
included sinus tachycardia, pupils 3-4 mm and sluggish, and BP 135/70.
Within 16 hours, the patient became awake and alert and was subsequently
extubated. Serum electrolytes and blood count were unremarkable. The
electrocardiogram at 18 hours postingestion showed a sinus tachycardia,
which lasted for approximately 40 hours postingestion. A follow-up
electrocardiogram at 42 hours postingestion was normal. Conclusion: This
ingestion resulted in the loss of consciousness with need for airway
protection and persistent tachycardia. Major overdoses of quetiapine warrant
close observation in an intensive care setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
quetiapine (drug dose, drug toxicity, pharmacology)
EMTREE DRUG INDEX TERMS
activated carbon (drug dose, drug therapy)
dopamine 1 receptor (endogenous compound)
dopamine 2 receptor (endogenous compound)
metoprolol (drug therapy)
naloxone (drug dose, drug therapy)
serotonin 2 receptor (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy)
schizophrenia (drug therapy)
unconsciousness (etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical feature
dose time effect relation
female
human
intravenous drug administration
oral drug administration
self poisoning (diagnosis, drug therapy)
sinus tachycardia (drug therapy, etiology)
DRUG TRADE NAMES
seroquel , United StatesZeneca
DRUG MANUFACTURERS
(United States)Zeneca
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
metoprolol (37350-58-6)
naloxone (357-08-4, 465-65-6)
quetiapine (111974-72-2)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998338838
MEDLINE PMID
9776965 (http://www.ncbi.nlm.nih.gov/pubmed/9776965)
PUI
L28460672
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1296
TITLE
Acute opiate overdose: Characteristics of 190 consecutive cases
AUTHOR NAMES
Cook S.
Moeschler O.
Michaud K.
Yersin B.
AUTHOR ADDRESSES
(Cook S.; Moeschler O., Bertrand.Yersin@chuv.hospvd.ch; Yersin B.) Emergency
Center, University Hospital (CHUV), .
(Michaud K.) Institute of Forensic Medicine, 1011 Lausanne, Switzerland.
(Moeschler O., Bertrand.Yersin@chuv.hospvd.ch) Department of Medicine, BH
10-709, 1011, Lausanne-CHUV, Switzerland.
CORRESPONDENCE ADDRESS
B. Yersin, Department of Medicine, BH 10-709, CHUV, 1011 Lausanne,
Switzerland. Email: Bertrand.Yersin@chuv.hospvd.ch
SOURCE
Addiction (1998) 93:10 (1559-1565). Date of Publication: 1998
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Aims. To characterize the population of drug users consulting the Emergency
Room (ER) of a university hospital with acute opiate overdose (AOO) and to
assess rate of referral to specialized treatment programme. Design. Survey
of a 12-month sample of AOO patients. Measurements. Medical and psychosocial
features of the drug users, details of emergency treatment and referral by a
mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne,
Switzerland). In addition fatal AOO cases were collected by the Institute of
Forensic Medicine (IFM) during the same period. Findings. One hundred and
eighty-four cases of AOO (134 patients) were treated. The files of the IFM
detailed six additional deceased cases. This population of drug users was
characterized by an over-representation of men (73%), by young age (27.4
years), by a high rate of multi-drugs use (90%) and by a high rate of
multiple previous overdoses (2.6). Average length of stay was 20.1 hours but
41% of cases stayed less than 8 hours. Only one patient was readmitted
within an 8-hour period. When discharged, 78% returned home. Unexpectedly,
67% of patients were not referred to any therapeutic programme for drug
addiction. Conclusion. This study shows the low mortality of AOO when
treated but also demonstrates the need to improve psychosocial evaluation
and referral of drug addicts admitted with AOO.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
age
article
emergency ward
fatality
female
gender
hospitalization
human
major clinical study
male
medical care
multiple drug abuse (epidemiology)
patient referral
psychosocial care
treatment planning
university hospital
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998348358
MEDLINE PMID
9926561 (http://www.ncbi.nlm.nih.gov/pubmed/9926561)
PUI
L28472996
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1297
TITLE
Analytical considerations in the use of capture to estimate prevalence: Case
studies of the estimation of opiate use in the metropolitan area of
Barcelona, Spain
AUTHOR NAMES
Domingo-Salvany A.
Hartnoll R.L.
Maguire A.
Brugal M.T.
Albertín P.
Caylà J.A.
Casabona J.
Suelves J.M.
AUTHOR ADDRESSES
(Domingo-Salvany A.; Hartnoll R.L.; Albertín P.) Inst. Munic. d'Investigacio
Medica, Barcelona, Spain.
(Hartnoll R.L.) Europ. Monitoring Ctr. Drugs Drug A., Lisboa, Portugal.
(Maguire A.; Casabona J.) Ctr. d'Estudis Epidemiologics S., Badalona, Spain.
(Brugal M.T.; Caylà J.A.) Servei d'Epidemiologia, Inst. Munic. Salut Pub. de
Barcelona, Barcelona, Spain.
(Suelves J.M.) Dept. de Sanitat i Seguretat Social, Generalitat de
Catalunya, Barcelona, Spain.
(Domingo-Salvany A.) Inst. Munic. d'Investigacio Medica, Dr. Aiguader 80,
08003 Barcelona, Spain.
CORRESPONDENCE ADDRESS
A. Domingo-Salvany, Inst. Municipal Investigacio Medica, Dr. Aiguader 80,
08003 Barcelona, Spain.
SOURCE
American Journal of Epidemiology (1998) 148:8 (732-740). Date of
Publication: 15 Oct 1998
ISSN
0002-9262
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
ABSTRACT
Capture-recapture, an indirect method widely used to estimate undetected
populations, has been criticized because it causes problems due to a lack of
compliance with several important assumptions and model selection
strategies. This paper expands on the problems encountered when applying
this methodology to drug abuse estimations, specifically the prevalence of
opiate use in the metropolitan area of Barcelona, Spain, in 1993. Three
samples of opiate users (from hospital emergency rooms, treatment centers,
and prisons) were available in the area studied; an additional sample
(mortality data) was analyzed for the city of Barcelona. Log-linear models
that provided a good fit were considered, to which further model selection
strategies were applied. A total of 3,207 unique individuals aged 15-44
years were identified in the three samples from the greater Barcelona area;
the mortality sample from the city of Barcelona contained an additional 83
individuals. Heterogeneity was observed in different age, sex, and residence
area subgroups. Population estimates differed widely according to the
log-linear model chosen. Minimum Akaike's information criterion model and
saturated model estimates were used to produce population prevalence rates.
The main problems the authors encountered in this study were related to
population definition, source heterogeneity, and assessment of an adequate
model, a problem associated with sample size.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
controlled study
drug dependence treatment
female
human
major clinical study
male
mortality
prevalence
prison
Spain
statistical analysis
urban area
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998358875
MEDLINE PMID
9786228 (http://www.ncbi.nlm.nih.gov/pubmed/9786228)
PUI
L28485283
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1298
TITLE
Anticholinergic syndrome precipitated by opioid reversal.
AUTHOR NAMES
Hicks S.D.
Wolfson A.B.
Asplin B.R.
Lipinski C.A.
Callaway C.W.
AUTHOR ADDRESSES
(Hicks S.D.; Wolfson A.B.; Asplin B.R.; Lipinski C.A.; Callaway C.W.)
Department of Emergency Medicine, University of Pittsburgh School of
Medicine, Pennsylvania, USA.
CORRESPONDENCE ADDRESS
S.D. Hicks, Department of Emergency Medicine, University of Pittsburgh
School of Medicine, Pennsylvania, USA.
SOURCE
Prehospital emergency care : official journal of the National Association of
EMS Physicians and the National Association of State EMS Directors (1998)
2:4 (328-329). Date of Publication: 1998 Oct-Dec
ISSN
1090-3127
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cholinergic receptor blocking agent (drug toxicity)
naloxone (adverse drug reaction)
narcotic antagonist (adverse drug reaction)
scopolamine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dyspnea (drug therapy)
headache (diagnosis, drug therapy)
heroin dependence (complication)
EMTREE MEDICAL INDEX TERMS
adult
akathisia (etiology)
article
case report
chemically induced disorder
clinical observation
clinical study
diagnosis
emergency treatment
female
hallucination
human
male
middle aged
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
scopolamine (138-12-5, 51-34-3, 55-16-3)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
9799024 (http://www.ncbi.nlm.nih.gov/pubmed/9799024)
PUI
L128324431
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1299
TITLE
Clinical and experimental study on treatment of acute alcohol intoxication
with xiangnaojing injection
AUTHOR NAMES
Bai J.
Zeng Q.
Chai Z.
AUTHOR ADDRESSES
(Bai J.; Zeng Q.; Chai Z.) Department of Emergency Medicine, China-Japan
Friendship Hospital, Beijing 100029.
CORRESPONDENCE ADDRESS
J. Bai, Department of Emergency Medicine, China-Japan Friendship Hospital,
Beijing 100029.
SOURCE
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese
journal of integrated traditional and Western medicine / Zhongguo Zhong xi
yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban (1998) 18:10
(607-609). Date of Publication: Oct 1998
ISSN
1003-5370
ABSTRACT
OBJECTIVE: To study the therapeutical mechanism of traditional Chinese
medicine Xingnaojing injection (XNJI) for acute alcohol intoxication.
METHODS: XNJI was used in treating the experimental model rabbits (n = 26)
and the patients (n = 8) admitted to the emergency department with acute
alcoholism. Before and after the treatment, beta-EP, superoxide anion (free
radicals) and SOD were measured. RESULTS: XNJI could enhance the regaining
consciousness of rabbits and patients, simultaneously reduce the
concentration of beta-EP in plasma to the normal level (drunk rabbits 127.09
+/- 13.67 ng/L, normal rabbits 41.48 +/- 7.46 ng/L. P < 0.01, drunk patients
292.97 +/- 14.85 ng/L, normal people 221.60 +/- 15.95 ng/L, P < 0.01). The
concentration change of superoxide anion (free radicals) in plasma of
rabbits and patients was similar to beta-EP (drunk rabbits 313.39 +/- 15.64
u/L, normal rabbits 254.27 +/- 21.71 u/L, P < 0.01; drunk patients 278.47
+/- 11.48 u/L, normal people 159.92 +/- 11.51 u/L, P < 0.01), and SOD was
inversely changed (drunk rabbits 53.57 +/- 6.48%, normal rabbits 77.18 +/-
7.89%, P < 0.01; drunk patients 43.76 +/- 7.84%, normal people 82.53 +/-
4.33%, P < 0.01). CONCLUSIONS: XNJI is similar to Naloxone in pharmacologic
action. And it is an effective antioxidant. It can be used for treating
alcoholism.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
herbaceous agent (drug therapy)
EMTREE DRUG INDEX TERMS
antioxidant (drug therapy)
beta endorphin
superoxide dismutase
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
animal
article
blood
female
human
Leporidae
male
middle aged
CAS REGISTRY NUMBERS
beta endorphin (59887-17-1)
superoxide dismutase (37294-21-6, 9016-01-7, 9054-89-1)
LANGUAGE OF ARTICLE
Chinese
MEDLINE PMID
11477845 (http://www.ncbi.nlm.nih.gov/pubmed/11477845)
PUI
L33509028
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1300
TITLE
Effects of risperidone in overdose
AUTHOR NAMES
Acri A.A.
Henretig F.M.
AUTHOR ADDRESSES
(Acri A.A.; Henretig F.M.) Children's Hospital of Philadelphia, Poison
Control Center, Philadelphia, PA, United States.
(Acri A.A.) Poison Control Center, 3600 Market St, Philadelphia, PA 19104,
United States.
CORRESPONDENCE ADDRESS
A.A. Acri, Poison Control Center, 3600 Market St, Philadelphia, PA 19104,
United States.
SOURCE
American Journal of Emergency Medicine (1998) 16:5 (498-501). Date of
Publication: 1998
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
This study was a 13-month prospective, descriptive case series of
risperidone overdose reported by telephone to a regional poison control
center (PCC) serving Philadelphia, PA. Patients were seen in local
Philadelphia-area emergency departments. The variables examined were medical
history, therapeutic use of risperidone, time postingestion, reported
coingestants, clinical findings, decontamination and treatment,
electrocardiograph results, laboratory data, standard toxicologic screen
results, and length of time in hospital. Thirty-one patients (29
adult/adolescent, 2 pediatric) with reported risperidone overdose were
identified. Risperidone was the sole ingestant in 15 cases (1 mg to 180 mg).
The major observed effects in this group included lethargy (7),
spasm/dystonia (3), hypotension (2), tachycardia (6), and dysrhythmia (1).
Sixteen cases involved coingestants, including benzodiazepines, selective
serotonin reuptake inhibitors, ethanol, tricyclic antidepressants, lithium,
anticonvulsants, diphenhydramine, ibuprofen, and anticholinergic agents.
Major effects in these patients included lethargy (10), coma (1), seizure
(1), tachycardia (7), bradycardia (1), hypotension (4), and a syndrome of
muscle spasms, diaphoresis, and fever. Treatment provided for patients in
this study included antiarrhythmics (1), diphenhydramine (2), anticonvulsant
(1), vasopressor agent (1), endotracheal intubation/assisted ventilation
(5), and supportive care. One patient who coingested imipramine died of
medical complications. In the remaining patients, symptoms resolved within
24 hours in the majority, with all patients asymptomatic at 72 hours
postingestion. These data show that risperidone toxicity manifests primarily
as mild central nervous system effects and reversible neuromuscular and
cardiovascular effects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
risperidone (drug toxicity)
EMTREE DRUG INDEX TERMS
adenosine (drug therapy)
alcohol
antiarrhythmic agent (drug therapy)
anticonvulsive agent (drug therapy)
benzatropine mesilate
benzodiazepine
bicarbonate (drug therapy)
clonazepam
diltiazem (drug therapy)
diphenhydramine (drug therapy)
dopamine (drug therapy)
doxepin
flumazenil (drug therapy)
fluoxetine
ibuprofen
imipramine
lithium
lorazepam (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug toxicity)
paroxetine
phenytoin (drug therapy)
serotonin uptake inhibitor
sertraline
tricyclic antidepressant agent
trihexyphenidyl
unindexed drug
zolpidem tartrate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
anticonvulsant therapy
article
artificial ventilation
child
clinical article
drug intoxication (drug therapy, etiology)
dystonia
endotracheal intubation
female
heart arrhythmia (drug therapy, etiology)
human
hypotension
lethargy
male
priority journal
seizure (drug therapy, etiology)
tachycardia
CAS REGISTRY NUMBERS
adenosine (58-61-7)
alcohol (64-17-5)
benzatropine mesilate (132-17-2)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
clonazepam (1622-61-3)
diltiazem (33286-22-5, 42399-41-7)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
doxepin (1229-29-4, 1668-19-5)
flumazenil (78755-81-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
ibuprofen (15687-27-1)
imipramine (113-52-0, 50-49-7)
lithium (7439-93-2)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
paroxetine (61869-08-7)
phenytoin (57-41-0, 630-93-3)
risperidone (106266-06-2)
sertraline (79617-96-2)
trihexyphenidyl (144-11-6, 52-49-3)
zolpidem tartrate (99294-93-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998283028
MEDLINE PMID
9725965 (http://www.ncbi.nlm.nih.gov/pubmed/9725965)
PUI
L28385615
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1301
TITLE
Treatment of acute anticholinergic poisoning with physostigmine
AUTHOR NAMES
Beaver K.M.
Gavin T.J.
AUTHOR ADDRESSES
(Beaver K.M.; Gavin T.J.) Department of Emergency Medicine, Allegheny
University Hospital, Hahnemann Division, Philadelphia, PA, United States.
(Beaver K.M.) Department of Emergency Medicine, Allegheny University
Hospital, Hahnemann Division, Broad and Vine Sts, Philadelphia, PA 19102,
United States.
CORRESPONDENCE ADDRESS
K.M. Beaver, Department of Emergency Medicine, Allegheny Univ.
Hosp.-Hahnemann Div., Broad and Vine Sts, Philadelphia, PA 19102, United
States.
SOURCE
American Journal of Emergency Medicine (1998) 16:5 (505-507). Date of
Publication: 1998
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Five cases of acute anticholinergic poisoning presenting to an inner- city
emergency department (ED) are discussed. All five patients presented with
classic signs and symptoms of anticholinergic toxicity, which included
tachycardia, hot, dry and flushed skin, markedly dilated and fixed pupils,
and pronounced delirium. The patients were violently agitated, and physical
restraint was required. Initial treatment with benzodiazepines did not
diminish their combative behavior. Treatment with intravenous physostigmine
salicylate resulted in a decrease in agitation within 15 to 20 minutes of
therapy. No untoward effects occurred as a result of treatment with
physostigmine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug toxicity)
cholinesterase inhibitor (drug administration, drug dose, drug therapy,
pharmacokinetics, pharmacology)
cocaine (drug toxicity)
diamorphine (drug toxicity)
physostigmine (drug administration, drug dose, drug therapy,
pharmacokinetics, pharmacology)
scopolamine (drug toxicity)
EMTREE DRUG INDEX TERMS
lorazepam (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anticholinergic effect
drug intoxication (diagnosis, drug therapy, etiology)
drug overdose (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
article
cholinesterase inhibition
clinical article
emergency treatment
human
intravenous drug administration
poison center
priority journal
substance abuse
treatment outcome
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
scopolamine (138-12-5, 51-34-3, 55-16-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998283030
MEDLINE PMID
9725967 (http://www.ncbi.nlm.nih.gov/pubmed/9725967)
PUI
L28385617
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1302
TITLE
Treatment and monitoring of acute opiate overdose
ORIGINAL (NON-ENGLISH) TITLE
Overdose d'opiaces: Quel traitement, quelle surveillance?
AUTHOR NAMES
Moeschler O.
Yersin B.
AUTHOR ADDRESSES
(Moeschler O.) Ctr. Interdisciplinaire des Urgences, Serv.
d'Anesthesiologie, BH 06.660.
(Yersin B.) Ctr. Interdisciplinaire des Urgences, Division d'Abus de
Substances, CHUV, 1011 Lausanne.
CORRESPONDENCE ADDRESS
Ctr. Interdisciplinaire des Urgences, Serv. d'Anesthesiologie, BH 06.660.
SOURCE
Medecine et Hygiene (1998) 56:2218 (1505-1510). Date of Publication: 15 Aug
1998
ISSN
0025-6749
ABSTRACT
Virtually every emergency medicine physician comes into contact with victims
of opioid poisoning. Initial emergency treatment of opioid overdose is
rather simple and effective with the exception of patients in cardiac
arrest: ventilatory support is followed by filtrated administration of IV
naloxone, a narcotic antagonist. The correct emergency department evaluation
and the definition of a safe minimal period of careful observation after
opiate overdose to prevent recurrent toxicity is still debated. Although it
is recommended that patients be observed for a minimum of 6 to 8 hours for
evidence of relapse or the development of pulmonary edema, this is often not
accepted by the patients themselves in daily practice. Care to victims of
opiate overdose includes psychosocial evaluation and referral to drug
addiction treatment programs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug therapy)
narcotic antagonist (drug therapy)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
artificial ventilation
cardiopulmonary arrest
first aid
heart arrest
heroin dependence
human
intoxication
intramuscular drug administration
intravenous drug administration
lung edema (diagnosis)
opiate addiction
psychosocial care
relapse
respiration depression (therapy)
review
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1998292650
PUI
L28399191
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1303
TITLE
Preparedness of practicing pediatricians in Louisiana to manage emergencies
AUTHOR NAMES
Shetty A.K.
Hutchinson S.W.
Mangat R.
Peck G.Q.
AUTHOR ADDRESSES
(Shetty A.K.; Hutchinson S.W.; Mangat R.; Peck G.Q.)
(Shetty A.K.; Hutchinson S.W.; Mangat R.; Peck G.Q.) Department of
Pediatrics, Div. of Gen. Pediat. and Adol. Med., Louisiana State Univ.
Medical Center, New Orleans, LA, United States.
(Shetty A.K.) Louisiana State Univ. Medical Center, Department of
Pediatrics, 1542 Tulane Ave, T8-1, New Orleans, LA 70118, United States.
CORRESPONDENCE ADDRESS
A.K. Shetty, Louisiana State Univ. Medical Ctr., Department of Pediatrics,
1542 Tulane Ave., New Orleans, LA 70118, United States.
SOURCE
Southern Medical Journal (1998) 91:8 (745-748). Date of Publication: August
1998
ISSN
0038-4348
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Background. Surveys in recent years show that office emergencies are likely
to occur in pediatric offices and that most offices are not equipped to deal
with these situations. Methods. To determine the pediatrician's preparedness
to manage emergencies, we surveyed a randomly selected sample of 240
office-based pediatricians in Louisiana. We asked for information about
basic and advanced cardiac life support training of the physicians and
staff, availability of office equipment and medications, prearranged
emergency plans, and staff preparedness. Results. Only 73% of pediatricians
were trained in pediatric advanced life support (PALS). Of all support
staff, only 48% were trained in basic life support, and 30% were trained in
PALS. The most common deficiencies in equipment included intraosseous
needles (62%), endotracheal tubes (54%), oxygen tanks (39%), intravenous
catheters (29%), and nebulizers (22%). Availability of medications ranged
from 75% for epinephrine 1:1,000 to 22% for calcium chloride. Although two
thirds of the pediatricians had designed emergency plans for their offices,
only 20% were conducting mock drills. Conclusions. Deficiencies exist among
pediatricians and office staff regarding appropriate levels of preparedness
to handle pediatric emergencies. Recommendations are made to attain
appropriate levels of preparedness.
EMTREE DRUG INDEX TERMS
activated carbon
aminophylline
atropine
bicarbonate
calcium chloride
corticosteroid (drug administration)
diazepam
epinephrine
glucose
lidocaine
lorazepam
naloxone
oxygen
phenytoin
plasma substitute
Ringer lactate solution
salbutamol (drug administration)
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
pediatrician
EMTREE MEDICAL INDEX TERMS
article
certification
clinical trial
controlled clinical trial
controlled study
defibrillator
endotracheal tube
female
human
inhalational drug administration
intravenous catheter
intravenous drug administration
laryngoscopy
male
mask
medical device
medical education
medical staff
monitor
nebulizer
needle
pulse oximetry
questionnaire
randomized controlled trial
stethoscope
tank
CAS REGISTRY NUMBERS
Ringer lactate solution (8022-63-7)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
phenytoin (57-41-0, 630-93-3)
salbutamol (18559-94-9)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998273821
MEDLINE PMID
9715220 (http://www.ncbi.nlm.nih.gov/pubmed/9715220)
PUI
L28374526
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1304
TITLE
Near fatal intoxication with controlled-release morphine tablets in a
depressed woman
AUTHOR NAMES
Westerling D.
Säwe J.
Eklundh G.
AUTHOR ADDRESSES
(Westerling D.) Dept. of Anesth. and Intensive Care, Lund University
Hospital, Lund, Sweden.
(Eklundh G.) Department of Internal Medicine, Lund University Hospital,
Lund, Sweden.
(Säwe J.) Department of Clinical Pharmacology, Karolinska Institute,
Huddinge University Hospital, Huddinge, Sweden.
(Westerling D.) Dept. of Anesth. and Intensive Care, Lund University
Hospital, S-221 85 Lund, Sweden.
CORRESPONDENCE ADDRESS
D. Westerling, Dept. of Anesthesiol./Intensive Care, Lund University
Hospital, S-221 85 Lund, Sweden.
SOURCE
Acta Anaesthesiologica Scandinavica (1998) 42:5 (586-589). Date of
Publication: 1998
ISSN
0001-5172
BOOK PUBLISHER
Blackwell Munksgaard, 1 Rosenorns Alle, P.O. Box 227, Copenhagen V, Denmark.
ABSTRACT
Background: A 46-year-old woman suffering from a reactive depression was
admitted to the emergency room in coma and with severe respiratory failure.
She later developed cardiovascular instability and general convulsions. Two
days following admission the patient had no respiratory effort but was able
to communicate in writing that she had ingested a large amount of
controlled- release morphine tablets. Following treatment with naloxone she
was successfully weaned from the respirator the next day. Methods: Sampling
for determination of plasma and urine concentrations of morphine and its
metabolites morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G)
was started 60 h after the presumed time of intake and continued up to 8
days after admission. Results: The initial plasma concentrations of
morphine, M3G and M6G were 2160, 13 100 and 2330 nM, respectively,
compatible with a lethal close in an opioid-naive patient. The urinary
recovery of morphine, M3G and M6G corresponded to 6.8 mmol, equivalent to an
oral intake of at least 2500 mg. Conclusion: The plasma concentrations of
morphine and morphine metabolites documented in this case, indicative of
considerable absorption of drug, demonstrate that prolonged observation is
necessary following intoxications with controlled-release morphine tablets.
This case also highlights the importance of continuous follow-up of oral
morphine therapy, so that unused drug is not left unaccounted for in the
patient's home.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (drug therapy, pharmacology)
morphine 3 glucuronide (endogenous compound)
naloxone (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
depression (diagnosis, drug therapy)
drug overdose (diagnosis)
EMTREE MEDICAL INDEX TERMS
adult
area under the curve
article
case report
controlled release formulation
drug absorption
drug blood level
drug metabolism
female
follow up
human
human cell
human tissue
priority journal
respiratory failure (diagnosis)
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
morphine 3 glucuronide (20290-09-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998160010
MEDLINE PMID
9605377 (http://www.ncbi.nlm.nih.gov/pubmed/9605377)
PUI
L28218483
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1305
TITLE
A tale of novel intoxication: Seven cases of γ-hydroxybutyric acid overdose
AUTHOR NAMES
Li J.
Stokes S.A.
Woeckener A.
AUTHOR ADDRESSES
(Li J.; Stokes S.A.; Woeckener A.) Mount Auburn Hospital, Department of
Emergency Medicine, 330 Mount Auburn Street, Cambridge, MA 02238, United
States.
CORRESPONDENCE ADDRESS
J. Li, Mount Auburn Hospital, Department of Emergency Medicine, 330 Mount
Auburn Street, Cambridge, MA 02238, United States. Email:
jamesli@varren.med.harvard.edu
SOURCE
Annals of Emergency Medicine (1998) 31:6 (723-728). Date of Publication:
1998
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: We describe seven patients presenting with combination
substance abuse involving γ-hydroxybutyric acid (GHB). Methods: During a 3-
month period, we identified consecutive patients with GHB ingestion
confirmed by urine mass spectrometry presenting to a high-volume urban
emergency department. Results: All patients presented with acute delirium
and transient but severe respiratory depression. With supportive care,
including intubation and mechanical ventilation in four cases, normal
mentation and respiratory function returned within 2 to 6 hours. None of
these patients had documented seizures, and none of the four patients who
received naloxone had a reversal response. This clinical observation
supports previous experimental work in GHB-intoxicated human subjects
demonstrating neither epileptiform changes on electroencephalography nor
reversal with naloxone. Two findings are remarkable in this series. The
first is the observation of a peculiar state of violent aggression present
on stimulation of the GHB-intoxicated patient despite near or total apnea.
The fact that patients fully recovered from this state may be the result of
a previously demonstrated GHB hypoxia-sparing effect. The second is the
observation of ECG abnormalities in several cases, including U waves in five
patients. Conclusion: Emergency physicians should be alerted to this agent,
its characteristic effects, and its potential for serious sequelae including
respiratory arrest and death.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydroxybutyric acid (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
delirium (complication)
drug overdose
epileptic discharge
respiration depression (complication, drug therapy)
EMTREE MEDICAL INDEX TERMS
apnea (complication, therapy)
article
artificial ventilation
clinical article
death
electroencephalogram
human
intubation
mass spectrometry
priority journal
respiratory arrest
thinking
CAS REGISTRY NUMBERS
hydroxybutyric acid (1320-61-2, 35054-79-6)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998182861
MEDLINE PMID
9624312 (http://www.ncbi.nlm.nih.gov/pubmed/9624312)
PUI
L28252628
DOI
10.1016/S0196-0644(98)70231-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(98)70231-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1306
TITLE
A fatal overdose of transdermally administered fentanyl
AUTHOR NAMES
Kramer C.
Tawney M.
AUTHOR ADDRESSES
(Kramer C., CKramer%PCS@MCGH.org; Tawney M.) Mount Clemens General Hospital,
Department of Emergency Medicine, .
(Kramer C., CKramer%PCS@MCGH.org) Mount Clemens General Hospital, Department
of Emergency Medicine, 1000 Harrington Blvd, Mt Clemens, MI 48043, United
States.
CORRESPONDENCE ADDRESS
C. Kramer, Mount Clemens General Hospital, Department of Emergency Medicine,
1000 Harrington Blvd, Mt Clemens, MI 48043, United States. Email:
CKramer%PCS@MCGH.org
SOURCE
Journal of the American Osteopathic Association (1998) 98:7 (385-386). Date
of Publication: July 1998
ISSN
0098-6151
BOOK PUBLISHER
American Osteopathic Association, 142 East Ontario Street, Chicago, United
States.
ABSTRACT
We present a case of fentanyl overdose via mucous membrane absorption. A
31-year-old man presented to the emergency department in respiratory arrest.
At intubation, a Duragesic transdermal patch (75 μg/h) was recovered from
the buccal cavity. A second fentanyl transdermal patch (75 μg/h) was noted
on the right lateral aspect of the thigh. Postmortem blood evaluation
returned a venous fentanyl level of 17.2 μg/L. The therapeutic range for
analgesic use is 1 μg/L to 3 μg/L. Drug screens were positive for
benzodiazepines and cocaine. Mass spectrophotometry/gas chromatography was
used to determine fentanyl levels and to confirm drug screen results. Case
history, findings at intubation, and high fentanyl blood concentration
suggest the cause of respiratory arrest and death was fentanyl overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug administration, drug dose, drug toxicity)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
cocaine
naloxone
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
opiate addiction
respiratory arrest
EMTREE MEDICAL INDEX TERMS
adult
article
buccal mucosa
case report
drug absorption
drug half life
drug screening
fatality
human
male
resuscitation
transdermal drug administration
DRUG TRADE NAMES
duragesic , United StatesJanssen
DRUG MANUFACTURERS
(United States)Janssen
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998259593
MEDLINE PMID
9695458 (http://www.ncbi.nlm.nih.gov/pubmed/9695458)
PUI
L28357392
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1307
TITLE
A prospective study of acute poisonings in Finnish hospital patients
AUTHOR NAMES
Lapatto-Reiniluoto O.
Kivistö K.T.
Pohjola-Sintonen S.
Luomanmäki K.
Neuvonen P.J.
AUTHOR ADDRESSES
(Lapatto-Reiniluoto O.; Luomanmäki K.) Department of Internal Medicine,
Helsinki University Central Hospital, Helsinki, Finland.
(Lapatto-Reiniluoto O.; Kivistö K.T.; Neuvonen P.J.) Department of Clinical
Pharmacology, Helsinki University Central Hospital, Helsinki, Finland.
(Pohjola-Sintonen S.) Peijas Hospital, Vantaa, Finland.
(Kivistö K.T.) Department of Clinical Pharmacology, Helsinki University
Central Hospital, P.O. Box 360, FIN-00029 HYKS, Finland.
CORRESPONDENCE ADDRESS
K.T. Kivisto, Department of Clinical Pharmacology, Helsinki University
Central Hospital, PO Box 360, FIN-00029 HYKS, Finland.
SOURCE
Human and Experimental Toxicology (1998) 17:6 (307-311). Date of
Publication: June 1998
ISSN
0960-3271
BOOK PUBLISHER
SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States.
ABSTRACT
1. We have carried out a prospective study of all adult patients presenting
with acute poisoning during one month to the Helsinki University Central
Hospital (Meilahti Hospital). 2. Two hundred and twenty-six cases of acute
poisoning (113 males and 113 females) presented to the emergency department.
Most cases in both men (66%) and women (67%) involved alcohol. As to drugs,
psychotropic agents predominated in both men and women. The frequency of
patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between
8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to
presentation was longer than 4 h. 3. The clinical status of the patients on
arrival was generally good; more than half (55%) of them were fully awake.
Serious symptoms (e.g. unconsciousness, insufficient respiration
necessitating intubation, aspiration, convulsions or hypotension) occurred
in 15% of the presentations. There were no fatalities. 4. One hundred and
thirty-five patients (60%) received at least one 50-g dose of activated
charcoal. However, charcoal was given in 86% of the cases of drug poisoning.
Gastric lavage was performed in 112 cases (50%), and 106 cases (47%)
involved both gastric lavage and administration of charcoal. Twenty-one
patients received antidotes (flumazenil, calcium gluconate or naloxone) and
three patients were hemodialysed. 5. Of the 226 cases, 142 (63%) were
managed solely in the emergency department. Of the 84 cases admitted to the
hospital, eight had to be managed in the intensive care unit. Almost all
patients (94%) were discharged within 24 h. 6. In this survey on 226
consecutive cases of acute poisoning, about two-thirds of the cases involved
alcohol, while the most common drugs taken were psychotropic agents. The
poisoning was mild in the great majority of the cases. Activated charcoal
was generally administered in all but trivial cases of drug poisoning.
EMTREE DRUG INDEX TERMS
activated carbon (drug dose, drug therapy)
alcohol (drug toxicity)
flumazenil (drug therapy)
gluconate calcium (drug therapy)
naloxone (drug therapy)
psychotropic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, epidemiology, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
aspiration
breathing
convulsion
emergency ward
female
Finland
hemodialysis
hospital patient
human
hypotension
intensive care
intubation
major clinical study
male
priority journal
stomach lavage
symptom
unconsciousness
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
flumazenil (78755-81-4)
gluconate calcium (299-28-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998248488
MEDLINE PMID
9688353 (http://www.ncbi.nlm.nih.gov/pubmed/9688353)
PUI
L28342338
DOI
10.1191/096032798678908864
FULL TEXT LINK
http://dx.doi.org/10.1191/096032798678908864
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1308
TITLE
Office-based anaesthesia: The UK perspective
AUTHOR NAMES
Smith I.
AUTHOR ADDRESSES
(Smith I.) Directorate of Anaesthesia, Keele Univ., N. Staffordshire Hosp.,
Staffordshire ST4 6QG, United Kingdom.
CORRESPONDENCE ADDRESS
I. Smith, Keele University, North Staffordshire Hospital, Stoke-on-Trent,
Staffordshire ST4 6QG, United Kingdom.
SOURCE
Ambulatory Surgery (1998) 6:2 (69-74). Date of Publication: Jun 1998
ISSN
0966-6532
ABSTRACT
Although office-based anaesthesia is not prevalent in the United Kingdom,
anaesthesia has long been provided in community dental surgeries. Because of
concerns over the safety of providing anaesthesia in hazardous remote
locations, several expert working parties have examined UK dental
anaesthesia and made numerous recommendations for safe practice. Concerning
training, general anaesthesia, sedation, equipment, monitoring,
resuscitation and building layout, these recommendations provide an
excellent basis for local, regional or national guidelines for many forms of
office-based anaesthesia. Putting the recommendations into practice,
however, has had a fundamental impact on the provision of UK dental
anaesthetic services and may have significant cost implications. These
aspects should be carefully considered by anyone involved with planning or
delivering office-based anaesthesia.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
calcium chloride
epinephrine
lidocaine
oxygen
EMTREE DRUG INDEX TERMS
aminophylline
antihistaminic agent
diazepam
flumazenil
glucose
glyceryl trinitrate
hydrocortisone
midazolam
naloxone
salbutamol
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dental anesthesia
outpatient department
United Kingdom
EMTREE MEDICAL INDEX TERMS
anesthetic equipment
article
clinical practice
dental surgery
emergency treatment
general anesthesia
human
patient monitoring
practice guideline
resuscitation
sedation
training
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
flumazenil (78755-81-4)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
salbutamol (18559-94-9)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998254041
PUI
L28350486
DOI
10.1016/S0966-6532(98)00041-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S0966-6532(98)00041-9
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1309
TITLE
A young woman found unconscious at home
AUTHOR NAMES
Fulde G.
AUTHOR ADDRESSES
(Fulde G.) Emergency Department, St Vincent's Hospital, Sydney, NSW,
Australia.
CORRESPONDENCE ADDRESS
G. Fulde, Emergency Department, St Vincent's Hospital, Sydney, NSW,
Australia.
SOURCE
Modern Medicine of Australia (1998) 41:3 (140-142). Date of Publication:
1998
ISSN
1030-3782
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
digoxin (drug toxicity)
heparin (drug toxicity)
opiate agonist (drug toxicity)
organophosphorus compound (drug toxicity)
paracetamol (drug toxicity)
warfarin (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
amphetamine (drug toxicity)
atropine (drug therapy)
beta adrenergic receptor blocking agent (drug toxicity)
carbon monoxide (drug toxicity)
chloral hydrate (drug toxicity)
cocaine (drug toxicity)
deferoxamine (drug therapy)
diamorphine (drug toxicity)
digoxin antibody (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
heavy metal (drug toxicity)
iron (drug toxicity)
isoprenaline (drug therapy)
methadone (drug toxicity)
naloxone (drug dose, drug therapy)
pralidoxime (drug therapy)
protamine (drug therapy)
vitamin K group (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy)
unconsciousness (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical feature
differential diagnosis
drug identification
emergency treatment
female
human
syndrome delineation
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
chloral hydrate (302-17-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
deferoxamine (70-51-9)
diamorphine (1502-95-0, 561-27-3)
digoxin (20830-75-5, 57285-89-9)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
iron (14093-02-8, 53858-86-9, 7439-89-6)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
protamine (11061-43-1, 9007-31-2, 9012-00-4)
vitamin K group (12001-79-5)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1998111933
PUI
L28155248
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1310
TITLE
Availability, use and cost of antidotes in Catalonia, Spain
ORIGINAL (NON-ENGLISH) TITLE
Disponibilidad, utilizacion y coste de los antidotos en Cataluna
AUTHOR NAMES
Nogué S.
Munné P.
Soy D.
Millá J.
AUTHOR ADDRESSES
(Nogué S.; Munné P.) U. de Toxicol. Clínica, Hospital Clinic i Provincial,
Barcelona, Spain.
(Soy D.) Servicio de Farmacia, Hospital Clinic i Provincial, Barcelona,
Spain.
(Millá J.) Servicio de Urgencias, Hospital Clinic i Provincial, Barcelona,
Spain.
(Nogué S.) Villarroel. 172. 2.a 2.a, 08036 Barcelona, Spain.
CORRESPONDENCE ADDRESS
S. Nogue, Villarroel, 172, 08036 Barcelona, Spain.
SOURCE
Medicina Clinica (1998) 110:16 (609-613). Date of Publication: 9 May 1998
ISSN
0025-7753
BOOK PUBLISHER
Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain.
ABSTRACT
Background: To know the availability of antidotes in hospital and extra-
hospital emergency services in Catalonia (Spain), their real use, and the
cost. Patients and Methods: Availability was studied by means of a
transversal questionnaire carried out in 24 hospitals and 3 extra-hospital
emergency services in Catalonia; the real use of antidotes was investigated
using a prospective study carried out for one year in the same 24 hospitals,
and the cost was determined using the data obtained over 12 months in one
large hospital. Results: Average availability was 35 antidotes in hospital
and 13 in extra-hospital emergency services. In no service did the
availability coincide exactly with that of another service, nor with the
recommendations made by international institutions (World Health
Organization and International Programme for Chemical Safety) or the
Government of Catalonia. The low incidence of availability of antidotes to
cyanide was notable. Antidotes were used in 12.9% of acute intoxications. In
167 cases treated with these drugs, only 9 different antidotes were used.
The consumption of these antidotes represents 0.1% of the budget of a
pharmacy service in one large hospital. Conclusions: The availability of
antidotes in Catalonia is heterogeneous and some services lack antidotes
whose use is considered essential. Antidotes are scarcely used in acute
intoxications and their economic cost is low.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy, pharmacoeconomics)
cyanide (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (drug therapy, pharmacoeconomics)
apomorphine (drug therapy, pharmacoeconomics)
ascorbic acid (drug therapy, pharmacoeconomics)
atropine (drug therapy, pharmacoeconomics)
dantrolene (drug therapy, pharmacoeconomics)
epinephrine (drug therapy, pharmacoeconomics)
flumazenil (drug therapy, pharmacoeconomics)
folic acid (drug therapy, pharmacoeconomics)
folinic acid (drug therapy, pharmacoeconomics)
gluconate calcium (drug therapy, pharmacoeconomics)
glucose (drug therapy, pharmacoeconomics)
hydroxocobalamin (drug therapy, pharmacoeconomics)
isoprenaline (drug therapy, pharmacoeconomics)
magnesium sulfate (drug therapy, pharmacoeconomics)
mannitol (drug therapy, pharmacoeconomics)
naloxone (drug therapy, pharmacoeconomics)
neostigmine (drug therapy, pharmacoeconomics)
noradrenalin (drug therapy, pharmacoeconomics)
penicillamine (drug therapy, pharmacoeconomics)
physostigmine (drug therapy, pharmacoeconomics)
propranolol (drug therapy, pharmacoeconomics)
pyridoxine (drug therapy, pharmacoeconomics)
sodium nitrite (drug therapy, pharmacoeconomics)
sodium thiosulfate (drug therapy, pharmacoeconomics)
succimer (drug therapy, pharmacoeconomics)
unindexed drug (drug therapy, pharmacoeconomics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
intoxication (diagnosis, drug therapy, epidemiology, prevention)
EMTREE MEDICAL INDEX TERMS
article
cyanide poisoning (drug therapy, prevention)
drug bioavailability
drug cost
economic aspect
health care quality
human
multicenter study
Spain
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
apomorphine (314-19-2, 58-00-4)
ascorbic acid (134-03-2, 15421-15-5, 50-81-7)
atropine (51-55-8, 55-48-1)
cyanide (57-12-5)
dantrolene (14663-23-1, 7261-97-4)
flumazenil (78755-81-4)
folic acid (59-30-3, 6484-89-5)
folinic acid (58-05-9, 68538-85-2)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
hydroxocobalamin (13422-51-0, 13422-52-1)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
magnesium sulfate (7487-88-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
noradrenalin (1407-84-7, 51-41-2)
penicillamine (2219-30-9, 52-67-5)
physostigmine (57-47-6, 64-47-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
succimer (10008-75-0, 2418-14-6, 2922-54-5, 304-55-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English, Spanish
EMBASE ACCESSION NUMBER
1998202985
MEDLINE PMID
9656198 (http://www.ncbi.nlm.nih.gov/pubmed/9656198)
PUI
L28280026
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1311
TITLE
Opioid toxicity recurrence after an initial response to naloxone
AUTHOR NAMES
Watson W.A.
Steele M.T.
Muelleman R.L.
Rush M.D.
AUTHOR ADDRESSES
(Watson W.A., WaWatson@CCTR.UMKC.EDU) Department of Emergency Medicine,
Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, United
States.
(Steele M.T.; Muelleman R.L.; Rush M.D.)
CORRESPONDENCE ADDRESS
W.A. Watson, Department Emergency Medicine, Truman Medical Center, 2301
Holmes Street, Kansas City, MO 64108, United States. Email:
Wawatson@CCTR.UMKC.EDU
SOURCE
Journal of Toxicology - Clinical Toxicology (1998) 36:1-2 (11-17). Date of
Publication: 1998
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
Objective: To determine the frequency and potential predictors of opioid
toxicity recurrence after a response to naloxone in adult Emergency
Department patients. Methods: A retrospective case-control study of
naloxone-treated patients with opioid toxicity over an 8-year period. Both
the patient response to naloxone and recurrence of opioid toxicity was
determined by an expert Delphi Panel. The frequency of opioid toxicity
recurrence was compared by the duration of opioid effect, the route of
opioid exposure, and the presence of other CNS depressant drugs. Results:
Ninety of 221 (41%) cases with a discharge diagnosis of opioid toxicity were
treated with naloxone; six patients were excluded because of a lack of
toxicity. There was a response to naloxone in 50% of the 84 cases, and
recurrence of toxicity in 31% (95% CI 17-45%) of naloxone responders. The
most common opioids were codeine, heroin, propoxyphene, and
oxycodone/hydrocodone. Recurrence of toxicity was more common with
long-acting opioids (p = 0.04), and was not associated with the route of
opioid exposure (p = 0.42), or presence of ethanol and other CNS depressants
(p ≤ 0.87). Conclusion: Opioid toxicity recurrence after a response to
naloxone occurred in approximately 1/3 of adult Emergency Department opioid
overdose cases. Recurrence was more common with longacting opioids and was
not associated with the route of opioid exposure. Other clinically useful
predictors of toxicity recurrence were not identified.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine (drug therapy, drug toxicity)
dextropropoxyphene (drug therapy, drug toxicity)
diamorphine (drug therapy, drug toxicity)
hydrocodone (drug therapy, drug toxicity)
naloxone (drug therapy)
opiate (drug therapy, drug toxicity)
oxycodone (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, etiology)
drug overdose (drug therapy, etiology)
drug toxicity (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
article
case control study
drug efficacy
emergency ward
female
human
major clinical study
male
recurrent disease
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998135592
MEDLINE PMID
9541035 (http://www.ncbi.nlm.nih.gov/pubmed/9541035)
PUI
L28185389
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1312
TITLE
Nalmefene: A long-acting opioid antagonist. Clinical applications in
emergency medicine
AUTHOR NAMES
Wang D.S.
Sternbach G.
Varon J.
AUTHOR ADDRESSES
(Wang D.S.; Sternbach G.) Division of Emergency Medicine, Stanford
University Medical Center, Stanford, CA, United States.
(Varon J.) Depts. of Anesth./Critical Care Med., University of Texas, M. D.
Anderson Cancer Center, Houston, TX, United States.
(Sternbach G.) Division of Emergency Medicine, MSOB X-300, Stanford
University Medical Center, Stanford, CA, United States.
CORRESPONDENCE ADDRESS
G. Sternbach, Division of Emergency Medicine, MSOB X-300, Stanford
University Medical Center, Stanford, CA 94305, United States.
SOURCE
Journal of Emergency Medicine (1998) 16:3 (471-475). Date of Publication:
May/June 1998
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
The use of the opioid antagonist naloxone is well known to the experienced
health care provider. The availability of the longer acting opioid
antagonist nalmefene has several potential benefits in clinical practice.
Nalmefene has a plasma half-life of almost 11 h, compared to 60-90 rain for
naloxone. Nalmefene has been shown to reverse opioid intoxication for as
long as 8 h, reducing the need for continuous monitoring of intoxicated
patients and repeated dosing of naloxone. Single dose administration has
also been used effectively in the reversal of opiate- assisted conscious
sedation. In addition, this agent has been used in the treatment of diseases
as diverse as interstitial cystitis and chronic alcohol dependence. However,
the long duration of action enables extended withdrawal reactions in the
chronically opioid-dependent patient. The prolonged opioid antagonism of
nalmefene has several applications in the clinical practice of emergency
medicine, and is a useful addition in certain situations to the
pharmacologic armamentarium of the practicing emergency physician.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (adverse drug reaction, drug administration, drug comparison, drug
dose, drug interaction, pharmacokinetics, pharmacology)
opiate derivative
EMTREE DRUG INDEX TERMS
acetylsalicylic acid plus oxycodone plus oxycodone terephthalate
alphaprodine
atropine plus diphenoxylate
butorphanol tartrate
dextropropoxyphene
fentanyl citrate (drug dose, drug interaction)
hydromorphone
methadone
nalbuphine
naloxone (drug administration, drug comparison, pharmacokinetics,
pharmacology)
naltrexone (drug administration, drug comparison, pharmacokinetics)
opiate antagonist (adverse drug reaction, drug administration, drug
comparison, drug dose, drug interaction, pharmacokinetics, pharmacology)
oxycodone plus paracetamol
oxymorphone
pentazocine
pethidine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
interstitial cystitis
opiate addiction
EMTREE MEDICAL INDEX TERMS
alcoholism
article
detoxification
diarrhea (side effect)
dose response
drug antagonism
drug half life
drug mechanism
drug monitoring
human
intravenous drug administration
oral drug administration
priority journal
sedation
tremor (side effect)
vertigo (side effect)
vomiting (side effect)
withdrawal syndrome
DRUG TRADE NAMES
darvocet
darvon
demerol
dilaudid
dolophine
lomotil
narcan , United StatesEndo
nisentil
nubain
numorphan
percocet
percodan
revex , United StatesOhmeda
stadol
sublimaze
talwin
trexan
DRUG MANUFACTURERS
(United States)Endo
(United States)Ohmeda
CAS REGISTRY NUMBERS
alphaprodine (561-78-4, 77-20-3)
atropine plus diphenoxylate (55840-97-6)
butorphanol tartrate (58786-99-5)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl citrate (990-73-8)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nalbuphine (20594-83-6, 23277-43-2)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
oxymorphone (357-07-3, 76-41-5)
pentazocine (359-83-1, 64024-15-3)
percodan (64336-56-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998170053
MEDLINE PMID
9610980 (http://www.ncbi.nlm.nih.gov/pubmed/9610980)
PUI
L28232716
DOI
10.1016/S0736-4679(98)00019-5
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(98)00019-5
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1313
TITLE
Prehospital gastrointestinal decontamination of toxic ingestions: A missed
opportunity
AUTHOR NAMES
Wax P.M.
Cobaugh D.J.
AUTHOR ADDRESSES
(Wax P.M.; Cobaugh D.J.) Department of Emergency Medicine, Finger Lakes Reg.
Poison Contr. Ctr., Univ. of Rochester Medical Center, Rochester, NY, United
States.
(Wax P.M.) Department of Emergency Medicine, University of Rochester, School
of Medicine, Rochester, NY 14642, United States.
CORRESPONDENCE ADDRESS
P.M. Wax, Department of Emergency Medicine, Univ. Rochester School of
Medicine, Rochester, NY 14642, United States.
SOURCE
American Journal of Emergency Medicine (1998) 16:2 (114-116). Date of
Publication: 1998
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The purpose of this study was to determine if emergency medical services
(EMS) providers routinely initiate field gastrointestinal decontamination of
adult drug overdose patients transported to the emergency department (ED). A
retrospective prehospital chart review was performed on adult patients
identified as drug overdose who were transported by EMS. ED charts on
patients transported to a university hospital were reviewed for follow-up
data. Prehospital care records showed that gastrointestinal decontamination
was initiated in only 6 of 361 (2%) patients, all of whom received ipecac.
No patient received activated charcoal. The median transport time was 25
minutes (range, 5 to 66 minutes). Follow-up data on patients transported to
the university hospital revealed that 30 of 43 (70%) patients who might have
been suitable candidates for prehospital activated charcoal actually
received activated charcoal in the ED. Median time to activated charcoal in
the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in
the field appears to be deferred despite its known loss of efficacy over
time. The failure to start activated charcoal in the field contributes to
the delay in initiating activated charcoal therapy.
EMTREE DRUG INDEX TERMS
activated carbon
analgesic agent
antibiotic agent
antidepressant agent
antitussive agent
bicarbonate
cardiac agent
diphenhydramine
ipecac
naloxone
neuroleptic agent
opiate derivative
sedative agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
EMTREE MEDICAL INDEX TERMS
adult
article
detoxification
emergency medicine
emergency ward
female
follow up
human
major clinical study
male
patient transport
priority journal
retrospective study
university hospital
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
bicarbonate (144-55-8, 71-52-3)
diphenhydramine (147-24-0, 58-73-1)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Gastroenterology (48)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998094546
MEDLINE PMID
9517681 (http://www.ncbi.nlm.nih.gov/pubmed/9517681)
PUI
L28130765
DOI
10.1016/S0735-6757(98)90024-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(98)90024-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1314
TITLE
The opiate dependent patient - Increase of users
ORIGINAL (NON-ENGLISH) TITLE
Der opioidabhangige patient - Der konsum nimmt zu
AUTHOR NAMES
Freye E.
AUTHOR ADDRESSES
(Freye E.) Abt. Gefasschirurgie N., Heinrich-Heine-Univ. Düsseldorf, .
(Freye E.) Hamener Straße 37, D-40882 Ratingen, Germany.
CORRESPONDENCE ADDRESS
E. Freye, Hamener Strasse 37, D-40882 Ratingen, Germany.
SOURCE
Anasthesiologie und Intensivmedizin (1998) 39:2 (73-86). Date of
Publication: 1998
ISSN
0170-5334
ABSTRACT
Summary: Heroin can still be considered the illegal drug number one among
illicit opioid addicts. Data from the first quarter of 1995 and 1996 reports
that cocaine use has stabilized or slightly decreased across the nation
while heroin comparatively is still much higher, especially among young low
and middle-income adults, teens and particularly middle-class suburbanites.
Ethnographers indicate that cocaine use is not as popular among adolescents
and young adults as it once was, it is not seen as fashionable and the
preference of heroin over cocaine is thought to be because the drug makes
the user calm. Thus an increasing number of sources are reporting
'double-breasted' dealing or 'one plus one' sales, in which cocaine and
heroin are sold by the same person. This deviation from the traditional
single drug market has already had noticable effects on heroin quality.
Individuals who have not previously dealt with heroin may not know enough
about the drug to cut and package it properly. Inexperienced dealers often
cut the heroin inconsistently and purity may range from 2% to 30%. In
addition, new heroin dealers may adulterate the heroin with a large variety
of pharmacologically active and non active compounds which often result in a
variable toxicity of the drug. Also, designer drugs of the fentanyl series
and that of pethidine are appearing more frequently on the market, compounds
which are characterized by a high purity and a high toxicity when compared
to their mother compound. Such practices result in an increased number of
opioid overdoses and users appearing at emergency rooms for problems related
to the substance with which heroin is mixed have to be treated accordingly.
While the final aim in the treatment of drug addicts is abstinence from the
drug, various techniques are available to free a user from the opioid. Among
these the 'ultra-rapid detoxification technique' in anaesthesia has raised
interest as many addicts are willing to give up their drug career but are
incapable of coping with the abstinence syndrome. Similar to maintenance
programmes with methadone, however, detoxification does not guarantee no
relapse unless a psychosocial stabilization is initiated in highly motivated
individual accompanied by a maintenance programme with the opioid antagonist
naltrexone.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine (pharmacology)
diamorphine (pharmacology)
illicit drug (pharmacology)
EMTREE DRUG INDEX TERMS
fentanyl derivative (pharmacology)
methadone (pharmacology)
naltrexone (pharmacology)
opiate agonist (pharmacology)
pethidine (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
substance abuse
EMTREE MEDICAL INDEX TERMS
detoxification
ethnology
psychosocial disorder (complication)
quality control
review
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naltrexone (16590-41-3, 16676-29-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
German, English
EMBASE ACCESSION NUMBER
1998075988
PUI
L28106797
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1315
TITLE
Evaluating toxic alcohol poisoning in the emergency setting
AUTHOR NAMES
Williams R.H.
Erickson T.
AUTHOR ADDRESSES
(Williams R.H., rwilliam@uic.edu) Department of Pathology, Division of
Clinical Pathology, Univ. Illinois at Chicago Med. Ctr., Chicago, IL, United
States.
(Erickson T.) Department of Emergency Medicine, Division of Toxicology,
Univ. Illinois at Chicago Med. Ctr., Chicago, IL, United States.
(Williams R.H., rwilliam@uic.edu) Univ. Illinois at Chicago Med. Ctr.,
Department of Pathology, Division of Clinical Pathology, 840 S Wood St.,
201G CSB, Chicago, IL 60612, United States.
CORRESPONDENCE ADDRESS
R.H. Williams, University of Illinois, Chicago Medical Center, Department of
Pathology, 840 S Wood St, Chicago, IL 60612, United States. Email:
rwilliam@uic.edu
SOURCE
Laboratory Medicine (1998) 29:2 (102-108). Date of Publication: 1998
ISSN
0007-5027
ABSTRACT
Ingestion of a toxic alcohol often occurs when an alcoholic patient cannot
obtain ethanol and thus, seeks an ethanol substitute. Methanol produces
visual disturbances, while ethylene glycol produces pulmonary and renal
disturbances. Ingestion of isopropanol results in acetone production that
can lead to central nervous system depression. Unlike methanol and ethylene
glycol poisoning, however, isopropanol poisoning generally does not produce
major disturbances in acid base balance. Most clinical laboratories do not
perform toxic alcohol analyses. Thus, the clinician relies on interpretation
of other clinical laboratory data to ascertain the presence or absence of a
toxic alcohol.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2 propanol (drug toxicity)
ethylene glycol (drug toxicity)
methanol (drug toxicity)
EMTREE DRUG INDEX TERMS
acetone (drug toxicity)
alcohol (drug administration, drug therapy)
glucose
naloxone
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (diagnosis, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
acid base balance
adult
case report
emergency medicine
hemodialysis
human
kidney disease (etiology)
lung disease (etiology)
male
osmolality
review
visual disorder (etiology)
CAS REGISTRY NUMBERS
2 propanol (67-63-0)
acetone (67-64-1)
alcohol (64-17-5)
ethylene glycol (107-21-1)
glucose (50-99-7, 84778-64-3)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998077896
PUI
L28109518
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1316
TITLE
Outcome study of prehospital patients signed out against medical advice by
field paramedics
AUTHOR NAMES
Moss S.T.
Chan T.C.
Buchanan J.
Dunford J.V.
Vilke G.M.
AUTHOR ADDRESSES
(Moss S.T.; Chan T.C.; Buchanan J.; Dunford J.V.; Vilke G.M.) Department of
Emergency Medicine, University of California, San Diego Medical Center, 200
West Arbor Drive, San Diego, CA 92103, United States.
CORRESPONDENCE ADDRESS
G.M. Vilke, Department of Emergency Medicine, University of California, San
Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, United
States. Email: gmvilke@ucsd.edu
SOURCE
Annals of Emergency Medicine (1998) 31:2 (247-250). Date of Publication:
1998
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To describe the incidence and demographic data of
prehospital patients who contact paramedics by way of the 911 system, refuse
transport against medical advice (AMA), then call 911 and are subsequently
reevaluated by paramedics in the following 48 hours. Methods: We conducted a
retrospective observational review of records using the San Diego County
Quality Assurance Network database for prehospital providers. All paramedic
911 responses that made base hospital contact over a 3-month period were
reviewed to identify patients who signed out AMA. The main outcome measure
was to identify patients who signed out AMA and then called 911 again within
48 hours. The demographics, complaints, treatments, and dispositions of
these patients are described. Results: Of 6,512 total 911 responses
reviewed, 443 (7%) involved patients who signed out AMA. Of these patients,
156 cases (35.2%) were listed as trauma and 287 (64.8%) were medical, with
cardiac chest pain, seizure, and respiratory distress/shortness of breath
the most frequently noted medical subcategories. Fifty-one (11.5%) such
patients received treatment; 34 received dextrose, 12 naloxone, 4 albuterol,
and 1 a splint. Patient names were available in 5,515 of the total 6,512
responses and 431 of the 443 AMA cases, permitting computer searching of
reevaluations by paramedics. Of the 431 AMA patients for whom a name was
available, 10 (2%) called 911 again within 48 hours. All 10 callbacks were
made for a related chief complaint, and all 10 of these patients were
transported (4 admitted to hospital, 1 died en route, 1 transferred to
another facility, 4 discharged from the ED). Of these 10 patients, 7 (70%)
were older than 65 years, compared with 17% of all AMA patients older than
65 years. Conclusion: On the basis of our findings, patients over the age of
65 years have a propensity to recontact paramedics and should be
aggressively encouraged to seek emergency medical treatment. Future
prospective studies should be mounted to examine at patient outcome and to
assess why patients sign out AMA after making contact with paramedics.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
paramedical disciplines
EMTREE MEDICAL INDEX TERMS
article
health care system
human
interpersonal communication
normal human
priority journal
treatment outcome
United States
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998055621
MEDLINE PMID
9472189 (http://www.ncbi.nlm.nih.gov/pubmed/9472189)
PUI
L28079700
DOI
10.1016/S0196-0644(98)70315-4
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(98)70315-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1317
TITLE
Oral poisonings: Guidelines for initial evaluation and treatment
AUTHOR NAMES
Larsen L.C.
Cummings D.M.
AUTHOR ADDRESSES
(Larsen L.C.; Cummings D.M.) East Carolina University, School of Medicine,
Greenville, NC, United States.
CORRESPONDENCE ADDRESS
L.C. Larsen, Department of Family Medicine, East Carolina Univ. Sch. of
Medicine, Brody Medical Sciences Bldg., 600 Moye Blvd., Greenville, NC
27858-4354, United States.
SOURCE
American Family Physician (1998) 57:1 (85-92). Date of Publication: 1998
ISSN
0002-838X
BOOK PUBLISHER
American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Suite
440, Leawood, United States.
ABSTRACT
The initial evaluation and management of poisoned patients should be
comprehensive and include an accurate history whenever possible,
stabilization of the patient's condition, a physical assessment to evaluate
the extent of poisoning and the presence of concurrent conditions,
decontamination of the gastrointestinal tract using activated charcoal,
gastric lavage, administration of ipecac or irrigation, poison-specific
treatment with administration of antidotes when indicated and proper
disposition. Consultation with a poison control center is often helpful in
assessing and treating these patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug toxicity)
calcium channel blocking agent (drug toxicity)
cocaine (drug toxicity)
narcotic agent (drug toxicity)
paracetamol (drug toxicity)
salicylic acid (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
alcohol (drug therapy, drug toxicity)
bicarbonate (drug therapy)
calcium (drug therapy)
deferoxamine mesylate (drug therapy)
digoxin antibody (drug therapy)
flumazenil (drug therapy)
glucagon (drug therapy)
naloxone (drug therapy)
physostigmine salicylate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical feature
clinical protocol
emergency treatment
poison center
review
stomach lavage
symptomatology
treatment planning
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
cocaine (50-36-2, 53-21-4, 5937-29-1)
deferoxamine mesylate (138-14-7, 5115-09-3)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine salicylate (57-64-7, 71214-04-5)
salicylic acid (63-36-5, 69-72-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998042787
MEDLINE PMID
9447216 (http://www.ncbi.nlm.nih.gov/pubmed/9447216)
PUI
L28063208
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1318
TITLE
Elderly patients with altered mental status
AUTHOR NAMES
O'Keefe K.P.
Sanson T.G.
AUTHOR ADDRESSES
(O'Keefe K.P.; Sanson T.G.) 812 Lorena Road, Lutz, FL 33549, United States.
CORRESPONDENCE ADDRESS
K.P. O'Keefe, 812 Lorena Road, Lutz, FL 33549, United States.
SOURCE
Emergency Medicine Clinics of North America (1998) 16:4 (701-715). Date of
Publication: 1998
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
Mental status changes in the elderly are a source of concern and a challenge
for the emergency physician. A variety of medical conditions and psychiatric
disturbances are potential causes of those symptoms. Acute changes must be
differentiated from mental status alterations occurring as a result of
chronic conditions. This article focuses on the emergency evaluation,
treatment, and differential diagnosis of this symptom complex.
EMTREE DRUG INDEX TERMS
antibiotic agent (adverse drug reaction)
anticonvulsive agent (adverse drug reaction)
antiemetic agent (adverse drug reaction)
antihistaminic agent (adverse drug reaction)
antiinflammatory agent (adverse drug reaction)
antineoplastic agent (adverse drug reaction)
benzodiazepine derivative (drug therapy)
cardiovascular agent (adverse drug reaction)
corticosteroid (adverse drug reaction)
droperidol (drug therapy)
glucose (drug therapy)
haloperidol (drug therapy)
hormone derivative (adverse drug reaction)
lidocaine (drug therapy)
lorazepam (drug therapy)
muscle relaxant agent (adverse drug reaction)
naloxone (drug therapy)
narcotic agent (adverse drug reaction, drug toxicity)
neuromuscular blocking agent (drug dose)
psychotropic agent (adverse drug reaction)
serotonin agonist (adverse drug reaction)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cognitive defect (diagnosis, etiology, therapy)
consciousness disorder (diagnosis, etiology, therapy)
geriatric patient
EMTREE MEDICAL INDEX TERMS
aged
anamnesis
brain hemorrhage (diagnosis)
delirium (diagnosis)
dementia (diagnosis)
diagnostic test
differential diagnosis
emergency treatment
human
hypertension encephalopathy (diagnosis, etiology)
hypoglycemia (diagnosis, drug therapy, etiology)
hypoxia (diagnosis)
intoxication (diagnosis, drug therapy, etiology)
intracranial hypertension (drug therapy)
intramuscular drug administration
intravenous drug administration
meningitis (diagnosis)
mental disease (diagnosis)
neuroleptic malignant syndrome (side effect)
neurologic examination
oral drug administration
patient monitoring
physical examination
polypharmacy
priority journal
review
steroid therapy
violence (drug therapy)
Wernicke encephalopathy (diagnosis, drug therapy, etiology, prevention)
DRUG TRADE NAMES
haldol
CAS REGISTRY NUMBERS
droperidol (548-73-2)
glucose (50-99-7, 84778-64-3)
haloperidol (52-86-8)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Gerontology and Geriatrics (20)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1998403182
MEDLINE PMID
9889736 (http://www.ncbi.nlm.nih.gov/pubmed/9889736)
PUI
L28541511
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1319
TITLE
Evaluation of a diagnostic protocol for patients with coma of unknown origin
ORIGINAL (NON-ENGLISH) TITLE
Ein protokoll zur abklarung von patienten mit koma unklarer genese
AUTHOR NAMES
Oschatz E.
Bur A.
Lang W.
Kofler J.
Herkner H.
Müllner M.
Barrientos M.
Woisetschläger C.
Wagner O.
Schindler E.
Laggner A.N.
AUTHOR ADDRESSES
(Oschatz E.; Bur A.; Kofler J.; Herkner H.; Müllner M.; Barrientos M.;
Woisetschläger C.; Laggner A.N.) Abteilung für Notfallmedizin,
Universitätskliniken, Allgemeines Krankenhaus Wien, Austria.
(Lang W.) Universitätsklinik für Neurologie, Universitätskliniken,
Allgemeines Krankenhaus Wien, Austria.
(Wagner O.) Klinisches Institut für Medizinische und Chemische
Labordiagnostik, Universitätskliniken, Allgemeines Krankenhaus Wien,
Austria.
(Schindler E.) Klinische Abteilung für Neurologie, Universitätskliniken,
Allgemeines Krankenhaus Wien, Austria.
(Oschatz E.) Abteilung für Notfallmedizin, AKH der Stadt Wien, Währinger
Gürtel 18-20, A-1090 Wien, Austria.
CORRESPONDENCE ADDRESS
E. Oschatz, Abteilung fur Notfallmedizin, AKH der Stadt Wien, Wahringer
Gurtel 18-20, A-1090 Wien, Osterreich, Austria.
SOURCE
Wiener Klinische Wochenschrift (1997) 109:24 (949-953). Date of Publication:
23 Dec 1997
ISSN
0043-5325
BOOK PUBLISHER
Springer Wien, Sachsenplatz 4-6, P.O. Box 89, Vienna, Austria.
ABSTRACT
Objective: Evaluation of a diagnostic protocol for patients with coma of
unknown origin Objective: Evaluation of the applicability of a protocol
designed for the quick and efficient management of patients with coma of
unknown origin (CUO). Methods: Every patient admitted to our Emergency
Department with the diagnosis of CUO was evaluated with our diagnostic
protocol. The first diagnostic steps included evaluation of the hemodynamic
and respiratory situation, Glasgow Coma Scale, basic neurologic and clinical
examination, as well as blood withdrawal, for analysis of metabolic and
toxicologic parameters. If indicated, cranial computer tomography (CCT)
and/or lumbar puncture were performed. Results: Within the study period from
1.1. 1995 until 30. 9. 1996, 122 patients (65 males, median age 50 years, 25
and 75 percentile: 33; 69) were included. Blood analysis and the
toxicological screening were diagnostic effective in 66 patients, clinical
examination and body temperature in one case each, CCT in 50 patients and
lumbar puncture in 2 patients. By the use of this diagnostic protocol 51
neurologic, 38 toxicologic, 28 metabolic and 2 infectious causes of coma
were diagnosed (98%). Etiology of 2 of the comas remained unclear.
Conclusion: By using our protocol, 98% of the causes of CUO were clarified.
The main causes of coma were of neurological, toxicological and metabolic
origin. CCT and the blood analysis were the most important procedures
leading to a final diagnosis.
EMTREE DRUG INDEX TERMS
flumazenil
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (etiology)
EMTREE MEDICAL INDEX TERMS
adult
aged
article
blood analysis
brain scintiscanning
clinical protocol
computer assisted tomography
diagnostic approach route
female
hemodynamic monitoring
human
lumbar puncture
major clinical study
male
pathogenesis
respiratory function
toxicity
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Anesthesiology (24)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
1998042683
MEDLINE PMID
9491538 (http://www.ncbi.nlm.nih.gov/pubmed/9491538)
PUI
L28063104
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1320
TITLE
ISMP medication error report analysis
AUTHOR NAMES
Cohen M.R.
AUTHOR ADDRESSES
(Cohen M.R.) 300 West Street Road, Warminster, PA 18974-3231, United States.
CORRESPONDENCE ADDRESS
M.R. Cohen, 300 West Street Road, Warminster, PA 18974-3231, United States.
Email: mcohen@ismp.org
SOURCE
Hospital Pharmacy (1997) 32:11 (1462-1465). Date of Publication: 1997
ISSN
0018-5787
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
flumazenil (drug therapy)
lorazepam (drug therapy)
naloxone (drug therapy)
penicillin G potassium (drug administration)
EMTREE DRUG INDEX TERMS
benzathine penicillin
benzodiazepine derivative (drug therapy)
midazolam
pethidine
procaine penicillin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
respiration depression (drug therapy)
seizure (drug therapy)
EMTREE MEDICAL INDEX TERMS
drug labeling
drug use
emergency treatment
hospital pharmacy
human
pharmacist
practice guideline
professional practice
review
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
benzathine penicillin (1538-09-6)
flumazenil (78755-81-4)
lorazepam (846-49-1)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
penicillin G potassium (113-98-4, 1406-08-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
procaine penicillin (54-35-3, 6130-64-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1997375915
PUI
L27517687
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1321
TITLE
Cardio-pulmonar reanimation in paediatrics patients
ORIGINAL (NON-ENGLISH) TITLE
Reanimacion cardiopulmonar basica y avanzada en el paciente pediatrico
AUTHOR NAMES
Romero C.
Clerire N.
Bueno M.
Duran G.
Carrascosa S.
AUTHOR ADDRESSES
(Romero C.; Clerire N.; Bueno M.; Duran G.; Carrascosa S.) Servicio de
Pediatria, Hospital Virgen del Camino, Pamplona, Spain.
CORRESPONDENCE ADDRESS
C. Romero, Servicio de Pediatria, Hospital Virgen del Camino, Pamplona,
Spain.
SOURCE
Pediatria Integral (1997) 3:2 (218-230). Date of Publication: 1997
ISSN
1135-4542
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug therapy)
bicarbonate (drug therapy)
calcium chloride (drug therapy)
epinephrine (drug therapy)
glucose (drug therapy)
lidocaine (drug therapy)
EMTREE DRUG INDEX TERMS
amiodarone (drug therapy)
digoxin (drug therapy)
isoprenaline (drug therapy)
naloxone (drug therapy)
propranolol (drug therapy)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
resuscitation
EMTREE MEDICAL INDEX TERMS
airway
airway obstruction (therapy)
assisted ventilation
cardiopulmonary arrest (drug therapy)
child care
defibrillation
emergency treatment
endotracheal intubation
fluid therapy
heart massage
human
intravenous drug administration
review
sinus bradycardia (drug therapy)
sinus tachycardia (drug therapy)
supraventricular premature beat (drug therapy)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
digoxin (20830-75-5, 57285-89-9)
glucose (50-99-7, 84778-64-3)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Spanish
EMBASE ACCESSION NUMBER
1998197119
PUI
L28271988
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1322
TITLE
The use of analgesics in patients with acute abdominal pain
AUTHOR NAMES
LoVecchio F.
Oster N.
Sturmann K.
Nelson L.S.
Flashner S.
Finger R.
AUTHOR ADDRESSES
(LoVecchio F.) Good Samaritan Regional Medical Center, Department of Medical
Toxicology, Phoenix, AZ, United States.
(Oster N.; Flashner S.; Finger R.) Mount Sinai School of Medicine Integrated
Residency in Emergency Medicine, Beth Israel Medical Center, New York, NY,
United States.
(Oster N.; Flashner S.; Finger R.) Elmhurst Hospital, Elmhurst, NY, United
States.
(Sturmann K.) Emergency Medicine Residency, Beth Israel Medical Center, New
York, NY, United States.
(Nelson L.S.) New York City Poison Control Center, Bellevue Hospital, New
York, NY, United States.
(LoVecchio F.) Good Samaritan Regional Medical Center, Department of Medical
Toxicology, 625 E. McDowell Road Suite, Phoenix, AZ 85006, United States.
CORRESPONDENCE ADDRESS
F. LoVecchio, Good Samaritan Reg. Medical Center, Department of Medical
Toxicology, 625 E. McDowell Road Suite, Phoenix, AZ 85006, United States.
SOURCE
Journal of Emergency Medicine (1997) 15:6 (775-779). Date of Publication:
November/December 1997
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Analgesics in patients with acute abdominal pain are often withheld for fear
that they may change physical examination findings and thus may be unsafe.
We conducted a randomized, prospective, placebo-controlled trial to
investigate changes in physical examination following the administration of
placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal
pain. One patient was withdrawn secondary to inadequate documentation. Of
the 48 patients who completed the trial, a statistically significant change
in physical examination was noted in both groups receiving analgesics, but
not in the placebo group. No adverse events or delays in diagnosis were
attributed to the administration of analgesics. We conclude that physical
examination does change after the administration of analgesics in patients
with acute abdominal pain and that a larger study is needed to evaluate
analgesic safety in this subpopulation of emergency department patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine derivative (clinical trial, drug administration, drug dose, drug
therapy)
EMTREE DRUG INDEX TERMS
buprenorphine (drug therapy)
naloxone
opiate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute abdomen (diagnosis, drug therapy)
analgesia
EMTREE MEDICAL INDEX TERMS
abdominal pain (diagnosis, drug therapy)
article
clinical article
clinical observation
clinical protocol
clinical trial
controlled clinical trial
controlled study
differential diagnosis
dose response
drug efficacy
emergency treatment
female
human
intravenous drug administration
male
pain assessment
physical examination
priority journal
randomized controlled trial
risk assessment
scoring system
treatment outcome
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Surgery (9)
Drug Literature Index (37)
Gastroenterology (48)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997381337
MEDLINE PMID
9404792 (http://www.ncbi.nlm.nih.gov/pubmed/9404792)
PUI
L27524571
DOI
10.1016/S0736-4679(97)00183-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0736-4679(97)00183-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1323
TITLE
Evaluation of fast track admission policy for children with sickle cell
crises: Questionnaire survey of parents' preferences
AUTHOR NAMES
Fertleman C.R.
Gallagher A.
Rossiter M.A.
AUTHOR ADDRESSES
(Fertleman C.R., c.fertleman@ucl.ac.uk; Gallagher A.; Rossiter M.A.) North
Middlesex Hospital, London N18 1QX.
(Fertleman C.R., c.fertleman@ucl.ac.uk) Department of Paediatrics, Medical
School, University College London, London WC1N 6JJ.
CORRESPONDENCE ADDRESS
C.R. Fertleman, Department of Paediatrics, Univ. College London Medical
School, Rayne Institute, London WC1N 6JJ, United Kingdom. Email:
c.fertleman@ucl.ac.uk
SOURCE
British Medical Journal (1997) 315:7109 (650). Date of Publication: 1997
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
In Britain most people with painful sickle cell crises are admitted to
hospital through an accident and emergency department. Interviews with
patients have shown that this is unsatisfactory because the staff are often
inexperienced in dealing with pain from sickle cell crises. Patients want
immediate and effective pain relief and not to be asked irrelevant
questions. An audit in our department in early 1994 showed that children
with painful sickle cell crises waited over an hour to receive analgesia. In
October 1994 we therefore set up a fast track system whereby children with
severe pain from sickle cell crises are admitted directly to the ward after
a telephone call from a parent. All 112 children with sickle cell disease
have preprescribed doses of pethidine and naloxone written on a prescription
chart that is kept on the children's ward. A nurse assesses the child
immediately on arrival and gives intramuscular pethidine if appropriate. A
doctor is then able to assess and admit a calmer child.
EMTREE DRUG INDEX TERMS
naloxone (drug combination, drug therapy)
pethidine (drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital admission
sickle cell crisis (disease management, drug therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
analgesia
article
child
clinical article
clinical audit
emergency ward
female
health care policy
human
infant
intramuscular drug administration
male
pain (complication, drug therapy)
parent
prescription
priority journal
questionnaire
satisfaction
time
United Kingdom
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Hematology (25)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997278535
MEDLINE PMID
9310567 (http://www.ncbi.nlm.nih.gov/pubmed/9310567)
PUI
L27387176
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1324
TITLE
Insufficient stocking of poisoning antidotes
AUTHOR NAMES
Davis N.M.
AUTHOR ADDRESSES
(Davis N.M.)
SOURCE
Hospital Pharmacy (1997) 32:8 (1078-1103). Date of Publication: 1997
ISSN
0018-5787
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
toxin
EMTREE DRUG INDEX TERMS
acetylcysteine
alcohol
cardiac glycoside
cyanide
deferoxamine
digoxin antibody F(ab) fragment
ethylene glycol
flumazenil
iron
isoniazid
methanol
naloxone
opiate
organophosphate insecticide
pralidoxime
pyridoxine
venom antiserum
viper venom
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital pharmacy
EMTREE MEDICAL INDEX TERMS
drug cost
drug storage
editorial
emergency ward
health care availability
inventory control
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
alcohol (64-17-5)
cyanide (57-12-5)
deferoxamine (70-51-9)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
iron (14093-02-8, 53858-86-9, 7439-89-6)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pralidoxime (6735-59-7)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pharmacy (39)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1997252060
PUI
L27349628
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1325
TITLE
Cocaine balloon aspiration: Successful removal with bronchoscopy
AUTHOR NAMES
Cobaugh D.J.
Schneider S.M.
Benitez J.G.
Donahoe M.P.
AUTHOR ADDRESSES
(Cobaugh D.J.) Finger Lakes Regional Poison Center, Univ. of Rochester
Medical Center, Rochester, NY, United States.
(Schneider S.M.) Department of Emergency Medicine, Univ. of Rochester
Medical Center, Rochester, NY, United States.
(Benitez J.G.) Toxicology Treatment Program, Department of Emergency
Medicine, Univ. of Pittsburgh Medical Center, Pittsburgh, PA, United States.
(Donahoe M.P.) Div. Pulmon., Allerg. Critical C., Univ. of Pittsburgh
Medical Center, Pittsburgh, PA, United States.
(Cobaugh D.J.) Finger Lakes Regional Poison Center, Univ. of Rochester
Medical Center, Box 321, 601 Elmwood Avenue, Rochester, NY 14642, United
States.
CORRESPONDENCE ADDRESS
D.J. Cobaugh, Finger Lakes Regional Poison Center, Univ. of Rochester
Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States.
SOURCE
American Journal of Emergency Medicine (1997) 15:5 (544-546). Date of
Publication: 1997
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Ingestion of balloons containing illicit substances along with the potential
toxic sequelae associated with these ingestions have been described in the
literature. This report describes the successful bronchoscopic retrieval of
a cocaine balloon after aspiration. A 39-year-old man was witnessed
swallowing several balloons that were thought to contain heroin. Shortly
after ingestion, the patient became unconscious and required nasotracheal
intubation. Before intubation, several balloons were removed from the
oropharynx. Naloxone 4 mg was administered en route to the emergency
department (ED). Following naloxone, the patient awoke and became agitated
and combative. On arrival in the ED, midazolam, succinylcholine, and
vecuronium were required to manage his combativeness. Vital signs were:
heart rate, 130 beats/min; blood pressure, 128/86 mm Hg; respirations, 12
breaths/min; temperature, 96.5°F. A balloon and balloon tip were removed
during lavage. Whole bowel irrigation with a polyethylene glycol electrolyte
solution was initiated. A right upper lobe infiltrate was identified on
chest X-ray and aspiration of a balloon was suspected. At bronchoscopy, a
small yellow, intact balloon visualized in the basilar segment of the right
lower lobe was removed. Toxicologic analysis of the balloon contents found
cocaine. The rest of the patient's hospital course was unremarkable and he
was discharged 5 days after admission. This case brings to light the
potential concerns, such as respiratory compromise, associated with
aspiration of small balloons in the body stuffer. Additionally, the
potential for the development of toxicity if the balloon ruptures and toxin
absorption occurs through the lungs should be considered. Emergency
physicians and toxicologists should be aware of this significant
complication of packet ingestion in the body packer or stuffer and be
prepared to intervene early during the course of the patient's treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
EMTREE DRUG INDEX TERMS
macrogol
midazolam
naloxonazine
suxamethonium
vecuronium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
foreign body aspiration (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
balloon
bronchoscopy
case report
human
intestine lavage
intravenous drug administration
male
nasotracheal intubation
priority journal
unconsciousness
violence
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
macrogol (25322-68-3)
midazolam (59467-70-8)
naloxonazine (82824-01-9)
suxamethonium (306-40-1, 71-27-2)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997252165
MEDLINE PMID
9270402 (http://www.ncbi.nlm.nih.gov/pubmed/9270402)
PUI
L27349733
DOI
10.1016/S0735-6757(97)90207-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(97)90207-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1326
TITLE
Poisoning and overdose
AUTHOR NAMES
Giorgi D.F.
Jagoda A.
AUTHOR ADDRESSES
(Giorgi D.F.; Jagoda A.) Department of Emergency Medicine, Mount Sinai
School of Medicine, New York, NY, United States.
(Jagoda A.) FACEP, Department of Emergency Medicine, .
(Giorgi D.F.) Department of Emergency Medicine, Box 1149, Mount Sinai School
of Medicine, New York, NY 10029, United States.
CORRESPONDENCE ADDRESS
D.F. Giorgi, Department of Emergency Medicine, Box 1149, Mount Sinai School
of Medicine, New York, NY 10029, United States.
SOURCE
Mount Sinai Journal of Medicine (1997) 64:4-5 (283-291). Date of
Publication: September/October 1997
ISSN
0027-2507
BOOK PUBLISHER
John Wiley and Sons Inc., 111 River Street, Hoboken, United States.
ABSTRACT
The differential diagnosis of all patients with altered mental status must
include drug toxicity. In particular, intentional or unintentional
overdosing and/or poisoning are common emergency department presenting
complaints. A comprehensive approach to managing these patients must
incorporate aggressive information gathering, a careful physical examination
looking for toxic syndromes, and diagnostic testing. Proper decontamination
is the key to effective management, as is the use of specific antidotes when
indicated.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug administration, drug dose, drug therapy,
pharmacology)
antidote (drug therapy)
flumazenil (drug administration, drug dose, drug therapy, pharmacology)
nalmefene (drug administration, drug dose, drug therapy, pharmacokinetics)
naloxone (drug administration, drug dose, drug therapy, pharmacokinetics)
EMTREE DRUG INDEX TERMS
anticonvulsive agent (drug therapy)
benzodiazepine (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
calcium channel blocking agent (drug toxicity)
carbon monoxide (drug toxicity)
cardiovascular agent (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
cyanide (drug toxicity)
deferoxamine (drug dose, drug therapy)
digitalis glycoside (drug toxicity)
diphenhydramine (drug dose, drug therapy)
heparin (drug toxicity)
iron (drug toxicity)
isoniazid (drug toxicity)
lead (drug toxicity)
mercury (drug toxicity)
opiate agonist (drug toxicity)
organophosphate pesticide (drug toxicity)
paracetamol (drug toxicity)
phenobarbital (drug therapy)
phenothiazine (drug toxicity)
protamine sulfate (drug dose, drug therapy)
pyridoxine (drug administration, drug dose, drug therapy)
tricyclic antidepressant agent (drug toxicity)
unindexed drug
warfarin (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy, etiology, therapy)
intoxication (diagnosis, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
consciousness disorder (complication)
dialysis
emergency treatment
hemoperfusion
human
immunotherapy
intravenous drug administration
review
seizure (complication, drug therapy)
stomach lavage
syndrome delineation
DRUG TRADE NAMES
narcan
revex
romazicon
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
benzodiazepine (12794-10-4)
carbon monoxide (630-08-0)
cyanide (57-12-5)
deferoxamine (70-51-9)
diphenhydramine (147-24-0, 58-73-1)
flumazenil (78755-81-4)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
iron (14093-02-8, 53858-86-9, 7439-89-6)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
lead (7439-92-1)
mercury (14302-87-5, 7439-97-6)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenothiazine (92-84-2)
protamine sulfate (9009-65-8)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997268586
MEDLINE PMID
9293729 (http://www.ncbi.nlm.nih.gov/pubmed/9293729)
PUI
L27374126
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1327
TITLE
Sedation of children for emergency imaging
AUTHOR NAMES
Frush D.P.
Bisset III G.S.
AUTHOR ADDRESSES
(Frush D.P.; Bisset III G.S.) Department of Radiology, Pedriatic Radiology
Section, Duke University Medical Center, PO Box 3808, Durham, NC 27710,
United States.
CORRESPONDENCE ADDRESS
D.P. Frush, Department of Radiology, Pedriatic Radiology Section, Duke
University Medical Center, PO Box 3808, Durham, NC 27710, United States.
SOURCE
Radiologic Clinics of North America (1997) 35:4 (789-797). Date of
Publication: 1997
ISSN
0033-8389
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Successful and safe sedation is an important technical aspect of pediatric
imaging for the radiologist. Sedation of children requiring acute diagnostic
evaluation presents additional challenges including uncertain past medical
history and nothing-by-mouth status, unknown allergies, and unstable
clinical status. This article focuses on the techniques and problems of
sedating children in an acute setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
chloral hydrate (adverse drug reaction, pharmacology)
diazepam (adverse drug reaction, pharmacology)
fentanyl citrate (adverse drug reaction, pharmacology)
methohexital (adverse drug reaction, pharmacology)
midazolam (adverse drug reaction, pharmacology)
pentobarbital (adverse drug reaction, pharmacology)
EMTREE DRUG INDEX TERMS
chlorpromazine (adverse drug reaction, drug interaction, pharmacology)
flumazenil (adverse drug reaction, pharmacology)
morphine (adverse drug reaction, pharmacology)
naloxone (adverse drug reaction, pharmacology)
pethidine (adverse drug reaction, drug interaction, pharmacology)
promethazine (adverse drug reaction, drug interaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diagnostic imaging
sedation
EMTREE MEDICAL INDEX TERMS
bronchospasm (side effect)
clinical protocol
dose calculation
drug choice
drug safety
gastrointestinal toxicity (side effect)
human
priority journal
respiration depression (side effect)
review
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
fentanyl citrate (990-73-8)
flumazenil (78755-81-4)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Radiology (14)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997243809
MEDLINE PMID
9216624 (http://www.ncbi.nlm.nih.gov/pubmed/9216624)
PUI
L27339536
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1328
TITLE
Emergency medicine in general practice: Coma and state of confusion
ORIGINAL (NON-ENGLISH) TITLE
Medecine d'urgence du praticien: Coma et etat confusionnel
AUTHOR NAMES
Briefer J.-P.
Unger P.-F.
AUTHOR ADDRESSES
(Briefer J.-P.; Unger P.-F.) 29, Av. Eugene-Lance, 1212 Grand-Lancy,
Switzerland.
CORRESPONDENCE ADDRESS
J.-P. Briefer, 29, Av. Eugene-Lance, 1212 Grand-Lancy, Switzerland.
SOURCE
Revue Medicale de la Suisse Romande (1997) 117:4 (285-286). Date of
Publication: 1997
ISSN
0035-3655
BOOK PUBLISHER
Societe Medicale de la Suisse Romande, 2 rue Bellefontaine, P.O. Box 3093,
Lausanne, Switzerland.
EMTREE DRUG INDEX TERMS
clonazepam
diazepam
flumazenil
flunitrazepam
glucose
naloxone
promazine
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
confusion
EMTREE MEDICAL INDEX TERMS
adult
aged
case report
emergency medicine
general practice
human
intravenous drug administration
male
short survey
DRUG TRADE NAMES
anexate
benerva
narcan
prazine
rivotril
rohypnol
valium
CAS REGISTRY NUMBERS
clonazepam (1622-61-3)
diazepam (439-14-5)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
promazine (53-60-1, 58-40-2)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1997162525
MEDLINE PMID
9281021 (http://www.ncbi.nlm.nih.gov/pubmed/9281021)
PUI
L27228926
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1329
TITLE
Emergency medicine in general practice: Emergencies for alcoholic and drug
dependent patients
ORIGINAL (NON-ENGLISH) TITLE
Medecine d'urgence du praticien: Urgences chez le patient alcoolique et chez
le toxicomane
AUTHOR NAMES
Perrin J.
Yersin B.
AUTHOR ADDRESSES
(Perrin J.; Yersin B.) Dpt. de Medecine, CHUV, 1011 Lausanne, Switzerland.
CORRESPONDENCE ADDRESS
B. Yersin, Dpt. de Medecine, CHUV, 1011 Lausanne, Switzerland.
SOURCE
Revue Medicale de la Suisse Romande (1997) 117:4 (305-307). Date of
Publication: 1997
ISSN
0035-3655
BOOK PUBLISHER
Societe Medicale de la Suisse Romande, 2 rue Bellefontaine, P.O. Box 3093,
Lausanne, Switzerland.
EMTREE DRUG INDEX TERMS
chlorprothixene
clonazepam
clonidine
diazepam
flumazenil
flunitrazepam
glucose
mianserin
naloxone
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism
drug dependence
EMTREE MEDICAL INDEX TERMS
adult
case report
emergency medicine
general practice
human
intravenous drug administration
male
short survey
DRUG TRADE NAMES
anexate
benerva
catapresan
narcan
rivotril
rohypnol
tolvon
truxal
valium
CAS REGISTRY NUMBERS
chlorprothixene (113-59-7, 6469-93-8)
clonazepam (1622-61-3)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
diazepam (439-14-5)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
glucose (50-99-7, 84778-64-3)
mianserin (21535-47-7, 24219-97-4)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1997162527
MEDLINE PMID
9281027 (http://www.ncbi.nlm.nih.gov/pubmed/9281027)
PUI
L27228928
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1330
TITLE
Reversal of opioid intoxication. Therapeutic guidelines
AUTHOR NAMES
Hung O.L.
Hoffman R.S.
AUTHOR ADDRESSES
(Hung O.L.) New York City Poison Control Center, New York, NY, United
States.
(Hoffman R.S.) Department of Emergency Medicine, Bellevue Hospital Center,
New York University Medical Center, New York, NY, United States.
(Hung O.L.) New York City Poison Control Center, 455 First Avenue, New York,
NY 10016, United States.
CORRESPONDENCE ADDRESS
O.L. Hung, New York City Poison Control Center, 455 First Avenue, New York,
NY 10016, United States.
SOURCE
CNS Drugs (1997) 7:3 (176-186). Date of Publication: 1997
ISSN
1172-7047
ABSTRACT
Opioid intoxication is one of the most common causes of drug-related
emergency department visits in the developed world. Successful treatment
requires the timely recognition of intoxication, early airway intervention
and the judicious use of an antidote (usually naloxone), when appropriate.
During the last decade, naloxone treatment strategies have undergone
substantial evolution. This has resulted largely from the recognition that
the treatment of the opioid intoxicated patient must differ from that of the
patient recovering from physician-controlled anaesthesia in the operating
room or procedure suite. The use of standard administration of naloxone by
paramedics in the field or physicians in the emergency department is often
either ineffective or produces unwanted opioid withdrawal in opioid-tolerant
patients. Also, in the setting of polysubstance overdose or trauma, the use
of naloxone may have deleterious effects. Current management strategies
emphasise the need for individualised therapy for opioid-intoxicated
patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (drug therapy)
naloxone (drug therapy)
naltrexone (drug therapy)
opiate (drug toxicity)
opiate antagonist (drug therapy)
EMTREE DRUG INDEX TERMS
codeine (drug toxicity)
diamorphine (drug toxicity)
fentanyl (drug toxicity)
methadone (drug toxicity)
oxycodone (drug toxicity)
oxymorphone (drug toxicity)
paregoric (drug toxicity)
pentazocine (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
emergency treatment
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
human
priority journal
review
CAS REGISTRY NUMBERS
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
oxymorphone (357-07-3, 76-41-5)
paregoric (8029-99-0)
pentazocine (359-83-1, 64024-15-3)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997113361
PUI
L27162923
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1331
TITLE
Drug poisoning: Which treatment?
ORIGINAL (NON-ENGLISH) TITLE
Intoxications medicamenteuses: Quel traitement?
AUTHOR NAMES
Chalier M.
AUTHOR ADDRESSES
(Chalier M.) Clinique de Médecine II, Dept. de Médecine, Hôpital Cantonal
Universitaire, 1211 Genève 14, Switzerland.
CORRESPONDENCE ADDRESS
M. Chalier, Clinique de Medecine II, Departement de Medecine, Hopital
Cantonal Universitaire, 1211 Geneve 14, Switzerland.
SOURCE
Medecine et Hygiene (1997) 55:2163 (1001-1002). Date of Publication: 14 May
1997
ISSN
0025-6749
ABSTRACT
Drug poisoning always is worrisome and is a frequent problem of Public
health service. Its incidence rate is about 1,5% to 3% of the admissions to
the Emergency Room of a University Hospital, but is certainly
underestimated. The aim of this article is to transmit some important
messages: 1) protocoled management of this problem should decrease mortality
(which should never exceed 1%) and morbidity at a minimum rate; 2) every
patient should benefit from evaluation by a psychiatrist; 3) 'primum non
nocere', that is, avoid 'mixtures' (antidotes); 4) activated charcoal is the
treatment of choice for gastro-intestinal decontamination; 5) national
poisoning registration centers should be called promptly by the
practitioners to help in the management of this difficult problem.
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
antidote (drug therapy)
glucose (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
hospitalization
human
mortality
oxygen therapy
short survey
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1997187032
PUI
L27262779
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1332
TITLE
Clonidine poisoning in Jefferson County, Alabama
AUTHOR NAMES
Nichols M.H.
King W.D.
James L.P.
AUTHOR ADDRESSES
(Nichols M.H.; King W.D.; James L.P.) Pediatric Emergency Medicine,
Children's Hospital of Alabama, 1600 Seventh Avenue South, Birmingham, AL
35233, United States.
CORRESPONDENCE ADDRESS
M.H. Nichols, Pediatric Emergency Medicine, Children's Hospital of Alabama,
1600 Seventh Avenue South, Birmingham, AL 35233, United States.
SOURCE
Annals of Emergency Medicine (1997) 29:4 (511-517). Date of Publication:
1997
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To describe the epidemiology of clonidine-related
hospitalization in children, to evaluate the efficacy of naloxone, and to
review the clinical effects of clonidine toxicity. Methods: This was a
retrospective analysis in an urban teaching pediatric emergency department
with an annual census of 55,000 involving 80 children younger than 6 years
who were admitted for clonidine ingestion during a 6-year period. Results:
Clonidine commonly belonged to the patient's grandmother (54%). Black
children were twice as likely to be hospitalized for clonidine ingestion
than white children compared with children hospitalized for any injury.
Average time to onset of symptoms was 35 minutes. Decreased level of
consciousness was the most common presenting symptom (96%). Mean ED vital
signs were systolic blood pressure, 102 mm Hg; pulse, 98; respirations, 25
(six patients intubated); and temperature, 36.6°C, Naloxone was administered
to 49% of patients, 84% of whom demonstrated no response. Conclusion:
Clonidine ingestion is endemic in our area. Serious clinical effects mandate
that all children with clonidine ingestion be triaged to a health care
facility. Naloxone as an antidote for clonidine remains controversial.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
clonidine (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (diagnosis, drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
article
breathing rate
drug response
female
hospitalization
human
infant
major clinical study
male
preschool child
priority journal
pulse rate
symptomatology
systolic blood pressure
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997104683
MEDLINE PMID
9095013 (http://www.ncbi.nlm.nih.gov/pubmed/9095013)
PUI
L27149204
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1333
TITLE
Tramadol overdose requiring prolonged opioid antagonism [9]
AUTHOR NAMES
Sachdeva D.K.
Jolly B.T.
AUTHOR ADDRESSES
(Sachdeva D.K.; Jolly B.T.) Department of Emergency Medicine, George
Washington Univ. Med. Center, Washington, DC, United States.
CORRESPONDENCE ADDRESS
D.K. Sachdeva, Department of Emergency Medicine, George Washington Univ.
Med. Center, Washington, DC, United States.
SOURCE
American Journal of Emergency Medicine (1997) 15:2 (217-218). Date of
Publication: 1997
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug dose, drug therapy)
tramadol (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
case report
clinical feature
depression
disease association
dose response
drowsiness
emergency treatment
human
Human immunodeficiency virus infection
intravenous drug administration
letter
male
priority journal
respiration depression
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1997102563
MEDLINE PMID
9115538 (http://www.ncbi.nlm.nih.gov/pubmed/9115538)
PUI
L27147053
DOI
10.1016/S0735-6757(97)90116-9
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(97)90116-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1334
TITLE
Pediatric emergencies for the generalist
AUTHOR NAMES
Kuraishi A.
AUTHOR ADDRESSES
(Kuraishi A.) San Bernardino County Hospital, San Bernardino, CA, United
States.
(Kuraishi A.) 33833 Liberty Road, Yucaipa, CA 92399, United States.
CORRESPONDENCE ADDRESS
A. Kuraishi, 33833 Liberty Road, Yucaipa, CA 92399, United States.
SOURCE
Comprehensive Therapy (1997) 23:2 (130-134). Date of Publication: 1997
ISSN
0098-8243
BOOK PUBLISHER
Humana Press Inc., 999 Riverview Drive, Suite 208, Totowa, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug dose, drug therapy)
bicarbonate (drug dose, drug therapy)
epinephrine (drug dose, drug therapy)
lorazepam (drug dose, drug therapy)
methylprednisolone (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
activated carbon (drug dose, drug therapy)
ampicillin (drug dose, drug therapy)
ceftriaxone (drug dose, drug therapy)
dexamethasone (drug dose, drug therapy)
diazepam (drug dose, drug therapy)
diphenhydramine (drug dose, drug therapy)
furosemide (drug dose, drug therapy)
gentamicin (drug dose, drug therapy)
glucagon (drug dose, drug therapy)
insulin (drug dose, drug therapy)
lidocaine (drug dose, drug therapy)
paraldehyde (drug dose, drug therapy)
pethidine (drug dose, drug therapy)
phenobarbital (drug dose, drug therapy)
salbutamol (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
childhood disease (diagnosis, drug therapy, therapy)
childhood injury (diagnosis, therapy)
emergency medicine
EMTREE MEDICAL INDEX TERMS
child
child care
general practice
general practitioner
human
infant
review
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
ceftriaxone (73384-59-5, 74578-69-1)
dexamethasone (50-02-2)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
furosemide (54-31-9)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
insulin (9004-10-8)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
paraldehyde (123-63-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1997091416
MEDLINE PMID
9083724 (http://www.ncbi.nlm.nih.gov/pubmed/9083724)
PUI
L27131243
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1335
TITLE
Prehospital treatment of patients with i.v. heroin overdose: what are we
treating?
AUTHOR NAMES
Pedersen C.B.
Steentoft A.
Worm K.
Sprehn M.
Mogensen T.
Sørensen M.B.
AUTHOR ADDRESSES
(Pedersen C.B.; Steentoft A.; Worm K.; Sprehn M.; Mogensen T.; Sørensen
M.B.) Mobile Intensive Care Unit of Copenhagen, Denmark.
CORRESPONDENCE ADDRESS
C.B. Pedersen, Mobile Intensive Care Unit of Copenhagen, Denmark.
SOURCE
Prehospital and disaster medicine : the official journal of the National
Association of EMS Physicians and the World Association for Emergency and
Disaster Medicine in association with the Acute Care Foundation (1997) 12:2
(163-166). Date of Publication: 1997 Apr-Jun
ISSN
1049-023X
ABSTRACT
OBJECTIVE: To measure blood levels of morphine and additional drugs in
patients suspected of intravenous (i.v.) heroin abuse and to evaluate the
effects of antidote treatment. DESIGN: Prehospital blood sampling in 52
patients. RESULTS: Forty-five patients were blood-positive for heroin, eight
of whom were hospitalized. Forty-one patients also had abused additional
drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or
carbamazepine. Seven patients had taken either only methadone or
ketobemidione: one was admitted. Treatment with increasing doses of naloxone
indicated a necessity for hospitalization. Six of 14 patients treated with
naloxone (1.8 mg were hospitalized. Seven patients had an extremely high
blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in
moderate doses. CONCLUSION: This study indicates that under prehospital
conditions, it is difficult to identify a patient intoxicated only with
intravenous heroin. Nearly all patients treated were cases of multiple
drug/alcohol overdoses. Even the symptoms associated with extremely high
blood levels of morphine could be reversed with naloxone in moderate doses.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
narcotic agent (drug toxicity)
narcotic antagonist (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
intoxication (etiology, therapy)
substance abuse (complication)
EMTREE MEDICAL INDEX TERMS
adult
article
blood
clinical trial
Denmark
female
human
male
methodology
middle aged
treatment outcome
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
10187003 (http://www.ncbi.nlm.nih.gov/pubmed/10187003)
PUI
L128326716
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1336
TITLE
Titrated intravenous opioids from the same syringe: An infection risk?
AUTHOR NAMES
Taylor M.
Bourke J.
Anderson M.
Davey R.
Kelly A.-M.
Guthrie B.
AUTHOR ADDRESSES
(Taylor M.; Bourke J.; Anderson M.; Davey R.; Kelly A.-M.; Guthrie B.)
Emergency Department, Western Hospital Footscray, Private Bag, Footscray
3011, Australia.
CORRESPONDENCE ADDRESS
A.-M. Kelly, Emergency Department, Western Hospital Footscray, Private Bag,
Footscray 3011, Australia.
SOURCE
Journal of Accident and Emergency Medicine (1997) 14:1 (33-35). Date of
Publication: 1997
ISSN
1351-0622
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Objective - (1) To compare the rate of contamination of syringes prepared
under laminar flow conditions in pharmacy with those prepared by nurses in
the emergency department; (2) to determine whether the time elapsed since
preparation or number of doses given affected the contamination rate; (3) to
determine whether any adverse effects resulted from bacterially contaminated
drugs. Methods - Prospective, blinded trial exploring the effect of method
of preparation, time since preparation, and number of doses given on
contamination rates and infective adverse events associated with bacterially
contaminated specimens. Results - The rate of bacterial contamination was
12% (95% confidence interval 6% to 18%). There was no difference in
contamination rate in respect of method of preparation, number of doses
given, or time since preparation. No infective complications were
identified. Conclusions - Abandonment of titrated intravenous opioids is not
justified by the results. However, there is concern about the use of this
technique of pain control for immunocompromised patients and those with
prosthetic heart valves.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterium contamination
clinical practice
emergency ward
infection complication (complication, prevention)
syringe
EMTREE MEDICAL INDEX TERMS
article
human
intermethod comparison
intravenous drug administration
laminar flow
nurse
pain (drug therapy)
pharmacy
time
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1997047475
MEDLINE PMID
9023621 (http://www.ncbi.nlm.nih.gov/pubmed/9023621)
PUI
L27067832
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1337
TITLE
Potential danger of nalmefene use in the emergency department [5]
AUTHOR NAMES
Gaeta T.J.
Capodano R.J.
Spevack T.A.
AUTHOR ADDRESSES
(Gaeta T.J.; Capodano R.J.; Spevack T.A.) Department of Emergency Medicine,
St Barnabas Hospital, Bronx, NY, United States.
CORRESPONDENCE ADDRESS
T.J. Gaeta, Department of Emergency Medicine, St Barnabas Hospital, Bronx,
NY, United States.
SOURCE
Annals of Emergency Medicine (1997) 29:1 (193-194). Date of Publication:
1997
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (drug administration, drug comparison, drug dose, drug therapy,
pharmacology)
narcotic antagonist (drug administration, drug comparison, drug dose, drug
therapy, pharmacology)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative
diamorphine (drug toxicity)
naloxone (drug administration, drug comparison, drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
heroin dependence (drug therapy)
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
bradypnea
case report
clinical feature
dose response
drug half life
drug withdrawal
human
intravenous drug administration
letter
priority journal
respiration depression
DRUG MANUFACTURERS
Ohmeda
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1997021780
MEDLINE PMID
8998112 (http://www.ncbi.nlm.nih.gov/pubmed/8998112)
PUI
L27030046
DOI
10.1016/S0196-0644(97)70334-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(97)70334-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1338
TITLE
Drugs for the doctor's bag
AUTHOR NAMES
Murtagh J.
AUTHOR ADDRESSES
(Murtagh J.) Department of General Practice, Monash University, Melbourne.
CORRESPONDENCE ADDRESS
J. Murtagh, Department of General Practice, Monash University, Melbourne,
Vic., Australia.
SOURCE
Australian Prescriber (1996) 19:4 (89-92). Date of Publication: 1996
ISSN
0312-8008
ABSTRACT
The doctor's bag should contain drugs to treat life-threatening emergencies
and other serious medical conditions. Almost all of these emergency drugs
are administered parenterally, but it is helpful to carry oral and inhaler
preparations for certain conditions. Storage and safe-keeping should be
considered in selecting appropriate drugs. The emergency drugs provided by
the Pharmaceutical Benefits Scheme cover most situations.
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
atropine
benzatropine
chlorpromazine
diazepam
epinephrine
ergometrine
erythromycin
furosemide
glucose
glyceryl trinitrate
haloperidol
hydrocortisone sodium succinate
ipratropium bromide
lidocaine
metoclopramide
morphine (adverse drug reaction)
naloxone
penicillin G
pethidine (adverse drug reaction)
phenytoin
prochlorperazine
promethazine
salbutamol
sumatriptan
unindexed drug
verapamil (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
EMTREE MEDICAL INDEX TERMS
devices
drug choice
drug dependence (side effect)
drug indication
general practitioner
heart block (side effect)
human
inhalational drug administration
intramuscular drug administration
intravenous drug administration
oral drug administration
pharmaceutics
practice guideline
short survey
storage
vomiting (side effect)
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
benzatropine (86-13-5)
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
ergometrine (60-79-7)
erythromycin (114-07-8, 70536-18-4)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
ipratropium bromide (22254-24-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenytoin (57-41-0, 630-93-3)
prochlorperazine (58-38-8)
promethazine (58-33-3, 60-87-7)
salbutamol (18559-94-9)
sumatriptan (103628-46-2)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996356976
PUI
L26391789
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1339
TITLE
Medical and legal aspects of pre-hospital care for patients suffering from
narcotic overdose
ORIGINAL (NON-ENGLISH) TITLE
Aspetti clinici e medico-legali del soccorso extraospedaliero nell'overdose
da oppiacei
AUTHOR NAMES
Ori C.
Spagna A.
Salvaterra F.
Rago C.
Fabbris M.
Bettin C.
Zanette G.
AUTHOR ADDRESSES
(Ori C.; Spagna A.; Salvaterra F.; Rago C.; Fabbris M.; Bettin C.; Zanette
G.) Universita degli Studi di Padova, Istituto Anestesiologia Rianimazione,
Padova, Italy.
CORRESPONDENCE ADDRESS
C. Ori, Universita degli Studi di Padova, Istituto Anestesiologia
Rianimazione, Padova, Italy.
SOURCE
Acta Anaesthesiologica Italica (1996) 47:1 (71-79). Date of Publication:
1996
ISSN
0374-4965
ABSTRACT
In the period among August 1989 and December 1992 the Medical Emergency
Department (SUEM) of Padova recorded 811 out-of-hospital interventions to
assist 749 addicts suffering for narcotic overdose. Number of interventions
and number of patients don't coincide since often the same patient has been
assisted more times. The gathered data originate from the reporting of
interventions filled by the SUEM medical staff and they include: date, time
and place of the intervention, data of the patient, clinical conditions and
their evolution after treatment, applied therapeutic measures, final
destination of the patient, eventual refusal of the patient to the proposal
of admission to the hospital. The SUEM medical staff did not follow a fixed
protocol; however the treatments were substantially homogeneous and, in many
cases, probably decisive. The greatest uncertains in the medical staff of
SUEM, however, did not arise from medical problems: in fact, it emerges
clearly that, in more than 40% of the cases, patients refused the admission
to the hospital. The patients considered in this study are often able to
oppose just because of an injection of naloxone and, as the effect of the
antagonist subsides, might revert in the state of acute poisoning,
constituting a risk for themselves and for other people. The two possible
behaviours, that are to allow the patient to sign a form for the refusal of
the admission or, if physician recognizes the state of necessity, to force
the admission of the patient, are not exempt from possible legal
consequences and, unfortunately, neither the doctrine neither the
jurisprudence address this serious question.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (complication, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
article
drug dependence
emergency medicine
hospital admission
human
medicolegal aspect
patient compliance
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English, Italian
EMBASE ACCESSION NUMBER
1996355898
PUI
L26390664
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1340
TITLE
The use of nalbuphine in analgesia
ORIGINAL (NON-ENGLISH) TITLE
Place de la nalbuphine (Nubain®) dans l'arsenal analgesique moderne
AUTHOR NAMES
Senard M.
Tazarourte K.
Darmon P.L.
AUTHOR ADDRESSES
(Senard M.; Darmon P.L.) Serv. de Reanimation Chir. et T., Hôpital
Henri-Mondor, 51, av. du Mar.-de-Lattre-de-Tass., 94010 Créteil Cedex,
France.
(Tazarourte K.) Serv. d'Aide Medicale Urgente 94, Hôpital Henri-Mondor, 51,
av. du Mar.-de-Lattre-de-Tass., 94010 Créteil Cedex, France.
CORRESPONDENCE ADDRESS
M. Senard, Serv. de Reanimat. Chir./Traumatol., Hopital Henri-Mondor, 51,
Ave du Mal-de-Lattre-de-Tassigny, 94010 Creteil Cedex, France.
SOURCE
Urgences Medicales (1996) 15:4 (169-176). Date of Publication: 1996
ISSN
0923-2524
ABSTRACT
Following a short reminder on pain pathophysiology, pharmacological
properties of nalbuphine, an agonist-antagonist analgesic agent, are
presented. Based on published results, the use of nalbuphine in anesthesia,
analgesia, intensive care and emergency medicine is discussed: regarding
perioperative analgesia, nalbuphine could not be demonstrated to have
specific advantages compared to usual opioid agonists. However, it appears
that nalbuphine can be recommended as a first choice antalgic drug for
prehospital or intrahospital emergency units utilization because of limited
respiratory and cardiovascular side effects, easy stocking and a simple
administrative prescription procedure.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalbuphine (drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
buprenorphine
butorphanol
dezocine
fentanyl
morphine
nalorphine
naloxone
naltrexone
pentazocine
pethidine
piritramide
tilidine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency medicine
intensive care
pain (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
drug safety
drug use
human
pathophysiology
prescription
review
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
butorphanol (42408-82-2)
dezocine (53648-55-8)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
piritramide (302-41-0)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1996328647
PUI
L26359758
DOI
10.1016/0923-2524(96)82414-3
FULL TEXT LINK
http://dx.doi.org/10.1016/0923-2524(96)82414-3
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1341
TITLE
Information on opiate and cocaine consumption in the emergency room clinical
records: validity and reliability
ORIGINAL (NON-ENGLISH) TITLE
Información sobre el consumo de opioides y cocaína en la anamnesis de
urgencias: validez y fiabilidad.
AUTHOR NAMES
Pérez K.
Domingo-Salvany A.
Garcés J.M.
Hartnoll R.L.
AUTHOR ADDRESSES
(Pérez K.; Domingo-Salvany A.; Garcés J.M.; Hartnoll R.L.) Institut
Municipal d'Investigació, Mèdica, Barcelona.
CORRESPONDENCE ADDRESS
K. Pérez, Institut Municipal d'Investigació, Mèdica, Barcelona.
SOURCE
Medicina clínica (1996) 107:18 (702-705). Date of Publication: 23 Nov 1996
ISSN
0025-7753
ABSTRACT
BACKGROUND: Data on drug consumption obtained from emergency room clinical
records have been used for various epidemiological purposes. However the
validity and reliability of these data remain unknown. This paper assesses
the reliability and validity of an Emergency Room Toxicological Register
(HMR) which has collected information on drug misuse from emergency room
clinical records since 1979, and examines the implications for
epidemiological applications. SUBJECTS AND METHODS: An Emergency Room Survey
(ERS) was carried out in a Barcelona Hospital including opiate or cocaine
users identified by the physician and a systematic sample of other patients
age 15 to 49 years old. Data on clinical records of interviewed patients
were also reviewed. Episodes from identified drug users (686) and HMR (676)
for the same study period were linked and validity and reliability were
analyzed. RESULTS: Sensitivity ranged between 63 and 86%, and specificity
was 98%, Kappa index higher than 0.72 and intraclass correlation coefficient
was 0.99. CONCLUSIONS: Information about drug users included in emergency
room clinical records proved to be valid as an information system for drug
use surveillance. However data about patterns of less heavy users, as
cocaine use, are underreported.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
narcotic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
addiction (epidemiology)
emergency
health survey
EMTREE MEDICAL INDEX TERMS
adult
article
female
human
male
reproducibility
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
LANGUAGE OF ARTICLE
Spanish
MEDLINE PMID
9082080 (http://www.ncbi.nlm.nih.gov/pubmed/9082080)
PUI
L127208730
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1342
TITLE
Insufficient stocking of poisoning antidotes in hospital pharmacies
AUTHOR NAMES
Dart R.C.
Stark Y.
Fulton B.
Koziol-McLain J.
Lowenstein S.R.
AUTHOR ADDRESSES
(Dart R.C.; Stark Y.; Fulton B.) Rocky Mt. Poison and Drug Center, Denver
Dept. of Health and Hospitals, University Colorado Hlth. Sci. Ctr., Denver,
CO, United States.
(Koziol-McLain J.; Lowenstein S.R.) Colorado Emergency Med. Res. Center,
University Colorado Hlth. Sci. Ctr., Denver, CO, United States.
(Dart R.C.) Rocky Mt. Poison and Drug Center, 8802 E Ninth Ave, Denver, CO
80220, United States.
CORRESPONDENCE ADDRESS
R.C. Dart, Rocky Mountain Poison/Drug Ctr., 8802 F Ninth Ave., Denver, CO
80220, United States.
SOURCE
Journal of the American Medical Association (1996) 276:18 (1508-1510). Date
of Publication: 13 Nov 1996
ISSN
0098-7484
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Objective. - To determine whether antidotes for poisoning and overdose are
available in hospitals that provide emergency department care. Design. -
Written survey of hospital pharmacy directors, each of whom reported the
amount currently in stock of 8 different antidotes: antivenin (Crotalidae)
polyvalent, cyanide kit, deferoxamine mesylate, digoxin immune Fab, ethanol,
naloxone hydrochloride, pralidoxime chloride, and pyridoxine hydrochloride.
Participants. - Pharmacy directors of all hospitals with emergency
departments in Colorado, Montana, and Nevada. Main Outcome Measures. -
Proportions of hospitals with insufficient stocking of each antidote,
defined as complete lack of the antidote or an amount inadequate to initiate
treatment of 1 seriously poisoned 70-kg patient. Results. - Questionnaires
were mailed to 137 hospital pharmacy directors and 108 (79%) responded. Only
1 (0.9%) of the 108 hospitals stocked all 8 antidotes in adequate amounts.
The rate of insufficient stocking for individual antidotes ranged from 2%
(for naloxone) to 98% (for digoxin immune Fab). In a multiple regression
analysis, smaller hospital size and lack of a formal review of antidote
stocking were independent predictors of the number of antidotes stocked
insufficiently. Conclusions. - Insufficient stocking of antidotes is a
widespread problem in Colorado, Montana, and Nevada. Although these states
are served by a certified regional poison center, potentially lifesaving
antidotes are frequently not available when and where they might be needed
to treat a single poisoned patient.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
alcohol
deferoxamine mesylate
digoxin antibody
naloxone
pralidoxime chloride
pyridoxine
venom antiserum
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hospital pharmacy
intoxication
EMTREE MEDICAL INDEX TERMS
article
emergency treatment
health care availability
hospital management
priority journal
resource management
CAS REGISTRY NUMBERS
alcohol (64-17-5)
deferoxamine mesylate (138-14-7, 5115-09-3)
naloxone (357-08-4, 465-65-6)
pralidoxime chloride (51-15-0)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996363693
MEDLINE PMID
8903263 (http://www.ncbi.nlm.nih.gov/pubmed/8903263)
PUI
L26398760
DOI
10.1001/jama.276.18.1508
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.276.18.1508
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1343
TITLE
After antagonization of acute opiate overdose: A survey at hospitals in
Vienna
AUTHOR NAMES
Seidler D.
Stühlinger G.H.
Fischer G.
Woisetschlaeger C.
Berzlanovich A.
Schmid R.
Hirschl M.M.
Laggner A.N.
AUTHOR ADDRESSES
(Seidler D.; Stühlinger G.H.; Woisetschlaeger C.; Hirschl M.M.; Laggner
A.N.) Department of Emergency Medicine, University of Vienna, University
Clinics, Vienna, Austria.
(Fischer G.) Department of General Psychiatry, Outpatient Clinic of Drug
Addiction, University Clinics, Vienna, Austria.
(Berzlanovich A.) Forensic Institute, University of Vienna, University
Clinics, Vienna, Austria.
(Seidler D.) Department of Emergency Medicine, General Hospital, University
Clinics, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
(Schmid R.)
CORRESPONDENCE ADDRESS
D. Seidler, Department of Emergency Medicine, General Hospital, University
Clinics, Wahringer Gurtel 18-20, A-1090 Vienna, Austria.
SOURCE
Addiction (1996) 91:10 (1479-1487). Date of Publication: 1996
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
This study describes the clinical management and characteristics of people
who, following acute opioid overdose, are taken to hospital after efficient
antagonization by the pre-hospital emergency service. In addition, it
defines areas of interest for further research. Over a 4-month period
(September-December 1993) we collected data by a structured protocol sheet
on patients' characteristics, anamnestic data on abuse and emergencies,
clinical presentation, treatment by specific antidote and routine laboratory
investigations. Outcome was verified by retrospective review of prehospital
and forensic data. We studied 77 subjects, predominantly young males, who
were involved in 83 emergencies, mostly occurring at weekends. In more than
60% of cases a single administration of specific antidote sufficed to
stabilize the patients; 64% of patients left hospital against medical advice
after an average stay of less than 6 hours; 46% denied daily opioid abuse
and half the subjects, especially younger drug-users, seemed interested in
counselling. This hospital-based study did not provide reliable data on the
epidemiology of opioid overdose. Clinical management is determined by
experience, pragmatism and beliefs. Efforts towards secondary prevention of
drug problems at emergency departments might be warranted and further
research on pattern and management of opioid overdose is needed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
opiate antagonist (drug therapy)
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
diazepam (drug therapy)
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
anamnesis
article
Austria
clinical feature
clinical protocol
data analysis
drug abuse
emergency health service
female
forensic medicine
hospital
hospitalization
human
intravenous drug administration
laboratory test
major clinical study
male
medical research
oral drug administration
patient care
patient counseling
treatment outcome
CAS REGISTRY NUMBERS
diazepam (439-14-5)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996331477
MEDLINE PMID
8917916 (http://www.ncbi.nlm.nih.gov/pubmed/8917916)
PUI
L26362776
DOI
10.1111/j.1360-0443.1996.tb02252.x
FULL TEXT LINK
http://dx.doi.org/10.1111/j.1360-0443.1996.tb02252.x
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1344
TITLE
The complexities of managing severe burns with associated trauma
AUTHOR NAMES
Dougherty W.
Waxman K.
AUTHOR ADDRESSES
(Dougherty W.; Waxman K.) Department of Surgery, USC School of Medicine,
1450 San Pablo Street, Los Angeles, CA 90033, United States.
CORRESPONDENCE ADDRESS
W. Dougherty, Department of Surgery, USC School of Medicine, 1450 San Pablo
Street, Los Angeles, CA 90033, United States.
SOURCE
Surgical Clinics of North America (1996) 76:4 (923-958). Date of
Publication: 1996
ISSN
0039-6109
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
A high incidence of severe inhalation injuries can be expected in the
combined injury patient. The initial management remains attention to the
ATLS priorities of airway, breathing, and circulation, with prompt and safe
transfer to a regional center of excellence. The treatment of either the
burn or the associated injuries may be compromised by their combined
presence, and a team approach is essential to their optimal management.
Circulatory management goals based on oxygen consumption and delivery allow
greater understanding and control of the physiologic demands placed on the
patient by the disease process. The management of inhalation injury and ARDS
is at an exciting turning point in history, and we now have in hand and use
many techniques that allow salvage of these mortal conditions. Pain
management is essential to humane care and requires frequent assessment and
patient control to be effective. Rehabilitation of the burn and trauma
patient starts on the day of injury and requires team dedication to the
areas of greatest morbidity early in the planning of surgical priorities and
physical therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine sulfate (drug administration, drug comparison, drug dose, drug
therapy, pharmacokinetics)
nitric oxide (drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
amikacin (drug administration, drug therapy)
aminoglycoside antibiotic agent (drug combination, drug interaction)
amphotericin B (drug administration, drug therapy)
cefazolin (drug administration, drug therapy)
codeine (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
deferoxamine
diazepam (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
dimethyl sulfoxide
fentanyl (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
fluconazole (drug administration, drug therapy)
flumazenil (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
free radical
heparin (drug administration, drug dose, drug therapy)
hydromorphone (drug administration, drug comparison, drug dose, drug
therapy, pharmacokinetics)
hydroxyzine (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
ketamine (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
lorazepam (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
mafenide (drug administration, drug therapy)
midazolam (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
naloxone (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
neuromuscular blocking agent (drug combination, drug interaction)
nystatin (drug administration, drug therapy)
paracetamol (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
pethidine (drug administration, drug comparison, drug dose, drug therapy,
pharmacokinetics)
sulfadiazine silver (drug administration, drug therapy)
vancomycin (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal injury (complication, diagnosis, surgery)
burn (surgery)
lung burn (complication, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
adult
airway obstruction (complication, therapy)
antibiotic prophylaxis
child
clinical protocol
clinical trial
deep vein thrombosis (complication, drug therapy, prevention)
emergency treatment
fluid therapy
fracture treatment
human
hypovolemic shock (complication, therapy)
intensive care unit
intramuscular drug administration
intranasal drug administration
intravenous drug administration
major clinical study
oral drug administration
pain (complication, drug therapy, prevention)
priority journal
resuscitation
review
sepsis (complication, drug therapy, prevention)
thrombosis prevention
vascular access
DRUG TRADE NAMES
ativan
dilaudid
narcan
romazicon
sulfamylon
valium
versed
CAS REGISTRY NUMBERS
amikacin (37517-28-5, 39831-55-5)
amphotericin B (1397-89-3, 30652-87-0)
cefazolin (25953-19-9, 27164-46-1)
codeine (76-57-3)
deferoxamine (70-51-9)
diazepam (439-14-5)
dimethyl sulfoxide (67-68-5)
fentanyl (437-38-7)
fluconazole (86386-73-4)
flumazenil (78755-81-4)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydromorphone (466-99-9, 71-68-1)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lorazepam (846-49-1)
mafenide (138-37-4, 138-39-6)
midazolam (59467-70-8)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
nitric oxide (10102-43-9)
nystatin (1400-61-9, 34786-70-4, 62997-67-5)
paracetamol (103-90-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
sulfadiazine silver (22199-08-2)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Surgery (9)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996255260
MEDLINE PMID
8782481 (http://www.ncbi.nlm.nih.gov/pubmed/8782481)
PUI
L26276852
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1345
TITLE
Prehospital opiate emergencies in Vienna
AUTHOR NAMES
Seidler D.
Woisetschlaeger C.
Schmeiser-Rieder A.
Hirschl M.M.
Kaff A.
Laggner A.N.
AUTHOR ADDRESSES
(Seidler D.; Woisetschlaeger C.; Hirschl M.M.; Laggner A.N.) Department of
Emergency Medicine, AKH, General Hospital, Vienna, Austria.
(Schmeiser-Rieder A.) Institute of Social Medicine, University of Vienna,
Vienna, Austria.
(Kaff A.) Emergency Medical Service, Vienna, Austria.
(Seidler D.) Department of Emergency Medicine, AKH, General Hospital Vienna,
Waehringer Guertel 18-20, A-1090 Vienna, Austria.
CORRESPONDENCE ADDRESS
D. Seidler, Department of Emergency Medicine, AKH, General Hospital Vienna,
Waehringer Guertel 18-20, A-1090 Vienna, Austria.
SOURCE
American Journal of Emergency Medicine (1996) 14:4 (436-439). Date of
Publication: 1996
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
To establish baseline data on prehospital emergencies caused by opiates
during a 4-month period, a retrospective analysis of run records of the
Emergency Medical System in Vienna, the capital of Austria, was conducted.
During the study period, there were 308 opioid emergencies involving 240
persons, an average of 2.5 overdoses per day. Severely compromised patients
were treated in 67.8% of the 306 emergencies, and 79.3% of emergencies were
transported to hospital; 52.5% of the involved persons were younger than 22
years of age. Sex distribution and periodicity and frequency of emergencies
differed among age groups. A subgroup of individuals involved repeatedly in
emergencies was identified, partly showing temporal clustering of fatal and
nonfatal overdoses. Persons involved in opiate emergencies belong to
heterogenous subgroups. At a local level, research should be initiated to
clarify the pattern and impact of these emergencies on overall drug abuse
prevention.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
article
calculation
demography
disease control
periodicity
priority journal
sex difference
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996219033
MEDLINE PMID
8768175 (http://www.ncbi.nlm.nih.gov/pubmed/8768175)
PUI
L26240857
DOI
10.1016/S0735-6757(96)90069-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0735-6757(96)90069-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1346
TITLE
Diagnosis and management of opioid- and benzodiazepine-induced comatose
overdose in children
AUTHOR NAMES
Perry H.E.
Shannon M.W.
AUTHOR ADDRESSES
(Perry H.E.; Shannon M.W.) Division of Emergency Medicine, Children's
Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
CORRESPONDENCE ADDRESS
H.E. Perry, Division of Emergency Medicine, Children's Hospital, 300
Longwood Avenue, Boston, MA 02115, United States.
SOURCE
Current Opinion in Pediatrics (1996) 8:3 (243-247). Date of Publication:
1996
ISSN
1040-8703
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Opioids and benzodiazepines are two of the most common exposures that cause
depressed mental status in children. Establishing a diagnosis of these
intoxications may be difficult and is complicated by drugs from these two
classes that are not detectable by routine toxicologic screening techniques.
Naloxone and flumazenil can be used as diagnostic as well as therapeutic
medications in these ingestions. We present a brief review of the mechanism
of action, administration recommendations, and adverse effects of naloxone
and flumazenil. Although the empiric use of naloxone and flumazenil in the
comatose adult patient who presents to the emergency department is being
reexamined, many of the concerns do not apply to children. There is still an
important role for empiric administration of both naloxone and flumazenil.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine (drug toxicity)
flumazenil (adverse drug reaction, drug therapy, pharmacology)
naloxone (drug therapy, pharmacology)
opiate agonist (drug toxicity)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid receptor
chloride channel
opiate receptor
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (etiology)
drug overdose
EMTREE MEDICAL INDEX TERMS
drug abuse
electrocardiogram
heart arrhythmia (side effect)
human
intoxication (drug therapy)
priority journal
review
seizure (side effect)
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996220094
MEDLINE PMID
8814402 (http://www.ncbi.nlm.nih.gov/pubmed/8814402)
PUI
L26241938
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1347
TITLE
Cardiac arrest after Caesarean section under subarachnoid block
AUTHOR NAMES
Scull T.J.
Carli F.
AUTHOR ADDRESSES
(Scull T.J.; Carli F.) Department of Anaesthesia, McGill University, Royal
Victoria Hospital, 687 Pine Ave West, Montreal, Que. H3A 1A1, Canada.
(Scull T.J.) Nuffield Department of Anaesthesia, John Radcliffe Hospital,
Oxford, United Kingdom.
CORRESPONDENCE ADDRESS
F. Carli, Department of Anaesthesia, McGill University, Royal Victoria
Hospital, 687 Pine Ave West, Montreal, Que. H3A 1A1, Canada.
SOURCE
British Journal of Anaesthesia (1996) 77:2 (274-276). Date of Publication:
August 1996
ISSN
0007-0912
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
ABSTRACT
Cardiac arrest occurred on arrival in the recovery room after emergency
Caesarean section under subarachnoid block. The patient was resuscitated
successfully and recovered with no adverse effects. The current literature
is reviewed and the pathophysiological mechanisms involved in the aetiology
of cardiac arrest under subarachnoid block are discussed. Early use of
adrenaline to treat severe bradycardia or hypotension is recommended.
EMTREE DRUG INDEX TERMS
epinephrine (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cesarean section
heart arrest (complication, drug therapy, etiology, therapy)
spinal anesthesia
EMTREE MEDICAL INDEX TERMS
adult
article
bradycardia (complication, drug therapy, etiology)
case report
emergency surgery
female
human
hypotension (complication, drug therapy, etiology)
intravenous drug administration
pathophysiology
priority journal
recovery room
resuscitation
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Obstetrics and Gynecology (10)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996235312
MEDLINE PMID
8881641 (http://www.ncbi.nlm.nih.gov/pubmed/8881641)
PUI
L26254520
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1348
TITLE
Another piece of the puzzle.
AUTHOR NAMES
Meador S.A.
AUTHOR ADDRESSES
(Meador S.A.)
CORRESPONDENCE ADDRESS
S.A. Meador,
SOURCE
Academic emergency medicine : official journal of the Society for Academic
Emergency Medicine (1996) 3:7 (657). Date of Publication: Jul 1996
ISSN
1069-6563
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug therapy)
narcotic agent (drug toxicity)
narcotic antagonist (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS
emergency health service
human
intoxication (drug therapy)
note
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
8816179 (http://www.ncbi.nlm.nih.gov/pubmed/8816179)
PUI
L126285401
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1349
TITLE
Out-of-hospital treatment of opioid overdoses in an urban setting
AUTHOR NAMES
Sporer K.A.
Firestone J.
Isaacs S.M.
AUTHOR ADDRESSES
(Sporer K.A., karl_sporer@quickmail.ucsf.edu) University of California, San
Francisco, CA, United States.
(Sporer K.A., karl_sporer@quickmail.ucsf.edu) San Francisco General
Hospital, Base Hospital, Department of Emergency Services, San Francisco,
CA, United States.
(Firestone J.) Univ. of California, Los Angeles, School of Medicine, Los
Angeles, CA, United States.
(Isaacs S.M.) Department of Public Health, Paramedic Division, San
Francisco, CA, United States.
(Sporer K.A., karl_sporer@quickmail.ucsf.edu) Emergency Services, San
Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110,
United States.
CORRESPONDENCE ADDRESS
K.A. Sporer, Emergency Services, San Francisco General Hospital, 1001
Potrero Avenue, San Francisco, CA 94110, United States.
SOURCE
Academic Emergency Medicine (1996) 3:7 (660-667). Date of Publication: July
1996
ISSN
1069-6563
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Objectives: To investigate clinical outcomes in a cohort of opioid overdose
patients treated in an out-of-hospital urban setting noted for a high
prevalence of IV opioid use. Methods: A retrospective review was performed
of presumed opioid overdoses that were managed in 1993 by the emergency
medical services (EMS) system in a single-tiered, urban advanced life
support (ALS) EMS system. Specifically, all patients administered naloxone
by the county paramedics were reviewed. Those patients with at least 3 of 5
objective criteria of an opioid overdose [respiratory rate <6/min, pinpoint
pupils, evidence of IV drug use, Glasgow Coma Scale (GCS) score <12, or
cyanosis] were included. A response to naloxone was defined as improvement
to a GCS ≤14 and a respiratory rate ≤10/min within 5 minutes of naloxone
administration. ED dispositions of opioid-overdose patients brought to the
county hospital were reviewed. All medical examiner's cases deemed to be
opioid-overdose-related deaths by postmortem toxicologic levels also were
reviewed. Results: There were 726 patients identified with presumed opioid
overdoses. Most patients (609/726, 85.4%) had an initial pulse and blood
pressure (BP). Most (94%) of this group responded to naloxone and all were
transported. Of the remainder, 101 (14%) had obvious signs of death and 16
(2.2%) were in cardiopulmonary arrest without obvious signs of death. Of the
patients in full arrest, 2 had return of spontaneous circulation but neither
survived. Of the 609 patients who had initial BPs, 487 (80%) received
naloxone IM (plus bag-valve-mask ventilation) and 122 (20%) received the
drug IV. Responses to naloxone were similar; 94% IM vs 90% IV. Of 443
patients transported to the county hospital, 12 (2.7%) were admitted. The
admitted patients had noncardiogenic pulmonary edema (n = 4), pneumonia (n =
2), other infections (n = 2), persistent respiratory depression (n = 2), and
persistent alteration in mental status (n = 2). The patients with pulmonary
edema were clinically obvious upon ED arrival. Hypotension was never noted
and bradycardia was seen in only 2% of our presumed-opioid-overdose
population. Conclusions: The majority of the opioid-overdose patients who
had initial BPs responded readily to naloxone, with few patients requiring
admission. Noncardiogenic pulmonary edema was uncommon and when present,
hypoxia was evident upon arrival to the ED. Naloxone administered IM in
conjunction with bag-valve-mask ventilation was effective in this patient
population. The opioid-overdose patients in cardiopulmonary arrest did not
survive.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
diamorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
EMTREE MEDICAL INDEX TERMS
adult
article
cardiopulmonary arrest
drug abuse
emergency health service
female
hospitalization
human
hypoxia
intoxication
major clinical study
male
priority journal
treatment planning
urban area
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996212693
MEDLINE PMID
8816181 (http://www.ncbi.nlm.nih.gov/pubmed/8816181)
PUI
L26234517
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1350
TITLE
Mortality trends in a cohort of opiate addicts, Catalonia, Spain
AUTHOR NAMES
Ortí R.M.
Domingo-Salvany A.
Muñoz A.
Macfarlane D.
Suelves J.M.
Antó J.M.
AUTHOR ADDRESSES
(Ortí R.M.; Domingo-Salvany A.; Macfarlane D.; Antó J.M.) Dept. of
Epidemiol. and Pub. Health, Inst. Munic. d'Investigacio Medica, Univ.
Autònoma de Barcelona, Dr. Aiguader 80, E-08004, Barcelona, Spain.
(Ortí R.M.) Ctr. de Salut Pub. de l'Area 12, Conselleria de Sanitat i Salut,
Generalitat Valenciana, Dénia, Spain.
(Muñoz A.) Department of Epidemiology, Johns Hopkins Sch. of Public Health,
Baltimore, MD, United States.
(Suelves J.M.) Dept. de Sanitat i Seguretat Social, Generalitat de
Catalunya, Barcelona, Spain.
CORRESPONDENCE ADDRESS
A. Domingo-Salvany, Dept Epidemiology Public Health, Inst Municipal
d'Investigacio Medica, Universitat Autonoma de Barcelona, Dr Aiguader 80,
E-08004, Barcelona, Spain.
SOURCE
International Journal of Epidemiology (1996) 25:3 (545-553). Date of
Publication: June 1996
ISSN
0300-5771
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
ABSTRACT
Background. Opiate addiction affects young adults whose life expectancy is
reduced as a consequence of their habit. In the midst of the AIDS epidemic,
the present study objective was to analyse recent overall and cause-specific
mortality trends among opiate addicts in Catalonia (Spain). Method.
Mortality was assessed retrospectively in an opiate addict cohort assembled
from admissions to hospital emergency wards and drug treatment centres
during the period 1985-1991. The cohort included 15 711 opiate addicts (12
045 men and 3666 women) aged 15-44 years. Overall and cause-specific
mortality trends were analysed using age as the time scale and Cox
regression with staggered entry determined by the age at entry in the study.
Annual trends were adjusted by sex and source of entry, and were stratified
by length of opiate use. Results. Mortality rates increased throughout the
entire period from 13.8 to 34.8 deaths per 1000 person-years, with a
statistically significant increase in 1987-1988 and 1988-1989. In a model
including age, gender, source of entry and length of drug use, risk
increased significantly in men and for longer length of use, but not with
age and for source of entry into the study cohort. The causes of death
associated with high mortality rates were AIDS and the causes directly
related to addiction. Conclusions. A threefold increase in mortality rates
was observed during the period, mainly accounted for by AIDS and direct
addiction-related causes. Length of opiate use was an important determinant
of mortality.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
mortality
EMTREE MEDICAL INDEX TERMS
acquired immune deficiency syndrome
adolescent
adult
article
cohort analysis
emergency ward
female
human
life expectancy
major clinical study
male
model
opiate addiction
priority journal
regression analysis
risk
sex difference
Spain
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996207731
MEDLINE PMID
8671555 (http://www.ncbi.nlm.nih.gov/pubmed/8671555)
PUI
L26229555
DOI
10.1093/ije/25.3.545
FULL TEXT LINK
http://dx.doi.org/10.1093/ije/25.3.545
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1351
TITLE
Medical considerations in child and adolescent substance abuse: Medical
complications, pain management, and emergency treatment
AUTHOR NAMES
Dell M.L.
AUTHOR ADDRESSES
(Dell M.L.) Medical Psychiatric Unit, Egleston Children's Hospital, 1405
Clifton Road, NE, Atlanta, GA 30322, United States.
CORRESPONDENCE ADDRESS
M.L. Dell, Medical Psychiatric Unit, Egleston Children's Hospital, 1405
Clifton Road, NE, Atlanta, GA 30322, United States.
SOURCE
Child and Adolescent Psychiatric Clinics of North America (1996) 5:1
(123-147). Date of Publication: 1996
ISSN
1056-4993
ABSTRACT
This article addresses medical aspects of substance use, abuse, and
dependence, in three sections medical complications of abuse and dependence
in relatively healthy individuals, the use of abusable chemicals and
medications in medically ill children, and emergency room presentation and
assessment of the physical manifestations of substance abuse and dependence.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
benzodiazepine derivative (drug toxicity)
cannabis (drug toxicity)
hydrocarbon (drug toxicity)
nicotine (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
adrenergic receptor stimulating agent (drug toxicity)
amphetamine derivative (drug toxicity)
anabolic agent (drug toxicity)
barbituric acid derivative (drug toxicity)
benzodiazepine receptor blocking agent (drug therapy)
caffeine (drug toxicity)
clonidine (drug therapy)
cocaine (drug toxicity)
diazepam (drug therapy)
haloperidol (drug therapy)
ipecac (drug toxicity)
laxative (drug toxicity)
lorazepam (drug therapy)
lysergide (drug toxicity)
midazolam (drug therapy)
naloxone (drug therapy)
narcotic agent (drug therapy)
opiate agonist (drug toxicity)
phencyclidine (drug toxicity)
phenobarbital (drug therapy)
psychedelic agent (drug toxicity)
psychostimulant agent (drug toxicity)
toluene derivative (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
substance abuse
EMTREE MEDICAL INDEX TERMS
adolescent
alcohol intoxication (drug therapy)
bacterial arthritis (etiology)
bacterial endocarditis (etiology)
cardiotoxicity
child
cigarette smoking
emergency treatment
hepatitis B (etiology)
human
Human immunodeficiency virus infection (epidemiology, etiology)
intramuscular drug administration
intravenous drug administration
nephrotoxicity
neurotoxicity
oral drug administration
pain (drug therapy)
priority journal
resuscitation
review
suicide attempt (prevention)
tobacco (drug toxicity)
withdrawal syndrome (drug therapy)
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
caffeine (30388-07-9, 58-08-2)
cannabis (8001-45-4, 8063-14-7)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
haloperidol (52-86-8)
ipecac (8012-96-2)
lorazepam (846-49-1)
lysergide (50-37-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
phencyclidine (77-10-1, 956-90-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996043399
PUI
L26041436
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1352
TITLE
Inappropriate use of naloxone in cancer patients with pain
AUTHOR NAMES
Manfredi P.L.
Ribeiro S.
Chandler S.W.
Payne R.
AUTHOR ADDRESSES
(Manfredi P.L.; Ribeiro S.; Payne R.) Department of Neuro-Oncology,
University of Texas, M.D. Anderson Cancer Center, Houston, TX, United
States.
(Chandler S.W.) Division of Pharmacy, University of Texas, M.D. Anderson
Cancer Center, Houston, TX, United States.
(Payne R.) Department of Neuro-Oncology, University of Texas, M.D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States.
CORRESPONDENCE ADDRESS
R. Payne, Department of Neuro-Oncology, Texas Univ. M.D. Anderson Can. Ctr.,
Box 8, 1515 Holcombe Boulevard, Houston, TX 77030, United States.
SOURCE
Journal of Pain and Symptom Management (1996) 11:2 (131-134). Date of
Publication: February 1996
ISSN
0885-3924
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
Opioid overdose is rarely the primary cause of altered mental status in
cancer patients receiving opioid therapy. The inappropriate administration
of naloxone to reverse an abnormal mental status can cause severe withdrawal
symptoms and pain. To illustrate this problem, we report the case of a
patient inappropriately treated with naloxone and the results of a
retrospective review of the medical records of 15 consecutive patients with
cancer treated with naloxone in the emergency department over a 5-month
period. We offer guidelines for a more thoughtful approach to the management
of patients with cancer who present with encephalopathy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
hydromorphone (drug therapy)
ibuprofen (drug therapy)
naloxone (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
aged
article
cancer patient
case report
confusion (side effect)
drug use
human
intravenous drug administration
male
practice guideline
vomiting (side effect)
CAS REGISTRY NUMBERS
hydromorphone (466-99-9, 71-68-1)
ibuprofen (15687-27-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cancer (16)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996078281
MEDLINE PMID
8907145 (http://www.ncbi.nlm.nih.gov/pubmed/8907145)
PUI
L26073500
DOI
10.1016/0885-3924(95)00150-6
FULL TEXT LINK
http://dx.doi.org/10.1016/0885-3924(95)00150-6
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1353
TITLE
Conscious sedation for pediatric orthopaedic emergencies
AUTHOR NAMES
Graff K.J.
Kennedy R.M.
Jaffe D.M.
AUTHOR ADDRESSES
(Graff K.J.) Sect. of Gen. and Emergency Pediat., University of Colorado,
School of Medicine, Denver, CO, United States.
(Kennedy R.M.; Jaffe D.M.) Division of Emergency Medicine, Department of
Pediatrics, Washington Univ. School of Medicine, St. Louis, MO, United
States.
(Jaffe D.M.) Washington University, School of Medicine, Division of
Emergency Medicine, One Children's Place, St. Louis, MO 63110-1077, United
States.
CORRESPONDENCE ADDRESS
D.M. Jaffe, Division of Emergency Medicine, Washington Univ. School of
Medicine, One Children's Place, St. Louis, MO 63110-1077, United States.
SOURCE
Pediatric Emergency Care (1996) 12:1 (31-35). Date of Publication: February
1996
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
The objective of this study was to assess complications and risk factors
among children undergoing conscious sedation (CS) with fentanyl (F) and
midazolam (M) for reduction of fractures and dislocations. A 22-month
retrospective review was made of an urban pediatric emergency department's
records after implementing a CS protocol for the administration of F/M. Data
collection was facilitated by standard CS forms, and data were analyzed
using descriptive statistics, χ(2) analysis, Fisher's exact test, t test,
odds ratio, and logistic regression. A total of 339 children (65% boys),
mean age of 8.4 years, were enrolled in the study. The mean time to sedation
was 11.3 ± 6.2 minutes and to discharge was 92 ± 36.3 minutes. The mean
total doses of M and F were 0.17 ± 0.08 mg/kg and 1.5 ± 0.8 μg/kg,
respectively. An alteration in respiratory status occurred in 37 (11.0%)
patients: 28 (8.3%) had oxygen saturation <90%; 16 (4.7%) received oxygen;
12 (3.6%) were given verbal breathing reminders, eight (2.4%) received
airway positioning maneuvers, and 2 (0.6%) received naloxone. Four patients
(1.2%) vomited. None required assisted ventilation, intubation, or admission
resulting from complications of CS. Characteristics associated with the
respiratory events included female sex (odds ratio = 2.2) and deep sedation
(odds ratio = 2.7). We conclude that complications associated with F/M
administered by protocol were few, minor, and easily managed. Patients who
are female or who enter a state of deep sedation may be at modestly
increased risk for alterations in respiratory status. Careful attention to
monitoring vital functions on all patients is necessary to provide safe CS.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug comparison, drug dose)
midazolam (drug comparison, drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
child care
fracture
pediatric anesthesia
sedation
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
breathing
child
clinical trial
drowsiness
drug safety
female
human
infant
major clinical study
male
oxygen saturation
patient monitoring
risk assessment
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
midazolam (59467-70-8)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996078374
MEDLINE PMID
8677176 (http://www.ncbi.nlm.nih.gov/pubmed/8677176)
PUI
L26073559
DOI
10.1097/00006565-199602000-00009
FULL TEXT LINK
http://dx.doi.org/10.1097/00006565-199602000-00009
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1354
TITLE
Sedation in pediatric patients
AUTHOR NAMES
Suresh S.
Hall S.C.
AUTHOR ADDRESSES
(Suresh S.; Hall S.C.) Children's Memorial Hospital, Northwestern
University, Chicago, IL, United States.
(Suresh S.) Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL
60614, United States.
CORRESPONDENCE ADDRESS
S. Suresh, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL
60614, United States.
SOURCE
Indian Journal of Pediatrics (1996) 63:1 (13-22). Date of Publication:
January/February 1996
ISSN
0019-5456
BOOK PUBLISHER
Springer India, Barakhamba Road 110001, New Delhi, India.
ABSTRACT
Sedation is being used increasingly in children to allay anxiety and
discomfort. Sedation can also increase the efficiency of performing both
diagnostic and therapeutic procedures in children. There are a wide array of
available sedation methods that are used by radiologists,
gastroenterologists, hematologists/oncologists and emergency room physicians
everyday. Indiscriminate use of sedatives has led to seizures, respiratory
arrests and death in a variety of practice settings. With improved
monitoring capability, more potent drugs and better understanding of the
pharmacokinetics in children, it is possible to provide better care.
EMTREE DRUG INDEX TERMS
butorphanol
chloral hydrate
chlorpromazine
diazepam
fentanyl
flumazenil
ketamine
methohexital
midazolam
morphine
nalbuphine
naloxone
pentobarbital
pethidine
propofol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
sedation
EMTREE MEDICAL INDEX TERMS
anxiety
child
discomfort
human
intramuscular drug administration
intravenous drug administration
oral drug administration
patient care
patient monitoring
review
DRUG TRADE NAMES
demerol
thorazine
CAS REGISTRY NUMBERS
butorphanol (42408-82-2)
chloral hydrate (302-17-0)
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1996094360
MEDLINE PMID
10829960 (http://www.ncbi.nlm.nih.gov/pubmed/10829960)
PUI
L26098885
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1355
TITLE
Effect of acute alcohol intoxication on the opioid system in humans
AUTHOR NAMES
Aguirre J.C.
Del Arbol J.L.
Rico J.
Raya J.
Ruiz-Requena M.E.
AUTHOR ADDRESSES
(Aguirre J.C.; Del Arbol J.L.; Rico J.; Raya J.) Department of Medicine,
School of Medicine, University of Granada, E-18071 Granada, Spain.
(Ruiz-Requena M.E.) Department of Biochemistry and Molecular Biology, School
of Medicine, University of Granada, E-18071 Granada, Spain.
(Del Arbol J.L.) Carrera del Genil 35, 18009 Granada, Spain.
CORRESPONDENCE ADDRESS
J.L. Del Arbol, Carrera del Genil 35, 18009 Granada, Spain.
SOURCE
Alcohol (1995) 12:6 (559-562). Date of Publication: 1995
ISSN
0741-8329
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
We investigated the possible relation between the endogenous opioid system
and acute alcoholic intoxication in 21 subjects, of whom 13 were drinkers
who came to the emergency service with evident symptoms of drunkenness, and
8 were nondrinkers who consumed 1 g alcohol per kg body weight over a short
period. Different patterns of changes were found in the two groups for
plasma concentrations of β-endorphin and adrenocorticotropic hormone. In
drinkers, plasma levels of both substances increased, whereas in nondrinkers
both concentrations decreased, the declines being especially notable 15, 30,
and 45 min after ingestion. We found no differences between the two groups
in plasma cortisol concentrations. The different levels of these substances
may reflect differences in drinking behavior between the two groups.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
beta endorphin (endogenous compound)
corticotropin (endogenous compound)
opiate peptide (endogenous compound)
opiate receptor
EMTREE DRUG INDEX TERMS
hydrocortisone (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication
EMTREE MEDICAL INDEX TERMS
adolescent
adult
alcohol consumption
article
clinical article
clinical protocol
controlled study
drinking behavior
female
habituation
human
male
CAS REGISTRY NUMBERS
alcohol (64-17-5)
beta endorphin (59887-17-1)
corticotropin (11136-52-0, 9002-60-2, 9061-27-2)
hydrocortisone (50-23-7)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995360645
MEDLINE PMID
8590619 (http://www.ncbi.nlm.nih.gov/pubmed/8590619)
PUI
L25358653
DOI
10.1016/0741-8329(95)02002-0
FULL TEXT LINK
http://dx.doi.org/10.1016/0741-8329(95)02002-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1356
TITLE
Comparison of cocaine and opiate exposures between young urban and suburban
children
AUTHOR NAMES
Rosenberg N.M.
Marino D.
Meert K.L.
Kauffman R.F.
AUTHOR ADDRESSES
(Rosenberg N.M.; Marino D.; Meert K.L.; Kauffman R.F.) Children's Hospital
of Michigan, 3901 Beaubien, Detroit, MI 48201, United States.
CORRESPONDENCE ADDRESS
N.M. Rosenberg, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI
48201, United States.
SOURCE
Archives of Pediatrics and Adolescent Medicine (1995) 149:12 (1362-1364).
Date of Publication: 1995
ISSN
1072-4710
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
ABSTRACT
Objective: To determine the prevalence of cocaine and opiate metabolites in
the urine of young urban and suburban children. Design: Survey. Sailing:
Urban and suburban emergency departments and private pediatric practices.
Patients: A convenience sample of 1469 children between 1 and 60 months of
age who required a urinalysis for investigation of the chief complaint.
Interventions: None. Main Outcome Measures: Urine was screened for
benzoylecgonine and opiates using an enzyme-multiplied immunoassay technique
and a fluorescence-polarization immunoassay, both with a sensitivity of 50
ng/mL. Results: Benzoylecogonine was identified in the urine of 45 children
(3.1%) (95% CI, 2.2% to 3.9%) and opiates in the urine of 38 children (2.6%)
(95% CI, 1.8% to 3.4%). No difference was observed between urban and
suburban health care facilities in the percentage of patients whose urine
tested positive for benzoylecgonine (29 of 1011 vs 16 of 458, P=.6) or
opiates (28 of 1011 vs 10 of 458, P=.6). Conclusion: Exposure to illicit
drugs, as reflected by urinary metabolites, is similar for urban and
suburban children.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
opiate agonist (endogenous compound)
EMTREE DRUG INDEX TERMS
benzoylecgonine
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
opiate addiction
EMTREE MEDICAL INDEX TERMS
article
child
controlled study
enzyme linked immunosorbent assay
female
fluorescence polarization immunoassay
human
major clinical study
male
preschool child
priority journal
rural population
school child
urban population
urinalysis
CAS REGISTRY NUMBERS
benzoylecgonine (519-09-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995364652
MEDLINE PMID
7489075 (http://www.ncbi.nlm.nih.gov/pubmed/7489075)
PUI
L25359572
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1357
TITLE
Intranasal butorphanol-induced apraxia reversed by naloxone
AUTHOR NAMES
Gora-Harper M.L.
Sunahara J.F.
Gray M.S.
AUTHOR ADDRESSES
(Gora-Harper M.L.; Sunahara J.F.; Gray M.S.) Drug Information Center,
University of Kentucky Hospital, 800 Rose Street, Lexington, KY 40536-0084,
United States.
CORRESPONDENCE ADDRESS
M.L. Gora-Harper, Drug Information Center, University of Kentucky Hospital,
800 Rose Street, Lexington, KY 40536-0084, United States.
SOURCE
Pharmacotherapy (1995) 15:6 I (798-800). Date of Publication: 1995
ISSN
0277-0008
BOOK PUBLISHER
Pharmacotherapy Publications Inc., 750 Washington Street, Boston, United
States.
ABSTRACT
Intranasal butorphanol is an opioid agonist-antagonist that is effective for
the treatment of acute pain. Common adverse effects associated with the
agent are somnolence, dizziness, nausea, and vomiting; they are readily
reversed with naloxone. A patient developed signs and symptoms consistent
with apraxia after a single dose of intranasal butorphanol. She was mentally
alert, but she was unable to move or speak despite normal muscle lone and
reflex movements. When she attempted to speak she had no voluntary control.
At the emergency room she was administered naloxone 2 mg intramuscularly,
which resulted in complete reversal of the symptoms in a short time. No
other published cases describe these findings with butorphanol. Health care
professionals should be aware that patients who are prescribed intranasal
butorphanol, even in typical doses, may be at risk for such a reaction. This
is important because, unlike the injectable formulation, the intranasal
product is primarily used in the outpatient setting.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
butorphanol tartrate (adverse drug reaction, drug administration, drug
therapy)
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
apraxia (side effect)
sinusitis (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
drug efficacy
female
headache (complication)
human
intranasal drug administration
nausea (side effect)
somnolence (side effect)
vertigo (side effect)
vomiting (side effect)
DRUG TRADE NAMES
stadol , United StatesBristol
DRUG MANUFACTURERS
(United States)Bristol
CAS REGISTRY NUMBERS
butorphanol tartrate (58786-99-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Otorhinolaryngology (11)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995351355
MEDLINE PMID
8602392 (http://www.ncbi.nlm.nih.gov/pubmed/8602392)
PUI
L25352348
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1358
TITLE
The nontraumatic coma in general practice
ORIGINAL (NON-ENGLISH) TITLE
LE COMA NON TRAUMATIQUE EN PRATIQUE EXTRAHOSPITALIERE
AUTHOR NAMES
Enrico J.F.
Kaeser P.
Sidotti C.
Keitari R.
AUTHOR ADDRESSES
(Enrico J.F.; Kaeser P.; Sidotti C.; Keitari R.) Unite de Soins Intensifs,
Hopital des Cadolles, 2000 Neuchatel, Switzerland.
CORRESPONDENCE ADDRESS
J.F. Enrico, Unite de Soins Intensifs, Hopital des Cadolles, 2000 Neuchatel,
Switzerland.
SOURCE
Schweizerische Rundschau fur Medizin/Praxis (1995) 84:45 (1321-1330). Date
of Publication: 1995
ISSN
0369-8394
BOOK PUBLISHER
Verlag Hans Huber AG, Langgassstrasse 76, Bern, Switzerland.
ABSTRACT
After a short review on pathophysiologic mechanisms of comatous states and
their complications, a cohort of 392 comatous patients (Glasgow Coma Scale ≤
8) hospitalized to intensive care is analyzed in order to estimate the
relative frequency of the different causes of nontraumatic coma. Depending
on pathology, the following practical, sequential procedure is recommended:
at first, identification and treatment of disorders of viral functions,
objective estimate of the severeness of the coma and rapid diagnostic
orientation with a targeted neurologic investigation; then, simple
therapeutic interventions in order to treat reversible causes of a metabolic
encephalopathy as well as immediate measures for neuroprotection
(anticonvulsive and antihypotensive therapy, oxygen, etc.). An initial,
adequate control of the comatous patient is mandatory in order to limit
invalidizing cerebral complications.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anticonvulsive agent (drug therapy)
catecholamine (drug therapy)
oxygen (drug therapy)
EMTREE DRUG INDEX TERMS
clonazepam (drug therapy)
diazepam (drug therapy)
dopamine (drug therapy)
epinephrine (drug therapy)
flumazenil (drug therapy)
hetastarch (drug therapy)
hydrocortisone (drug therapy)
labetalol (drug therapy)
lorazepam (drug therapy)
naloxone (drug therapy)
nitroprusside sodium (drug therapy)
phenytoin (drug therapy)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma (diagnosis, drug therapy, etiology, therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
article
human
hypotension (drug therapy)
intravenous drug administration
metabolic encephalopathy (drug therapy)
DRUG TRADE NAMES
anexate
benerva
epanutin
narcan
nipride
plasmasteril
rivotril
stesolid
temesta
trandate
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
clonazepam (1622-61-3)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
hetastarch (9005-27-0)
hydrocortisone (50-23-7)
labetalol (32780-64-6, 36894-69-6)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
oxygen (7782-44-7)
phenytoin (57-41-0, 630-93-3)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
General Pathology and Pathological Anatomy (5)
Internal Medicine (6)
Neurology and Neurosurgery (8)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French, English, German
EMBASE ACCESSION NUMBER
1995328293
MEDLINE PMID
7491461 (http://www.ncbi.nlm.nih.gov/pubmed/7491461)
PUI
L25340506
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1359
TITLE
Nalmefene - A long-acting injectable opioid antagonist
AUTHOR ADDRESSES
SOURCE
Medical Letter on Drugs and Therapeutics (1995) 37:960 (97-98). Date of
Publication: 1995
ISSN
0025-732X
BOOK PUBLISHER
Medical Letter Inc., 1000 Main Street, New Rochelle, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (adverse drug reaction, clinical trial, drug dose,
pharmacokinetics, pharmacology)
opiate antagonist (adverse drug reaction, clinical trial, drug dose,
pharmacokinetics, pharmacology)
opiate receptor
EMTREE DRUG INDEX TERMS
naloxone
naltrexone
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS
clinical trial
drug approval
drug cost
drug information
drug mechanism
drug overdose
emergency ward
food and drug administration
human
lung edema (side effect)
nausea (side effect)
short survey
vomiting (side effect)
DRUG TRADE NAMES
narcan
revex Ohmeda
trexan
DRUG MANUFACTURERS
Ohmeda
CAS REGISTRY NUMBERS
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Health Policy, Economics and Management (36)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1995317862
MEDLINE PMID
7565300 (http://www.ncbi.nlm.nih.gov/pubmed/7565300)
PUI
L25320882
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1360
TITLE
Voluntary drug intoxications in an emergency ward
ORIGINAL (NON-ENGLISH) TITLE
INTOXICATIONS MEDICAMENTEUSES VOLONTAIRES RECUES DANS UN SERVICE D'ACCUEIL
DES URGENCES
AUTHOR NAMES
Staikowsky F.
Uzan D.
Grillon N.
Pevirieri F.
Hafi A.
Michard F.
AUTHOR ADDRESSES
(Staikowsky F.; Uzan D.; Grillon N.; Pevirieri F.; Hafi A.; Michard F.)
Serv. Accueil des Urgences Medicales, Hopital Bichat-Claude Bernard, 46 Rue
Henri Huchard, F-75877 Paris Cedex 18, France.
CORRESPONDENCE ADDRESS
F. Staikowsky, Serv. Accueil des Urgences Medicales, Hopital Bichat-Claude
Bernard, 46 Rue Henri Huchard, F-75877 Paris Cedex 18, France.
SOURCE
Presse Medicale (1995) 24:28 (1296-1300). Date of Publication: 1995
ISSN
0755-4982
BOOK PUBLISHER
Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex,
France.
ABSTRACT
Objectives: The aim of this study was to ascertain the specific nature of
voluntary drug intoxications seen in emergency wards receiving adult
patients. Methods: From July 1992 to June 1993, all patients presenting at
the emergency room with voluntary drug intoxication were assessed
retrospectively. There were 727 patients (482 females and 245 males, mean
age 33.3 ± 12 years, age range 15-92) admitted for 804 episodes of voluntary
drug intoxication. Results: A past history of psychiatric problems or drug
abuse was found in 42.8 and 9.1% of the patients respectively. The time laps
between ingestion and consultation was noted for 43% (5 h 30 ± 9 h, range
15-4320 min). The drug ingested was identified in 89% of the cases and 1.7
drugs were ingested per episode (range 1-8). Generally, only 1 (52%) or 2
(21%) drugs were ingested. Nonbarbituric psychotropic agents were ingested
in 79.7% of the cases. Alcohol had also been consumed in 36.5% of the cases.
Treatment was gastric lavage in 34.4%, activated carbon in 16.7%, flumazenil
in 16.9%, naloxone and N-acetyl-cysteine in 3.4%. Twelve patients required
intubation. Patients were admitted to a medical (n = 156) or psychiatric (n
= 67) ward or an intensive care unit (n = 61). Nearly 25% of the patients
left hospital either against medical advice or left without notice.
Conclusion: Voluntary drug intoxications seen in emergency rooms require
care by a well coordinated team of clinicians and psychiatrists.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine (drug therapy)
activated carbon (drug therapy)
alcohol
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
amitriptyline
bromazepam
clomipramine
clorazepate
clorazepate dipotassium
flunitrazepam
fluoxetine
lorazepam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
emergency medicine
suicide
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
female
health care quality
human
major clinical study
male
mental health care
DRUG TRADE NAMES
anafranil Ciba Geigy
laroxyl Hoffmann La Roche
lexomil Hoffmann La Roche
prozac Lilly
rohypnol Hoffmann La Roche
temesta , FranceWyeth
tranxene Sanofi Winthrop
DRUG MANUFACTURERS
Ciba Geigy
Hoffmann La Roche
Lilly
Sanofi Winthrop
(France)Wyeth
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
bromazepam (1812-30-2)
clomipramine (17321-77-6, 303-49-1)
clorazepate (20432-69-3, 23887-31-2)
clorazepate dipotassium (57109-90-7)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Forensic Science Abstracts (49)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French, English
EMBASE ACCESSION NUMBER
1995296035
MEDLINE PMID
7501621 (http://www.ncbi.nlm.nih.gov/pubmed/7501621)
PUI
L25302384
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1361
TITLE
Combination fentanyl and diazepam for pediatric conscious sedation.
AUTHOR NAMES
Pohlgeers A.P.
Friedland L.R.
Keegan-Jones L.
AUTHOR ADDRESSES
(Pohlgeers A.P.; Friedland L.R.; Keegan-Jones L.) Children's Emergency
Center, Wolfson Children's Hospital, Emergency Physicians, Inc.,
Jacksonville, FL 32207, USA.
CORRESPONDENCE ADDRESS
A.P. Pohlgeers, Children's Emergency Center, Wolfson Children's Hospital,
Emergency Physicians, Inc., Jacksonville, FL 32207, USA.
SOURCE
Academic emergency medicine : official journal of the Society for Academic
Emergency Medicine (1995) 2:10 (879-883). Date of Publication: Oct 1995
ISSN
1069-6563
ABSTRACT
OBJECTIVES: To evaluate the safety and to describe the use of combination IV
diazepam and fentanyl in the pediatric emergency department (PED) as
outpatient conscious sedation (CS) for orthopedic procedures. METHODS: A
retrospective chart review of a standardized protocol for CS administered to
133 consecutive patients requiring CS for outpatient orthopedic procedures.
The patients were continuously monitored for heart rate, respiratory rate,
and arterial O2 saturation (Sao2) by pulse oximetry. The study was conducted
at a large urban PED and regional referral center. RESULTS: A total of 133
children (mean age 8.5 years) received 138 orthopedic procedures. Mean (+/-
SD) total diazepam dose was 0.12 +/- 0.05 mg/kg; mean total fentanyl dose
was 3.18 +/- 1.04 micrograms/kg. Mean time intervals were 4.6 minutes from
initial drug administration to start of procedure, 15.5 minutes to end of
procedure, and 56 minutes to meeting criteria for release home.
Complications included Sao2 < 90% for 15 patients (11%, 95% CI 6.4-17.4%),
vomiting for one (0.7%, 95% CI 0.1-4.2%), and severe pruritus for one (0.7%,
95% CI 0.1-4.2%). An episode of Sao2 < 90% was associated with a higher
initial mean fentanyl dose (2.60 vs 1.95 micrograms/kg; p = 0.0005), but was
not associated with a higher initial mean diazepam dose (p = 0.28).
Parenteral opioid use for pain management prior to CS was not associated
with an increased risk for Sao2 < 90% (p = 0.42). Heart rate, respiratory
rate, and blood pressure were stable during the observational period. No
patient required naloxone, flumazenil, artificial airway control, or
admission to the hospital. CONCLUSIONS: At the doses given in the study, the
use of combination diazepam and fentanyl for outpatient CS of PED patients
during orthopedic procedures was not associated with serious complications.
A higher initial fentanyl dose was associated with episodes of Sao2 < 90%.
Therefore, an initial dose of < or = 2.0 micrograms/kg fentanyl titrated to
effect is recommended.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diazepam (adverse drug reaction)
fentanyl (adverse drug reaction)
intravenous anesthetic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
conscious sedation (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS
article
child
dislocation (surgery)
drug combination
emergency
fracture (surgery)
human
retrospective study
CAS REGISTRY NUMBERS
diazepam (439-14-5)
fentanyl (437-38-7)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
8542487 (http://www.ncbi.nlm.nih.gov/pubmed/8542487)
PUI
L126189583
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1362
TITLE
Health professional perceptions of opioid dependence among patients with
pain
AUTHOR NAMES
Waldrop R.D.
Mandry C.
AUTHOR ADDRESSES
(Waldrop R.D.; Mandry C.) Department of Emergency Medicine, Earl K. Long
Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805, United States.
CORRESPONDENCE ADDRESS
R.D. Waldrop, Department of Emergency Medicine, Earl K. Long Medical Center,
5825 Airline Highway, Baton Rouge, LA 70805, United States.
SOURCE
American Journal of Emergency Medicine (1995) 13:5 (529-531). Date of
Publication: 1995
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The purpose of this study was to determine the percentage of patients
perceived by health professionals to be opioid dependent among all patients
presenting with pain and specifically among sickle cell patients with pain.
Surveys were completed by all staff, residents, and names at an urban
teaching hospital with an emergency department population consisting
primarily of lower socioeconomic patients of African-American origin. The
surveys requested a percentage estimate of all pain patients and sickle cell
patients with pain presenting to this hospital who they perceived to be
opioid dependent. The estimated percentage of opioid dependent patients
presenting to the emergency department with pain was 4% for staff (P < .05,
n = 14), 9% for residents (n = 31), and 7% for nurses (n = 41), and the
estimates for sickle cell patients presenting with pain only were 8%, 17%,
and 13% respectively (P < .05). All health professional groups surveyed
estimated opioid dependence in patients with pain far in excess of that
shown in previous studies. It is unknown whether pain medication are
withheld inappropriately by physicians who perceived patients with pain to
be opioid dependent, and that this deserved further study especially among
sickle cell patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (diagnosis)
EMTREE MEDICAL INDEX TERMS
analgesia
article
emergency ward
human
medical staff
normal human
pain (complication)
physician attitude
priority journal
sickle cell anemia (diagnosis)
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995252771
MEDLINE PMID
7662056 (http://www.ncbi.nlm.nih.gov/pubmed/7662056)
PUI
L25252072
DOI
10.1016/0735-6757(95)90163-9
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(95)90163-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1363
TITLE
Fentanyl in the emergency service
ORIGINAL (NON-ENGLISH) TITLE
FENTANYL IM RETTUNGSDIENST
AUTHOR NAMES
Uhr T.
Lichte U.
AUTHOR ADDRESSES
(Uhr T.; Lichte U.) Von-Werth-Strasse 37-49, 50670 Koln, Germany.
CORRESPONDENCE ADDRESS
T. Uhr, Von-Werth-Strasse 37-49, 50670 Koln, Germany.
SOURCE
Notfall Medizin (1995) 21:7 (378-379). Date of Publication: 1995
ISSN
0341-2903
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency health service
EMTREE MEDICAL INDEX TERMS
adult
aged
article
case report
female
human
intravenous drug administration
male
DRUG TRADE NAMES
narcanti
DRUG MANUFACTURERS
Janssen
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1995238690
PUI
L25239010
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1364
TITLE
Treatment of acute injury of the cervical spine.
AUTHOR NAMES
Slucky A.V.
Eismont F.J.
AUTHOR ADDRESSES
(Slucky A.V.; Eismont F.J.) Hospital for Special Surgery, New York, New
York, USA.
CORRESPONDENCE ADDRESS
A.V. Slucky, Hospital for Special Surgery, New York, New York, USA.
SOURCE
Instructional course lectures (1995) 44 (67-80). Date of Publication: 1995
ISSN
0065-6895
EMTREE DRUG INDEX TERMS
ganglioside GM1 (drug therapy)
lipid peroxide
methylprednisolone (drug therapy)
naloxone (drug therapy)
pregnane derivative (drug therapy)
protirelin (drug therapy)
tirilazad
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cervical spine (surgery)
spinal cord injury (therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
classification
cryoanesthesia
diagnostic imaging
drug antagonism
emergency health service
female
human
injury
male
middle aged
pathophysiology
physical examination
resuscitation
review
CAS REGISTRY NUMBERS
ganglioside GM1 (37758-47-7)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
protirelin (24305-27-9)
tirilazad (110101-66-1, 110101-67-2, 111793-42-1)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
7797894 (http://www.ncbi.nlm.nih.gov/pubmed/7797894)
PUI
L125083662
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1365
TITLE
Doctors' legal position in treating temporarily incompetent patients
AUTHOR NAMES
Hodgkinson D.W.
Gray A.J.
Dalal B.
Wilson P.
Szawarski Z.
Sensky T.
Gillett G.
Yates D.W.
AUTHOR ADDRESSES
(Hodgkinson D.W.; Gray A.J.; Dalal B.; Wilson P.; Szawarski Z.; Sensky T.;
Gillett G.; Yates D.W.) Accident and Emergency Department, Stockport Acute
Services NHS Trust, Stockport Infirmary, Stockport SK1 3UJ, United Kingdom.
CORRESPONDENCE ADDRESS
D.W. Hodgkinson, Accident and Emergency Department, Stockport Acute Services
NHS Trust, Stockport Infirmary, Stockport SK1 3UJ, United Kingdom.
SOURCE
British Medical Journal (1995) 311:6997 (115-118). Date of Publication: 1995
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
Doctors in accident and emergency departments are sometimes presented with
patients with potentially life threatening conditions who refuse to consent
to treatment. The doctors then face a dilemma: to withhold necessary
treatment or to act against a patient's express wishes. Two such cases are
presented, and we asked a lawyer, two medical ethicists, a psychiatrist, and
an accident and emergency physician to comment on the implications.
EMTREE DRUG INDEX TERMS
antidepressant agent (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
decision making
emergency medicine
medicolegal aspect
EMTREE MEDICAL INDEX TERMS
adult
case report
depression (drug therapy)
drug overdose (drug therapy)
emergency ward
human
informed consent
male
medical ethics
note
physician
priority journal
psychiatrist
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995213701
MEDLINE PMID
7613365 (http://www.ncbi.nlm.nih.gov/pubmed/7613365)
PUI
L25207471
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1366
TITLE
Occult cocaine and opiate exposure in children and associated physical
findings
AUTHOR NAMES
Rosenberg N.M.
Meert K.L.
Marino D.
Yee H.
Kauffman R.E.
AUTHOR ADDRESSES
(Rosenberg N.M.; Meert K.L.; Marino D.; Yee H.; Kauffman R.E.) Children's
Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201-2196,
United States.
CORRESPONDENCE ADDRESS
N.M. Rosenberg, Children's Hospital of Michigan, 3901 Beaubien Boulevard,
Detroit, MI 48201-2196, United States.
SOURCE
Pediatric Emergency Care (1995) 11:3 (167-169). Date of Publication: 1995
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
We determined the prevalence of cocaine and opiate exposure and the
association of exposure with objective physical findings in children
presenting to an urban pediatric emergency department. The study included
942 children between one and 60 months of age who required urinalysis for
investigation of their chief complaint. Anonymously and without informed
consent, urine was screened for benzoylecgonine (BE) and opiates, using an
enzyme multiplied immunoassay technique (EMIT) with sensitivity of 50 ng/ml.
EMIT-positive samples were rescreened using a fluorescence polarization
immunoassay (FPIA). Specimens positive by both EMIT and FPIA were confirmed
by gas chromatography/mass spectrometry (GC/MS) if sufficient quantity of
urine was available. BE was identified in 41 (4.4%) and opiates in 46 (4.9%)
patients by both EMIT and FPIA. The presence of BE or opiate was confirmed
by GC/MS in all 34 cases where sufficient urine was available. The age- and
sex- adjusted systolic and diastolic blood pressure percentiles were
greater, and head circumference and weight percentiles were lower in
BE-positive patients compared to those with negative drug screens. There
were no associations between opiate exposure and any of these variables. We
conclude that occult postnatal cocaine exposure is associated with
measurable physical and physiologic differences.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzoylecgonine
cocaine
illicit drug
opiate derivative
EMTREE MEDICAL INDEX TERMS
article
enzyme multiplied immunoassay technique
female
fluorescence polarization immunoassay
growth retardation
human
hypertension
infant
major clinical study
male
preschool child
urinalysis
CAS REGISTRY NUMBERS
benzoylecgonine (519-09-5)
cocaine (50-36-2, 53-21-4, 5937-29-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995198481
MEDLINE PMID
7651872 (http://www.ncbi.nlm.nih.gov/pubmed/7651872)
PUI
L25186383
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1367
TITLE
Preventing fatalities from anaphylaxis: An emergency medicine physician's
perspective
AUTHOR NAMES
Zull D.N.
AUTHOR ADDRESSES
(Zull D.N.) Northwestern Univ. Medical School, 303 East Chicago Avenue,
Chicago, IL 60611, United States.
CORRESPONDENCE ADDRESS
D.N. Zull, Northwestern Univ. Medical School, 303 East Chicago Avenue,
Chicago, IL 60611, United States.
SOURCE
Allergy Proceedings (1995) 16:3 (113-114). Date of Publication: 1995
ISSN
1046-9354
BOOK PUBLISHER
OceanSide Publications Inc., 95 Pitman Street, Providence, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antihistaminic agent (drug therapy)
epinephrine (drug administration, drug therapy)
histamine H1 receptor antagonist (drug combination, drug therapy)
histamine H2 receptor antagonist (drug combination, drug therapy)
steroid (drug therapy)
EMTREE DRUG INDEX TERMS
cimetidine (drug therapy)
diphenhydramine (drug therapy)
famotidine (drug therapy)
glucagon (drug therapy)
glyceryl trinitrate
heliox
methylprednisolone (drug therapy)
naloxone (drug therapy)
ranitidine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anaphylaxis (drug therapy)
anaphylaxis (drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
aerosol
airway obstruction (drug therapy, therapy)
asthma
clinical feature
drug indication
editorial
emergency treatment
fluid therapy
heart disease
high risk patient
human
hypotension (drug therapy, therapy)
inhalational drug administration
intramuscular drug administration
intravenous drug administration
oral drug administration
patient positioning
subcutaneous drug administration
sublingual drug administration
DRUG TRADE NAMES
benadryl
epipen
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
cimetidine (51481-61-9, 70059-30-2)
diphenhydramine (147-24-0, 58-73-1)
famotidine (76824-35-6)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glyceryl trinitrate (55-63-0)
heliox (58933-55-4)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
ranitidine (66357-35-5, 66357-59-3)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Immunology, Serology and Transplantation (26)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1995195302
MEDLINE PMID
7557367 (http://www.ncbi.nlm.nih.gov/pubmed/7557367)
PUI
L25186554
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1368
TITLE
Conscious sedation in the pediatric emergency department
AUTHOR NAMES
Andrews J.S.
AUTHOR ADDRESSES
(Andrews J.S.) Division of General Pediatrics, Johns Hopkins Children's
Center, 600 North Wolfe Street, Baltimore, MD 21287-3144, United States.
CORRESPONDENCE ADDRESS
J.S. Andrews, Division of General Pediatrics, Johns Hopkins Children's
Center, 600 North Wolfe Street, Baltimore, MD 21287-3144, United States.
SOURCE
Current Opinion in Pediatrics (1995) 7:3 (309-313). Date of Publication:
1995
ISSN
1040-8703
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
ABSTRACT
Anxiety-provoking and painful emergency department procedures such as
laceration repair are made more tolerable to the pediatric patient and
easier for the practitioner through the judicious use of pharmacologic
agents for conscious sedation and analgesia. Both the American Academy of
Pediatrics and the American College of Emergency Physicians have published
documents that guide the physician in the use of these agents in the care of
children. Most new information concerns the evaluation of new drugs for use
in the pediatric emergency department, adverse effects of familiar products,
and evaluation of sedative and analgesic antagonist medications that may
increase a practitioner's control when conscious sedation is used. Large,
controlled trials of protocols and drugs are necessary to establish safe,
appropriate standards for conscious sedation in the pediatric emergency
department.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (adverse drug reaction)
barbituric acid derivative (adverse drug reaction)
benzodiazepine derivative (adverse drug reaction)
narcotic agent (adverse drug reaction)
narcotic antagonist (adverse drug reaction)
sedative agent (adverse drug reaction)
EMTREE DRUG INDEX TERMS
chloral hydrate (adverse drug reaction)
chlorpromazine
diazepam (adverse drug reaction)
fentanyl (adverse drug reaction)
ketamine (adverse drug reaction)
methohexital (adverse drug reaction)
midazolam (adverse drug reaction)
morphine (adverse drug reaction)
nalmefene (adverse drug reaction)
naloxone (adverse drug reaction)
nitrous oxide (adverse drug reaction)
pentobarbital (adverse drug reaction)
pethidine (adverse drug reaction)
promethazine (adverse drug reaction)
propofol (adverse drug reaction)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug induced disease (side effect)
pediatric anesthesia
EMTREE MEDICAL INDEX TERMS
aneuploidy (side effect)
apnea (side effect)
child
clinical protocol
emergency medicine
gastrointestinal symptom (side effect)
heart arrhythmia (side effect)
human
liver disease (side effect)
priority journal
respiration depression (side effect)
respiratory failure (side effect)
review
DRUG TRADE NAMES
phenergan , United StatesWyeth Ayerst
thorazine , United StatesSmithKline Beecham
DRUG MANUFACTURERS
(United States)Sanofi Winthrop
(United States)SmithKline Beecham
(United States)Wyeth Ayerst
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
methohexital (151-83-7, 309-36-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propofol (2078-54-8)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995178065
MEDLINE PMID
7663619 (http://www.ncbi.nlm.nih.gov/pubmed/7663619)
PUI
L25173553
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1369
TITLE
Cardiac arrest during pregnancy
AUTHOR NAMES
Dildy G.A.
Clark S.L.
AUTHOR ADDRESSES
(Dildy G.A.; Clark S.L.) Perinatal Center, Utah Valley Regional Medical
Center, 1034 North 500 West, Provo, UT 84604, United States.
CORRESPONDENCE ADDRESS
G.A. Dildy, Perinatal Center, Utah Valley Regional Medical Center, 1034
North 500 West, Provo, UT 84604, United States.
SOURCE
Obstetrics and Gynecology Clinics of North America (1995) 22:2 (303-314).
Date of Publication: 1995
ISSN
0889-8545
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Cardiac arrest occurs rarely in pregnancy. Nevertheless, the practicing
obstetrician stands a likely chance of encountering this acute condition at
least once over the course of a busy career. A basic understanding of
maternal-fetal physiology and the acute management of cardiac arrest are of
key importance. ECC is not significantly changed from that administered to
the nonpregnant patient. Factors unique to pregnancy, however, such as
lateral uterine displacement, effects of drugs on the mother and the fetus,
and the issues of perimortem cesarean section should be understood by the
consulting obstetrician. The critical period in management of these patients
is within the first several minutes of the event. In many situations, the
obstetrician may be the first to arrive and initiate therapy before the
arrival of multidisciplinary assistance. Prompt initial management will give
the mother and fetus the best chances for survival.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
adenosine (drug therapy)
diltiazem (drug therapy)
magnesium sulfate (drug therapy)
morphine sulfate (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
atropine (drug administration, drug dose, drug therapy)
bicarbonate (drug therapy)
bretylium (drug administration, drug dose, drug therapy)
diazepam (drug administration, drug dose, drug therapy)
epinephrine (drug administration, drug dose, drug therapy)
gluconate calcium (drug therapy)
isoprenaline (drug therapy)
lidocaine (drug administration, drug dose, drug therapy)
naloxone (drug administration, drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
acute heart infarction (complication, diagnosis, drug therapy, etiology,
therapy)
heart arrest (complication, diagnosis, drug therapy, etiology, therapy)
heart arrhythmia (complication, diagnosis, drug therapy, etiology, therapy)
pregnancy complication
EMTREE MEDICAL INDEX TERMS
algorithm
cardiovascular disease (complication, diagnosis, drug therapy, etiology,
therapy)
cesarean section
clinical protocol
defibrillation
emergency treatment
female
fluid therapy
human
intravenous drug administration
maternal mortality
medical decision making
oxygen therapy
priority journal
resuscitation
review
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
diazepam (439-14-5)
diltiazem (33286-22-5, 42399-41-7)
gluconate calcium (299-28-5)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium sulfate (7487-88-9)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Obstetrics and Gynecology (10)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995171508
MEDLINE PMID
7651673 (http://www.ncbi.nlm.nih.gov/pubmed/7651673)
PUI
L25166162
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1370
TITLE
Patients intoxicated with heroin or heroin mixtures: how long should they be
monitored?
AUTHOR NAMES
Osterwalder J.J.
AUTHOR ADDRESSES
(Osterwalder J.J.) Department of Emergency Medicine and Surgery,
Kantonsspital St Gallen, Switzerland.
CORRESPONDENCE ADDRESS
J.J. Osterwalder, Department of Emergency Medicine and Surgery,
Kantonsspital St Gallen, Switzerland.
SOURCE
European journal of emergency medicine : official journal of the European
Society for Emergency Medicine (1995) 2:2 (97-101). Date of Publication: Jun
1995
ISSN
0969-9546
ABSTRACT
Our investigation was carried out in subjects intoxicated with heroin or
heroin mixtures to find out the time interval during which delayed
life-threatening complications become manifest, such as pulmonary oedema or
relapse into respiratory depression or coma after naloxone treatment. We
studied prospectively all drug intoxications between 1991 and 1992. Of the
538 intoxications, we assessed in detail 160 outpatients who lived within
the catchment area of our hospital. The outcome variables studied were (1)
rehospitalization for pulmonary oedema, (2) relapse into coma, and/or (3)
death and cause within 24 h after release from hospital. Deaths occurring
outside our hospital have to be reported, as decreed by law, to the
Institute for Forensic Medicine. The results of our investigation showed no
rehospitalization owing to pulmonary oedema or coma, but one death, outside
the hospital, owing to delayed pulmonary oedema. This delayed complication
had an incidence of 0.6% (95% confidence interval 0-3.8%). A reintoxication
could be excluded in this patient. Based on reliable report, the pulmonary
oedema occurred between approximately 2 1/4 and 8 1/4 hours after
intoxication. In the literature, only two cases of delayed pulmonary oedema
have been reported with reliable time statements (4 and 6 h after
hospitalization). We therefore conclude that surveillance for at least 8 h
is essential after successful treatment to exclude delayed pulmonary oedema
in patients intoxicated with heroin or heroin mixtures.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
narcotic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
benzodiazepine derivative (drug toxicity)
cannabis (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
monitoring
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
clinical trial
drug interaction
emergency health service
female
Glasgow coma scale
heroin dependence (therapy)
human
intoxication (diagnosis, therapy)
male
methodology
mortality
prospective study
survival rate
Switzerland (epidemiology)
time
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
diamorphine (1502-95-0, 561-27-3)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
9422191 (http://www.ncbi.nlm.nih.gov/pubmed/9422191)
PUI
L128200213
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1371
TITLE
The medical rucksack in the mountains: Survey on the choice of different
users
ORIGINAL (NON-ENGLISH) TITLE
LE SAC MEDICAL DE MONTAGNE: ENQUETE SUR LES CHOIX DE DIFFERENTS UTILISATEURS
AUTHOR NAMES
Dindart J.M.
Wurmser O.
Bouvard M.
AUTHOR ADDRESSES
(Dindart J.M.; Wurmser O.; Bouvard M.) Unite Medical du Secours en Montagne,
SAMU 64B, Centre Hospitalier, BP 1156, 64011 Pau Cedex, France.
CORRESPONDENCE ADDRESS
J.M. Dindart, Unite Medical du Secours en Montagne, SAMU 64B, Centre
Hospitalier, BP 1156, 64011 Pau Cedex, France.
SOURCE
Urgences Medicales (1995) 14:2 (81-85). Date of Publication: 1995
ISSN
0923-2524
ABSTRACT
The mobile emergency services intervening in mountains are faced with the
problem of the conditionning of medical materials. The mobile emergency
service in Pau has tried to make an inventory of the various medical
rucksacks used both in the French and Swiss massifs. Whereas the content is
often similar, the container is very eclectic and depends on the type of
massifs. In conclusion we endeavour to describe the ideal medical rucksack
which is yet to be designed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
cardiovascular agent
sedative agent
EMTREE DRUG INDEX TERMS
amoxicillin plus clavulanic acid
ceftriaxone
droperidol
flumazenil
hydroxyzine
lysine acetylsalicylate
metoclopramide
naloxone
ornidazole
paracetamol
penicillin G
propofol
salbutamol
terbutaline
theophylline
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory care
mountaineering
EMTREE MEDICAL INDEX TERMS
article
emergency medicine
France
health care delivery
health care utilization
human
DRUG TRADE NAMES
anexate
aspegic
atarax
augmentin
bricanyl
dafalgan
diprivan
droleptan
narcan
penicillin g
primperan
rocephin
salbutamol
theophylline
tiberal
ventolin
CAS REGISTRY NUMBERS
amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1)
ceftriaxone (73384-59-5, 74578-69-1)
droperidol (548-73-2)
flumazenil (78755-81-4)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
lysine acetylsalicylate (34220-70-7, 37933-78-1, 62952-06-1, 77337-52-1)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
ornidazole (16773-42-5)
paracetamol (103-90-2)
penicillin G (1406-05-9, 61-33-6)
propofol (2078-54-8)
salbutamol (18559-94-9)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French, English
EMBASE ACCESSION NUMBER
1995129769
PUI
L25128354
DOI
10.1016/0923-2524(96)80616-3
FULL TEXT LINK
http://dx.doi.org/10.1016/0923-2524(96)80616-3
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1372
TITLE
Submental injection of naloxone [3]
AUTHOR NAMES
Salvucci Jr. A.A.
Eckstein M.
Iscovich A.L.
AUTHOR ADDRESSES
(Salvucci Jr. A.A.; Eckstein M.; Iscovich A.L.) Department of Emergency
Medicine, Los Angeles County USC Med. Ctr., Univ. Southern California Sch.
Med., Los Angeles, CA, United States.
CORRESPONDENCE ADDRESS
A.A. Salvucci Jr., Department of Emergency Medicine, Los Angeles County USC
Med. Ctr., Univ. Southern California Sch. Med., Los Angeles, CA, United
States.
SOURCE
Annals of Emergency Medicine (1995) 25:5 (719-720). Date of Publication:
1995
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug administration, drug therapy, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
respiration depression (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
case report
drug absorption
emergency treatment
human
injection
intravenous drug administration
letter
male
priority journal
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1995137694
MEDLINE PMID
7741359 (http://www.ncbi.nlm.nih.gov/pubmed/7741359)
PUI
L25136278
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1373
TITLE
Use of capture-recapture to estimate the prevalence of opiate addiction in
Barcelona, Spain, 1989
AUTHOR NAMES
Domingo-Salvany A.
Hartnoll R.L.
Maguire A.
Suelves J.M.
Anto J.M.
AUTHOR ADDRESSES
(Domingo-Salvany A.; Hartnoll R.L.; Maguire A.; Suelves J.M.; Anto J.M.)
Inst. Municipal d'Investigacio Med., Dr. Aiguader, 80, 08004 Barcelona,
Spain.
CORRESPONDENCE ADDRESS
A. Domingo-Salvany, Inst. Municipal d'Investigacio Med., Dr. Aiguader, 80,
08004 Barcelona, Spain.
SOURCE
American Journal of Epidemiology (1995) 141:6 (567-574). Date of
Publication: 1995
ISSN
0002-9262
BOOK PUBLISHER
Oxford University Press, Great Clarendon Street, Oxford, United Kingdom.
ABSTRACT
It is difficult to obtain accurate prevalence estimates of opiate addiction
with direct methods. The capture-recapture method has been used to estimate
the prevalence of hidden populations, including opiate addicts. In this
study, we applied capture-recapture, including log-linear modeling, to
estimate the prevalence of opiate addicts in Barcelona, Spain. Anonymous
identification data from three 1989 sources (hospital emergency rooms,
treatment admissions, and heroin overdose deaths) in Barcelona were used to
obtain population samples. For prevalence estimation, two strategies were
followed: 1) emergency room data only, divided into trimesters; and 2) all
three sources used simultaneously. Estimates based only on emergency room
data were lower than estimates obtained by the simultaneous analysis of all
three data sources; the latter estimates gave narrower confidence intervals
(6,324-7,414 addicts), giving a prevalence for Barcelona in 1989 of between
8.5 and 9.9 opiate addicts per 1,000 residents aged 15-44 years. The
estimated prevalence varied by sex and age group and was highest in males
aged 15-29 years (between 17.1 and 21.2). At least 42% had contacted one or
more of the services studied, although only one in seven had been admitted
for treatment during 1989. Capture-recapture is the election method for
prevalence estimation when direct methods are not feasible.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
diamorphine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
opiate addiction (epidemiology)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
drug dependence treatment
drug overdose (epidemiology)
emergency ward
female
human
major clinical study
male
narcotic dependence (epidemiology)
prevalence
Spain
substance abuse
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995101747
MEDLINE PMID
7900724 (http://www.ncbi.nlm.nih.gov/pubmed/7900724)
PUI
L25100339
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1374
TITLE
Comparison of adverse drug reactions detected by pharmacy and medical
records departments
AUTHOR NAMES
Johnstone D.M.
Kirking D.M.
Vinson B.E.
AUTHOR ADDRESSES
(Johnstone D.M.; Kirking D.M.; Vinson B.E.) Pharmaceutical Services
Department, Michigan Capital Medical Center, Lansing, MI 48910, United
States.
CORRESPONDENCE ADDRESS
D.M. Johnstone, Pharmaceutical Services Department, Michigan Capital Medical
Center, Lansing, MI 48910, United States.
SOURCE
American Journal of Health-System Pharmacy (1995) 52:3 (297-301). Date of
Publication: 1995
ISSN
1079-2082
BOOK PUBLISHER
American Society of Health-Systems Pharmacy, 7272 Wisconsin Ave., Bethesda,
United States.
ABSTRACT
Adverse drug reactions (ADRs) detected by the pharmacy and medical records
departments of a multispecialty teaching hospital were studied. The charts
of all adult patients who were identified by the pharmacy or medical records
departments as having had an ADR and who were discharged from the hospital
between July and September 1990 were reviewed. Data on patient demographics
and the characteristics of the ADRs were collected, and the causality and
severity of each ADR were assessed by two pharmacists and one physician. A
total of 110 charts representing 117 ADRs were reviewed. Twenty-five (21%)
of the ADRs were identified by the pharmacy department and 101 (86%) by the
medical records department; 9 (8%) were reported by both departments. The
pharmacy and medical records groups of patients were demographically
similar, except that the percentage of patients admitted through the
emergency room was significantly smaller for the pharmacy department group.
ADRs identified by the pharmacy were most commonly cutaneous, and those
identified by medical records were most commonly neurologic. For the
pharmacy department, hypersensitivity reactions accounted for the largest
number of ADRs, while for medical records the largest number involved
abnormal laboratory test values. Anti-infectives were involved in two thirds
of the pharmacy- identified ADRs, compared with only a fifth of the ADRs
identified by medical records. Mean causality and severity scores did not
differ significantly between the groups. The medical records department
identified four times as many ADRs as the pharmacy department. Observed
differences in the number and types of reactions, manifestations, patient
locations, and suspected drugs probably reflect the different surveillance
methods and ADR definitions used by the two departments.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antihistaminic agent (adverse drug reaction)
antiinfective agent (adverse drug reaction)
cardiovascular agent (adverse drug reaction)
central nervous system agents (adverse drug reaction)
hormone (adverse drug reaction)
EMTREE DRUG INDEX TERMS
antiasthmatic agent (adverse drug reaction)
anticoagulant agent (adverse drug reaction)
antidote (drug therapy)
antineoplastic agent (adverse drug reaction)
benzatropine mesilate (drug therapy)
diagnostic agent (adverse drug reaction)
dipeptidyl carboxypeptidase inhibitor (adverse drug reaction)
diphenhydramine (drug therapy)
diphenoxylate (drug therapy)
epinephrine (drug therapy)
erythromycin (adverse drug reaction)
hydrocortisone (drug therapy)
kaolin (drug therapy)
naloxone (drug therapy)
nonsteroid antiinflammatory agent (adverse drug reaction)
pectin (drug therapy)
polystyrenesulfonate sodium (drug therapy)
vancomycin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dermatitis (diagnosis, drug therapy, side effect)
drug hypersensitivity (diagnosis, drug therapy, side effect)
medical record
neurologic disease (diagnosis, drug therapy, side effect)
pharmacy
EMTREE MEDICAL INDEX TERMS
adult
article
emergency ward
female
gastrointestinal symptom (side effect)
human
hypotension (side effect)
major clinical study
male
patient monitoring
priority journal
software
teaching hospital
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
benzatropine mesilate (132-17-2)
diphenhydramine (147-24-0, 58-73-1)
diphenoxylate (3810-80-8, 915-30-0)
erythromycin (114-07-8, 70536-18-4)
hydrocortisone (50-23-7)
kaolin (1332-58-7)
naloxone (357-08-4, 465-65-6)
pectin (9000-69-5)
polystyrenesulfonate sodium (37349-16-9, 39291-70-8, 62744-35-8, 9080-79-9)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995077699
MEDLINE PMID
7749958 (http://www.ncbi.nlm.nih.gov/pubmed/7749958)
PUI
L25076300
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1375
TITLE
Status epilepticus in children
AUTHOR NAMES
Roberts M.R.
Eng-Bourquin J.
AUTHOR ADDRESSES
(Roberts M.R.; Eng-Bourquin J.) 6301 Pine Hollow Drive, East Lansing, MI
48823, United States.
CORRESPONDENCE ADDRESS
M.R. Roberts, 6301 Pine Hollow Drive, East Lansing, MI 48823, United States.
SOURCE
Emergency Medicine Clinics of North America (1995) 13:2 (489-507). Date of
Publication: 1995
ISSN
0733-8627 (electronic)
0733-8627
BOOK PUBLISHER
W.B. Saunders
ABSTRACT
The emergency physician caring for children should have a thorough
understanding of all aspects of SE. The morbidity and mortality attributable
to this condition can be minimized through rapid recognition of the
disorder, a rational therapeutic and diagnostic plan, and recognition and
management of typical complications. Promising developments include new
drugs, such as the phenytoin prodrug and the use of newer dosing methods and
routes of administration for current drugs, such as very high-dose
phenobarbital, thiopental barbiturate coma, and continuously infused
midazolam.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anticonvulsive agent (adverse drug reaction, drug administration, drug
combination, drug comparison, drug dose, drug therapy)
benzodiazepine derivative (adverse drug reaction, drug administration, drug
combination, drug comparison, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
4 aminobutyric acid (endogenous compound)
chloral hydrate (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy)
diazepam (adverse drug reaction, drug administration, drug combination, drug
comparison, drug dose, drug therapy, pharmacokinetics)
fosphenytoin sodium (adverse drug reaction, drug comparison, drug therapy,
pharmacokinetics)
gluconate calcium (drug dose, drug therapy)
lidocaine (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
lorazepam (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
magnesium sulfate (drug dose, drug therapy)
midazolam (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
naloxone (drug therapy)
paraldehyde (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
pentobarbital (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy)
phenobarbital (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy)
phenytoin (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
thiopental (adverse drug reaction, drug combination, drug comparison, drug
dose, drug therapy)
valproic acid (adverse drug reaction, drug combination, drug comparison,
drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
epileptic state (diagnosis, drug therapy, etiology, prevention, therapy)
EMTREE MEDICAL INDEX TERMS
anticonvulsant therapy
bradycardia (side effect)
clinical feature
disease classification
drowsiness (side effect)
electroencephalogram
emergency treatment
febrile convulsion (diagnosis, etiology)
heart arrhythmia (side effect)
human
hypotension (side effect)
intramuscular drug administration
intraosseous drug administration
intravenous drug administration
Lennox Gastaut syndrome (diagnosis, etiology)
liver toxicity
newborn period
onset age
pathophysiology
priority journal
rectal drug administration
respiration depression (side effect)
review
DRUG TRADE NAMES
acc 9653
CAS REGISTRY NUMBERS
4 aminobutyric acid (28805-76-7, 56-12-2)
chloral hydrate (302-17-0)
diazepam (439-14-5)
fosphenytoin sodium (92134-98-0)
gluconate calcium (299-28-5)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
magnesium sulfate (7487-88-9)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
paraldehyde (123-63-7)
pentobarbital (57-33-0, 76-74-4)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
thiopental (71-73-8, 76-75-5)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995158037
MEDLINE PMID
7737031 (http://www.ncbi.nlm.nih.gov/pubmed/7737031)
PUI
L25156319
COPYRIGHT
Copyright 2014 Elsevier B.V., All rights reserved.
RECORD 1376
TITLE
Emergency alternatives to intravenous access: Intraosseous, intratracheal,
sublingual, and other-site drug administration
AUTHOR NAMES
Orlowski J.P.
AUTHOR ADDRESSES
(Orlowski J.P.) Pediatric Intensive Care Unit, University Community
Hospital, 3100 East Fletcher Avenue, Tampa, FL 33613-4688, United States.
CORRESPONDENCE ADDRESS
J.P. Orlowski, Pediatric Intensive Care Unit, University Community Hospital,
3100 East Fletcher Avenue, Tampa, FL 33613-4688, United States.
SOURCE
Pediatric Clinics of North America (1994) 41:6 (1183-1199). Date of
Publication: 1994
ISSN
0031-3955
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Difficulties and delays in establishing intravenous access are not uncommon
in emergency situations in pediatrics. Alternatives to venous cannulation
exist, including intraosseous access, intratracheal drug administration,
sublingual and intralingual injection, the intrapenile route, and
intracardiac injection. Each of these emergency alternatives to intravenous
access is discussed from the historical, technical, utilitarian, and
risk-benefit aspects. It is concluded that the intraosseous effective
alternative to intravenous access in emergency situations.
EMTREE DRUG INDEX TERMS
atropine (drug administration)
bicarbonate (drug administration)
calcium chloride (drug administration)
diazepam (drug administration)
dobutamine (drug administration)
dopamine (drug administration)
epinephrine (drug administration)
isoprenaline (drug administration)
lidocaine (drug administration)
midazolam (drug administration)
naloxone (drug administration)
propranolol (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug delivery system
emergency treatment
EMTREE MEDICAL INDEX TERMS
child
critical illness
drug administration
emergency medicine
extravasation (complication)
fracture (complication)
human
injection site
intraosseous drug administration
intratracheal drug administration
lung embolism (complication)
osteomyelitis (complication)
pediatrics
review
sublingual drug administration
vascular access
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994376540
MEDLINE PMID
7984381 (http://www.ncbi.nlm.nih.gov/pubmed/7984381)
PUI
L24373653
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1377
TITLE
Does naloxone cause a positive urine opiate screen?
AUTHOR NAMES
Storrow A.B.
Wians Jr. F.H.
Mikkelsen S.L.
Norton J.
AUTHOR ADDRESSES
(Storrow A.B.; Wians Jr. F.H.; Mikkelsen S.L.; Norton J.) Department of
Emergency Medicine, Wilford Hall Medical Center/PSAE, 2200 Bergquist Drive,
San Antonio, TX 78236-5300, United States.
CORRESPONDENCE ADDRESS
A.B. Storrow, Department of Emergency Medicine, Wilford Hall Medical
Center/PSAE, 2200 Bergquist Drive, San Antonio, TX 78236-5300, United
States.
SOURCE
Annals of Emergency Medicine (1994) 24:6 (1151-1153). Date of Publication:
1994
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To determine whether the excreted metabolites of naloxone
hydrochloride cause positive urine toxicologic screens for opiates. Design:
Prospective, randomized, double-blinded human protocol. Setting: Urban Level
I military emergency department. Participants: Fourteen adult volunteers who
took no routine medications, were not pregnant, had no known sensitivity to
naloxone, and who were negative for a pretest urine and serum toxicologic
screen. Interventions: We administered either 2 or 4 mg IV naloxone to 14
subjects. Urine drug screening was obtained before administration and at 60
minutes, 6 hours, and 48 hours after administration. Results: All urine drug
screens using the enzyme-multiplied immunoassay technique were negative for
opiates at both dosage levels. The sample size of 14 yielded a power of more
than .99 to detect the difference between positive and negative samples.
Conclusion: Although the metabolites of naloxone hydrochloride are similar
in structure to oxymorphone and are excreted in human urine for several
days, naloxone was not associated with a positive enzymatic urine screen for
opiates.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (clinical trial, drug analysis, drug dose, pharmacokinetics)
opiate (clinical trial, drug concentration, pharmacokinetics)
oxymorphone (drug analysis)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug screening
drug urine level
EMTREE MEDICAL INDEX TERMS
adult
article
clinical trial
controlled clinical trial
controlled study
double blind procedure
drug structure
enzyme multiplied immunoassay technique
human
human experiment
intravenous drug administration
normal human
priority journal
prospective study
randomized controlled trial
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxymorphone (357-07-3, 76-41-5)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994373123
MEDLINE PMID
7978599 (http://www.ncbi.nlm.nih.gov/pubmed/7978599)
PUI
L24368155
DOI
10.1016/S0196-0644(94)70247-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(94)70247-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1378
TITLE
A comprehensive review of naloxone for the emergency physician
AUTHOR NAMES
Chamberlain J.M.
Klein B.L.
AUTHOR ADDRESSES
(Chamberlain J.M.; Klein B.L.) Emergency Medical Trauma Center, Children's
National Medical Center, George Washington Univ. Sch. of Med., Washington,
DC, United States.
CORRESPONDENCE ADDRESS
J.M. Chamberlain, Emergency Medical Trauma Center, Children's National
Medical Center, George Washington Univ. Sch. of Med., Washington, DC, United
States.
SOURCE
American Journal of Emergency Medicine (1994) 12:6 (650-660). Date of
Publication: 1994
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Naloxone has enjoyed long-standing success as a safe and effective opioid
antagonist and has been invaluable in defining the role of endogenous opioid
pathways in the response to pathological states such as sepsis and
hypovolemia. We look forward to exciting research to further elucidate these
pathways and to improve outcome by modulating the patient's physiological
response to these stresses.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug dose, drug therapy, pharmacokinetics,
pharmacology)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
benzodiazepine derivative (drug toxicity)
clonidine (drug toxicity)
narcotic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (drug therapy)
asphyxia (drug therapy)
drug overdose (drug therapy)
shock (drug therapy)
EMTREE MEDICAL INDEX TERMS
dose response
drug activity
drug efficacy
drug mechanism
drug metabolism
drug safety
fetus disease (drug therapy)
hemorrhagic shock (drug therapy)
human
hypertension (side effect)
intramuscular drug administration
intravenous drug administration
newborn disease (drug therapy)
pain (side effect)
priority journal
review
septic shock (drug therapy)
somnolence (side effect)
spinal cord injury (drug therapy)
supraventricular tachycardia (side effect)
CAS REGISTRY NUMBERS
alcohol (64-17-5)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Pediatrics and Pediatric Surgery (7)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994361958
MEDLINE PMID
7945608 (http://www.ncbi.nlm.nih.gov/pubmed/7945608)
PUI
L24358917
DOI
10.1016/0735-6757(94)90033-7
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(94)90033-7
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1379
TITLE
Psychiatric medications for deployment
AUTHOR NAMES
Ritchie E.C.
AUTHOR ADDRESSES
(Ritchie E.C.) Department of Psychiatry, Walter Reed Army Medical Center,
Washington, DC 20307-5001, United States.
CORRESPONDENCE ADDRESS
E.C. Ritchie, Department of Psychiatry, Walter Reed Army Medical Center,
Washington, DC 20307-5001, United States.
SOURCE
Military Medicine (1994) 159:10 (647-649). Date of Publication: 1994
ISSN
0026-4075
BOOK PUBLISHER
Association of Military Surgeons of the US, 9320 Old Georgetown Road,
Bethesda, United States.
ABSTRACT
Standard medical sick-call chests used in the military contain either
outdated or no psychiatric medications. Yet certain psychiatric medications
are either useful or essential for the field and deployment. This article
discusses suitable medications for both psychiatric emergencies and for
chronic treatment of depression or anxiety. Psychiatric medications to avoid
in deployment are also listed. Some dosing guidelines are provided. The
article ends with a proposed 'psychiatric sick-call chest' to be prepared in
advance of deployment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidepressant agent (drug therapy)
anxiolytic agent (drug therapy)
benzodiazepine derivative (drug therapy)
lithium
neuroleptic agent (drug therapy)
sedative agent (drug therapy)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon
benzatropine mesilate (drug therapy)
buspirone (drug therapy)
carbamazepine
chlorpromazine (adverse drug reaction, drug therapy)
diazepam (drug therapy)
diphenhydramine (drug therapy)
fluoxetine (drug therapy)
haloperidol (drug therapy)
ipecac
lorazepam (drug therapy)
monoamine oxidase inhibitor
naloxone
paracetamol (drug toxicity)
paroxetine (drug therapy)
serotonin uptake inhibitor (drug therapy)
sertraline (drug therapy)
temazepam (drug therapy)
trazodone (drug therapy)
triazolam (drug therapy)
tricyclic antidepressant agent (drug therapy)
unindexed drug
valproate semisodium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
mental disease
military medicine
EMTREE MEDICAL INDEX TERMS
agitation
alcohol withdrawal syndrome
anticholinergic effect
anxiety
article
drug overdose (drug therapy)
extrapyramidal symptom (drug therapy)
human
hypotension (side effect)
insomnia (drug therapy)
intramuscular drug administration
intravenous drug administration
oral drug administration
psychosis (drug therapy)
sedation
DRUG TRADE NAMES
ativan
benadryl
buspar
cogentin
depakote
desyrel
halcion
haldol
mucomyst
narcan
paxil
prozac
restoril
tegretol
thorazine
tylenol
valium
zoloft
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
benzatropine mesilate (132-17-2)
buspirone (33386-08-2, 36505-84-7)
carbamazepine (298-46-4, 8047-84-5)
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
fluoxetine (54910-89-3, 56296-78-7, 59333-67-4)
haloperidol (52-86-8)
ipecac (8012-96-2)
lithium (7439-93-2)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
paroxetine (61869-08-7)
sertraline (79617-96-2)
temazepam (846-50-4)
trazodone (19794-93-5, 25332-39-2)
triazolam (28911-01-5)
valproate semisodium (76584-70-8)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1995024569
MEDLINE PMID
7870322 (http://www.ncbi.nlm.nih.gov/pubmed/7870322)
PUI
L25023295
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1380
TITLE
Fatal seizures after flumazenil administration in a patient with mixed
overdose
AUTHOR NAMES
Haverkos G.P.
DiSalvo R.P.
Imhoff T.E.
AUTHOR ADDRESSES
(Haverkos G.P.; DiSalvo R.P.; Imhoff T.E.) Department of Pharmacy, Good
Samaritan Hospital, 375 Dixmyth Ave., Cincinnati, OH 45220, United States.
CORRESPONDENCE ADDRESS
G.P. Haverkos, Department of Pharmacy, Good Samaritan Hospital, 375 Dixmyth
Ave., Cincinnati, OH 45220, United States.
SOURCE
Annals of Pharmacotherapy (1994) 28:12 (1347-1349). Date of Publication:
1994
ISSN
1060-0280
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
OBJECTIVE: To report a fatal case of refractory status epilepticus
precipitated by flumazenil use in a mixed benzodiazepine-tricyclic
antidepressant overdose. CASE SUMMARY: A 39-year-old woman was brought to
the emergency room (ER) in a stupor from a suspected suicidal overdose of an
unknown mixture of drugs. Past medical history included seizures and
psychiatric disorders managed with benzodiazepine and tricyclic
antidepressants. Initial ER electrocardiogram showed a QRS interval of 136
milliseconds. The patient developed refractory seizures after being given
flumazenil. Lorazepam, phenytoin, and phenobarbital were administered;
however, seizures persisted for 4 hours, resulting in rhabdomyolysis, acute
renal failure, severe brain damage, and death. DISCUSSION: Flumazenil should
be used with caution in patients with chronic benzodiazepine use, prior
seizure history, or when a mixed overdose is suspected. Flumazenil may
unmask tricyclic antidepressant-induced seizures by antagonizing the
antiepileptic effect or concomitantly ingested benzodiazepine. In this
patient seizures occurred within two minutes of flumazenil administration.
As benzodiazepine- induced central nervous system depression is rarely
life-threatening, the use of flumazenil must be balanced against potential
risk. CONCLUSIONS: Seizure risk factors should be assessed in all patients
in whom flumazenil use is considered. If risk factors are present, the
benefit of flumazenil use is outweighed by the potential risk. If flumazenil
is used, resulting seizures may require larger doses of benzodiazepine.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
clonazepam (drug therapy, drug toxicity)
diazepam (drug therapy, drug toxicity)
doxepin (drug therapy, drug toxicity)
flumazenil (adverse drug reaction, drug administration, drug dose, drug
therapy)
EMTREE DRUG INDEX TERMS
benzodiazepine derivative (drug therapy, drug toxicity)
bicarbonate (drug dose, drug therapy)
dopamine (drug therapy)
epinephrine (drug therapy)
lorazepam (drug administration, drug dose, drug therapy)
naloxone (drug administration, drug dose, drug therapy)
phenobarbital (drug administration, drug dose, drug therapy)
phenytoin (drug administration, drug dose, drug therapy)
tricyclic antidepressant agent (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
depression (drug therapy)
drug overdose (drug therapy)
epileptic state (side effect)
EMTREE MEDICAL INDEX TERMS
acute kidney failure (complication)
adult
article
brain injury (complication)
case report
clinical feature
coma
dose response
female
human
intravenous drug administration
priority journal
rhabdomyolysis (complication)
seizure (drug therapy)
sleep disorder (drug therapy)
stupor
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
clonazepam (1622-61-3)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
doxepin (1229-29-4, 1668-19-5)
flumazenil (78755-81-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, Spanish, French
EMBASE ACCESSION NUMBER
1995017627
MEDLINE PMID
7696723 (http://www.ncbi.nlm.nih.gov/pubmed/7696723)
PUI
L25016358
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1381
TITLE
Thoracolumbar spine fractures with neurologic deficit
AUTHOR NAMES
Chapman J.R.
Anderson P.A.
AUTHOR ADDRESSES
(Chapman J.R.; Anderson P.A.) Department of Orthopaedic Surgery, Harborview
Medical Center, 325 Ninth Avenue, Seattle, WA 98104, United States.
CORRESPONDENCE ADDRESS
J.R. Chapman, Department of Orthopaedic Surgery, Harborview Medical Center,
325 Ninth Avenue, Seattle, WA 98104, United States.
SOURCE
Orthopedic Clinics of North America (1994) 25:4 (595-612). Date of
Publication: 1994
ISSN
0030-5898
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The prognosis of patients with thoracolumbar spine fractures and neurologic
deficits has improved in terms of survival and quality of life since
principles of timely fracture reduction, decompression, and stabilization
have been implemented. In patients with incomplete spinal cord injuries,
acute intervention has been shown to lead to improved neurologic recovery
rates. The type of surgical treatment and timing depends upon the fracture
type and neurologic status of the patient.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methylprednisolone (clinical trial, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
ganglioside (drug therapy)
lazaroid (drug therapy)
naloxone (clinical trial, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fracture treatment
neurologic disease (complication, diagnosis, etiology, surgery)
spinal cord injury (complication, diagnosis, drug therapy, etiology,
surgery)
spine fracture (diagnosis, surgery)
thoracolumbar spine
EMTREE MEDICAL INDEX TERMS
anterior spine fusion
clinical trial
complication
computer assisted tomography
devices
disease classification
drug megadose
emergency treatment
fracture dislocation
fracture fixation
fracture immobilization
human
nonhuman
nuclear magnetic resonance imaging
priority journal
review
spinal cord compression (complication, diagnosis, etiology, surgery)
spinal cord decompression
spine radiography
surgery
CAS REGISTRY NUMBERS
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Orthopedic Surgery (33)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994315795
MEDLINE PMID
8090473 (http://www.ncbi.nlm.nih.gov/pubmed/8090473)
PUI
L24319252
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1382
TITLE
Endobronchial administration of drugs. Technique and value in emergency
medicine
ORIGINAL (NON-ENGLISH) TITLE
ENDOBRONCHIALE MEDIKAMENTENAPPLIKATION. TECHNIK UND STELLENWERT IN DER
NOTFALLMEDIZIN
AUTHOR NAMES
Zeisel U.
AUTHOR ADDRESSES
(Zeisel U.) Institut fur Anaesthesiologie, Universitat Wurzburg, Josef
Schneider Str. 2, D-97078 Wurzburg, Germany.
CORRESPONDENCE ADDRESS
U. Zeisel, Institut fur Anaesthesiologie, Universitat Wurzburg, Josef
Schneider Str. 2, D-97078 Wurzburg, Germany.
SOURCE
Notfall Medizin (1994) 20:9 (484-491). Date of Publication: 1994
ISSN
0341-2903
ABSTRACT
The aim of the present article is to summarize the current state of the art
of the endobronchial administration of drugs in emergencies. Although some
studies seem to question the benefit of this route of administration, its
efficacy appears largely to have been accepted in the literature. However,
differences in study design and methods of administration make a comparison
between studies difficult. A positive effect has so far been demonstrated
not only for adrenalin, but also for atropine and lidocaine. Diazepam and
naloxone have to date been administered in this way only to animals, and in
a few individual patients. To achieve a reliable effect, care must be taken
to ensure an adequate dosage, total volume, correct technique and to produce
a proper aerosol. If this is done, the physician has available to him an
effective tool which saves him time over the i.v. access, and may even be
the sole route for providing medication when the latter is not possible.
EMTREE DRUG INDEX TERMS
atropine (drug administration)
diazepam (drug administration)
epinephrine (drug administration)
lidocaine (drug administration)
naloxone (drug administration)
noradrenalin (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary arrest
resuscitation
EMTREE MEDICAL INDEX TERMS
emergency medicine
endobronchial intubation
human
intravenous drug administration
review
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
1994305941
PUI
L24306655
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1383
TITLE
Emergency admissions of opioid drug abusers for overdose: A chronobiological
study of enhanced risk
AUTHOR NAMES
Manfredini R.
Gallerani M.
Calo G.
Pasin M.
Govoni M.
Fersini C.
AUTHOR ADDRESSES
(Manfredini R.; Gallerani M.; Calo G.; Pasin M.; Govoni M.; Fersini C.)
Institute of Internal Medicine, University of Ferrara, Via Savonarola 9,
I-44100 Ferrara, Italy.
CORRESPONDENCE ADDRESS
R. Manfredini, Institute of Internal Medicine, University of Ferrara, Via
Savonarola 9, I-44100 Ferrara, Italy.
SOURCE
Annals of Emergency Medicine (1994) 24:4 (615-618). Date of Publication:
1994
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To determine whether there is a specific temporal risk for
opioid drug overdose. Design: To study patients presenting to the ED in a
comatose state from accidental drug opioid overdose. Participants: Two
hundred seventy-four patients were admitted to the ED of the Hospital of
Ferrara, Italy, from 1988 to 1990, 225 men (82.1%; mean age, 25±3.4 years)
and 49 women (17.9%; mean age, 23.5±2.8 years). Interventions: Month, day,
and hour and minute of admissions were recorded, and time-qualified
frequency data were analyzed by the single cosinor method. Results: Cosinor
analysis demonstrated a significant circadian rhythm for both the total
number of observations and the separate male and female subgroups with an
early evening peak ('acrophase') at about 7:00 PM. No significant circannual
rhythm was evident, but for the total group a significant 6-month rhythm was
demonstrable with peaks in late November and late May. Conclusion: There is
a distinct 'chronorisk' of opioid drug overdose in the early evening hours.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
opiate addiction
EMTREE MEDICAL INDEX TERMS
accident
adult
article
chronobiology
circadian rhythm
emergency ward
female
hospital admission
human
major clinical study
male
priority journal
risk
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994308766
MEDLINE PMID
8092587 (http://www.ncbi.nlm.nih.gov/pubmed/8092587)
PUI
L24302827
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1384
TITLE
Drug administration via the endobronchial route. Possibilities of drug
administration in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
Medikamentengabe über den endobronchialen Zugang. Möglichkeiten der
Applikation in der Notfallmedizin.
AUTHOR NAMES
Mielke L.
Entholzner E.
Hargasser S.
Hipp R.
AUTHOR ADDRESSES
(Mielke L.; Entholzner E.; Hargasser S.; Hipp R.)
CORRESPONDENCE ADDRESS
L. Mielke,
SOURCE
Fortschritte der Medizin (1994) 112:27 (377-380). Date of Publication: 30
Sep 1994
ISSN
0015-8178
ABSTRACT
For cardiopulmonary resuscitation, the endobronchial route represents a good
means of administering drugs with a systemic effect, such as adrenaline and
atropine, even without a venous line. Via this route, however, higher doses
are needed (2.5 times as much as those normally given intravenously). In
order to produce a larger surface area within the bronchio-alveolar space
and thus speed up absorption, the drugs are diluted in 5-10 ml solvent
(isotonic saline solution or distilled water). For endobronchial
administration of a drug, various techniques are employed, for example,
simply injecting it into the upper end of the (endotracheal) tube, puncture
of the tube the use of an application probe introduced into the
endobronchial tube, aspiration or venacaval catheter, or the EDGAR tube with
an injection needle incorporated within the tube wall. After injection, the
diluted medication is distributed into the tiny branches of the bronchial
tree by repeated hyperventilation. Despite the need for an adequate
alternative to the venous route in the field of cardiopulmonary
resuscitation, we still have very few reliable facts about the endobronchial
application technique.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug administration, pharmacokinetics)
epinephrine (drug administration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
diazepam (drug administration, pharmacokinetics)
lidocaine (drug administration, pharmacokinetics)
naloxone (drug administration, pharmacokinetics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
resuscitation
EMTREE MEDICAL INDEX TERMS
article
human
inhalational drug administration
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
German
MEDLINE PMID
7988973 (http://www.ncbi.nlm.nih.gov/pubmed/7988973)
PUI
L125007310
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1385
TITLE
Updated bedside charts for calculating pediatric doses of emergency
medications
AUTHOR NAMES
Campbell M.M.
Taeubel M.A.
Kraus D.M.
AUTHOR ADDRESSES
(Campbell M.M.; Taeubel M.A.; Kraus D.M.) Department of Pharmacy Practice,
College of Pharmacy, University of Illinois, 833 South Wood Street, Chicago,
IL 60612, United States.
CORRESPONDENCE ADDRESS
D.M. Kraus, Department of Pharmacy Practice, College of Pharmacy, University
of Illinois, 833 South Wood Street, Chicago, IL 60612, United States.
SOURCE
American Journal of Hospital Pharmacy (1994) 51:17 (2147-2152). Date of
Publication: 1994
ISSN
0002-9289
BOOK PUBLISHER
American Society of Health-Systems Pharmacy, 7272 Wisconsin Ave., Bethesda,
United States.
EMTREE DRUG INDEX TERMS
adenosine (drug dose)
atropine (drug dose)
bicarbonate (drug dose)
calcium chloride (drug dose)
epinephrine (drug dose)
glucose (drug dose)
naloxone (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dose calculation
emergency treatment
pediatrics
EMTREE MEDICAL INDEX TERMS
clinical pharmacy
human
intensive care
note
priority journal
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1994277601
MEDLINE PMID
7985691 (http://www.ncbi.nlm.nih.gov/pubmed/7985691)
PUI
L24279985
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1386
TITLE
Initial resuscitation and vascular access
AUTHOR NAMES
Rieger A.
Berman J.M.
Striebel H.W.
AUTHOR ADDRESSES
(Rieger A.; Berman J.M.; Striebel H.W.) Anesthesio./Critical Care Med.
Dept., University Medical Center, Steglitz, Berlin, Germany.
CORRESPONDENCE ADDRESS
A. Rieger, Anesthesio./Critical Care Med. Dept., University Medical Center,
Steglitz, Berlin, Germany.
SOURCE
International Anesthesiology Clinics (1994) 32:1 (47-77). Date of
Publication: 1994
ISSN
0020-5907
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug administration)
epinephrine (drug administration)
ketamine (drug dose, pharmacology)
lidocaine (drug administration)
naloxone (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
childhood injury (epidemiology)
pediatric anesthesia
resuscitation
vascular access
EMTREE MEDICAL INDEX TERMS
abdominal blunt trauma
age
arterial pressure
artificial ventilation
central venous catheter
child
electrocardiogram
emergency ward
endobronchial intubation
epidemiology
falling
heart arrest
hemodynamics
human
injury scale
intraosseous drug administration
intravenous drug administration
primary medical care
priority journal
pulse oximetry
review
thorax injury
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1994268254
MEDLINE PMID
8144254 (http://www.ncbi.nlm.nih.gov/pubmed/8144254)
PUI
L24266398
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1387
TITLE
Guidelines for the management of patients with acute ischemic stroke: A
statement for healthcare professionals from a special writing group of the
stroke council, American Heart Association
AUTHOR NAMES
Adams Jr. H.P.
Brott T.G.
Crowell R.M.
Furlan A.J.
Gomez C.R.
Grotta J.
Helgason C.M.
Marler J.R.
Woolson R.F.
Zivin J.A.
Feinberg W.
Mayberg M.
AUTHOR ADDRESSES
(Adams Jr. H.P.; Brott T.G.; Crowell R.M.; Furlan A.J.; Gomez C.R.; Grotta
J.; Helgason C.M.; Marler J.R.; Woolson R.F.; Zivin J.A.; Feinberg W.;
Mayberg M.) Office of Scientific Affairs, American Heart Association, 7272
Greenville Ave, Dallas, TX 75231-4596, United States.
(Adams Jr. H.P.; Brott T.G.; Crowell R.M.; Furlan A.J.; Gomez C.R.; Grotta
J.; Helgason C.M.; Marler J.R.; Woolson R.F.; Zivin J.A.; Feinberg W.;
Mayberg M.)
CORRESPONDENCE ADDRESS
H.P. Adams Jr., Office of Scientific Affairs, American Heart Association,
7272 Greenville Ave, Dallas, TX 75231-4596, United States.
SOURCE
Circulation (1994) 90:3 (1588-1601). Date of Publication: September 1994
ISSN
0009-7322
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
21 aminosteroid (pharmacology)
anticonvulsive agent (drug administration, drug dose, drug therapy)
danaparoid (drug therapy)
dextrorphan (pharmacology)
fibrinolytic agent (adverse drug reaction, drug therapy)
furosemide (drug administration, drug dose, drug therapy, pharmacology)
heparin (adverse drug reaction, drug therapy)
mannitol (drug administration, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
4 phosphonomethylpipecolic acid (pharmacology)
adenosine (endogenous compound)
amphetamine derivative
anticoagulant agent (adverse drug reaction)
antihypertensive agent (drug administration, drug therapy)
antipyretic agent (drug therapy)
arachidonic acid (endogenous compound)
barbituric acid derivative
calcium antagonist (drug administration, pharmacokinetics)
captopril (drug administration, drug therapy)
diuretic agent (drug therapy)
electrolyte (endogenous compound)
enalapril (drug therapy)
glucose (endogenous compound)
haloperidol
hypertensive agent (drug therapy)
labetalol (drug therapy)
naloxone
nicardipine (drug administration, drug therapy)
nimodipine
oxygen
unindexed drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cerebrovascular accident (diagnosis, drug therapy)
health care personnel
EMTREE MEDICAL INDEX TERMS
article
brain edema (complication, drug therapy, surgery, therapy)
brain hemorrhage (diagnosis, side effect)
clinical trial
computer assisted tomography
controlled clinical trial
controlled study
emergency health service
health care cost
health care quality
hemodilution
human
hydrocephalus (surgery)
hypertension (complication, diagnosis, drug therapy, therapy)
hypotension (drug therapy, side effect, therapy)
intraarterial drug administration
intracranial hypertension (complication)
intravenous drug administration
nonhuman
oral drug administration
organization
priority journal
randomized controlled trial
seizure (drug therapy)
subcutaneous drug administration
sublingual drug administration
thrombosis (diagnosis, drug therapy, prevention, therapy)
DRUG TRADE NAMES
cgs 19755
org 10172
CAS REGISTRY NUMBERS
4 phosphonomethylpipecolic acid (110347-85-8)
adenosine (58-61-7)
arachidonic acid (506-32-1, 6610-25-9, 7771-44-0)
captopril (62571-86-2)
danaparoid (83513-48-8)
dextrorphan (125-73-5, 143-98-6)
enalapril (75847-73-3)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
haloperidol (52-86-8)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
labetalol (32780-64-6, 36894-69-6)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
nicardipine (54527-84-3, 55985-32-5)
nimodipine (66085-59-4)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Radiology (14)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1994288691
MEDLINE PMID
8087974 (http://www.ncbi.nlm.nih.gov/pubmed/8087974)
PUI
L24284492
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1388
TITLE
Cyanide overdose: Survival with fatal blood concentration without antidotal
therapy
AUTHOR NAMES
Saincher A.
AUTHOR ADDRESSES
(Saincher A.) Children's Hospital, 840 Sherbrook Street, Winnipeg, Man.,
Canada.
CORRESPONDENCE ADDRESS
M. Tenenbein, Children's Hospital, 840 Sherbrook Street, Winnipeg, Man. R3A
1S1, Canada.
SOURCE
Journal of Emergency Medicine (1994) 12:4 (555-557). Date of Publication:
1994
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
Cyanide poisoning is an uncommon emergency department problem. It has a high
mortality, and specific antidotal therapy can be lifesaving. We describe a
23-year-old man who ingested potassium cyanide and survived without
antidotal therapy. His blood cyanide concentration was 4.65 mg/L, which is
within the lethal range. The arterial venous oxygen saturation gradient was
considered in the decision regarding antidote administration. Our experience
underscores the importance of supportive care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
potassium cyanide (drug toxicity)
thiosulfate
EMTREE DRUG INDEX TERMS
creatine kinase (endogenous compound)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cyanide poisoning (therapy)
EMTREE MEDICAL INDEX TERMS
adult
antibiotic therapy
arterial gas
blood gas analysis
case report
clinical feature
diuresis
glucose blood level
human
kidney function test
male
oxygen consumption
oxygen saturation
priority journal
review
rhabdomyolysis (complication)
CAS REGISTRY NUMBERS
creatine kinase (9001-15-4)
naloxone (357-08-4, 465-65-6)
potassium cyanide (151-50-8)
thiosulfate (14383-50-7)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994245229
MEDLINE PMID
7963405 (http://www.ncbi.nlm.nih.gov/pubmed/7963405)
PUI
L24243057
DOI
10.1016/0736-4679(94)90359-X
FULL TEXT LINK
http://dx.doi.org/10.1016/0736-4679(94)90359-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1389
TITLE
Treatment of more frequent mediament poisoning in the pediatric patient
ORIGINAL (NON-ENGLISH) TITLE
TRATAMIENTO DE LAS INTOXICACIONES PEDIATRICAS MEDICAMENTOSAS MAS FRECUENTES
AUTHOR NAMES
Andres Martin A.
Bedoya Perez R.
Andres Martin M.C.
AUTHOR ADDRESSES
(Andres Martin A.; Bedoya Perez R.; Andres Martin M.C.) C/Marques del
Nervion 23, 41005 Sevilla, Spain.
CORRESPONDENCE ADDRESS
A. Andres Martin, C/Marques del Nervion 23, 41005 Sevilla, Spain.
SOURCE
Pediatrika (1994) 14:2 (59-67). Date of Publication: 1994
ISSN
0211-3465
ABSTRACT
Acute poisoning is an important chapter in emergency words in hospitals.
They appear frequently and the pediatrician is faced more often with
intoxications produced by new products with strange compositions and
difficult to find out. Based on the author's experience and after consulting
the available bibliography we have made general treatment rules to follow in
the most frequent drug poisoning.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug toxicity)
barbituric acid derivative (drug toxicity)
codeine (drug toxicity)
diphenoxylate (drug toxicity)
neuroleptic agent (drug toxicity)
paracetamol (drug toxicity)
salicylic acid (drug toxicity)
theophylline (drug toxicity)
tranquilizer (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
antiarrhythmic agent (drug therapy)
antidote (drug therapy)
antihistaminic agent (drug therapy)
bicarbonate (drug therapy)
biperiden (drug therapy)
corticosteroid (drug therapy)
diazepam (drug therapy)
diuretic agent (drug therapy)
gluconate calcium (drug therapy)
glucose (drug therapy)
hydrocortisone (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
physostigmine (drug therapy)
pilocarpine (drug therapy)
propranolol (drug therapy)
unindexed drug
verapamil (drug therapy)
vitamin K group (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
child
diuresis
emergency treatment
human
intravenous drug administration
oral drug administration
pediatrics
rehydration
review
vomiting
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
biperiden (1235-82-1, 514-65-8)
codeine (76-57-3)
diazepam (439-14-5)
diphenoxylate (3810-80-8, 915-30-0)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
physostigmine (57-47-6, 64-47-1)
pilocarpine (148-72-1, 54-71-7, 92-13-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
salicylic acid (63-36-5, 69-72-7)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
verapamil (152-11-4, 52-53-9)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
Spanish, English
EMBASE ACCESSION NUMBER
1994232328
PUI
L24232853
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1390
TITLE
The effectiveness of surgery on the treatment of acute spinal cord injury
and its relation to pharmacological treatment
AUTHOR NAMES
Duh M.-S.
Shepard M.J.
Wilberger J.E.
Bracken M.B.
Tator C.H.
Marshall L.F.
AUTHOR ADDRESSES
(Duh M.-S.; Shepard M.J.; Wilberger J.E.; Bracken M.B.; Tator C.H.; Marshall
L.F.) Dept. of Epidemiology/Public Health, Yale Medical School, 60 College
Street, New Haven, CT 06520-8034, United States.
CORRESPONDENCE ADDRESS
M.B. Bracken, Dept. of Epidemiology/Public Health, Yale Medical School, 60
College Street, New Haven, CT 06520-8034, United States.
SOURCE
Neurosurgery (1994) 35:2 (240-249). Date of Publication: 1994
ISSN
0148-396X
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
USING DATA FROM the Second National Acute Spinal Cord Injury Study (NASCIS
II), the authors sought to characterize the role of surgery in the
management of traumatic spinal cord injury and to examine the interaction
between pharmacological treatment and surgery. Patients who did not undergo
surgery had more severe spinal cord injuries initially than those who had
surgery. However, no differences in neurological improvement at 1-year
follow-up were found between those who underwent surgery and those who did
not. The results suggest that either early surgery (≤ 25 hours after injury)
or late surgery (> 200 hours) may be associated with increased neurological
recovery, particularly motor function; but these results are equivocal.
Surgery was not shown to interact with pharmacological treatments,
indicating that the effect of drug treatment in NASCIS II, reported
elsewhere, is not influenced by surgery. Other independent variables that
best predicted improvement in motor score were age of 25 years or younger,
incomplete injury, and lower baseline emergency department neurological
scores. This study does not provide clinically relevant evidence concerning
the efficacy of timing or the value of surgery in treating patients with
spinal cord injuries. A randomized study on the timing and efficacy of
spinal cord surgery is needed to obtain valid comparisons of the efficacy of
surgical treatments.
EMTREE DRUG INDEX TERMS
methylprednisolone (drug comparison, drug therapy, pharmacology)
naloxone (drug comparison, drug therapy, pharmacology)
placebo (drug comparison)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
spinal cord injury (drug therapy, surgery)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
clinical trial
conservative treatment
controlled clinical trial
controlled study
disease severity
drug efficacy
human
laminectomy
major clinical study
male
motor performance
priority journal
randomized controlled trial
surgical approach
surgical technique
CAS REGISTRY NUMBERS
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994247375
MEDLINE PMID
7969831 (http://www.ncbi.nlm.nih.gov/pubmed/7969831)
PUI
L24236042
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1391
TITLE
Improve cardiac arrest outcomes
AUTHOR NAMES
Cohen A.D.
Baxter H.
AUTHOR ADDRESSES
(Cohen A.D.; Baxter H.) St James's University Hospital, Leeds, United
Kingdom.
CORRESPONDENCE ADDRESS
H. Baxter, St James's University Hospital, Leeds, United Kingdom.
SOURCE
Hospital Pharmacy Practice (1994) 4:5 (203-204+206). Date of Publication:
1994
ISSN
0962-9734
BOOK PUBLISHER
Medicom Group, Thameside House, Hurst Road,, Hampton Court, Surrey, United
Kingdom.
ABSTRACT
An audit of drugs used in cardiopulmonary resuscitation (CPR) was carried
out over a six month period. A prospective study examined cases of cardiac
arrests requiring CPR by attending crash calls and auditing drug usage. This
enabled a direct comparison between St James's Resuscitation Committee
guidelines and current hospital practice. Fourteen cases of true cardiac
arrests were identified for analysis. Five patients (33.7 per cent) survived
initial resuscitation with three patients (21.4 per cent) being discharged
alive and well. Drug administration followed published guidelines in 90.9
per cent of cases. Emergency boxes were found to contain a sufficient and
comprehensive supply of drugs. An accurate record of events at the scene and
a rapid replacement and return of crash boxes to the wards were two positive
outcomes of the study.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
calcium chloride
diazepam
epinephrine
hydrocortisone
isoprenaline
lidocaine
naloxone
EMTREE DRUG INDEX TERMS
aminophylline
bretylium
chlorpheniramine
dobutamine
doxapram
glyceryl trinitrate
verapamil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart arrest
EMTREE MEDICAL INDEX TERMS
adult
aged
article
clinical article
clinical audit
clinical trial
emergency treatment
female
human
male
resuscitation
survival rate
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
calcium chloride (10043-52-4)
chlorpheniramine (132-22-9)
diazepam (439-14-5)
dobutamine (34368-04-2, 52663-81-7)
doxapram (113-07-5, 309-29-5, 7081-53-0)
glyceryl trinitrate (55-63-0)
hydrocortisone (50-23-7)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994187671
PUI
L24186088
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1392
TITLE
The value of acute medical services sited adjacent to areas of high
drug-injecting activity [5]
AUTHOR NAMES
Green S.T.
Goldberg D.J.
Carr S.V.
Taylor A.
Frischer M.
Gruer L.
AUTHOR ADDRESSES
(Green S.T.; Goldberg D.J.; Carr S.V.; Taylor A.; Frischer M.; Gruer L.)
Dept Infection and Tropical Medicine, Ruchill Hospital, Glasgow G20 9NB,
United Kingdom.
CORRESPONDENCE ADDRESS
S.T. Green, Dept Infection and Tropical Medicine, Ruchill Hospital, Glasgow
G20 9NB, United Kingdom.
SOURCE
Addiction (1994) 89:6 (763-764). Date of Publication: 1994
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
EMTREE DRUG INDEX TERMS
flumazenil
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
emergency health service
EMTREE MEDICAL INDEX TERMS
drug abuse
geographic distribution
human
intravenous drug administration
letter
CAS REGISTRY NUMBERS
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1994198319
MEDLINE PMID
8069179 (http://www.ncbi.nlm.nih.gov/pubmed/8069179)
PUI
L24183465
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1393
TITLE
Drug-induced pulmonary disease
AUTHOR NAMES
Rosenow III E.C.
AUTHOR ADDRESSES
(Rosenow III E.C.) Division of Pulmonary Diseases, Mayo Clinic, Rochester,
MN, United States.
CORRESPONDENCE ADDRESS
E.C. Rosenow III, Division of Pulmonary Diseases, Mayo Clinic, Rochester,
MN, United States.
SOURCE
Disease-a-Month (1994) 40:5 (257-310). Date of Publication: 1994
ISSN
0011-5029
ABSTRACT
Drug-induced disease of any system or organ can be associated with high
morbidity and mortality, and it is tremendously costly to the health care of
our country. More than 100 medications are known to affect the lungs
adversely, including the airways in the form of cough and asthma, the
interstitium with interstitial pneumonitis and noncardiac pulmonary edema,
and the pleura with pleural effusions. Patients commonly do not even know
what medications they are taking, do not bring them to the physician's
office for identification, and usually do not relate over-the-counter
medications with any problems they have. They assume that all
nonprescription drugs are safe. Patients also believe that if they are
taking prescription medications at their discretion, meaning on an asneeded
basis, then these medications are also not important. This situation
stresses just how imperative it is for the physician to take an accurate
drug history in all patients seen with unexplained medical situations.
Cardiovascular drugs that most commonly produce a pulmonary abnormality are
amiodarone, the angiotensin-converting enzyme inhibitors, and β-blockers.
Pulmonary complications will develop in 6% of patients taking amiodarone and
15% taking angiotensin-converting enzyme inhibitors, with the former
associated with interstitial pneumonitis that can be fatal and the latter
associated with an irritating cough that is not associated with any
pathologic or physiologic sequelae of consequence. The β-blockers can
aggravate obstructive lung disease in any patient taking them. Of the
antiinflammatory agents, acetylsalicylic acid can produce several different
airway and parenchymal complications, including aggravation of asthma in up
to 5% of patients with asthma, a noncardiac pulmonary edema when levels
exceed 40 mg/dl, and a pseudosepsis syndrome. More than 200 products contain
aspirin. Low-dose methotrexate is proving to be a problem because
granulomatous interstitial pneumonitis develops in 5% of those patients
receiving it. This condition occurs most often in patients receiving the
drug for rheumatoid arthritis, but it has been reported in a few patients
receiving it for refractory asthma. Chemotherapeutic drug-induced lung
disease is almost always associated with fever, thus mimicking opportunistic
infection, which is the most common cause of pulmonary complications in the
immunocompromised host. However, in 10% to 15% of patients, the pulmonary
infiltrate is due to an adverse effect from a chemotherapeutic agent. This
complication is frequently fatal even when recognized early. Some
medications produce a cytotoxic effect, meaning an atypia of the type I and
II pneumocytes, whereas others produce a noncardiac pulmonary edema,
microangiopathic hemolytic anemia with pulmonary edema, an eosinophilic
pneumonitis, or a granulomatous reaction. The clinician responsible for
these patients must relate to the pathologist what medications the patient
may be taking. Illicit drugs, especially heroin and cocaine, are tremendous
problems to the physician in the emergency department. The use of these
drugs must be kept in mind when the patient has unexplained acute pulmonary
symptoms. Nitrofurantoin is by far the most common antibiotic-induced lung
disease, with the acute reaction having been reported in more than 1000
cases around the world. It is associated with acute onset of dyspnea, cough,
and fever but rapidly resolves with discontinuation. The long-term side
effect is a separate reaction that mimics idiopathic interstitial
pneumonitis and fibrosis except that it usually responds slowly to
discontinuation and sometimes to the addition of corticosteroids. Numerous
other medications are associated with adverse drug reactions affecting the
lungs, airways, and pleura, and they must be kept in mind when confronted
with the patient who has an unexplained pulmonary problem.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antibiotic agent (adverse drug reaction)
antiinflammatory agent (adverse drug reaction)
antineoplastic agent (adverse drug reaction, drug therapy)
beta adrenergic receptor blocking agent (adverse drug reaction, drug
administration)
cardiovascular agent (adverse drug reaction, drug dose)
cocaine (drug toxicity)
diamorphine (drug toxicity)
dipeptidyl carboxypeptidase inhibitor (adverse drug reaction)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid (adverse drug reaction, pharmacology)
amiodarone (adverse drug reaction, drug concentration, drug dose, drug
therapy)
analgesic agent (adverse drug reaction)
anticoagulant agent (adverse drug reaction)
bromocriptine (adverse drug reaction)
corticosteroid (adverse drug reaction, drug therapy)
dantrolene (adverse drug reaction)
hydrochlorothiazide (adverse drug reaction)
methotrexate (adverse drug reaction, drug administration, drug dose, drug
interaction, drug therapy)
methysergide (adverse drug reaction)
naloxone (adverse drug reaction)
nilutamide (adverse drug reaction, drug therapy)
nitrofurantoin (adverse drug reaction)
oral contraceptive agent (adverse drug reaction)
sclerosing agent (adverse drug reaction)
tricyclic antidepressant agent (adverse drug reaction)
unindexed drug
uterus spasmolytic agent (adverse drug reaction, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
asthma (drug therapy, side effect)
coughing (drug therapy, side effect)
drug induced disease (diagnosis, etiology, side effect)
interstitial pneumonia (diagnosis, drug therapy, side effect)
lung edema (etiology, side effect, therapy)
pleura effusion (side effect)
EMTREE MEDICAL INDEX TERMS
angioneurotic edema (side effect)
bronchiolitis (etiology)
dyspnea (side effect)
human
hypercapnia (side effect)
intramuscular drug administration
intrathecal drug administration
intravenous drug administration
lung fibrosis (diagnosis, side effect)
metabolic acidosis (side effect)
nonhuman
oral drug administration
review
systemic lupus erythematosus (side effect)
thorax radiography
topical drug administration
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
amiodarone (1951-25-3, 19774-82-4, 62067-87-2)
bromocriptine (25614-03-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dantrolene (14663-23-1, 7261-97-4)
diamorphine (1502-95-0, 561-27-3)
hydrochlorothiazide (58-93-5)
methotrexate (15475-56-6, 59-05-2, 7413-34-5)
methysergide (16509-15-2, 361-37-5, 62288-72-6)
naloxone (357-08-4, 465-65-6)
nilutamide (63612-50-0)
nitrofurantoin (54-87-5, 67-20-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994151223
PUI
L24159873
DOI
10.1016/0011-5029(94)90024-8
FULL TEXT LINK
http://dx.doi.org/10.1016/0011-5029(94)90024-8
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1394
TITLE
Psychotropic drug consumption and other factors associated with heroin
overdose
AUTHOR NAMES
Gutiérrez-Cebollada J.
De La Torre R.
Ortuño J.
Garcés J.M.
Camí J.
AUTHOR ADDRESSES
(Gutiérrez-Cebollada J.; Garcés J.M.) Department of Internal Medicine,
Hospital Universitari del Mar, Spain.
(De La Torre R.; Ortuño J.; Camí J.) Institut Municipal d'Investigació
Mèdica, Universítat Autònoma de Barcelona, Barcelona, Spain.
(Camí J.) Institut Municipal d'Investigació Mèdica (IMIM), Doctor Aiguader
80, 08003, Barcelona, Spain.
CORRESPONDENCE ADDRESS
J. Cami, Inst Municipal Investig Med (IMIM), Doctor Aiguader 80, 08003
Barcelona, Spain.
SOURCE
Drug and Alcohol Dependence (1994) 35:2 (169-174). Date of Publication: 1994
ISSN
0376-8716
BOOK PUBLISHER
Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland.
ABSTRACT
In clinical or forensic practice there are few studies assessing which risk
factors are associated with heroin overdoses. A series of 76 consecutive
non-fatal heroin overdoses were compared to 22 consecutive subjects who
self-injected heroin within 1 h before admission to the emergency room.
Whereas blood levels of alcohol and IgE and urinary cocaine metabolite
levels were similar in both groups, higher benzodiazepine plasma levels were
detected in the heroin overdose group. The assessment of methadone,
dextropropoxyphene, amphetamines and cannabis in urine analysis did not show
differences between both groups. The interview revealed that only 48% of
subjects in the heroin overdose group self-administered the last dose of
heroin before admission in the usual setting as compared to 100% of subjects
in the non-overdose group. The application of a log-linear regression model
identified self-injection of heroin in an unusual place and plasma
concentrations of total morphine and benzodiazepines as risk factors for
heroin overdose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
psychotropic agent
EMTREE DRUG INDEX TERMS
alcohol
amphetamine derivative
benzodiazepine derivative
cannabis
cocaine
dextropropoxyphene
drug metabolite
immunoglobulin E (endogenous compound)
methadone
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (drug therapy, epidemiology)
EMTREE MEDICAL INDEX TERMS
adult
alcohol blood level
article
comparative study
drug urine level
emergency ward
female
geography
human
interview
intravenous drug administration
major clinical study
male
priority journal
regression analysis
risk factor
urinalysis
CAS REGISTRY NUMBERS
alcohol (64-17-5)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
immunoglobulin E (37341-29-0)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994163707
MEDLINE PMID
7914483 (http://www.ncbi.nlm.nih.gov/pubmed/7914483)
PUI
L24154037
DOI
10.1016/0376-8716(94)90124-4
FULL TEXT LINK
http://dx.doi.org/10.1016/0376-8716(94)90124-4
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1395
TITLE
Heroin lung: Report of two cases
AUTHOR NAMES
Wang M.-L.
Lin J.L.
Liaw S.-J.
Bullard M.J.
AUTHOR ADDRESSES
(Wang M.-L.; Lin J.L.; Liaw S.-J.; Bullard M.J.) Department of Emergency,
Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan.
CORRESPONDENCE ADDRESS
M.-L. Wang, Department of Emergency, Chang Gung Memorial Hospital, 199
Tun-Hwa North Road, Taipei, Taiwan.
SOURCE
Journal of the Formosan Medical Association (1994) 93:2 (170-172). Date of
Publication: 1994
ISSN
0929-6646
BOOK PUBLISHER
Elsevier (Singapore) Pte Ltd, 3 Killiney Road, 08-01, Winsland House I,
Singapore, Singapore.
ABSTRACT
Heroin lung is the most frequent complication of heroin intoxication. In
September 1991 and January 1993, two young men aged 19 and 22 years
presented with a sudden loss of consciousness and cyanosis after injecting
heroin. They were both brought to our emergency department in the night and
were immediately intubated and given 100% oxygen. Following intravenous
naloxone, they both regained consciousness. The first patient's chest X ray
revealed increased bilateral perihilar lung markings and mild patchy
alveolar edema while the second patient showed a bat's wing shaped confluent
alveolar edema. The blood gases in both cases revealed hypoxemia and
hypercapnia. Follow-up chest roentgenograms on the second hospital day in
case 1 and the third hospital day in case 2 revealed partial clearing of the
lung fields. Fever developed on the second hospital day and they both
received two weeks of antibiotics prior to discharge. Case 1 had normal
pulmonary function testing, but case 2 developed mild restrictive lung
changes. Review of the literature shows that heroin can cause a fulminant
but rapidly reversible form of pulmonary edema. The treatment for this
noncardiogenic pulmonary edema is adequate ventilation, good pulmonary
toilet, and naloxone to reverse the respiratory and central nervous system
depression. Diuretics, digitalis and morphine are not recommended in the
treatment of heroin lung.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
digitalis
diuretic agent
dopamine
furosemide
gentamicin
morphine
penicillin G
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
lung toxicity (drug therapy)
EMTREE MEDICAL INDEX TERMS
adult
article
case report
clinical feature
coma
drug intoxication
human
intravenous drug administration
lung edema
male
respiratory failure
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
digitalis (8031-42-3, 8053-83-6)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
penicillin G (1406-05-9, 61-33-6)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994136961
MEDLINE PMID
7912590 (http://www.ncbi.nlm.nih.gov/pubmed/7912590)
PUI
L24147688
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1396
TITLE
Airway management in respiratory emergencies
AUTHOR NAMES
Einarsson O.
Rochester C.L.
Rosenbaum S.
AUTHOR ADDRESSES
(Einarsson O.; Rochester C.L.; Rosenbaum S.) Pulmonary/Critical Care Med.
Section, Yale University School of Medicine, 333 Cedar Street, New Haven, CT
06510, United States.
CORRESPONDENCE ADDRESS
O. Einarsson, Pulmonary/Critical Care Med. Section, Yale University School
of Medicine, 333 Cedar Street, New Haven, CT 06510, United States.
SOURCE
Clinics in Chest Medicine (1994) 15:1 (13-34). Date of Publication: 1994
ISSN
0272-5231
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Securing the airway is an important first step in respiratory emergencies.
In this article, general principles of airway management are reviewed. The
techniques of tracheal intubation, including surgical routes of airway
access, are discussed in reference to special circumstances that can arise
in acute airway management.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (adverse drug reaction, drug comparison)
carbon dioxide (endogenous compound)
local anesthetic agent (drug administration, drug combination, drug
concentration, drug toxicity, pharmacokinetics)
muscle relaxant agent (adverse drug reaction, pharmacokinetics,
pharmacology)
opiate (adverse drug reaction, drug comparison)
oxygen (endogenous compound)
sedative agent (adverse drug reaction, drug administration, drug comparison)
steroid (drug administration, drug therapy)
EMTREE DRUG INDEX TERMS
acetylcholine (endogenous compound)
alfentanil (adverse drug reaction, drug administration, drug comparison)
antibiotic agent (drug therapy)
atracurium besilate (drug comparison)
cholinesterase (endogenous compound)
ephedrine (drug administration, drug combination)
epinephrine (drug administration)
fentanyl (adverse drug reaction, drug comparison)
flumazenil (drug therapy, pharmacology)
helium
ketamine
lidocaine (drug administration, drug combination)
midazolam (adverse drug reaction, drug administration, drug comparison)
naloxone (drug therapy)
narcotic agent (pharmacology)
pancuronium (drug comparison)
phenylephrine (drug administration, drug combination)
potassium (endogenous compound)
suxamethonium (adverse drug reaction, pharmacology)
tetracaine (drug administration, drug combination, drug concentration, drug
toxicity, pharmacokinetics)
unindexed drug
vecuronium (drug comparison)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
airway
emergency
endotracheal intubation
respiratory tract disease (complication, diagnosis, drug therapy, surgery,
therapy)
EMTREE MEDICAL INDEX TERMS
artificial ventilation
aspiration pneumonia (complication, prevention)
asthma (therapy)
bradycardia (side effect)
cervical spine injury (complication)
epistaxis (complication)
hemoptysis (diagnosis, therapy)
human
hypotension (side effect)
laryngoscopy
larynx edema (complication, drug therapy)
larynx spasm (complication)
nasotracheal intubation
postoperative complication
priority journal
respiration depression (drug therapy, side effect)
review
thorax injury (complication, diagnosis, therapy)
tracheoesophageal fistula (complication)
tracheostomy
upper respiratory tract obstruction (complication, drug therapy, therapy)
DRUG TRADE NAMES
mazicon
CAS REGISTRY NUMBERS
acetylcholine (51-84-3, 60-31-1, 66-23-9)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alfentanil (69049-06-5, 71195-58-9)
atracurium (64228-79-1)
carbon dioxide (124-38-9, 58561-67-4)
cholinesterase (9001-08-5)
ephedrine (299-42-3, 50-98-6)
fentanyl (437-38-7)
flumazenil (78755-81-4)
helium (7440-59-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
midazolam (59467-70-8)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxygen (7782-44-7)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
potassium (7440-09-7)
suxamethonium (306-40-1, 71-27-2)
tetracaine (136-47-0, 94-24-6)
vecuronium (50700-72-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994096314
MEDLINE PMID
8200189 (http://www.ncbi.nlm.nih.gov/pubmed/8200189)
PUI
L24097781
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1397
TITLE
Guidelines for the early management of patients with myocardial infarction
AUTHOR NAMES
Weston C.F.M.
Penny W.J.
Julian D.G.
AUTHOR ADDRESSES
(Weston C.F.M.) Depts. of Cardiol. and Epidemiology, University of Wales,
College of Medicine, Cardiff CF4 4XN, United Kingdom.
(Penny W.J.) University Hospital of Wales, Cardiff CF4 4XW, United Kingdom.
(Julian D.G.) British Heart Foundation, London W1H 4DH, United Kingdom.
CORRESPONDENCE ADDRESS
C.F.M. Weston, Department of Cardiology, University of Wales, College of
Medicine, Cardiff CF4 4XN, United Kingdom.
SOURCE
British Medical Journal (1994) 308:6931 (767-771). Date of Publication: 19
Mar 1994
ISSN
0959-8146
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
ABSTRACT
In light of recent publications relating to resuscitation and pre-hospital
treatment of patients suffering acute myocardial infarction the British
Heart Foundation convened a working group to prepare guidelines outlining
the responsibilities of general practitioners, ambulance services, and
admitting hospitals. The guidelines emphasise the importance of the rapid
provision of basic and advanced life support; adequate analgesia; accurate
diagnosis; and, when indicated, thrombolytic treatment. The working group
developed a standard whereby patients with acute myocardial infarction
should receive thrombolysis, when appropriate, within 90 minutes of alerting
the medical or ambulance service - the call to needle time. Depending on
local circumstances, achieving this standard may involve direct admissions
to coronary care units, 'fast track' assessments in emergency departments,
or pre-hospital thrombolytic treatment started by properly equipped and
trained general practitioners.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid (drug therapy)
nitrate (drug therapy)
oxygen (drug therapy)
EMTREE DRUG INDEX TERMS
analgesic agent (drug therapy)
atropine (drug therapy)
diamorphine (drug therapy)
epinephrine (drug therapy)
furosemide (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
fibrinolytic therapy
general practitioner
heart infarction (drug therapy)
EMTREE MEDICAL INDEX TERMS
aged
emergency medicine
human
intravenous drug administration
oral drug administration
patient education
priority journal
protocol
review
United Kingdom
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diamorphine (1502-95-0, 561-27-3)
furosemide (54-31-9)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
nitrate (14797-55-8)
oxygen (7782-44-7)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1994085884
MEDLINE PMID
8142834 (http://www.ncbi.nlm.nih.gov/pubmed/8142834)
PUI
L24087441
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1398
TITLE
Pre-hospital opiate and aspirin administration in patients with suspected
myocardial infarction.
AUTHOR NAMES
Wyllie H.R.
Dunn F.G.
AUTHOR ADDRESSES
(Wyllie H.R.; Dunn F.G.) Cardiac Department, Stobhill General Hospital,
Glasgow.
CORRESPONDENCE ADDRESS
H.R. Wyllie, Cardiac Department, Stobhill General Hospital, Glasgow.
SOURCE
BMJ (Clinical research ed.) (1994) 308:6931 (760-761). Date of Publication:
19 Mar 1994
ISSN
0959-8138
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid (drug administration)
narcotic agent (drug administration)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
heart infarction (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
coronary care unit
emergency health service
female
general practice
human
male
mortality
patient referral
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
7695672 (http://www.ncbi.nlm.nih.gov/pubmed/7695672)
PUI
L24888795
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1399
TITLE
Which antidotes should the general practitioner have in his emergency case?
ORIGINAL (NON-ENGLISH) TITLE
QUELS ANTIDOTES LE MEDECIN GENERALISTE DOIT-IL DETENIR DANS SA TROUSSE
D'URGENCE?
AUTHOR NAMES
Mathieu D.
Mathieu-Nolf M.
AUTHOR ADDRESSES
(Mathieu D.; Mathieu-Nolf M.) Service d'Urgence Respiratoire, Hopital
Calmette, CHU, 59037 Lille Cedex, France.
CORRESPONDENCE ADDRESS
D. Mathieu, Service d'Urgence Respiratoire, Hopital Calmette, CHU, 59037
Lille Cedex, France.
SOURCE
Revue du Praticien - Medecine Generale (1994) 8:245 (20-23). Date of
Publication: 1994
ISSN
0989-2737
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
EMTREE DRUG INDEX TERMS
acetylcysteine (adverse drug reaction)
activated carbon
deferoxamine
deferoxamine mesylate
dimercaprol
flumazenil
naloxone
paracetamol (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
emergency health service
gastrointestinal symptom (side effect)
human
intravenous drug administration
oral drug administration
short survey
skin toxicity (side effect)
DRUG TRADE NAMES
anexate
desferal
fluimucil
narcan
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
deferoxamine mesylate (138-14-7, 5115-09-3)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French
EMBASE ACCESSION NUMBER
1994067254
PUI
L24069541
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1400
TITLE
The new American Heart Association guidelines for cardiopulmonary
resuscitation and emergency cardiac care: Presented by the Emergency Cardiac
Care Subcommittee of the Heart and Stroke Foundation of Canada
AUTHOR NAMES
Christenson J.M.
Solimano A.J.
Williams J.
Connolly B.
Monik L.
Erb- Campbell H.
McGonigle L.
AUTHOR ADDRESSES
(Christenson J.M.; Solimano A.J.; Williams J.; Connolly B.; Monik L.; Erb-
Campbell H.; McGonigle L.) Heart/Stroke Foundation of Canada, 200-160 George
St., Ottawa, Ont. K1N 9M2, Canada.
CORRESPONDENCE ADDRESS
L. Monik, Heart/Stroke Foundation of Canada, 200-160 George St., Ottawa,
Ont. K1N 9M2, Canada.
SOURCE
Canadian Medical Association Journal (1993) 149:5 (585-590). Date of
Publication: 1993
ISSN
0820-3946
BOOK PUBLISHER
Canadian Association of Radiologists, 1740 boul.Cote-Vertu Blvd, St-Laurent,
Canada.
ABSTRACT
CPR courses (both basic and advanced) continue to evolve. The recent CPR and
ECC guidelines by the AHA consolidate the research and vast experience in
one document. These guidelines are helpful to lay people and health care
professionals who intervene in cases of cardiac arrest. They are also
excellent resources for those involved in coordinating ECC systems in the
community.
EMTREE DRUG INDEX TERMS
adenosine (drug therapy)
atropine (drug dose, drug therapy)
bicarbonate (drug therapy)
epinephrine (drug dose, drug therapy)
fibrinolytic agent (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cerebrovascular accident (drug therapy, epidemiology, therapy)
heart arrest (drug therapy, epidemiology, therapy)
heart failure (drug therapy, epidemiology, therapy)
resuscitation
sudden death
EMTREE MEDICAL INDEX TERMS
Canada
drug therapy
emergency medicine
epidemiology
fibrinolytic therapy
human
intramuscular drug administration
intravenous drug administration
medical education
priority journal
protocol
short survey
subcutaneous drug administration
survival
therapy
CAS REGISTRY NUMBERS
adenosine (58-61-7)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Public Health, Social Medicine and Epidemiology (17)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1993340871
MEDLINE PMID
8364815 (http://www.ncbi.nlm.nih.gov/pubmed/8364815)
PUI
L23340856
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1401
TITLE
Conscious sedation in the emergency department
AUTHOR NAMES
Schultz C.H.
AUTHOR ADDRESSES
(Schultz C.H.)
SOURCE
Western Journal of Medicine (1993) 159:5 (600-601). Date of Publication:
1993
ISSN
0093-0415
BOOK PUBLISHER
BMJ Publishing Group, Tavistock Square, London, United Kingdom.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, drug administration, drug combination, drug
dose, drug therapy, pharmaceutics, pharmacology)
ketamine (drug administration, drug dose, drug therapy, pharmaceutics,
pharmacology)
midazolam (adverse drug reaction, drug administration, drug combination,
drug dose, drug therapy, pharmaceutics, pharmacology)
EMTREE DRUG INDEX TERMS
chloral hydrate
flumazenil
naloxone (drug therapy)
nitrous oxide
pentobarbital
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anxiety
emergency ward
pain assessment (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
consciousness
dose calculation
drug formulation
drug mixture
drug safety
hallucination (side effect)
intramuscular drug administration
intravenous drug administration
oral drug administration
patient selection
priority journal
pruritus (side effect)
rectal drug administration
respiration depression (drug therapy, side effect)
sedation
DRUG TRADE NAMES
nembutal
versed
CAS REGISTRY NUMBERS
chloral hydrate (302-17-0)
fentanyl (437-38-7)
flumazenil (78755-81-4)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Surgery (9)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1993339509
MEDLINE PMID
8279165 (http://www.ncbi.nlm.nih.gov/pubmed/8279165)
PUI
L23339494
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1402
TITLE
Sedation in the pediatric emergency department: An overview of the 1992 AAP
committee on drugs recommendations
AUTHOR NAMES
Kroning D.R.
AUTHOR ADDRESSES
(Kroning D.R.) Pediatric Emergency Department, St. Lukes-Roosevelt Hospital,
New York, NY, United States.
CORRESPONDENCE ADDRESS
D.R. Kroning, Pediatric Emergency Department, St. Lukes-Roosevelt Hospital,
New York, NY, United States.
SOURCE
Emergency and Office Pediatrics (1993) 6:6 (131-134). Date of Publication:
1993
ISSN
1044-3797
EMTREE DRUG INDEX TERMS
benzodiazepine (drug combination)
chloral hydrate
diazepam
fentanyl
flumazenil
midazolam
morphine
naloxone
narcotic agent (drug combination)
pentobarbital
pethidine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
sedation
EMTREE MEDICAL INDEX TERMS
article
dental anesthesia
general anesthesia
health status
human
outpatient care
physician
DRUG TRADE NAMES
demerol
mazicon
narcan
nembutal
valium
versed
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
chloral hydrate (302-17-0)
diazepam (439-14-5)
fentanyl (437-38-7)
flumazenil (78755-81-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1994314749
PUI
L24304866
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1403
TITLE
Emergency medical services priority dispatch
AUTHOR NAMES
Curka P.A.
Pepe P.E.
Ginger V.F.
Sherrard R.C.
Ivy M.V.
Zachariah B.S.
AUTHOR ADDRESSES
(Curka P.A.; Pepe P.E.; Ginger V.F.; Sherrard R.C.; Ivy M.V.; Zachariah
B.S.) CHCREMS, 410 Bagby, Houston, TX 77002-1595, United States.
CORRESPONDENCE ADDRESS
P.E. Pepe, CHCREMS, 410 Bagby, Houston, TX 77002-1595, United States.
SOURCE
Annals of Emergency Medicine (1993) 22:11 (1688-1695). Date of Publication:
1993
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To test the ability of a locally designed priority dispatch
system to safely exclude the need for advanced life support (ALS). Design:
Retrospective review of emergency medical services (EMS) incident records to
determine how often the lone dispatch of basic life support (BLS) units,
staffed with basic emergency medical technicians, subsequently required or
involved ALS care. Setting: A large centralized municipal EMS system with a
tiered ALS/BLS ambulance response. All BLS units carry automated
defibrillators. Measurements: Consecutive EMS records (35,075) were reviewed
by computerized search for ALS procedures. Records indicating ALS procedures
were tabulated and then manually reviewed for the nature of and probable
indication for the ALS intervention. Intervention: Brief sequences of
computer-stored questions that help dispatchers identify (or exclude) signs
and symptoms indicating the need for ALS. Results: The dispatch triage
system spared ALS units from initial dispatch in 14,100 of the EMS incidents
(40.2%), increasing their availability and use for more serious calls. Among
these 14,100 cases, only 41 patients (0.3%) later received drugs such as
nitroglycerin and naloxone; another 27 patients (0.2%) received
resuscitative interventions such as epinephrine or defibrillation.
Furthermore, on closer analysis, the immediate presence of a paramedic might
have provided a true potential for advantage in outcome for only five or six
patients (less than 0.04 of the 14,100 BLS dispatches). Meanwhile, many
important operational, fiscal, and cost-effective patient care benefits were
realized with this system. Conclusion: A computer-aided dispatch triage
algorithm can facilitate improvements in both EMS system operations and
prehospital patient care by safely and reliably identifying EMS incidents
requiring only BLS.
EMTREE DRUG INDEX TERMS
epinephrine
glyceryl trinitrate
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
cost effectiveness analysis
defibrillation
health care quality
priority journal
rescue personnel
resuscitation
treatment planning
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
glyceryl trinitrate (55-63-0)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Health Policy, Economics and Management (36)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993319850
MEDLINE PMID
8214858 (http://www.ncbi.nlm.nih.gov/pubmed/8214858)
PUI
L23319835
DOI
10.1016/S0196-0644(05)81307-1
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(05)81307-1
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1404
TITLE
Small doses, big problems: A selected review of highly toxic common
medications
AUTHOR NAMES
Liebelt E.L.
Shannon M.W.
AUTHOR ADDRESSES
(Liebelt E.L.; Shannon M.W.) Children's Hospital, 300 Longwood Avenue,
Boston, MA 02115, United States.
CORRESPONDENCE ADDRESS
E.L. Liebelt, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115,
United States.
SOURCE
Pediatric Emergency Care (1993) 9:5 (292-297). Date of Publication: 1993
ISSN
0749-5161
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
ABSTRACT
Many commonly used medications have serious toxicity in children when
ingested in small doses. The toxicologic characteristics of methyl
salicylate, camphor, topical imidazolines, benzocaine, and diphenoxylate-
atropine are striking examples. All of these medications except Lomotil® are
over-the-counter and therefore, are often perceived as minimally harmful
when ingested. For all of these substances, however, doses as little as 1/4
teaspoon or 1/2 tablet can have serious or fatal consequences. Thus,
referral to an emergency department is prudent for ingestions involving
these products. Options for initial gastrointestinal (GI) decontamination
are variable, depending on the estimated amount and time of the ingestion.
Induction of emesis is contraindicated for significant camphor, topical
imidazoline, and Lomotil® ingestions. Activated charcoal should be
administered in all cases. Finally, the emergency physician must recognize
the potential seriousness of these ingestions, as well as their clinical
presentations to provide expeditious evaluation and treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine plus diphenoxylate (drug toxicity)
benzocaine (drug toxicity)
camphor (drug toxicity)
imidazoline derivative (drug toxicity)
salicylic acid methyl ester (drug toxicity)
EMTREE DRUG INDEX TERMS
activated carbon
alpha 2 adrenergic receptor
atropine
diazepam
ipecac
isoprenaline
laxative
methylene blue
naloxone
naphazoline
oxymetazoline
phenobarbital
tetryzoline
xylometazoline
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (etiology, therapy)
EMTREE MEDICAL INDEX TERMS
clinical feature
dialysis
diuresis
drug absorption
drug blood level
drug fatality (complication)
hemodialysis
hemoperfusion
human
hydration
methemoglobinemia (etiology, therapy)
respiration depression (complication, therapy)
review
seizure (etiology, therapy)
stomach lavage
vomiting
DRUG TRADE NAMES
afrin
clear eyes
lomotil
otrivin
tyzine
visine
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
atropine (51-55-8, 55-48-1)
atropine plus diphenoxylate (55840-97-6)
benzocaine (1333-08-0, 94-09-7)
camphor (464-49-3, 76-22-2, 8008-51-3)
diazepam (439-14-5)
ipecac (8012-96-2)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
naphazoline (5144-52-5, 550-99-2, 835-31-4)
oxymetazoline (1491-59-4, 2315-02-8)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
salicylic acid methyl ester (119-36-8)
tetryzoline (522-48-5, 84-22-0)
xylometazoline (1218-35-5, 526-36-3)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993306396
MEDLINE PMID
8247936 (http://www.ncbi.nlm.nih.gov/pubmed/8247936)
PUI
L23306382
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1405
TITLE
Discharging heroin overdose patients after observation [2]
AUTHOR NAMES
Brzozowski M.
Shih R.D.
Bania T.C.
Hoffman R.S.
Smith D.A.
Yealy D.M.
AUTHOR ADDRESSES
(Brzozowski M.; Shih R.D.; Bania T.C.; Hoffman R.S.; Smith D.A.; Yealy D.M.)
New York City Poison Control Center, Department of Emergency Services, New
York Univ. School of Medicine, New York, NY, United States.
CORRESPONDENCE ADDRESS
M. Brzozowski, New York City Poison Control Center, Department of Emergency
Services, New York Univ. School of Medicine, New York, NY, United States.
SOURCE
Annals of Emergency Medicine (1993) 22:10 (1638-1639). Date of Publication:
1993
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
alcohol
opiate antagonist (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
EMTREE MEDICAL INDEX TERMS
breathing rate
central nervous system depression
drug induced disease (diagnosis, drug therapy)
emergency ward
follow up
hospital admission
hospitalization
human
intravenous drug administration
letter
lung edema
mental health
nomenclature
observation
priority journal
respiration depression (diagnosis)
CAS REGISTRY NUMBERS
alcohol (64-17-5)
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1993296434
MEDLINE PMID
8214849 (http://www.ncbi.nlm.nih.gov/pubmed/8214849)
PUI
L23296420
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1406
TITLE
Opiate and cocaine consumers attending Barcelona emergency rooms: A one year
survey (1989)
AUTHOR NAMES
Domingo-Salvany A.
Hartnoll R.L.
Anto Ma. J.
AUTHOR ADDRESSES
(Domingo-Salvany A.; Hartnoll R.L.; Anto Ma. J.) Municipal Inst Medical
Research IMIM, Doctor Aiguader 80, E-08003 Barcelona, Spain.
CORRESPONDENCE ADDRESS
A. Domingo-Salvany, Municipal Inst Medical Research IMIM, Doctor Aiguader
80, E-08003 Barcelona, Spain.
SOURCE
Addiction (1993) 88:9 (1247-1256). Date of Publication: 1993
ISSN
0965-2140
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
Due to the limitations of standard epidemiological methods, indirect
indicators have often been used to describe the characteristics of drug
abusing populations and to assess prevalence trends in illegal drug use. In
Barcelona (Spain), a study of emergency room (ER) attendance was carried out
to describe the population of opiate/cocaine consumers across the whole city
who use this service. Three thousand four hundred and five consumers of
opiates and/or cocaine, aged 15-44 years, who attended ERs during 1989, were
identified. They accounted for 6807 episodes in the hospitals surveyed.
Their mean age was 26 years, men (73%) being 1 year older than women (25.2
years). The drug of abuse was specified in the clinical records of 60% of
individuals, heroin being the most frequently specified (56%). The main
reason for attendance was 'other medical condition' (OMC) (55% of episodes),
followed by withdrawal (34%) and overdoses (6%). Seventy-one percent of
individuals were residents of Barcelona city, yielding a rate of 3.2
opiate/cocaine consumers attending ERs per thousand Barcelona residents aged
15-44. The geographical distribution of the rates in the city showed a very
large difference between districts, the most deprived ones having a higher
rate of consumers attending ERs. ER data can provide valuable insights into
the nature and dimensions of drug abuse problems.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
opiate
EMTREE DRUG INDEX TERMS
diamorphine
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
data analysis
drug overdose
drug withdrawal
emergency ward
epidemiology
female
geographic distribution
health survey
human
major clinical study
male
medical record
Spain
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993274268
MEDLINE PMID
8241924 (http://www.ncbi.nlm.nih.gov/pubmed/8241924)
PUI
L23274254
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1407
TITLE
Antagonization in prehospital emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
ANTAGONISIERUNG IN DER NOTFALLMEDIZIN
AUTHOR NAMES
Schou J.
Deklerk J.
Scherb M.
Kubler J.
AUTHOR ADDRESSES
(Schou J.; Deklerk J.; Scherb M.; Kubler J.) Anasthesieabteilung, Stadt
Krankenhaus, D-7850 Lorrach, Germany.
CORRESPONDENCE ADDRESS
J. Schou, Anasthesieabteilung, Stadt Krankenhaus, D-7850 Lorrach, Germany.
SOURCE
Intensivmedizin und Notfallmedizin (1993) 30:1 (28-32). Date of Publication:
1993
ISSN
0175-3851
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol (drug toxicity)
flumazenil (drug therapy)
nalbuphine (drug therapy)
naloxone (drug therapy)
opiate (drug toxicity)
physostigmine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
drug overdose
emergency medicine
human
major clinical study
CAS REGISTRY NUMBERS
alcohol (64-17-5)
flumazenil (78755-81-4)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
1993266786
PUI
L23266772
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1408
TITLE
Infectious disease emergencies in the geriatric population
AUTHOR NAMES
Jacobs L.G.
AUTHOR ADDRESSES
(Jacobs L.G.) Montefiore Medical Center, 111 East 210th Street, Bronx, NY
10467, United States.
CORRESPONDENCE ADDRESS
L.G. Jacobs, Montefiore Medical Center, 111 East 210th Street, Bronx, NY
10467, United States.
SOURCE
Clinics in Geriatric Medicine (1993) 9:3 (559-575). Date of Publication:
1993
ISSN
0749-0690
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Infectious diseases continue to be a common cause for emergency department
visits among the elderly population. This phenomenon may be due to the
existence of comorbid diseases as well as alterations in immune function
with senescence. Diagnosis and acute management of specific infections are
discussed in this article, including meningitis, endocarditis, urinary tract
and skin infections, septic shock, and fever of unknown origin.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminoglycoside antibiotic agent (drug therapy)
antibiotic agent (drug therapy)
cephalosporin derivative (drug therapy)
EMTREE DRUG INDEX TERMS
ampicillin (drug therapy)
chloramphenicol (drug therapy)
cotrimoxazole (drug therapy)
erythromycin (drug therapy)
hepatitis B vaccine (drug therapy)
ibuprofen (drug therapy)
immunoglobulin antibody (drug therapy)
influenza vaccine (drug therapy)
naloxone (drug therapy)
oxacillin (drug therapy)
penicillin G (drug therapy)
Pneumococcus vaccine (drug therapy)
tetanus toxoid (drug therapy)
vancomycin (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterial endocarditis (diagnosis, drug therapy, etiology, surgery)
infection (diagnosis, drug therapy, etiology, prevention)
meningitis (diagnosis, drug therapy, etiology)
pneumonia (diagnosis, drug therapy, etiology)
skin infection (diagnosis, drug therapy, etiology)
urinary tract infection (diagnosis, drug therapy, etiology)
EMTREE MEDICAL INDEX TERMS
abdominal infection (diagnosis)
aged
antibiotic therapy
cellulitis (diagnosis, drug therapy, etiology)
collagen disease (diagnosis)
erysipelas (diagnosis, drug therapy, etiology)
fluid therapy
human
intravenous drug administration
oral drug administration
pyrexia idiopathica (diagnosis, etiology)
review
septic shock (diagnosis, drug therapy, therapy)
tuberculosis (diagnosis)
vaccination
CAS REGISTRY NUMBERS
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
chloramphenicol (134-90-7, 2787-09-9, 56-75-7)
cotrimoxazole (8064-90-2)
erythromycin (114-07-8, 70536-18-4)
ibuprofen (15687-27-1)
naloxone (357-08-4, 465-65-6)
oxacillin (1173-88-2, 66-79-5, 7240-38-2)
penicillin G (1406-05-9, 61-33-6)
tetanus toxoid (57425-69-1, 93384-51-1)
vancomycin (1404-90-6, 1404-93-9)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Public Health, Social Medicine and Epidemiology (17)
Gerontology and Geriatrics (20)
Immunology, Serology and Transplantation (26)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993259774
MEDLINE PMID
8374857 (http://www.ncbi.nlm.nih.gov/pubmed/8374857)
PUI
L23259760
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1409
TITLE
Safety assessment of high-dose narcotic analgesia for emergency department
procedures
AUTHOR NAMES
Barsan W.G.
Tomassoni A.J.
Seger D.
Danzl D.F.
Ling L.J.
Bartlett R.
AUTHOR ADDRESSES
(Barsan W.G.; Tomassoni A.J.; Seger D.; Danzl D.F.; Ling L.J.; Bartlett R.)
Department of Emergency Medicine, Cincinnati Univ. Emergency Care Ctr., 234
Goodman Street, Cincinnati, OH 45267-0769, United States.
CORRESPONDENCE ADDRESS
A.J. Tomassoni, Department of Emergency Medicine, Cincinnati Univ. Emergency
Care Ctr., 234 Goodman Street, Cincinnati, OH 45267-0769, United States.
SOURCE
Annals of Emergency Medicine (1993) 22:9 (1444-1449). Date of Publication:
1993
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To evaluate the safety of high-dose IV narcotics in
patients requiring analgesia for painful emergency department procedures.
Design: Prospective multicenter clinical trial. Setting: Five adult urban
EDs. Methods and measurements: All patients received IV meperidine (1.5 to
3.0 mg/kg) titrated to analgesia followed by a painful procedure. Vital
signs and alertness scale were recorded at regular intervals, and patients
were observed for four hours. Adverse events were monitored and documented.
Comparisons between baseline and postanalgesia intervals were made with a
repeated measures ANOVA (Dunnett's test). Results: Although statistically
significant changes in vital signs and alertness scale occurred, they were
not clinically significant. Opiate reversal with naloxone was not needed in
any patient, and no significant respiratory or circulatory compromise
occurred. Conclusion: This study of 72 patients demonstrates that high-dose
narcotic analgesia is appropriate, well tolerated, and safe when used in
selected patients before painful procedures in the ED. Narcotic antagonists
and resuscitation equipment nonetheless should be available to maximize
safety.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
pethidine (adverse drug reaction, drug dose, pharmacology)
EMTREE DRUG INDEX TERMS
naloxone (pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
emergency medicine
EMTREE MEDICAL INDEX TERMS
adult
alertness
article
controlled study
drug megadose
drug safety
female
human
human tissue
intravenous drug administration
major clinical study
male
nausea (side effect)
priority journal
vertigo (side effect)
vomiting (side effect)
DRUG TRADE NAMES
meperidine
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993253920
MEDLINE PMID
8363118 (http://www.ncbi.nlm.nih.gov/pubmed/8363118)
PUI
L23253906
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1410
TITLE
Documentation of clinical and cost-saving pharmacy interventions in the
emergency room
AUTHOR NAMES
Levy D.B.
AUTHOR ADDRESSES
(Levy D.B.) Department of Pharmacy Services, Detroit Receiving Hospital,
University Health Center, Detroit, MI 48201, United States.
CORRESPONDENCE ADDRESS
D.B. Levy, Department of Pharmacy Services, Detroit Receiving Hospital,
University Health Center, Detroit, MI 48201, United States.
SOURCE
Hospital Pharmacy (1993) 28:7 (624-627+630-634+653). Date of Publication:
1993
ISSN
0018-5787
BOOK PUBLISHER
Facts and Comparisons, 111 W. Port Plaza, Ste. 300, St. Louis, United
States.
ABSTRACT
Hospital pharmacists have shown clearly their benefit in patient care by
intervening to improve the drug use process. In this era of cost
containment, hospital administrators are likely to fund only those programs
that clearly improve patient care or reduce costs. To demonstrate the impact
on a hospital budget and to justify a position or service, documentation of
improvement and generation of a cost-savings report is essential. This
article discusses the types and methods of clinical and cost-saving
interventions that are made in a busy inner city university trauma center's
emergency department, and the methods by which our data are collected.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline (drug administration, drug therapy)
cimetidine (drug comparison, drug dose, drug interaction, pharmacokinetics)
erythromycin (drug interaction)
lidocaine (drug administration, drug dose, drug therapy)
phenobarbital (drug interaction)
theophylline (drug administration, drug concentration, pharmacokinetics)
EMTREE DRUG INDEX TERMS
activated carbon (drug combination, drug comparison, drug therapy)
antibiotic agent (drug administration, drug dose, drug therapy)
cephalosporin (drug administration, drug dose, drug therapy)
famotidine (drug comparison, drug dose, pharmacokinetics)
glucose (drug administration, drug dose)
glyceryl trinitrate (drug administration, drug dose)
ipecac (drug comparison, drug therapy)
naloxone (drug administration, drug dose)
penicillin derivative (drug administration, drug dose, drug therapy)
phenytoin (drug administration, drug concentration, drug dose, drug therapy,
pharmacokinetics)
potassium chloride (drug administration, pharmaceutics)
sedative agent (drug administration, drug dose, pharmacokinetics)
sorbitol (drug combination, drug comparison, drug therapy)
steroid (drug administration, pharmaceutics)
sultamicillin (drug administration, drug dose, drug therapy)
thiamine (drug administration, pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cost control
hospital pharmacy
EMTREE MEDICAL INDEX TERMS
antibiotic therapy
anticonvulsant therapy
article
chronic bronchitis (drug therapy)
cost effectiveness analysis
drug cost
drug efficacy
drug information
drug preference
drug safety
emergency health service
heart ventricle arrhythmia (drug therapy)
human
infection (drug therapy, prevention)
intoxication (drug therapy)
intravenous drug administration
medical documentation
oral drug administration
pharmacist
seizure (drug therapy)
DRUG TRADE NAMES
unasyn Roerig
DRUG MANUFACTURERS
Roerig
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
aminophylline (317-34-0)
cephalosporin (11111-12-9)
cimetidine (51481-61-9, 70059-30-2)
erythromycin (114-07-8, 70536-18-4)
famotidine (76824-35-6)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
ipecac (8012-96-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
potassium chloride (7447-40-7)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
sultamicillin (76497-13-7)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993210417
MEDLINE PMID
10127297 (http://www.ncbi.nlm.nih.gov/pubmed/10127297)
PUI
L23210403
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1411
TITLE
Activation of the opioid and nonopioid hypoalgesic systems at the level of
the brainstem and spinal cord: Does a coulometric relation predict the
emergence or form of environmentally induced hypoalgesia?
AUTHOR NAMES
Meagher M.W.
Chen P.-S.
Salinas J.A.
Grau J.W.
AUTHOR ADDRESSES
(Meagher M.W.; Chen P.-S.; Salinas J.A.; Grau J.W.) Department of
Psychology, Texas A and M University, College Station, TX 77843, United
States.
CORRESPONDENCE ADDRESS
M.W. Meagher, Department of Psychology, Texas A and M University, College
Station, TX 77843, United States.
SOURCE
Behavioral Neuroscience (1993) 107:3 (493-505). Date of Publication: 1993
ISSN
0735-7044
BOOK PUBLISHER
American Psychological Association Inc., 750 First Street NE, Washington,
United States.
ABSTRACT
Prior research suggests that a coulometric relation (Intensity x Duration)
determines whether an opioid or nonopioid hypoalgesic system is activated by
afferent nociceptive information. Using a paradigm that generates a
brainstem-mediated hypoalgesia on the tail-flick test, we found that a
coulometric relation does not predict either the emergence or the form of
shock-induced hypoalgesia in decerebrate rats. In fact, no evidence was
obtained that the brainstem's opioid hypoalgesic system can be activated by
ascending neurons. More severe shocks elicited hypoalgesia in spinalized
rats. Although a coulometric relation did not predict the emergence of
hypoalgesia in spinalized rats, shock severity did predict the form of the
hypoalgesia; the least severe shocks elicited an opioid hypoalgesia, and the
more severe shocks generated a nonopioid hypoalgesia. A similar pattern of
data was observed in intact rats exposed to the least severe shock
parameters.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naltrexone (pharmacology)
opiate (endogenous compound)
opiate receptor
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
nociception
EMTREE MEDICAL INDEX TERMS
animal cell
animal experiment
animal tissue
article
brain stem response
controlled study
coulometry
decerebration
electrostimulation
male
nonhuman
pain assessment
rat
receptor affinity
sensory nerve conduction
subcutaneous drug administration
tail flick test
CAS REGISTRY NUMBERS
naltrexone (16590-41-3, 16676-29-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Physiology (2)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993181951
MEDLINE PMID
8392349 (http://www.ncbi.nlm.nih.gov/pubmed/8392349)
PUI
L23181937
DOI
10.1037//0735-7044.107.3.493
FULL TEXT LINK
http://dx.doi.org/10.1037//0735-7044.107.3.493
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1412
TITLE
Prehospital seizure management: Triage criteria for the advanced life
support rescue team
AUTHOR NAMES
Abarbanell N.R.
AUTHOR ADDRESSES
(Abarbanell N.R.) Department of Surgery, Health Science Center Jacksonville,
University of Florida, 655 8th St, Jacksonville, FL 32209-6511, United
States.
CORRESPONDENCE ADDRESS
N.R. Abarbanell, Department of Surgery, Health Science Center Jacksonville,
University of Florida, 655 8th St, Jacksonville, FL 32209-6511, United
States.
SOURCE
American Journal of Emergency Medicine (1993) 11:3 (210-212). Date of
Publication: 1993
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
The present study was completed to establish advanced life support (ALS)
versus non-ALS triage criteria for use by ALS prehospital personnel when
faced with the seizure patient, in the hope of more efficient use of ALS
rescue teams. Preselected triage criteria for acuity of care based on
neurological condition, vital signs, and concomitant illness/injury were
tested against retrospective data (paramedic run reports) collected on 230
patients. Triage criteria sensitivity (SENS), specificity (SPEC), positive
predictive value (PPV), and negative predictive value (NPV) were determined
with a 95% confidence interval (CI). Point estimate of use/need of care was
noted. ALS interventions were instituted in 58 patients (25%). In 57 of
these cases, indication for and ALS intervention, were established on
initial patient assessment (SENS, 98.28; 95% CI, 90.76 to 99.96). Of 173
patients requiring no ALS intervention on initial assessment, only 1 (0.58%)
developed complications warranting ALS therapy during the course of
prehospital care (SPEC, 100.00; 95% CI, 100.00 to 99.99; PPV, 100.00; 95%
CI, 100.00 to 94.63; NPV, 99.42; 95% CI, 96.82 to 99.99). No inappropriate
use, point estimate (PE) [(0)/(172) (0.00% to 0.01%)] or unmet need, PE
[(0)/(58) (0.00% to 5.16%)] of care was noted. The data presented in this
study suggest that given similar field times, after initial patient
assessment by ALS personnel, it is reasonable and safe to triage seizure
patients who do not require ALS intervention to non-ALS rescue teams for
continuation of care and transportation.
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
diazepam (drug therapy)
glucose (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
seizure (diagnosis, drug therapy, etiology, therapy)
EMTREE MEDICAL INDEX TERMS
article
competence
drug overdose (diagnosis, drug therapy)
electrocardiography monitoring
emergency treatment
epileptic state (diagnosis, drug therapy, therapy)
fluid therapy
health care availability
heart block (diagnosis, drug therapy)
human
hypoglycemia (diagnosis, drug therapy)
intravenous drug administration
job performance
major clinical study
paramedical personnel
resuscitation
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Epilepsy Abstracts (50)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993181849
MEDLINE PMID
8489659 (http://www.ncbi.nlm.nih.gov/pubmed/8489659)
PUI
L23181835
DOI
10.1016/0735-6757(93)90126-V
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(93)90126-V
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1413
TITLE
ExacTech blood glucose meter clinical trial.
AUTHOR NAMES
Bartkus E.A.
Daya M.
Hedges J.R.
Jui J.
AUTHOR ADDRESSES
(Bartkus E.A.; Daya M.; Hedges J.R.; Jui J.) Department of Emergency
Medicine, Oregon Health Sciences University, Portland 97201.
CORRESPONDENCE ADDRESS
E.A. Bartkus, Department of Emergency Medicine, Oregon Health Sciences
University, Portland 97201.
SOURCE
Prehospital and disaster medicine : the official journal of the National
Association of EMS Physicians and the World Association for Emergency and
Disaster Medicine in association with the Acute Care Foundation (1993) 8:3
(217-227). Date of Publication: 1993 Jul-Sep
ISSN
1049-023X
ABSTRACT
INTRODUCTION: Current prehospital protocols for the management of patients
with altered mental status include the empiric administration of hypertonic
glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W)
may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted
additional health-care costs for the patient. The administration of D50W
also may worsen the neurological outcome of patients with local or
generalized ischemia. OBJECTIVE: To evaluate the ExacTech blood glucose
meter's ability to estimate blood glucose levels accurately and rapidly.
METHODS: Emergency medical technicians (EMTs) from selected advanced life
support (ALS) units in the Portland, Ore., metropolitan area participated in
a prospective clinical trial of the ExacTech blood glucose meter. A
convenience sample was drawn from emergency medical services (EMS) patients
with suspected diabetic emergencies, altered mental status, and other
neurological deficits. Venous blood samples were drawn from these
populations at the same time as the ExacTech readings were obtained. The
venous blood was submitted to the receiving hospitals for laboratory
analysis of blood glucose levels, and a comparison was made between the
results of the two methods. RESULTS: A total of 80 matched sets of data were
obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose
values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were
hypoglycemic (&.lt.60 mg/dl) and 23 (28.8%) were hyperglycemic ( greater
than 180 mg/dl). The ExacTech device sensitivity and specificity for
hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For
hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over
the range of the instrument (40-450 mg/dl) was 0.8656 (p less than .001). If
the prehospital "definition" of hypoglycemia (for threshold-to-treat) is
raised to 65 mg/dl, the device has 100% sensitivity in the sample
population. CONCLUSION: The device functioned accurately and consistently in
the prehospital environment over a wide range of temperatures, and in the
hands of many different individuals.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blood glucose monitoring
glucose blood level (drug analysis)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
aged
article
child
clinical trial
comparative study
devices
devices
emergency health service
evaluation study
female
human
male
methodology
middle aged
multicenter study
sensitivity and specificity
test strip
LANGUAGE OF ARTICLE
English
MEDLINE PMID
10146302 (http://www.ncbi.nlm.nih.gov/pubmed/10146302)
PUI
L24939541
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1414
TITLE
Acute valproic acid intoxication: Enhanced drug clearance with oral-
activated charcoal
AUTHOR NAMES
Farrar H.C.
Herold D.A.
Reed M.D.
AUTHOR ADDRESSES
(Farrar H.C.; Herold D.A.; Reed M.D.) Pediatric Pharmacol./Crit. Care Div.,
Rainbow Babies/Children's Hospital, 2074 Abington Road, Cleveland, OH 44106,
United States.
CORRESPONDENCE ADDRESS
M.D. Reed, Pediatric Pharmacol./Crit. Care Div., Rainbow Babies/Children's
Hospital, 2074 Abington Road, Cleveland, OH 44106, United States.
SOURCE
Critical Care Medicine (1993) 21:2 (299-301). Date of Publication: 1993
ISSN
0090-3493
BOOK PUBLISHER
Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug administration, drug dose, drug interaction, drug
therapy)
valproic acid (adverse drug reaction, drug concentration, drug dose, drug
interaction, drug toxicity, pharmaceutics, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
metoclopramide (drug administration, drug dose, drug therapy)
naloxone (drug dose, pharmacology)
valproate semisodium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
disease course
drug intoxication (drug therapy, therapy)
emergency treatment
EMTREE MEDICAL INDEX TERMS
article
case report
central nervous system depression
clinical feature
dose response
drug blood level
drug clearance
drug mechanism
drug protein binding
drug synthesis
fluid therapy
human
intravenous drug administration
liver toxicity (side effect)
male
medical record
oral drug administration
pancreatitis (side effect)
preschool child
priority journal
vomiting (drug therapy)
DRUG TRADE NAMES
depakote , United StatesAbbott
DRUG MANUFACTURERS
(United States)Abbott
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
valproate semisodium (76584-70-8)
valproic acid (1069-66-5, 99-66-1)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1993062849
MEDLINE PMID
8428486 (http://www.ncbi.nlm.nih.gov/pubmed/8428486)
PUI
L23062849
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1415
TITLE
Effectiveness and safety of intravenous nalmefene for emergency department
patients with suspected narcotic overdose: A pilot study
AUTHOR NAMES
Kaplan J.L.
Marx J.A.
AUTHOR ADDRESSES
(Kaplan J.L.; Marx J.A.) Northern Division, Department of Emergency
Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia,
PA 19141, United States.
CORRESPONDENCE ADDRESS
J.L. Kaplan, Northern Division, Department of Emergency Medicine, Albert
Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, United
States.
SOURCE
Annals of Emergency Medicine (1993) 22:2 (187-190). Date of Publication:
1993
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To evaluate the efficacy and safety of nalmefene, an
investigational narcotic antagonist that has potential advantages over
naloxone because of its four- to eight-hour half-life, in emergency
department patients with possible narcotic overdose. Design: Multi-
institutional, prospective, phase II, open-label study. Type of
participants: Complete data were available for 53 cases from two teaching
hospitals. Men 18 years old or older who would otherwise receive naloxone
were eligible (two women were enrolled inadvertently). Methods: Over four
hours, one to ten boluses (median, one) of 0.5 or 1.0 mg nalmefene IV were
given as often as every two minutes based on clinical need. Respirations,
blood pressure, pulse, pupil size, and overall clinical response were
monitored. Overall clinical response (1, no change; 2, partial response; 3,
complete response), first assessed at two minutes, was analyzed by the
Mann-Whitney U test. Results: Fifteen of 25 (0.5 mg) and nine of 28 (1.0 mg)
cases were opiate positive. Twelve of 15 (0.5 mg) and six of nine (1.0 mg)
opiate-positive cases had a rapid complete response. Coincident causes of
depressed sensorium were identified in the remaining six opiate-positive
cases. No difference in initial overall clinical response was seen between
0.5-mg and 1.0-mg opiate- positive cases (P = .59). No deterioration
requiring repeat nalmefene occurred in opiate-positive cases, even if
methadone (four), codeine (two), or pentazocine (one) was found. No serious
adverse events were judged to be related to nalmefene. Conclusion: Nalmefene
is effective in the reversal of opiate overdose and appears to be safe in
the management of patients with altered sensorium.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (clinical trial, drug administration, drug comparison, drug dose,
drug therapy, pharmacokinetics, pharmacology)
narcotic agent (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug comparison, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose (diagnosis, drug therapy, etiology)
emergency treatment
EMTREE MEDICAL INDEX TERMS
adult
article
clinical article
controlled study
dose time effect relation
drug efficacy
drug safety
emergency ward
female
human
intravenous drug administration
male
phase 2 clinical trial
priority journal
sensory system
CAS REGISTRY NUMBERS
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993058896
MEDLINE PMID
8427429 (http://www.ncbi.nlm.nih.gov/pubmed/8427429)
PUI
L23058896
DOI
10.1016/S0196-0644(05)80200-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(05)80200-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1416
TITLE
Comparison of midazolam and diazepam for conscious sedation in the emergency
department
AUTHOR NAMES
Wright S.W.
Chudnofsky C.R.
Dronen S.C.
Kothari R.
Birrer P.
Blanton D.M.
Bruner A.
AUTHOR ADDRESSES
(Wright S.W.; Chudnofsky C.R.; Dronen S.C.; Kothari R.; Birrer P.; Blanton
D.M.; Bruner A.) Vanderbilt University Medical Center, 240 Medical Center
South, Nashville, TN 37212, United States.
CORRESPONDENCE ADDRESS
S.W. Wright, Vanderbilt University Medical Center, 240 Medical Center South,
Nashville, TN 37212, United States.
SOURCE
Annals of Emergency Medicine (1993) 22:2 (201-205). Date of Publication:
1993
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study objective: To compare the efficacy of diazepam and midazolam when used
for conscious sedation in emergency department patients. Design:
Prospective, randomized, double-blind, multicenter trial. Setting: Three
university EDs. Type of participants: Patients requiring one of the
following procedures: abscess drainage, joint reduction, extensive suturing,
chest tube insertion, or lumbar puncture. Interventions: Diazepam (2.5
mg/mL) or midazolam (1 mg/mL) was administered until the desired level of
sedation was achieved to a maximum of 5 mL. Fentanyl citrate was
administered if needed for pain. Measurements and main results: Thirty-three
patients received diazepam and 36 received midazolam. Patients receiving
midazolam had a greater degree of early sedation (P < .05), a higher
90-minute alertness scale score (P < .05), more patients ready for discharge
at 90 minutes (P = .05), significantly less recall for the procedure (P <
.02), and less pain on injection (P < .01) than patients who were given
diazepam. Conclusions: Diazepam and midazolam are both effective for
conscious sedation in ED patients. Midazolam causes less pain on injection,
a significantly greater degree of early sedation, and a more rapid return to
baseline function.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diazepam (adverse drug reaction, drug comparison, pharmacokinetics,
pharmacology)
midazolam (adverse drug reaction, drug comparison, pharmacokinetics,
pharmacology)
EMTREE DRUG INDEX TERMS
fentanyl citrate (drug therapy)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
consciousness
emergency treatment
sedation
EMTREE MEDICAL INDEX TERMS
abscess drainage
adult
alertness
article
dislocation (therapy)
drug efficacy
emergency ward
female
human
intravenous drug administration
lumbar puncture
major clinical study
male
nausea (side effect)
pain (drug therapy)
priority journal
thorax drainage
vertigo (side effect)
CAS REGISTRY NUMBERS
diazepam (439-14-5)
fentanyl citrate (990-73-8)
midazolam (59467-70-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Surgery (9)
Internal Medicine (6)
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993058899
MEDLINE PMID
8427432 (http://www.ncbi.nlm.nih.gov/pubmed/8427432)
PUI
L23058899
DOI
10.1016/S0196-0644(05)80203-3
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(05)80203-3
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1417
TITLE
Drug intoxications in children
ORIGINAL (NON-ENGLISH) TITLE
INTOXICATIONS MEDICAMENTEUSES CHEZ L'ENFANT
AUTHOR NAMES
Wood C.
Gourrier E.
Mokhtari M.
AUTHOR ADDRESSES
(Wood C.; Gourrier E.; Mokhtari M.) Unite de Reanimation Pediatrique,
Hopital Saint-Vicent-de-Paul, 74, Avenue Denfert-Rochereau, 75014 Paris,
France.
CORRESPONDENCE ADDRESS
C. Wood, Unite de Reanimation Pediatrique, Hopital Saint-Vicent-de-Paul, 74,
Avenue Denfert-Rochereau, 75014 Paris, France.
SOURCE
Revue du Praticien - Medecine Generale (1992) 6:196 (21-26). Date of
Publication: 1992
ISSN
0989-2737
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (drug therapy)
cholinergic receptor blocking agent (drug toxicity)
cocaine (drug toxicity)
insecticide (drug toxicity)
nicotine (drug toxicity)
opiate (drug toxicity)
phenothiazine derivative (drug toxicity)
salicylic acid derivative (drug toxicity)
theophylline (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
activated carbon (drug therapy)
apomorphine (drug therapy)
calcium salt (drug therapy)
chelating agent (drug therapy)
deferoxamine (drug therapy)
dimercaprol (drug therapy)
edetic acid (drug therapy)
emetine (drug therapy)
flumazenil (drug therapy)
folic acid (drug therapy)
glucagon (drug therapy)
naloxone (drug therapy)
vitamin K group (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
accident
adsorption
child
childhood
diuresis
emergency treatment
hemodialysis
human
perfusion
short survey
stomach lavage
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
apomorphine (314-19-2, 58-00-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
edetic acid (150-43-6, 60-00-4)
emetine (316-42-7, 483-18-1)
flumazenil (78755-81-4)
folic acid (59-30-3, 6484-89-5)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
French
EMBASE ACCESSION NUMBER
1992365408
PUI
L22365390
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1418
TITLE
Managing pain emergencies. Part I
AUTHOR NAMES
MacLeod B.A.
Turturro M.A.
Lorei J.M.
Paris P.M.
AUTHOR ADDRESSES
(MacLeod B.A.; Turturro M.A.; Lorei J.M.; Paris P.M.) Department of
Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA,
United States.
CORRESPONDENCE ADDRESS
B.A. MacLeod, Department of Medicine, University of Pittsburgh, School of
Medicine, Pittsburgh, PA, United States.
SOURCE
IM - Internal Medicine (1992) 13:7 (14-22). Date of Publication: 1992
ISSN
0273-6608
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
alfentanil (adverse drug reaction, drug therapy)
butorphanol (adverse drug reaction, drug therapy)
codeine (adverse drug reaction, drug therapy)
dextropropoxyphene (adverse drug reaction, drug therapy)
fentanyl (adverse drug reaction, drug therapy)
hydrocodone (adverse drug reaction, drug therapy)
hydromorphone (adverse drug reaction, drug therapy)
morphine (adverse drug reaction, drug therapy)
nalbuphine (adverse drug reaction, drug therapy)
naloxone (adverse drug reaction, drug therapy)
oxycodone (adverse drug reaction, drug therapy)
pentazocine (adverse drug reaction, drug therapy)
pethidine (adverse drug reaction, drug therapy)
sufentanil (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
depression (side effect)
emergency health service
gastrointestinal symptom (side effect)
human
intramuscular drug administration
intravenous drug administration
nausea (side effect)
neurotoxicity (side effect)
oral drug administration
short survey
vomiting (side effect)
CAS REGISTRY NUMBERS
alfentanil (69049-06-5, 71195-58-9)
butorphanol (42408-82-2)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
fentanyl (437-38-7)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
morphine (52-26-6, 57-27-2)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1993021135
PUI
L23021135
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1419
TITLE
Drug safety in the emergency service
ORIGINAL (NON-ENGLISH) TITLE
ARZNEIMITTELSICHERHEIT IM RETTUNGSDIENST
AUTHOR NAMES
Wagner W.
AUTHOR ADDRESSES
(Wagner W.) St. Josef-Hospital, Burer Strasse 47, 4650 Gelsenkirchen-Horst,
Germany.
CORRESPONDENCE ADDRESS
W. Wagner, St. Josef-Hospital, Burer Strasse 47, 4650 Gelsenkirchen-Horst,
Germany.
SOURCE
Deutsche Apotheker Zeitung (1992) 132:43 (2297-2301). Date of Publication:
1992
ISSN
0011-9857
BOOK PUBLISHER
Deutscher Apotheker Verlag, Birkenwaldstr.44,, Stuttgart, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote (pharmaceutics)
cardiovascular agent (pharmaceutics)
fenoterol (pharmaceutics)
psychotropic agent (pharmaceutics)
EMTREE DRUG INDEX TERMS
alcuronium (pharmaceutics)
atropine (pharmaceutics)
biperiden (pharmaceutics)
clobutinol (pharmaceutics)
clonidine (pharmaceutics)
deferoxamine (pharmaceutics)
dexamethasone (pharmaceutics)
dextran (pharmaceutics)
diazepam (pharmaceutics)
digitoxin (pharmaceutics)
digoxin (pharmaceutics)
dimeticone (pharmaceutics)
dipyrone (pharmaceutics)
dobutamine (pharmaceutics)
droperidol (pharmaceutics)
etomidate (pharmaceutics)
fentanyl (pharmaceutics)
flumazenil (pharmaceutics)
flunitrazepam (pharmaceutics)
folic acid (pharmaceutics)
furosemide (pharmaceutics)
haloperidol (pharmaceutics)
heparin (pharmaceutics)
isosorbide dinitrate (pharmaceutics)
ketamine (pharmaceutics)
metildigoxin (pharmaceutics)
metoclopramide (pharmaceutics)
morphine (pharmaceutics)
naloxone (pharmaceutics)
nifedipine (pharmaceutics)
noradrenalin (pharmaceutics)
orciprenaline (pharmaceutics)
oxytocin (pharmaceutics)
pancuronium (pharmaceutics)
physostigmine (pharmaceutics)
phytomenadione (pharmaceutics)
prednisolone (pharmaceutics)
promethazine (pharmaceutics)
propafenone (pharmaceutics)
ranitidine (pharmaceutics)
sodium chloride (pharmaceutics)
sodium thiosulfate (pharmaceutics)
suxamethonium (pharmaceutics)
theophylline (pharmaceutics)
theophylline derivative (pharmaceutics)
thionine (pharmaceutics)
triflupromazine (pharmaceutics)
verapamil (pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
emergency medicine
EMTREE MEDICAL INDEX TERMS
ambulance
article
drug choice
drug safety
drug storage
drug use
CAS REGISTRY NUMBERS
alcuronium (15180-03-7, 23214-96-2)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
clobutinol (1215-83-4, 14860-49-2)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
deferoxamine (70-51-9)
dexamethasone (50-02-2)
dextran (87915-38-6, 9014-78-2)
diazepam (439-14-5)
digitoxin (71-63-6)
digoxin (20830-75-5, 57285-89-9)
dimeticone (32028-95-8, 68248-27-1, 9004-73-3, 9006-65-9)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
dobutamine (34368-04-2, 52663-81-7)
droperidol (548-73-2)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fenoterol (13392-18-2, 1944-12-3)
fentanyl (437-38-7)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
folic acid (59-30-3, 6484-89-5)
furosemide (54-31-9)
haloperidol (52-86-8)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
isosorbide dinitrate (87-33-2)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
metildigoxin (30685-43-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
noradrenalin (1407-84-7, 51-41-2)
orciprenaline (586-06-1, 5874-97-5)
oxytocin (50-56-6, 54577-94-5)
physostigmine (57-47-6, 64-47-1)
phytomenadione (11104-38-4, 84-80-0)
prednisolone (50-24-8)
promethazine (58-33-3, 60-87-7)
propafenone (34183-22-7, 54063-53-5)
ranitidine (66357-35-5, 66357-59-3)
sodium chloride (7647-14-5)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
suxamethonium (306-40-1, 71-27-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
theophylline derivative (2850-40-0)
thionine (581-64-6)
triflupromazine (1098-60-8, 146-54-3)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
German
EMBASE ACCESSION NUMBER
1992331102
PUI
L22331084
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1420
TITLE
Guidelines for cardiopulmonary resuscitation and emergency cardiac care,
VII: Neonatal resuscitation
AUTHOR NAMES
Kerber R.E.
Ornato J.P.
Brown D.D.
Chameides L.
Chandra N.C.
Cummins R.O.
Hazinski M.F.
Melker R.J.
Weaver W.D.
Abramson N.S.
Adams Jr. H.P.
Aghababian R.V.
Albarran-Sotelo R.
Alpert J.S.
Atkins J.A.
Aufderheide T.P.
Banner M.J.
Bar-Joseph G.
Becker L.
AUTHOR ADDRESSES
(Kerber R.E.; Ornato J.P.; Brown D.D.; Chameides L.; Chandra N.C.; Cummins
R.O.; Hazinski M.F.; Melker R.J.; Weaver W.D.; Abramson N.S.; Adams Jr.
H.P.; Aghababian R.V.; Albarran-Sotelo R.; Alpert J.S.; Atkins J.A.;
Aufderheide T.P.; Banner M.J.; Bar-Joseph G.; Becker L.)
SOURCE
Journal of the American Medical Association (1992) 268:16 (2276-2281). Date
of Publication: 1992
ISSN
0098-7484
BOOK PUBLISHER
American Medical Association, 515 North State Street, Chicago, United
States.
EMTREE DRUG INDEX TERMS
epinephrine (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
plasma substitute (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiopulmonary arrest (drug therapy, therapy)
newborn intensive care
resuscitation
EMTREE MEDICAL INDEX TERMS
Apgar score
assisted ventilation
body position
bradycardia (drug therapy)
circulation
clinical examination
endotracheal intubation
heart massage
human
meconium aspiration
newborn
oxygen therapy
prematurity
priority journal
review
tactile stimulation
thermoregulation
treatment planning
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1992323491
MEDLINE PMID
1404773 (http://www.ncbi.nlm.nih.gov/pubmed/1404773)
PUI
L22323473
DOI
10.1001/jama.268.16.2276
FULL TEXT LINK
http://dx.doi.org/10.1001/jama.268.16.2276
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1421
TITLE
Battlefield experience of a mobile surgical team: Anesthesiological approach
AUTHOR NAMES
Peric M.
Hamel D.
Kelecic M.
Matejcic A.
AUTHOR ADDRESSES
(Peric M.; Hamel D.; Kelecic M.; Matejcic A.) Dept. Anesthesiol. and Intens.
Ther., Sisters of Mercy Clinical Hospital, Vinogradska 29, Zagreb, Croatia.
CORRESPONDENCE ADDRESS
M. Peric, Dept. Anesthesiol. and Intens. Ther., Sisters of Mercy Clinical
Hospital, Vinogradska 29, Zagreb, Croatia.
SOURCE
Croatian Medical Journal (1992) 33:SUPPL. 2 (175-183). Date of Publication:
1992
ISSN
0353-9504
ABSTRACT
Practical experience of a Mobile Surgical Team (MST) working on battlefields
near Dakovo, Ilok, Novska and Samobor is described. Among a great number of
the wounded treated, 39 cases of seriously wounded subjects are presented.
Some important conclusions on a wartime hospital providing fluid
resuscitation and analgesia, relevant to the MST in war situations are
documented.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
anesthetic agent
antibiotic agent
nitrous oxide
plasma substitute
EMTREE DRUG INDEX TERMS
bicarbonate
dextran
dopamine
gelatin
hetastarch
ketoprofen
midazolam
morphine
naloxone
noradrenalin
opiate
pancuronium
pentazocine
pethidine
Ringer lactate solution
sedative agent
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
anesthesia
battle injury
war
wound care
EMTREE MEDICAL INDEX TERMS
article
colloid
crystalloid
emergency treatment
fluid therapy
hospital
human
resuscitation
Yugoslavia
CAS REGISTRY NUMBERS
bicarbonate (144-55-8, 71-52-3)
dextran (87915-38-6, 9014-78-2)
dopamine (51-61-6, 62-31-7)
gelatin (9000-70-8)
hetastarch (9005-27-0)
ketoprofen (22071-15-4, 57495-14-4)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
Ringer lactate solution (8022-63-7)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Dermatology and Venereology (13)
Anesthesiology (24)
Drug Literature Index (37)
Surgery (9)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992293182
PUI
L22293164
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1422
TITLE
Drug abusers in medical emergency care. Possibilities of prophylactic and
therapeutic interventions
ORIGINAL (NON-ENGLISH) TITLE
DROGENABHANGIGE IN DER MEDIZINISCHEN NOTFALLVERSORGUNG. MOGLICHKEITEN
PROPHYLAKTISCHER UND THERAPEUTISCHER INTERVENTIONEN
AUTHOR NAMES
Konegen N.
Heudtlass J.-H.
Spikofski W.
AUTHOR ADDRESSES
(Konegen N.; Heudtlass J.-H.; Spikofski W.) Inst. Sozialmed. Forsch. BOSOFO
e.V., Bahnhofstrasse 7a, D-4690 Herne 1, Germany.
CORRESPONDENCE ADDRESS
N. Konegen, Inst. Sozialmed. Forsch. BOSOFO e.V., Bahnhofstrasse 7a, D-4690
Herne 1, Germany.
SOURCE
Wiener Zeitschrift fur Suchtforschung (1992) 15:1 (3-11). Date of
Publication: 1992
ISSN
1012-9375
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
levallorphan (drug toxicity)
methadone (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aversion therapy
drug abuse
emergency treatment
fatality
intoxication
maintenance therapy
EMTREE MEDICAL INDEX TERMS
drug therapy
epidemiology
Germany
human
oral drug administration
review
DRUG TRADE NAMES
narcanti
polamidon
CAS REGISTRY NUMBERS
levallorphan (13075-35-9, 152-02-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, German
EMBASE ACCESSION NUMBER
1992291843
PUI
L22291825
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1423
TITLE
Pulmonary oedema - Prehospital treatment. Caution with morphine dosage
AUTHOR NAMES
Chambers J.A.
Baggoley C.J.
AUTHOR ADDRESSES
(Chambers J.A.; Baggoley C.J.) Accident and Emergency Department, Derriford
Hospital, Plymouth PL6 8DH, United Kingdom.
CORRESPONDENCE ADDRESS
J.A. Chambers, Accident and Emergency Department, Derriford Hospital,
Plymouth PL6 8DH, United Kingdom.
SOURCE
Medical Journal of Australia (1992) 157:5 (326-328). Date of Publication:
1992
ISSN
0025-729X
BOOK PUBLISHER
Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road,
Pyrmont, Australia.
ABSTRACT
Objective: To inform doctors of potential hazards if opioids are
administered in excessive doses to patients with acute pulmonary oedema.
Clinical features: Three elderly patients were unresponsive and hypotensive
on arrival in the emergency department. All had received morphine
parenterally as a component of pre-hospital treatment for acute pulmonary
oedema. Interventions and outcome: All were given naloxone intravenously,
regained consciousness and had a rise in blood pressure. Conclusion:
Parenteral administration of opioids should be used with caution in acute
pulmonary oedema. The authors present a protocol for pre-hospital drug
therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (adverse drug reaction, drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
diuretic agent (drug therapy)
furosemide (drug therapy)
naloxone (drug therapy)
nitrate (drug therapy)
salbutamol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
lung edema (drug therapy)
EMTREE MEDICAL INDEX TERMS
aged
bronchospasm (complication, drug therapy)
case report
female
human
hypotension (drug therapy, side effect)
intramuscular drug administration
intravenous drug administration
male
note
priority journal
unconsciousness (drug therapy, side effect)
CAS REGISTRY NUMBERS
furosemide (54-31-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrate (14797-55-8)
salbutamol (18559-94-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992276186
MEDLINE PMID
1435476 (http://www.ncbi.nlm.nih.gov/pubmed/1435476)
PUI
L22276185
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1424
TITLE
Emergency department observation beds improve patient care: Society for
Academic Emergency Medicine Debate
AUTHOR NAMES
Graff L.
Zun L.S.
Leikin J.
Gibler B.
Weinstock M.S.
Mathews J.
Benjamin G.C.
AUTHOR ADDRESSES
(Graff L.; Zun L.S.; Leikin J.; Gibler B.; Weinstock M.S.; Mathews J.;
Benjamin G.C.) New Britain General Hospital, 100 Grand Street, New Britain,
CT 06050, United States.
CORRESPONDENCE ADDRESS
L. Graff, New Britain General Hospital, 100 Grand Street, New Britain, CT
06050, United States.
SOURCE
Annals of Emergency Medicine (1992) 21:8 (967-975). Date of Publication:
1992
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
creatine kinase MB (endogenous compound)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
antidote (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
emergency ward
observation
patient care
EMTREE MEDICAL INDEX TERMS
abdominal pain (etiology)
appendicitis (diagnosis, surgery)
coronary care unit
cost effectiveness analysis
diagnostic accuracy
drug blood level
health care cost
health insurance
hospital admission
hospital personnel
intoxication (drug therapy)
malpractice
medical decision making
note
nurse
physical examination
priority journal
thorax pain (etiology)
thorax radiography
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1992249242
MEDLINE PMID
1497166 (http://www.ncbi.nlm.nih.gov/pubmed/1497166)
PUI
L22249241
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1425
TITLE
Diagnosis and therapy of acute drug emergencies
ORIGINAL (NON-ENGLISH) TITLE
DIAGNOSTIK UND THERAPIE VON AKUTEN DROGENNOTFALLEN
AUTHOR NAMES
Albrecht K.
Lampe D.
AUTHOR ADDRESSES
(Albrecht K.; Lampe D.) Zentrale Rettungs-/Intensivther. Abt, Stadt.
Krankenhaus im Friedrichshain, Landsberger Allee 49, 1017 Berlin, Germany.
CORRESPONDENCE ADDRESS
K. Albrecht, Zentrale Rettungs-/Intensivther. Abt, Stadt. Krankenhaus im
Friedrichshain, Landsberger Allee 49, 1017 Berlin, Germany.
SOURCE
Zeitschrift fur Arztliche Fortbildung (1992) 86:14 (701-707). Date of
Publication: 1992
ISSN
0044-2178
BOOK PUBLISHER
Urban und Fischer Verlag Jena, P.O. Box 100537, Jena, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug therapy)
amphetamine derivative
bicarbonate (drug therapy)
cannabinoid
cocaine
diamorphine
diazepam (drug therapy)
epinephrine (drug therapy)
flecainide (drug therapy)
haloperidol (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
nifedipine (drug therapy)
opiate
phentolamine (drug therapy)
phenytoin (drug therapy)
physostigmine salicylate (drug therapy)
prednisolone (drug therapy)
promethazine (drug therapy)
propranolol (drug therapy)
thiopental (drug therapy)
EMTREE DRUG INDEX TERMS
phentolamine mesylate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
drug dependence
emergency
EMTREE MEDICAL INDEX TERMS
drug intoxication (drug therapy)
human
intravenous drug administration
oral drug administration
short survey
subcutaneous drug administration
DRUG TRADE NAMES
narcanti
regitin
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
bicarbonate (144-55-8, 71-52-3)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
flecainide (54143-55-4)
haloperidol (52-86-8)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phentolamine (50-60-2, 73-05-2)
phentolamine mesylate (65-28-1)
phenytoin (57-41-0, 630-93-3)
physostigmine salicylate (57-64-7, 71214-04-5)
prednisolone (50-24-8)
promethazine (58-33-3, 60-87-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
German
EMBASE ACCESSION NUMBER
1992257254
MEDLINE PMID
1529621 (http://www.ncbi.nlm.nih.gov/pubmed/1529621)
PUI
L22257253
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1426
TITLE
Hi mom, I'm home. Controversies in clinical care.
AUTHOR NAMES
Bourn S.
AUTHOR ADDRESSES
(Bourn S.)
CORRESPONDENCE ADDRESS
S. Bourn,
SOURCE
JEMS : a journal of emergency medical services (1992) 17:7 (95-97). Date of
Publication: Jul 1992
ISSN
0197-2510
EMTREE DRUG INDEX TERMS
morphine (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency health service
treatment outcome
EMTREE MEDICAL INDEX TERMS
article
human
information processing
standard
United States
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
10120075 (http://www.ncbi.nlm.nih.gov/pubmed/10120075)
PUI
L22958880
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1427
TITLE
The emergency kit of the general practitioner
ORIGINAL (NON-ENGLISH) TITLE
LA TROUSSE D'URGENCE DU GENERALISTE
AUTHOR NAMES
Lanotte R.
Lebret P.
AUTHOR ADDRESSES
(Lanotte R.; Lebret P.) Service de Reanimation Medicale, Hopital Bretonneau,
37044 Tours Cedex, France.
CORRESPONDENCE ADDRESS
P. Lebret, Service de Reanimation Medicale, Hopital Bretonneau, 37044 Tours
Cedex, France.
SOURCE
Revue de Medecine de Tours (1992) 26:3-4 (91-98). Date of Publication: 1992
ISSN
0557-7721
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
activated carbon
antibiotic agent
atropine
captopril
charcoal
corticosteroid
diazepam
epinephrine
flumazenil
furosemide
glucose
insulin
ipecac
isoprenaline
isosorbide dinitrate
lanatoside C
lidocaine
lysine acetylsalicylate
methergyn
methylprednisolone sodium succinate
methysergide
metoclopramide
n acetylleucine ethanolamine
naloxone
neutral insulin
nifedipine
paracetamol
paralyoc
terbutaline
theophylline
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
emergency medicine
EMTREE MEDICAL INDEX TERMS
human
short survey
DRUG TRADE NAMES
actrapid
adalat
anexate
aspegic
bricanyl
carbomix
cedilanide
dyspne inhal
isuprel
lasilix
lopril
methergyn
narcan
paralyoc
risordan
solumedrol
tanganil
valium
xylocaine
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
captopril (62571-86-2)
charcoal (16291-96-6)
diazepam (439-14-5)
flumazenil (78755-81-4)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
insulin (9004-10-8)
ipecac (8012-96-2)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
isosorbide dinitrate (87-33-2)
lanatoside C (17575-22-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lysine acetylsalicylate (34220-70-7, 37933-78-1, 62952-06-1, 77337-52-1)
methylprednisolone sodium succinate (2375-03-3, 2921-57-5)
methysergide (16509-15-2, 361-37-5, 62288-72-6)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
n acetylleucine ethanolamine (149-90-6)
naloxone (357-08-4, 465-65-6)
neutral insulin (9004-14-2)
nifedipine (21829-25-4)
paracetamol (103-90-2)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1992184056
PUI
L22184055
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1428
TITLE
Initial management of ingestions of toxic substances
AUTHOR NAMES
Kulig K.
AUTHOR ADDRESSES
(Kulig K.) Colorado Univ. Health Sciences Ctr., Campus Box B215, 4200 E.
Ninth Ave., Denver, CO 80262, United States.
CORRESPONDENCE ADDRESS
K. Kulig, Colorado Univ. Health Sciences Ctr., Campus Box B215, 4200 E.
Ninth Ave., Denver, CO 80262, United States.
SOURCE
New England Journal of Medicine (1992) 326:25 (1677-1681). Date of
Publication: 1992
ISSN
0028-4793
BOOK PUBLISHER
Massachussetts Medical Society, 860 Winter Street, Waltham, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
adrenergic receptor stimulating agent (drug toxicity)
alcohol (drug toxicity)
cholinergic receptor blocking agent (drug toxicity)
cholinergic receptor stimulating agent (drug toxicity)
opiate agonist (drug toxicity)
sedative agent (drug toxicity)
EMTREE DRUG INDEX TERMS
4 methylpyrazole (drug therapy)
antidote (drug dose, drug therapy)
atropine (drug administration, drug dose, drug therapy)
bicarbonate (drug administration, drug dose, drug therapy)
calcium (drug administration, drug dose, drug therapy)
flumazenil (drug dose, drug therapy)
glucagon (drug administration, drug dose, drug therapy)
hydroxocobalamin (drug therapy)
naloxone (drug dose, drug therapy)
opiate antagonist (drug therapy)
physostigmine (drug administration, drug dose, drug therapy)
pyridoxine (drug administration, drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
toxicology
EMTREE MEDICAL INDEX TERMS
acute disease
drug overdose (diagnosis, drug therapy, etiology)
electrocardiography
electrolyte blood level
human
ingestion
physical examination
priority journal
review
screening test
serum osmolarity
stomach emptying
thorax radiography
CAS REGISTRY NUMBERS
4 methylpyrazole (7554-65-6)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium (7440-70-2)
flumazenil (78755-81-4)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1992179653
MEDLINE PMID
1588982 (http://www.ncbi.nlm.nih.gov/pubmed/1588982)
PUI
L22179652
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1429
TITLE
Pediatric emergency information sheet using a microcomputer
AUTHOR NAMES
Muoghalu B.U.
Kaiser R.
Keller M.
Benson S.
Grant J.
McKeegan G.
AUTHOR ADDRESSES
(Muoghalu B.U.; Kaiser R.; Keller M.; Benson S.; Grant J.; McKeegan G.)
Williamsport Hospital/Medical Ctr., 777 Rural Avenue, Williamsport, PA
17701, United States.
CORRESPONDENCE ADDRESS
G. McKeegan, Williamsport Hospital/Medical Ctr., 777 Rural Avenue,
Williamsport, PA 17701, United States.
SOURCE
Hospital Pharmacy (1992) 27:1 (14-17). Date of Publication: 1992
ISSN
0018-5787
BOOK PUBLISHER
Facts and Comparisons, 111 W. Port Plaza, Ste. 300, St. Louis, United
States.
ABSTRACT
Calculating the appropriate dosage of a drug and the right equipment size
during an emergency situation can be a time-consuming, frustrating, and
error-prone process, considering the shortage of time during a
resuscitation. A microcomputer program was developed to aid in the care of
pediatric patients in emergency or 'code' situations. This is accomplished
by use of a printout of a patient-specific chart for most needed critical
care drugs and equipment used during an emergency. This program is written
in 'C' language and is menu-driven.
EMTREE DRUG INDEX TERMS
atropine
bicarbonate
bretylium
dopamine
epinephrine
furosemide
glucose
isoprenaline
lidocaine
mannitol
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dose
emergency
pediatrics
EMTREE MEDICAL INDEX TERMS
article
child
human
software
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Biophysics, Bioengineering and Medical Instrumentation (27)
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992140069
MEDLINE PMID
10116117 (http://www.ncbi.nlm.nih.gov/pubmed/10116117)
PUI
L22140068
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1430
TITLE
Psychiatric emergencies
ORIGINAL (NON-ENGLISH) TITLE
URGENCES EN PSYCHIATRIE
AUTHOR NAMES
Olie J.-P.
Brochier T.
AUTHOR ADDRESSES
(Olie J.-P.; Brochier T.) Service Hospitalo-Universitaire de Sante Mentale
et Therapeutique, Centre Hospitalier Sainte-Anne, 75014 Paris
CORRESPONDENCE ADDRESS
Service Hospitalo-Universitaire de Sante Mentale et Therapeutique, Centre
Hospitalier Sainte-Anne, 75014 Paris
SOURCE
Gazette Medicale (1992) 99:6 (15-23). Date of Publication: 1992
ISSN
0760-758X
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
lithium (drug therapy)
monoamine oxidase inhibitor (drug therapy)
neuroleptic agent (drug therapy)
EMTREE DRUG INDEX TERMS
alprazolam (drug therapy)
bromocriptine (drug therapy)
clorazepate (drug therapy)
clorazepate dipotassium
cyamemazine (drug therapy)
dantrolene (drug therapy)
diazepam (drug therapy)
haloperidol (drug therapy)
levodopa (drug therapy)
meprobamate (drug therapy)
naloxone (drug therapy)
sultopride (drug therapy)
tiapride (drug therapy)
tropatepine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitation
anxiety
delirium
schizophrenia (drug therapy)
suicide
EMTREE MEDICAL INDEX TERMS
article
drug therapy
human
DRUG TRADE NAMES
barnetil
equanil
haldol
lepticur
narcan
tercian
tiapridal
tranxene
valium
xanax
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
bromocriptine (25614-03-3)
clorazepate dipotassium (57109-90-7)
clorazepate (20432-69-3, 23887-31-2)
cyamemazine (3546-03-0)
dantrolene (14663-23-1, 7261-97-4)
diazepam (439-14-5)
haloperidol (52-86-8)
levodopa (59-92-7)
lithium (7439-93-2)
meprobamate (57-53-4)
naloxone (357-08-4, 465-65-6)
sultopride (53583-79-2)
tiapride (51012-32-9, 51012-33-0)
tropatepine (27574-24-9)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1992098352
PUI
L22098351
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1431
TITLE
Erratum: Epidemiological surveillance of opioid related episodes in an
emergency room of Barcelona, Spain (1979-1989)( British Journal of
Addiction(1991)86:11)
AUTHOR ADDRESSES
SOURCE
British Journal of Addiction (1992) 87:2 (322). Date of Publication: 1992
ISSN
0952-0481
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
error
EMTREE MEDICAL INDEX TERMS
erratum
priority journal
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1992081019
PUI
L22081018
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1432
TITLE
The contribution of drugs in neurological recovery after acute traumatic
spinal cord injury
ORIGINAL (NON-ENGLISH) TITLE
MEDICAMENTEUZE BEVORDERING VAN NEUROLOGISCH HERSTEL NA EEN ACUUT TRAUMATISCH
RUGGEMERGLETSEL
AUTHOR NAMES
Bosch D.A.
AUTHOR ADDRESSES
(Bosch D.A.) Afdeling Neurochirurgie, Academisch Medisch Centrum,
Meibergdreef 9, 1105 AZ Amsterdam
CORRESPONDENCE ADDRESS
Afdeling Neurochirurgie, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ
Amsterdam
SOURCE
Nederlands Tijdschrift voor Geneeskunde (1992) 136:5 (212-214). Date of
Publication: 1992
ISSN
0028-2162
BOOK PUBLISHER
Bohn Stafleu Van Loghum bv, P.O. Box 246, Houten, Netherlands.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ganglioside GM1 (drug comparison, drug therapy)
methylprednisolone (drug comparison, drug therapy)
EMTREE DRUG INDEX TERMS
naloxone (drug comparison, drug therapy)
placebo (drug comparison)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
spinal cord injury (drug therapy)
EMTREE MEDICAL INDEX TERMS
clinical trial
drug efficacy
human
short survey
CAS REGISTRY NUMBERS
ganglioside GM1 (37758-47-7)
methylprednisolone (6923-42-8, 83-43-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Dutch
EMBASE ACCESSION NUMBER
1992061838
MEDLINE PMID
1736139 (http://www.ncbi.nlm.nih.gov/pubmed/1736139)
PUI
L22061837
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1433
TITLE
Methylprednisolone or naloxone treatment after acute spinal cord injury:
1-year follow-up data: Results of the second National Acute Spinal Cord
Injury Study
AUTHOR NAMES
Bracken M.B.
Shepard M.J.
Collins Jr. W.F.
Holford T.R.
Baskin D.S.
Eisenberg H.M.
Flamm E.
Leo-Summers L.
Maroon J.C.
Marshall L.F.
Perot Jr. P.L.
Piepmeier J.
Sonntag V.K.H.
Wagner Jr. F.C.
Wilberger J.L.
Winn H.R.
Young W.
AUTHOR ADDRESSES
(Bracken M.B.; Shepard M.J.; Collins Jr. W.F.; Holford T.R.; Baskin D.S.;
Eisenberg H.M.; Flamm E.; Leo-Summers L.; Maroon J.C.; Marshall L.F.; Perot
Jr. P.L.; Piepmeier J.; Sonntag V.K.H.; Wagner Jr. F.C.; Wilberger J.L.;
Winn H.R.; Young W.) 60 College Street, New Haven, CT 06510, United States.
CORRESPONDENCE ADDRESS
M.B. Bracken, 60 College Street, New Haven, CT 06510, United States.
SOURCE
Journal of Neurosurgery (1992) 76:1 (23-31). Date of Publication: 1992
ISSN
0022-3085
BOOK PUBLISHER
American Association of Neurological Surgeons, 1224 West Main Street Suite
450, Charlottesville, United States.
ABSTRACT
The 1-year follow-up data of a multicenter randomized controlled trial of
methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or
naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute
spinal cord injury are reported and compared with placebo results. In
patients treated with methylprednisolone within 8 hours of injury, increased
recovery of neurological function was seen at 6 weeks and at 6 months and
continued to be observed 1 year after injury. For motor function, this
difference was statistically significant (p = 0.030), and was found in
patients with total sensory and motor loss in the emergency room (p = 0.019)
and in those with some preservation of motor and sensory function (p =
0.024). Naloxone-treated patients did not show significantly greater
recovery. Patients treated after 8 hours of injury recovered less motor
function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10)
as compared with those given placebo. Complication and mortality rates were
similar in either group of treated patients as compared with the placebo
group. The authors conclude that treatment with the study dose of
methylprednisolone is indicated for acute spinal cord trauma, but only if it
can be started within 8 hours of injury.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methylprednisolone (drug comparison, drug therapy, pharmacology)
naloxone (adverse drug reaction, drug comparison, drug therapy)
placebo (drug comparison)
EMTREE DRUG INDEX TERMS
methylprednisolone sodium succinate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain function
follow up
neurologic examination
spinal cord injury (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
controlled study
drug mechanism
heart arrhythmia (side effect)
human
lipid peroxidation
major clinical study
motor performance
paralytic ileus (side effect)
patient selection
priority journal
scoring system
skin sensation
survival
urinary tract infection (side effect)
CAS REGISTRY NUMBERS
methylprednisolone (6923-42-8, 83-43-2)
methylprednisolone sodium succinate (2375-03-3, 2921-57-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992026029
MEDLINE PMID
1727165 (http://www.ncbi.nlm.nih.gov/pubmed/1727165)
PUI
L22026029
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1434
TITLE
The empiric use of hypertonic dextrose in patients with altered mental
status: A reappraisal
AUTHOR NAMES
Hoffman J.R.
Schriger D.L.
Votey S.R.
Luo J.S.
AUTHOR ADDRESSES
(Hoffman J.R.; Schriger D.L.; Votey S.R.; Luo J.S.) UCLA Emergency Medicine
Center, 924 Westwood Boulevard, Los Angeles, CA 90024, United States.
CORRESPONDENCE ADDRESS
J.R. Hoffman, UCLA Emergency Medicine Center, 924 Westwood Boulevard, Los
Angeles, CA 90024, United States.
SOURCE
Annals of Emergency Medicine (1992) 21:1 (20-24). Date of Publication: 1992
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Study hypothesis: Neither response to hypertonic glucose (D(50)W) nor
presence of hypoglycemia can be reliably predicted by 'typical' clinical
findings (tachycardia, diaphoresis, and/or an available history of diabetes
mellitus) in prehospital patients with altered mental status (AMS).
Population: Three hundred forty consecutive patients who received D(50)W for
prehospital AMS as ordered by a university hospital paramedic base. Methods:
Review of prehospital records and tape recordings for all subjects to
determine presence or absence of tachycardia, diaphoresis, and/or available
history of diabetes mellitus at the time of field presentation, as well as
response to D(50)W; final diagnosis was determined from emergency department
charts in the 301 patients for whom they were available. Results:
Twenty-five patients (7.4%) had a complete response to D(50)W: 20 had
hypoglycemia, diagnosis for one patient was unknown, and four had other
causes of AMS. Three patients with an ED diagnosis of hypoglycemia had
partial or equivocal responses to D(50)W, and five had no response. Complete
responders were more likely than other patients to have diaphoresis (40% vs
13%, P < .001) and available history of diabetes (52% vs 12.1%, P < .001)
but not tachycardia (36% vs 35.2%, P = NS). Nine complete responders,
including five with hypoglycemia, had none of the three clinical signs.
Conclusion: Although patients with hypoglycemia who respond to D(50)W are
diaphoretic and have an available history of diabetes more often than other
patients with prehospital AMS, 25% of complete responders who are
hypoglycemic would not receive D(50)W if it were used only in patients with
'typical' clinical findings. Selective use of D(50)W for AMS is desirable
because very few patients respond, but it is only feasible with concomitant
field use of a rapid test of serum glucose.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
glucose (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blood glucose monitoring
clinical feature
hypoglycemia (diagnosis, drug therapy)
mental deficiency (drug therapy, etiology)
mental health
EMTREE MEDICAL INDEX TERMS
article
diabetes mellitus
diaphoresis
dose response
human
major clinical study
priority journal
reliability
screening test
tachycardia
CAS REGISTRY NUMBERS
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992012325
MEDLINE PMID
1539882 (http://www.ncbi.nlm.nih.gov/pubmed/1539882)
PUI
L22012325
DOI
10.1016/S0196-0644(05)82231-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(05)82231-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1435
TITLE
Caudal blockade for postoperative analgesia: A useful adjunct to
intramuscular opiates following emergency lower leg orthopaedic surgery
AUTHOR NAMES
McCrirrick A.
Ramage D.T.O.
AUTHOR ADDRESSES
(McCrirrick A.; Ramage D.T.O.) Department of Anaesthetics, Fremantle
Hospital, Fremantle, WA
CORRESPONDENCE ADDRESS
Department of Anaesthetics, Fremantle Hospital, Fremantle, WA
SOURCE
Anaesthesia and Intensive Care (1991) 19:4 (551-554). Date of Publication:
1991
ISSN
0310-057X
BOOK PUBLISHER
Australian Society of Anaesthetists, P.O. Box 600, Edgecliff, Australia.
ABSTRACT
The efficacy of a single caudal epidural injection of bupivacaine 20 ml 0.5%
following emergency orthopaedic surgery to the lower leg and ankle was
investigated. Forty adult patients were studied, randomised to either the
caudal or control group. The mean 24 hour postoperative papaveretum
consumption was significantly reduced in the caudal group. Analogue pain
scores as assessed in a double-blind manner were also significantly reduced
in this group. The duration of analgesia after caudal blockade was
approximately eight hours as estimated by the average time to the first dose
of papaveretum. Our study demonstrates that caudal blockade represents an
effective adjunct to intramuscular opiates following this type of surgery.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
fentanyl
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
epidural anesthesia
postoperative period
EMTREE MEDICAL INDEX TERMS
adolescent
adult
analgesia
article
clinical article
controlled study
female
human
intramuscular drug administration
intrathecal drug administration
intravenous drug administration
male
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991350538
MEDLINE PMID
1750637 (http://www.ncbi.nlm.nih.gov/pubmed/1750637)
PUI
L21349844
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1436
TITLE
Epidemiological surveillance of opioid-related episodes in an emergency room
of Barcelona, Spain (1979-1989)
AUTHOR NAMES
Domingo A.
Anto J.M.
Cami J.
AUTHOR ADDRESSES
(Domingo A.; Anto J.M.; Cami J.) Inst Mun d'Investigacio Med, Passeig
Maritim 25-29, 08003-Barcelona, Spain.
CORRESPONDENCE ADDRESS
A. Domingo, Inst Mun d'Investigacio Med, Passeig Maritim 25-29,
08003-Barcelona, Spain.
SOURCE
British Journal of Addiction (1991) 86:11 (1459-1466). Date of Publication:
1991
ISSN
0952-0481
BOOK PUBLISHER
Carfax Publishing Company, 4 Park Square, Milton Park, Abingdon,
Oxfordshire, United Kingdom.
ABSTRACT
In the early 80's opioid addiction was a low prevalence problem in Spain,
grew enormously during that decade and became the most important risk factor
for AIDS in recent years. The limitations of assessing the prevalence of
illegal drug use by means of standard epidemiological methods lead,
worldwide, to the use of indirect indicators. A Register of Toxicological
Emergencies, developed for research purposes and containing data from 1979
to 1989 at the Hospital del Mar (Barcelona) is described. Results for
opioid-related emergencies are presented, showing an epidemic increase in
the number of such emergencies after 1981. The total number of
opioid-related emergencies was 18042 with a mean of 2.23 opioid-related
emergency admissions per client throughout the whole period, implying that
some 8000 persons were seen. In episodes from non-arrestees, mean age
increased slightly over time, the male/female ratio being 2.5; withdrawal
was the more frequent reason for attendance (53%), overdoses accounting for
9% of admissions, and other medical conditions for 33%. Non-arrested women
were more likely to attend for other medical conditions and overdoses than
men. The importance of this kind of register as well as its limitations for
assessing the trend of opioid use prevalence is discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
opiate
EMTREE DRUG INDEX TERMS
illicit drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence (epidemiology)
emergency ward
EMTREE MEDICAL INDEX TERMS
acquired immune deficiency syndrome
adult
age
article
death
drug abuse
emergency
epidemic
female
gender
human
male
prevalence
priority journal
risk factor
Spain
toxicology
CAS REGISTRY NUMBERS
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English, French, Spanish
EMBASE ACCESSION NUMBER
1991332676
MEDLINE PMID
1777740 (http://www.ncbi.nlm.nih.gov/pubmed/1777740)
PUI
L21331982
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1437
TITLE
Hepatobiliary disease: Medical emergencies
AUTHOR NAMES
Mcintyre N.
AUTHOR ADDRESSES
(Mcintyre N.) University Department of Medicine, Royal Free Hospital, Pond
Street, London NW3 2QG
CORRESPONDENCE ADDRESS
University Department of Medicine, Royal Free Hospital, Pond Street, London
NW3 2QG
SOURCE
Bailliere's Clinical Gastroenterology (1991) 5:4 (709-736). Date of
Publication: 1991
ISSN
0950-3528
BOOK PUBLISHER
Bailliere Tindall Ltd, 32 Jamestown Road, London, United Kingdom.
ABSTRACT
Medical emergencies involving the liver and biliary tract are common
clinical problems. If it is already known that the patient has cirrhosis it
may be an easy matter to identify the cause of complications such as
gastrointestinal bleeding or coma, but it must be borne in mind that
oesophageal varices are not the only cause of such bleeding in cirrhotics
and that hepatic encephalopathy is not the only cause of coma. Bacterial
infection should always be considered as a possible cause of deterioration
in the clinical picture; it may be a complication of pre-existing acute or
chronic liver or biliary tract disease or a cause of hepatobiliary disease;
prompt administration of appropriate antibiotics may save the patient's
life. If there is any suspicion of biliary obstruction in a patient with
signs of bacteraemia the biliary tree should be drained without delay. The
key to the management of hepatobiliary emergencies lies in prompt and
appropriate supportive therapy, and then in a correct diagnosis which may
allow specific treatment to be administered. However, it is often difficult
to establish the cause, and the resources of a specialist centre may be
needed. Prompt referral is indicated when a patient is clearly very ill and
shows no signs of rapid improvement.
EMTREE DRUG INDEX TERMS
acetylcysteine (drug therapy)
aciclovir (drug therapy)
aminotransferase (drug concentration, endogenous compound)
antibiotic agent (drug therapy)
antidepressant agent (drug toxicity)
bilirubin (drug concentration, endogenous compound)
dextropropoxyphene (drug combination, drug toxicity)
dextropropoxyphene plus paracetamol
diuretic agent (drug therapy)
glucose (drug therapy)
halothane (adverse drug reaction)
herbaceous agent (drug toxicity)
isoniazid (adverse drug reaction, drug combination)
lactulose (drug therapy)
mannitol (drug therapy)
methionine (drug therapy)
naloxone (drug therapy)
nonsteroid antiinflammatory agent (drug toxicity)
paracetamol (drug combination, drug toxicity)
pentazocine (drug combination, drug toxicity)
phosphorus (drug toxicity)
potassium (drug concentration, endogenous compound)
rifampicin (adverse drug reaction, drug combination)
solvent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
hepatobiliary disease (diagnosis, drug therapy, epidemiology, etiology,
surgery)
EMTREE MEDICAL INDEX TERMS
adult respiratory distress syndrome (complication)
Amanita phalloides
ascites (complication, drug therapy, surgery, therapy)
autoimmunity
bacterial peritonitis (complication, diagnosis, drug therapy)
brain disease (complication, diagnosis)
cholangitis (complication, drug therapy)
cholestasis (diagnosis, therapy)
digestive system rupture (complication, diagnosis)
fatty liver
Guillain Barre syndrome (complication, diagnosis, etiology)
heart disease (complication)
heat stroke
human
hydrothorax (complication, surgery, therapy)
hypoglycemia (complication, therapy)
intravenous drug administration
jaundice
liver abscess (complication, diagnosis, drug therapy, etiology, therapy)
liver cancer (diagnosis)
liver failure (diagnosis, drug therapy, epidemiology, etiology, prevention,
side effect, surgery)
liver ischemia
liver transplantation
liver venoocclusive disease
malaria (diagnosis, epidemiology, etiology)
meningitis (complication)
multiple organ failure
oral drug administration
partial hepatectomy
review
vasculitis (complication, diagnosis, etiology)
virus hepatitis (diagnosis, drug therapy, epidemiology)
Wilson disease (diagnosis, epidemiology, etiology)
DRUG TRADE NAMES
cosalgesic
distalgesic
fortalgesic
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
aciclovir (59277-89-3)
aminotransferase (9031-66-7)
bilirubin (18422-02-1, 635-65-4)
dextropropoxyphene (1639-60-7, 469-62-5)
dextropropoxyphene plus paracetamol (39400-85-6)
glucose (50-99-7, 84778-64-3)
halothane (151-67-7, 66524-48-9)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
lactulose (4618-18-2)
mannitol (69-65-8, 87-78-5)
methionine (59-51-8, 63-68-3, 7005-18-7)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
pentazocine (359-83-1, 64024-15-3)
phosphorus (7723-14-0)
potassium (7440-09-7)
rifampicin (13292-46-1)
EMBASE CLASSIFICATIONS
Toxicology (52)
Gastroenterology (48)
Adverse Reactions Titles (38)
Drug Literature Index (37)
Immunology, Serology and Transplantation (26)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Cancer (16)
Surgery (9)
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992069369
MEDLINE PMID
1764620 (http://www.ncbi.nlm.nih.gov/pubmed/1764620)
PUI
L22069368
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1438
TITLE
Rational bases of modern therapy of bacterial meningitis. Review of the
literature and personal clinical experience of 122 paediatric cases
ORIGINAL (NON-ENGLISH) TITLE
BASI RAZIONALI DELLA MODERNA TERAPIA EZIOPATOGENETICA DELLA MENINGITE
BATTERICA. REVISIONE DELLA LETTERATURA ED ESPERIENZA PERSONALE SU 122 CASI
PEDIATRICI
AUTHOR NAMES
Pecco P.
Pavesio D.
Peisino M.G.
AUTHOR ADDRESSES
(Pecco P.; Pavesio D.; Peisino M.G.) Servizio di Accettazione, Ospedale
Infantile Regina Margherita, Piazza Polonia 94, 10126 Torino
CORRESPONDENCE ADDRESS
Servizio di Accettazione, Ospedale Infantile Regina Margherita, Piazza
Polonia 94, 10126 Torino
SOURCE
Minerva Pediatrica (1991) 43:12 (753-775). Date of Publication: 1991
ISSN
0026-4946
BOOK PUBLISHER
Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Turin, Italy.
ABSTRACT
Bacterial meningitis is a serious infectious disease, the course of which
depends on the correct use of antibiotics and an intensive symptomatic and
support therapy. The presence of microbes and their fractions in the CNS
determines inflammatory phenomena that lead, through complex mechanisms, to
the supportive treatment has the purpose of curbing the inflammatory
phenomena, reducing cerebral oedema and avoiding ischaemia. This therapy
makes use of cortison and mannitol. The effectiveness of cortisones in
reducing cerebral damage and, consequently, the neurological sequelae of the
disease has been documented in experimental models and in man. After
analysing the pathogenetic events of cerebral damage and the rationale of
the treatment, reference is made to a personal therapeutic protocol that
includes an aetiological treatment (Ceftriaxone 100 mg/kg/die), a support
therapy (desamethazone 0.2-0.3 mg/kg/die, mannitol, water restriction) and a
symptomatic therapy (for convulsions, high temperature and shock). Both the
antibiotic and cortisone are also introduced into the rachis on the occasion
of lumbar injection. 122 children suffering from non-tubercular bacterial
meningitis, admitted to the Emergency Department of Turin in the period
1984-89, were treated. A further 7 patients, admitted for the same
pathology, died within a few hours. In 88% of cases, aetiological agents
were found by bacterioscopic and/or cultural and/or coaglutinin on liquor
examination (Neisseria meningitides 47.5%, Haemophilus influenzae 20.5%,
Streptococcus pneumoniae 15.6%, others 4.1%). The patients were treated with
support therapy for as long as clinical conditions required it and with
Ceftriaxone until clinical cure, end of fever and normalisation of PRC. In
the reported series, 90% of patients were treated for from 3 to 6 days. This
duration of antibiotic therapy is shorter than that reported and recommended
in the literature. Therapeutic results were very good with 95% cure without
neurological sequelae even at 6 month/1 year follow-up. Only 6 patients
reported sequelae (2 irritative anomalies at EEG, 3 hypacousis, 12
psychomotor retardation). The results were also better than those reported
in the Italian and foreign literature. The Authors are convinced that, in
the hands of experienced physicians, timely antibiotic, anti-inflammatory,
cerebral anti-oedema and symptomatic treatment will improve the prognosis
for bacterial meningitis in infancy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antibiotic agent (drug therapy)
ceftriaxone (drug therapy)
corticosteroid (drug therapy)
dexamethasone (drug therapy)
mannitol (drug therapy)
EMTREE DRUG INDEX TERMS
acetylsalicylic acid
ampicillin (drug therapy)
cefotaxime (drug therapy)
ceftazidime (drug therapy)
cotrimoxazole (drug therapy)
diazepam
dopamine
gentamicin (drug therapy)
hydrocortisone
naloxone
phenobarbital
tetracycline (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bacterial meningitis (drug therapy, etiology)
brain edema (complication, drug therapy)
brain injury (complication, drug therapy)
EMTREE MEDICAL INDEX TERMS
article
clinical feature
convulsion (complication, drug therapy)
human
hypertension (complication, drug therapy)
pathophysiology
prognosis
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0)
cefotaxime (63527-52-6, 64485-93-4)
ceftazidime (72558-82-8)
ceftriaxone (73384-59-5, 74578-69-1)
cotrimoxazole (8064-90-2)
dexamethasone (50-02-2)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
gentamicin (1392-48-9, 1403-66-3, 1405-41-0)
hydrocortisone (50-23-7)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
tetracycline (23843-90-5, 60-54-8, 64-75-5)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Pediatrics and Pediatric Surgery (7)
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1992067284
MEDLINE PMID
1798401 (http://www.ncbi.nlm.nih.gov/pubmed/1798401)
PUI
L22067283
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1439
TITLE
Preclinical emergency care of the ambulatory dialysis patient
ORIGINAL (NON-ENGLISH) TITLE
PRAKLINISCHE NOTFALLVERSORGUNG DES AMBULANTEN DIALYSEPATIENTEN
AUTHOR NAMES
Giering H.
Werning F.
AUTHOR ADDRESSES
(Giering H.; Werning F.) Anasthesieabteilung, Krankenhaus Rummelsberg,
D-8501 Schwarzenbruck
CORRESPONDENCE ADDRESS
Anasthesieabteilung, Krankenhaus Rummelsberg, D-8501 Schwarzenbruck
SOURCE
Notarzt (1991) 7:5 (139-142). Date of Publication: 1991
ISSN
0177-2309
BOOK PUBLISHER
Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent (drug therapy)
antiarrhythmic agent (drug therapy)
cardiovascular agent (drug therapy)
catecholamine (drug therapy)
hypnotic sedative agent (drug therapy)
neuroleptic agent (drug therapy)
EMTREE DRUG INDEX TERMS
acetyldigoxin
acetylsalicylic acid (drug therapy)
adrenergic receptor stimulating agent (drug therapy)
aminophylline
antiasthmatic agent (drug therapy)
antidote (drug therapy)
atracurium besilate (drug therapy)
atracurium besilate
bicarbonate (drug therapy)
cafedrine plus theodrenaline
clemastine (drug therapy)
clemastine fumarate
clonidine (drug therapy)
corticosteroid (drug therapy)
dexamethasone (drug therapy)
dexamethasone isonicotinate
dextran (drug therapy)
diazepam (drug therapy)
digitoxin (drug therapy)
digoxin (drug therapy)
diuretic agent (drug therapy)
dobutamine (drug therapy)
dopamine (drug therapy)
droperidol (drug therapy)
epinephrine (drug therapy)
etilefrine
etomidate (drug therapy)
fenoterol (drug therapy)
fentanyl (drug therapy)
furosemide (drug therapy)
gelatin (drug therapy)
glucose (drug therapy)
human serum albumin (drug therapy)
ketamine (drug therapy)
ketamine
lidocaine (drug therapy)
methohexital (drug therapy)
methylprednisolone (drug therapy)
metoclopramide (drug therapy)
midazolam (drug therapy)
midazolam maleate
morphine (drug therapy)
naloxone (drug therapy)
nifedipine (drug therapy)
nitrate (drug therapy)
nitro pohl
orciprenaline (drug therapy)
physostigmine (drug therapy)
potassium (drug therapy)
prednisolone (drug therapy)
promethazine (drug therapy)
propafenone (drug therapy)
ranitidine (drug therapy)
scopolamine butyl bromide (drug therapy)
simethicone
sodium chloride (drug therapy)
suxamethonium (drug therapy)
terbutaline (drug therapy)
theophylline (drug therapy)
thiopental (drug therapy)
tramadol (drug therapy)
triamcinolone (drug therapy)
triflupromazine (drug therapy)
unclassified drug
urapidil (drug therapy)
vecuronium (drug therapy)
verapamil (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulatory care
dialysis
emergency medicine
kidney failure (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
cardiovascular disease (complication, drug therapy)
drug contraindication
drug indication
electrolyte disturbance (complication, drug therapy)
gastrointestinal hemorrhage (complication, drug therapy)
human
intramuscular drug administration
intravenous drug administration
respiratory distress (complication, drug therapy)
subcutaneous drug administration
DRUG TRADE NAMES
adalat
akrinor
alupent
aspisol
atosil
auxiloson
berotec
brevimytal
bricanyl
buscopan
catapresan
digimerck
dobutrex
dormicum
ebrantil
effortil
euphyllin
fortecortin
hypnomidate
isoptin
ketanest
lasix
narcanti
nitro pohl
norcuron
novodigal
pantolax
paspertin
psyquil
rytmonorm
sab simplex
solu decortin
suprarenin
tavegil
tracrium
tramal
trapanal
urbason
valium
volon
xylocain
zantic
CAS REGISTRY NUMBERS
acetyldigoxin (5355-48-6)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atracurium (64228-79-1)
atracurium besilate (64228-81-5)
bicarbonate (144-55-8, 71-52-3)
cafedrine plus theodrenaline (69910-62-9, 8004-31-7)
clemastine (15686-51-8)
clemastine fumarate (14976-57-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
dexamethasone (50-02-2)
dexamethasone isonicotinate (2265-64-7)
dextran (87915-38-6, 9014-78-2)
diazepam (439-14-5)
digitoxin (71-63-6)
digoxin (20830-75-5, 57285-89-9)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
droperidol (548-73-2)
etilefrine (10128-36-6, 534-87-2, 709-55-7, 943-17-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fenoterol (13392-18-2, 1944-12-3)
fentanyl (437-38-7)
furosemide (54-31-9)
gelatin (9000-70-8)
glucose (50-99-7, 84778-64-3)
human serum albumin (9048-49-1)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methohexital (151-83-7, 309-36-4)
methylprednisolone (6923-42-8, 83-43-2)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
midazolam maleate (59467-94-6, 65506-68-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
nitrate (14797-55-8)
orciprenaline (586-06-1, 5874-97-5)
physostigmine (57-47-6, 64-47-1)
potassium (7440-09-7)
prednisolone (50-24-8)
promethazine (58-33-3, 60-87-7)
propafenone (34183-22-7, 54063-53-5)
ranitidine (66357-35-5, 66357-59-3)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
simethicone (53663-76-6, 8050-81-5)
sodium chloride (7647-14-5)
suxamethonium (306-40-1, 71-27-2)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiopental (71-73-8, 76-75-5)
tramadol (27203-92-5, 36282-47-0)
triamcinolone (124-94-7)
triflupromazine (1098-60-8, 146-54-3)
urapidil (34661-75-1)
vecuronium (50700-72-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Urology and Nephrology (28)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1991298319
PUI
L21297625
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1440
TITLE
Management of acute intoxications in the Emergency Department
AUTHOR NAMES
Travers A.
AUTHOR ADDRESSES
(Travers A.) Dalhousie Medical School, Box 286, Halifax, NS
CORRESPONDENCE ADDRESS
Dalhousie Medical School, Box 286, Halifax, NS
SOURCE
Nova Scotia Medical Journal (1991) 70:4 (120-124). Date of Publication: 1991
ISSN
0838-2638
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug combination, drug therapy, pharmaceutics,
pharmacology)
antidote (drug administration, drug therapy)
EMTREE DRUG INDEX TERMS
antidepressant agent (pharmacology)
apomorphine (drug therapy)
beta adrenergic receptor blocking agent (pharmacology)
ipecac (drug therapy)
magnesium citrate (drug therapy)
magnesium sulfate (drug therapy)
naloxone (drug therapy)
narcotic agent (pharmacology)
salicylic acid derivative (drug combination, drug therapy)
sorbitol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
adolescent
adult
child
drug contraindication
human
intramuscular drug administration
oral drug administration
short survey
stomach emptying
vomiting
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
apomorphine (314-19-2, 58-00-4)
ipecac (8012-96-2)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Gastroenterology (48)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1991300930
PUI
L21300236
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1441
TITLE
Emergency pain treatment
ORIGINAL (NON-ENGLISH) TITLE
SCHMERZTHERAPIE IM NOTFALL
AUTHOR ADDRESSES
SOURCE
Ars Medici (1991) 81:7-8 (392-397). Date of Publication: 1991
ISSN
0004-2897
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid (drug therapy)
dipyrone (drug therapy)
fentanyl (drug therapy)
metoclopramide (drug therapy)
midazolam (drug therapy)
morphine (drug therapy)
naloxone (drug therapy)
pentazocine (drug therapy)
scopolamine butyl bromide (drug therapy)
tramadol (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
human
review
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
fentanyl (437-38-7)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1991249214
PUI
L21249902
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1442
TITLE
Rapid sequence anesthesia induction and advanced airway management in
pediatric patients
AUTHOR NAMES
Yamamoto L.G.
AUTHOR ADDRESSES
(Yamamoto L.G.) Department of Pediatrics, 1319 Punahou Street, Honolulu, HI
96826
CORRESPONDENCE ADDRESS
Department of Pediatrics, 1319 Punahou Street, Honolulu, HI 96826
SOURCE
Emergency Medicine Clinics of North America (1991) 9:3 (611-638). Date of
Publication: 1991
ISSN
0733-8627
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
A rapid controlled induction of anesthesia is useful to facilitate emergency
intubation and to reduce the complications of intubation in pediatric
patients. A protocol for rapid sequence intubation and suggestions for
optimizing airway management in the Emergency Department are described. The
use of end tidal carbon dioxide monitoring and pulse oximetry are strongly
advocated to monitor all intubations in the Emergency Department.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
muscle relaxant agent (drug therapy, pharmacology)
sedative agent (drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
fentanyl (drug therapy, pharmacology)
ketamine (drug therapy, pharmacology)
naloxone (drug therapy, pharmacology)
thiopental (drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia induction
EMTREE MEDICAL INDEX TERMS
child
emergency medicine
human
injury
priority journal
review
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
muscle relaxant agent (9008-44-0)
naloxone (357-08-4, 465-65-6)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Surgery (9)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991231874
MEDLINE PMID
2070770 (http://www.ncbi.nlm.nih.gov/pubmed/2070770)
PUI
L21232562
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1443
TITLE
Naloxone prevents and blocks the emergence of neuroleptic-mediated oral
stereotypic behaviors
AUTHOR NAMES
Pollock J.
Kornetsky C.
AUTHOR ADDRESSES
(Pollock J.; Kornetsky C.) Lab. of Behavioral Pharmacol., Boston Univ.
School of Med., 80 East Concord Street, Boston, MA 02118, United States.
CORRESPONDENCE ADDRESS
C. Kornetsky, Lab. of Behavioral Pharmacol., Boston Univ. School of Med., 80
East Concord Street, Boston, MA 02118, United States.
SOURCE
Neuropsychopharmacology (1991) 4:4 (245-249). Date of Publication: 1991
ISSN
0893-133X
BOOK PUBLISHER
Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom.
ABSTRACT
A commonly used animal model for tardive dyskinesia is the oral stereotypy
that is expressed by a challenge dose of a dopamine agonist after daily
administration of dopamine antagonists (neuroleptics). In the first of two
experiments the expression of this dopamine agonist-induced oral stereotypy
was prevented by the concomitant administration of the opiate antagonist
naloxone. In a second experiment, if the stereotypy was allowed to be
expressed, it could be blocked by the administration of naloxone. To the
extent that the effects of chronic neuroleptic treatment in rats is a model
for tardive dyskinesia, the results suggest that administration of naloxone
can both prevent and block the dyskinetic syndrome associated with
neuroleptic use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
haloperidol (drug interaction, pharmacology)
naloxone (drug interaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug antagonism
stereotypy
tardive dyskinesia
EMTREE MEDICAL INDEX TERMS
animal model
article
male
nonhuman
priority journal
rat
subcutaneous drug administration
DRUG MANUFACTURERS
DuPont
McNeil
CAS REGISTRY NUMBERS
haloperidol (52-86-8)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991205391
MEDLINE PMID
1678260 (http://www.ncbi.nlm.nih.gov/pubmed/1678260)
PUI
L21206079
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1444
TITLE
Wilderness emergency medical services: The experiences at Sequoia and Kings
Canyon National Parks
AUTHOR NAMES
Johnson J.
Maertins M.
Shalit M.
Bierbaum T.J.
Goldman D.E.
Lowe R.A.
AUTHOR ADDRESSES
(Johnson J.; Maertins M.; Shalit M.; Bierbaum T.J.; Goldman D.E.; Lowe R.A.)
Division of Emergency Medicine, UCSF School of Medicine, Box 0208, San
Francisco, CA 94143-0208, United States.
CORRESPONDENCE ADDRESS
R.A. Lowe, Division of Emergency Medicine, UCSF School of Medicine, Box
0208, San Francisco, CA 94143-0208, United States.
SOURCE
American Journal of Emergency Medicine (1991) 9:3 (211-216). Date of
Publication: 1991
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
This article describes the National Park Service wilderness emergency
medical services (EMS) system, as implemented at Sequoia-Kings Canyon
National Park. EMS records on all 434 patients in the period from August 1,
1986, to July 31, 1987, were reviewed. Most patients had minor problems.
Overall, 77% of patients contacting the EMS system were released at the
scene, and base hospital contact was made in only 28% of cases. However,
there were three deaths, 44 (10%) patients who received advanced life
support, and 292 (67%) patients who received basic life support. Seven
patients who received advanced life support were released without transport.
Decisions regarding scope of practice in a low-volume, wilderness EMS system
are complicated by long transport times and problems with skills
maintenance. Differences between the patients treated by a wilderness system
and those seen in most urban systems may make it appropriate to release a
greater portion of patients without ambulance transport. In a system with
long response and transport times, use of personnel with different training
than in the urban setting becomes necessary.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug therapy)
bicarbonate (drug therapy)
diazepam (drug therapy)
diphenhydramine (drug therapy)
epinephrine (drug therapy)
furosemide (drug therapy)
glucose (drug therapy)
glyceryl trinitrate (drug therapy)
lidocaine (drug therapy)
morphine (drug therapy)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
ipecac (drug therapy)
orciprenaline (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
geographic distribution
mortality
EMTREE MEDICAL INDEX TERMS
article
human
inhalational drug administration
intramuscular drug administration
intravenous drug administration
major clinical study
oral drug administration
subcutaneous drug administration
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
ipecac (8012-96-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
orciprenaline (586-06-1, 5874-97-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991190313
MEDLINE PMID
2018588 (http://www.ncbi.nlm.nih.gov/pubmed/2018588)
PUI
L21191001
DOI
10.1016/0735-6757(91)90078-X
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(91)90078-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1445
TITLE
As the pendulum swings: The saga of physostigmine
AUTHOR NAMES
Smilkstein M.J.
AUTHOR ADDRESSES
(Smilkstein M.J.) Section of Emergency Medicine and Trauma, Department of
Surgery, University of Colorado Health Sciences Center, Denver, CO
CORRESPONDENCE ADDRESS
Section of Emergency Medicine and Trauma, Department of Surgery, University
of Colorado Health Sciences Center, Denver, CO
SOURCE
Journal of Emergency Medicine (1991) 9:4 (275-277). Date of Publication:
1991
ISSN
0736-4679
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidepressant agent (drug toxicity)
physostigmine (adverse drug reaction, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
atropine (drug therapy)
cyclobenzaprine (drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency ward
toxicity
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
anticholinergic effect
bradycardia (side effect)
bronchospasm (side effect)
editorial
heart arrest (side effect)
hypertension (side effect)
seizure (side effect)
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
cyclobenzaprine (303-53-7, 6202-23-9)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Toxicology (52)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1991183204
MEDLINE PMID
1861064 (http://www.ncbi.nlm.nih.gov/pubmed/1861064)
PUI
L21183892
DOI
10.1016/0736-4679(91)90426-G
FULL TEXT LINK
http://dx.doi.org/10.1016/0736-4679(91)90426-G
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1446
TITLE
Cyclic antidepressants, lithium, and neuroleptic agents: Pharmacology and
toxicology
AUTHOR NAMES
Krishel S.
Jackimczyk K.
AUTHOR ADDRESSES
(Krishel S.; Jackimczyk K.) Maricopa Emerg. Med. Residency, 2601 East
Roosevelt, Phoenix, AZ 85010, United States.
CORRESPONDENCE ADDRESS
K. Jackimczyk, Maricopa Emerg. Med. Residency, 2601 East Roosevelt, Phoenix,
AZ 85010, United States.
SOURCE
Emergency Medicine Clinics of North America (1991) 9:1 (53-86). Date of
Publication: 1991
ISSN
0733-8627
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Cyclic antidepressants, lithium, and phenothiazines are frequently
prescribed to psychiatric patients. Emergency department physicians must be
familiar with these medications, and the pharmacologic and toxicologic
characteristics of them are discussed. Cyclic antidepressants are the
primary cause of drug-related death in the United States, with sodium
bicarbonate recognized as the treatment of choice. Lithium toxicity may be
subtle, and treatment is generally supportive in addition to volume
replacement with normal saline and hemodialysis for significant
intoxications. A neuroleptic overdose is managed primarily with supportive
care. Neuroleptic malignant syndrome must be considered in any psychiatric
patient presenting to the Emergency Department.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
lithium (adverse drug reaction, drug therapy, drug toxicity,
pharmacokinetics, pharmacology)
neuroleptic agent (adverse drug reaction, drug therapy, drug toxicity,
pharmacokinetics, pharmacology)
tricyclic antidepressant agent (adverse drug reaction, drug therapy, drug
toxicity, pharmacokinetics, pharmacology)
EMTREE DRUG INDEX TERMS
activated carbon (drug therapy)
amitriptyline (adverse drug reaction, pharmacology)
amoxapine (adverse drug reaction, pharmacology)
beta adrenergic receptor blocking agent (drug therapy)
bicarbonate (drug therapy)
bretylium (drug therapy)
chlorprothixene (adverse drug reaction, pharmacology)
clomipramine (adverse drug reaction, pharmacology)
doxepin (adverse drug reaction, pharmacology)
glucose (drug combination, drug therapy)
haloperidol (adverse drug reaction, pharmacology)
imipramine (adverse drug reaction, pharmacology)
lidocaine (drug therapy)
loxapine (adverse drug reaction, pharmacology)
loxapine succinate
maprotiline (adverse drug reaction, pharmacology)
metaraminol (adverse drug reaction, pharmacology)
molindone (adverse drug reaction, pharmacology)
naloxone (drug combination, drug therapy)
noradrenalin (drug therapy)
phenothiazine derivative (adverse drug reaction, pharmacology)
phenytoin (drug therapy)
physostigmine (drug therapy)
thiamine (drug combination, drug therapy)
tiotixene (adverse drug reaction, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
behavior
depression (drug therapy)
EMTREE MEDICAL INDEX TERMS
heart arrhythmia (drug therapy, side effect)
heart failure (drug therapy, side effect)
hypotension (drug therapy, side effect)
intoxication (drug therapy)
neuroleptic malignant syndrome (side effect)
neurotoxicity (side effect)
priority journal
review
DRUG TRADE NAMES
anafranil
aramine
haldol
loxitane
ludiomil
moban
navane
taractan
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
amoxapine (14028-44-5)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
chlorprothixene (113-59-7, 6469-93-8)
clomipramine (17321-77-6, 303-49-1)
doxepin (1229-29-4, 1668-19-5)
glucose (50-99-7, 84778-64-3)
haloperidol (52-86-8)
imipramine (113-52-0, 50-49-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lithium (7439-93-2)
loxapine (1977-10-2)
loxapine succinate (27833-64-3)
maprotiline (10262-69-8, 10347-81-6)
metaraminol (33402-03-8, 54-49-9)
molindone (15622-65-8, 7416-34-4)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
thiamine (59-43-8, 67-03-8)
tiotixene (5591-45-7)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991129127
MEDLINE PMID
1672106 (http://www.ncbi.nlm.nih.gov/pubmed/1672106)
PUI
L21129126
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1447
TITLE
Anxiety
AUTHOR NAMES
Kercher E.E.
AUTHOR ADDRESSES
(Kercher E.E.) Emergency Medicine Department, Kern Medical Center, 1830
Flower Street, Bakersfield, CA 93305, United States.
CORRESPONDENCE ADDRESS
E.E. Kercher, Emergency Medicine Department, Kern Medical Center, 1830
Flower Street, Bakersfield, CA 93305, United States.
SOURCE
Emergency Medicine Clinics of North America (1991) 9:1 (161-187). Date of
Publication: 1991
ISSN
0733-8627
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Anxiety is an ubiquitous condition and frequently is associated with
physical and emotional illness. Because of the physical nature of certain
symptoms associated with anxiety, patients often seek treatment and
evaluation in Emergency Departments rather than psychiatric settings. A
definition, the prevalence, classification, theories, clinical
manifestations, and management of the anxious patient in the acute setting
has been outlined in this article. This should help the emergency medicine
physician evaluate this special patient.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anxiolytic agent (drug comparison, drug therapy, pharmacology)
lorazepam (drug therapy)
midazolam (drug therapy)
morphine (adverse drug reaction, drug therapy)
EMTREE DRUG INDEX TERMS
barbituric acid derivative (adverse drug reaction, drug therapy,
pharmacology)
benzodiazepine derivative (adverse drug reaction, drug therapy,
pharmacology)
buspirone (adverse drug reaction, drug therapy, pharmacology)
diphenhydramine (adverse drug reaction, drug therapy, pharmacology)
haloperidol (adverse drug reaction, drug therapy, pharmacology)
hydroxyzine (adverse drug reaction, drug therapy, pharmacology)
imipramine (adverse drug reaction, drug therapy, pharmacology)
monoamine oxidase inhibitor (adverse drug reaction, drug therapy,
pharmacology)
naloxone (adverse drug reaction, drug therapy, pharmacology)
propranolol (adverse drug reaction, drug therapy, pharmacology)
thioridazine (adverse drug reaction, drug therapy, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anxiety
phobia
stress
EMTREE MEDICAL INDEX TERMS
behavior
drug therapy
emergency
headache
heart failure
human
hypertension (drug therapy, side effect)
intravenous drug administration
oral drug administration
priority journal
respiration depression (drug therapy, side effect)
review
DRUG TRADE NAMES
atarax
ativan
benadryl
buspar
haldol
inderal
mellaril
narcan
tofranil
versed
CAS REGISTRY NUMBERS
buspirone (33386-08-2, 36505-84-7)
diphenhydramine (147-24-0, 58-73-1)
haloperidol (52-86-8)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
imipramine (113-52-0, 50-49-7)
lorazepam (846-49-1)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
thioridazine (130-61-0, 50-52-2)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991129132
MEDLINE PMID
2001664 (http://www.ncbi.nlm.nih.gov/pubmed/2001664)
PUI
L21129131
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1448
TITLE
Unusual cause of methadone poisoning
AUTHOR NAMES
Gayle M.O.
Ryan C.A.
Nazarali S.
AUTHOR ADDRESSES
(Gayle M.O.; Ryan C.A.; Nazarali S.) Department of Pediatrics, 2C300 W.
Mackenzie Centre, University of Alberta Hosp., Edmonton, Alta. T6G 2R7,
Canada.
CORRESPONDENCE ADDRESS
M.O. Gayle, Department of Pediatrics, 2C300 W. Mackenzie Centre, University
of Alberta Hosp., Edmonton, Alta. T6G 2R7, Canada.
SOURCE
Acta Paediatrica Scandinavica (1991) 80:4 (486-487). Date of Publication:
1991
ISSN
0001-656X
BOOK PUBLISHER
Scandinavian University Press, P.O. Box 2959, Toyen, Oslo, Norway.
ABSTRACT
A child with respiratory distress was found to have been given an antibiotic
which was reconstituted with methadone. A delay in standard emergency room
management led to a delay in diagnosis and treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amoxicillin (drug combination, pharmaceutics)
methadone (drug combination, drug toxicity)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
case report
female
human
iatrogenic disease
preschool child
priority journal
CAS REGISTRY NUMBERS
amoxicillin (26787-78-0, 34642-77-8, 61336-70-7)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991120591
MEDLINE PMID
2058403 (http://www.ncbi.nlm.nih.gov/pubmed/2058403)
PUI
L21120590
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1449
TITLE
Poison emergencies
AUTHOR NAMES
Schauben J.L.
Spillane J.
AUTHOR ADDRESSES
(Schauben J.L.; Spillane J.) Clinical Toxicology Services, University of
Florida Health Science Center, Jacksonville, FL
CORRESPONDENCE ADDRESS
Clinical Toxicology Services, University of Florida Health Science Center,
Jacksonville, FL
SOURCE
U.S. Pharmacist (1991) 16:2 (37-58). Date of Publication: 1991
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug therapy)
antidote
glucose (drug therapy)
ipecac (drug therapy)
naloxone (drug therapy)
thiamine (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
health care
intoxication
stomach lavage
vomiting
EMTREE MEDICAL INDEX TERMS
human
intramuscular drug administration
intravenous drug administration
review
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
glucose (50-99-7, 84778-64-3)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1991116218
PUI
L21116217
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1450
TITLE
Emergency medical services and the adolescent patient
AUTHOR NAMES
Seidel J.S.
AUTHOR ADDRESSES
(Seidel J.S.) Dept. of Emergency Services, UCLA School of Medicine,
Harbor-UCLA Medical Center, 2000 West Carson Street, Torrance, CA 90509,
United States.
CORRESPONDENCE ADDRESS
J.S. Seidel, Dept. of Emergency Services, UCLA School of Medicine,
Harbor-UCLA Medical Center, 2000 West Carson Street, Torrance, CA 90509,
United States.
SOURCE
Journal of Adolescent Health (1991) 12:2 (95-100). Date of Publication: 1991
ISSN
1054-139X
BOOK PUBLISHER
Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States.
ABSTRACT
A study of 10,493 prehospital care report forms from 11 counties in
California demonstrated that the adolescent age group (ages 12 to 18 years)
accessed prehospital care through the emergency medical service (EMS) system
more frequently than other pediatric patients (5978 reports). They did so
most commonly for trauma (87.6%), but also for behavioral emergencies such
as suicide and psychiatric problems. The most common cause of injury was
automobiles, and care rendered was most commonly wound care and splinting.
The most common substances given to adolescents in the prehospital setting
were naloxone and 50% dextrose. EMS systems need to address the need for
triage and care of adolescent patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
glucose (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
injury
mental disease
motor vehicle
suicide
EMTREE MEDICAL INDEX TERMS
adolescent
article
human
priority journal
CAS REGISTRY NUMBERS
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1991107681
MEDLINE PMID
2015247 (http://www.ncbi.nlm.nih.gov/pubmed/2015247)
PUI
L21107680
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1451
TITLE
Significance and limits of emergency toxicological investigations
AUTHOR NAMES
Jaeger A.
Mangin P.
Sauder P.
Kopferschmitt J.
AUTHOR ADDRESSES
(Jaeger A.; Mangin P.; Sauder P.; Kopferschmitt J.) Service de Reanimation
Medicale, CHRU/Hospices Civils de Strasbourg, 67091 Strasbourg Cedex
CORRESPONDENCE ADDRESS
Service de Reanimation Medicale, CHRU/Hospices Civils de Strasbourg, 67091
Strasbourg Cedex
SOURCE
Revue du Praticien - Medecine Generale (1991) :125 (287-289+291-292). Date
of Publication: 1991
ISSN
0989-2737
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
flumazenil (drug therapy)
naloxone (drug therapy)
EMTREE DRUG INDEX TERMS
alcohol (drug toxicity)
barbituric acid derivative (drug toxicity)
benzodiazepine derivative (drug toxicity)
beta adrenergic receptor blocking agent (drug toxicity)
carbamic acid derivative (drug toxicity)
carbon monoxide (drug toxicity)
cocaine (drug toxicity)
colchicine (drug toxicity)
digitalis (drug toxicity)
ethylene glycol (drug toxicity)
lithium (drug toxicity)
methanol (drug toxicity)
opiate (drug toxicity)
paracetamol (drug toxicity)
paraquat (drug toxicity)
phenothiazine derivative (drug toxicity)
salicylic acid derivative (drug toxicity)
theophylline (drug toxicity)
tricyclic antidepressant agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
article
human
DRUG TRADE NAMES
anexate
narcan
CAS REGISTRY NUMBERS
alcohol (64-17-5)
carbon monoxide (630-08-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
colchicine (64-86-8)
digitalis (8031-42-3, 8053-83-6)
ethylene glycol (107-21-1)
flumazenil (78755-81-4)
lithium (7439-93-2)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1991080933
PUI
L21080932
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1452
TITLE
Drug abuse and emergency situations
AUTHOR NAMES
Kessler R.
Ryser D.H.
AUTHOR ADDRESSES
(Kessler R.; Ryser D.H.) Medizinische Abteilung, Anna-Seiler-Haus,
Inselspital, CH-3010 Bern
CORRESPONDENCE ADDRESS
Medizinische Abteilung, Anna-Seiler-Haus, Inselspital, CH-3010 Bern
SOURCE
Schweizerische Rundschau fur Medizin/Praxis (1991) 80:3 (31-35). Date of
Publication: 1991
ISSN
0369-8394
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
adrenergic receptor blocking agent (drug dose, drug therapy)
beta adrenergic receptor blocking agent (drug dose, drug therapy)
calcium channel blocking agent (drug therapy)
flumazenil (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
neuroleptic agent (drug dose, drug therapy)
EMTREE DRUG INDEX TERMS
alcohol (drug combination, drug toxicity)
benzodiazepine (drug combination, drug dose, drug therapy, drug toxicity)
captopril (drug therapy)
cocaine (drug combination, drug toxicity)
dantrolene
diamorphine (drug combination, drug toxicity)
diazepam
dipeptidyl carboxypeptidase inhibitor (drug therapy)
dopamine (drug therapy)
flunitrazepam (drug combination, drug toxicity)
haloperidol
labetalol
lidocaine (drug dose, drug therapy)
methadone (drug combination, drug toxicity)
midazolam maleate
nifedipine
opiate (drug combination, drug toxicity)
phentolamine
phentolamine mesylate
phenytoin (drug dose, drug therapy)
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular disease
drug intoxication (drug therapy)
drug overdose (drug therapy)
rhabdomyolysis
EMTREE MEDICAL INDEX TERMS
adolescent
adult
article
coma (drug therapy)
female
heart arrhythmia (drug therapy)
human
hypertension (drug therapy)
hyperthermia (drug therapy)
hypotension (drug therapy)
intramuscular drug administration
intravenous drug administration
major clinical study
male
muscle cramp (drug therapy)
psychosis (drug therapy)
respiration depression (drug therapy)
tachycardia (drug therapy)
DRUG TRADE NAMES
adalate
anexate
dantamacrin
dormicum
haldol
inderal
narcan
regitin
rohypnol
trandate
valium
CAS REGISTRY NUMBERS
alcohol (64-17-5)
benzodiazepine (12794-10-4)
captopril (62571-86-2)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dantrolene (14663-23-1, 7261-97-4)
diamorphine (1502-95-0, 561-27-3)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
haloperidol (52-86-8)
labetalol (32780-64-6, 36894-69-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
midazolam maleate (59467-94-6, 65506-68-5)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phentolamine mesylate (65-28-1)
phentolamine (50-60-2, 73-05-2)
phenytoin (57-41-0, 630-93-3)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Urology and Nephrology (28)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Internal Medicine (6)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1991050428
PUI
L21050427
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1453
TITLE
Naloxone dosage and route of administration for infants and children:
Addendum to emergency drug doses for infants and children
AUTHOR NAMES
Kauffman R.E.
Banner Jr. W.
Blumer J.L.
Gorman R.L.
Lambert G.H.
Snodgrass W.
AUTHOR ADDRESSES
(Kauffman R.E.; Banner Jr. W.; Blumer J.L.; Gorman R.L.; Lambert G.H.;
Snodgrass W.)
SOURCE
Pediatrics (1990) 86:3 (484-485). Date of Publication: 1990
ISSN
0031-4005
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
resuscitation
EMTREE MEDICAL INDEX TERMS
child
drug administration
drug dose
human
infant
intramuscular drug administration
intravenous drug administration
newborn
note
oral drug administration
priority journal
subcutaneous drug administration
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1990340900
PUI
L20334989
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1454
TITLE
Loss of consciousness after emergence from anaesthesia. A case of suspected
micturition syncope
AUTHOR NAMES
Kao Y.J.
Racz G.B.
AUTHOR ADDRESSES
(Kao Y.J.; Racz G.B.) Department of Anesthesiology, Texas Tech University
Health Sciences Center, School of Medicine, Lubbock, TX 79430
CORRESPONDENCE ADDRESS
Department of Anesthesiology, Texas Tech University Health Sciences Center,
School of Medicine, Lubbock, TX 79430
SOURCE
Anaesthesia (1990) 45:9 (738-740). Date of Publication: 1990
ISSN
0003-2409
BOOK PUBLISHER
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom.
ABSTRACT
A case of postanaesthesia micturition syncope with respiratory arrest is
described. If syncope occurs, the temporary myocardial ischaemia and
cerebral hypoperfusion may increase anaesthetic risk in the marginally
compensated patient. The loss of airway protection during the syncopal
period is also a cause of concern. We recommend the use of an indwelling
bladder catether during any prolonged surgical procedure.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anesthetic agent
EMTREE DRUG INDEX TERMS
atracurium besilate
nalbuphine
naloxone
nitrous oxide
sufentanil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
consciousness
emergency
faintness
micturition
EMTREE MEDICAL INDEX TERMS
adult
article
case report
human
male
priority journal
CAS REGISTRY NUMBERS
atracurium (64228-79-1)
nalbuphine (20594-83-6, 23277-43-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
sufentanil (56030-54-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1990320623
MEDLINE PMID
2240534 (http://www.ncbi.nlm.nih.gov/pubmed/2240534)
PUI
L20314712
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1455
TITLE
American Academy of Pediatrics Committee on Drugs: Naloxone dosage and route
of administration for infants and children: addendum to emergency drug doses
for infants and children.
AUTHOR ADDRESSES
SOURCE
Pediatrics (1990) 86:3 (484-485). Date of Publication: Sep 1990
ISSN
0031-4005
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
EMTREE MEDICAL INDEX TERMS
article
child
emergency
human
infant
newborn
organization
pediatrics
preschool child
United States
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
2388800 (http://www.ncbi.nlm.nih.gov/pubmed/2388800)
PUI
L20857490
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1456
TITLE
Selection of emergency drug in the pharmacy
ORIGINAL (NON-ENGLISH) TITLE
AUSWAHL IST REVISIONSBEDURFTIG
AUTHOR ADDRESSES
SOURCE
Deutsche Apotheker Zeitung (1990) 130:20 (1137-1138). Date of Publication:
1990
ISSN
0011-9857
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
charcoal
emetic agent
epinephrine
tetanus toxin
EMTREE DRUG INDEX TERMS
4 dimethylaminophenol
apomorphine
atropine
biperiden
buprenorphine
naloxone
obidoxime
physostigmine
polysiloxane
Ringer lactate solution
sodium thiosulfate
tetanus toxoid
tolonium chloride
vitamin K group
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
EMTREE MEDICAL INDEX TERMS
article
human
DRUG TRADE NAMES
akineton
anticholium
narcanti
temgesic
tetanol
toxogenin
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
buprenorphine (52485-79-7, 53152-21-9)
charcoal (16291-96-6)
naloxone (357-08-4, 465-65-6)
obidoxime (114-90-9, 7683-36-5)
physostigmine (57-47-6, 64-47-1)
Ringer lactate solution (8022-63-7)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
tetanus toxoid (57425-69-1, 93384-51-1)
tolonium chloride (92-31-9)
vitamin K group (12001-79-5)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1990171147
PUI
L20170789
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1457
TITLE
Antidotes in the emergency treatment of patients with intoxications
ORIGINAL (NON-ENGLISH) TITLE
ANTIDOTA ZUR ERSTBEHANDLUNG VON PATIENTEN MIT INTOXIKATION
AUTHOR NAMES
Rossi R.
Grunert A.
AUTHOR ADDRESSES
(Rossi R.; Grunert A.) Klinikum der Universitat Ulm, Prittwitzstr. 43, 7900
Ulm
CORRESPONDENCE ADDRESS
Klinikum der Universitat Ulm, Prittwitzstr. 43, 7900 Ulm
SOURCE
Munchener Medizinische Wochenschrift (1990) 132:15 (26-29). Date of
Publication: 1990
ISSN
0341-3098
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 dimethylaminophenol (drug therapy)
apomorphine (drug therapy)
atropine (drug therapy)
carbon (drug therapy)
corticosteroid (drug therapy)
flumazenil (drug therapy)
naloxone (drug therapy)
obidoxime (drug therapy)
physostigmine (drug therapy)
sodium thiosulfate (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
intoxication (drug therapy)
EMTREE MEDICAL INDEX TERMS
human
intravenous drug administration
note
oral drug administration
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
carbon (7440-44-0)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
obidoxime (114-90-9, 7683-36-5)
physostigmine (57-47-6, 64-47-1)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Dutch
EMBASE ACCESSION NUMBER
1990163385
PUI
L20163027
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1458
TITLE
Midazolam use in the emergency department
AUTHOR NAMES
Wright S.W.
Chudnofsky C.R.
Dronen S.C.
Wright M.B.
Borro n S.W.
AUTHOR ADDRESSES
(Wright S.W.; Chudnofsky C.R.; Dronen S.C.; Wright M.B.; Borro n S.W.)
Department of Emergency Medicine, University of Cincinnati Medical Center,
234 Goodman St, Cincinnati, OH 45267-0769
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, University of Cincinnati Medical Center,
234 Goodman St, Cincinnati, OH 45267-0769
SOURCE
American Journal of Emergency Medicine (1990) 8:2 (97-100). Date of
Publication: 1990
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Midazolam is the first water-soluble benzodiazepine. As with other
benzodiazepines it has amnestic, sedative, hypnotic, anxiolytic, and
anticonvulsant properties. Midazolam is about two to four times more potent
than diazepam. Midazolam has been extensively used for a variety of
outpatient procedures, but there has been no documentation of its safety in
emergency department patients. The authors retrospectively reviewed all
patients receiving medazolam during a 2-year period at the University of
Cincinnati Center for Emergency Care. The study population consisted of 389
patients (men 56%; women 44%) with an average age of 33.3 years. Midazolam
was used intravenously for sedation before a wide variety of painful
procedures and for agitation control. The average dose was 3.86 mg, with a
range of 0.5 mg to 20.0 mg. The majority of patients (79.2%) received
narcotics or sedative/hypnotic agents in addition to midazolam. There was an
overall complication rate of 1.0%. Two patients (0.5%) developed clinically
significant respiratory depression after midazolam use. Both patients had
also received fentanyl citrate and the respiratory depression was reversed
with naloxone. Two patients (0.5%) receiving several other drugs developed
short periods of hypotension. There were no apparent long term suquelae. The
authors conclude that midazolam can be safely used in the emergency
department setting. Careful dosing and titration to the desired clinical
effect is mandatory. Patients should be closely monitored to maximize
safety.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug combination, drug therapy)
midazolam (drug combination, drug dose, drug therapy)
morphine (drug combination, drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitation
emergency
incision
pain
respiratory arrest
sedation
EMTREE MEDICAL INDEX TERMS
adult
article
drug safety
drug therapy
female
human
intravenous drug administration
male
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
midazolam (59467-70-8)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Surgery (9)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1990155731
MEDLINE PMID
2302291 (http://www.ncbi.nlm.nih.gov/pubmed/2302291)
PUI
L20155373
DOI
10.1016/0735-6757(90)90192-3
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(90)90192-3
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1459
TITLE
Cocaine-related medical problems: Consecutive series of 233 patients
AUTHOR NAMES
Brody S.L.
Slovis C.M.
Wrenn K.D.
AUTHOR ADDRESSES
(Brody S.L.; Slovis C.M.; Wrenn K.D.) Division of General Medicine,
Department of Medicine, Emory University School of Medicine, Atlanta, GA
CORRESPONDENCE ADDRESS
S.L. Brody, 4623 Roxbury Drive, Bethesda, MD 20814, United States.
SOURCE
American Journal of Medicine (1990) 88:4 (325-331). Date of Publication:
1990
ISSN
0002-9343
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
Purpose: Little information describing common cocaine-related medical
problems is available. This study examined the nature, frequency, treatment,
incidence of complications, and emergency department deaths of patients
seeking medical care for acute and chronic cocaine-associated medical
problems. Patients and methods: A consecutive series of 233 hospital visits
by 216 cocaine-using patients over a 6-month period during 1986 and 1987 was
studied. Medical records were retrospectively reviewed to determine patient
characteristics, nature of complications, treatment, and outcome. Results:
Patients most commonly used cocaine intravenously (49%), but freebase or
crack use was also common (23.3%). Concomitant abuse of other intoxicants,
especially alcohol, was frequently seen (48.5%). The vast majority of
complaints were cardiopulmonary (56.2%), neurologic (39.1%), and psychiatric
(35.8%); multiple symptoms were often present (57.5%). The most common
complaint was chast pain through rarely was it believed to represent
ischemia. Altered mental status was common (27.4%) and ranged from psychosis
to coma. Short-term pharmacologic intervention was necessary in only 24% of
patients, and only 9.9% of patients were admitted. Acute mortality was less
than 1%. Conclusion: Most medical complications of cocaine are short-lived
and appear to be related to cocaine's hyperadrenergic effects. Patients
usually do not require short-term therapy or hospital admission. Acute
morbidity and mortality rates from cocaine use in patients presenting to the
hospital are very low, suggesting that a major focus in the treatment of
cocaine-related emergencies should be referral for drug abuse detoxification
and treatment.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine (adverse drug reaction, drug toxicity)
EMTREE DRUG INDEX TERMS
benzodiazepine
diphenhydramine
glyceryl trinitrate
haloperidol
labetalol
naloxone
nifedipine
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular disease (complication, diagnosis, side effect)
coma (complication, diagnosis, side effect)
mental disease (complication, diagnosis, side effect)
neurologic disease (complication, diagnosis, side effect)
psychosis (complication, diagnosis, side effect)
EMTREE MEDICAL INDEX TERMS
adult
article
fatality
female
human
major clinical study
male
priority journal
psychological aspect
CAS REGISTRY NUMBERS
benzodiazepine (12794-10-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diphenhydramine (147-24-0, 58-73-1)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
labetalol (32780-64-6, 36894-69-6)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1990147610
MEDLINE PMID
2327419 (http://www.ncbi.nlm.nih.gov/pubmed/2327419)
PUI
L20147265
DOI
10.1016/0002-9343(90)90484-U
FULL TEXT LINK
http://dx.doi.org/10.1016/0002-9343(90)90484-U
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1460
TITLE
Preparedness for pediatric emergencies encountered in the practitioner's
office
AUTHOR NAMES
Altieri M.
Bellet J.
Scott H.
AUTHOR ADDRESSES
(Altieri M.; Bellet J.; Scott H.) Dept. of Emergency Medicine, Fairfax
Hospital, 3300 Gallows Road, Falls Church, VA 22046, United States.
CORRESPONDENCE ADDRESS
M. Altieri, Dept. of Emergency Medicine, Fairfax Hospital, 3300 Gallows
Road, Falls Church, VA 22046, United States.
SOURCE
Pediatrics (1990) 85:5 (710-714). Date of Publication: 1990
ISSN
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
Pediatricians in the Washington, DC, metropolitan area were surveyed to
assess their readiness to deal with life-threatening emergencies in their
offices. Information about emergency equipment, prearranged emergency plans,
advanced life support training, and emergency medical services assistance
was elicited. Recommendations are made to attain appropriate levels of
preparedness in all of these areas.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline (drug therapy)
antibiotic agent (drug therapy)
atropine (drug therapy)
bicarbonate (drug therapy)
calcium chloride (drug therapy)
corticosteroid (drug therapy)
diazepam (drug therapy)
diphenhydramine (drug therapy)
epinephrine (drug therapy)
glucose (drug therapy)
lidocaine (drug therapy)
naloxone (drug therapy)
orciprenaline (drug therapy)
phenytoin (drug therapy)
salbutamol (drug therapy)
terbutaline (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency medicine
pediatrics
EMTREE MEDICAL INDEX TERMS
article
devices
devices
human
intravenous drug administration
priority journal
theoretical study
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
orciprenaline (586-06-1, 5874-97-5)
phenytoin (57-41-0, 630-93-3)
salbutamol (18559-94-9)
terbutaline (23031-25-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1990145182
MEDLINE PMID
2330230 (http://www.ncbi.nlm.nih.gov/pubmed/2330230)
PUI
L20144837
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1461
TITLE
Dosing guidelines for common neonatal and pediatric emergency drugs
AUTHOR NAMES
Horne E.
Nykamp D.
Spruill K.
AUTHOR ADDRESSES
(Horne E.; Nykamp D.; Spruill K.) Mercer University School of Pharmacy, 345
Boulevard, NE, Atlanta, GA 30312
CORRESPONDENCE ADDRESS
Mercer University School of Pharmacy, 345 Boulevard, NE, Atlanta, GA 30312
SOURCE
Hospital Pharmacy (1990) 25:2 (154). Date of Publication: 1990
ISSN
0018-5787
BOOK PUBLISHER
Facts and Comparisons, 111 W. Port Plaza, Ste. 300, St. Louis, United
States.
ABSTRACT
In some instances, pediatric emergency drug use will be necessary in areas
besides the neonatal intensive care unit, or emergency rooms of hospitals
which treat children. It is essential in the non-specialized areas that an
easily accessible, relevant, source of drug information be available for
emergency drug use. Drug dosing guidelines and monitoring parameters for the
pediatric population for 14 emergency drugs have been compiled into an
easy-to-read compendia in order to assist physicians, residents, nurses, and
pharmacists in instances when time is crucial.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline (adverse drug reaction, drug dose)
atropine (adverse drug reaction, drug dose)
bicarbonate (adverse drug reaction, drug dose)
calcium chloride (adverse drug reaction, drug dose)
dopamine (adverse drug reaction, drug dose)
epinephrine (adverse drug reaction, drug dose)
furosemide (adverse drug reaction, drug dose)
gluconate calcium (adverse drug reaction, drug dose)
glucose (drug dose)
lidocaine (adverse drug reaction, drug dose)
morphine (adverse drug reaction, drug dose)
naloxone (adverse drug reaction, drug dose)
phenobarbital (adverse drug reaction, drug dose)
phenytoin (adverse drug reaction, drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dose
drug information
pediatrics
EMTREE MEDICAL INDEX TERMS
article
bradycardia (side effect)
dehydration (side effect)
drug indication
headache (side effect)
human
hypertension (side effect)
hypokalemia (side effect)
hypotension (side effect)
insomnia (side effect)
miosis (side effect)
monitoring
respiration depression (side effect)
seizure (side effect)
side effect
sweating
tachycardia (side effect)
visual impairment (side effect)
xerostomia (side effect)
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1990123752
MEDLINE PMID
10103703 (http://www.ncbi.nlm.nih.gov/pubmed/10103703)
PUI
L20123407
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1462
TITLE
Medication dosages during pediatric emergencies: A simple and comprehensive
guide
AUTHOR NAMES
Tendler C.
Grossman S.
Tenenbaum J.
AUTHOR ADDRESSES
(Tendler C.; Grossman S.; Tenenbaum J.) Department of Pediatrics, The Mount
Sinai Hospital, New York, NY 10029
CORRESPONDENCE ADDRESS
Department of Pediatrics, The Mount Sinai Hospital, New York, NY 10029
SOURCE
Pediatrics (1989) 84:4 (731-735). Date of Publication: 1989
ISSN
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline (drug dose)
atropine (drug dose)
bicarbonate (drug dose)
calcium chloride (drug dose)
diazepam (drug dose)
dobutamine (drug dose)
dopamine (drug dose)
epinephrine (drug dose)
insulin (drug dose)
isoprenaline (drug dose)
lidocaine (drug dose)
mannitol (drug dose)
morphine (drug dose)
naloxone (drug dose)
nitroprusside sodium (drug dose)
pancuronium bromide (drug dose)
phenobarbital (drug dose)
phenytoin (drug dose)
verapamil (drug dose)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dose
emergency medicine
intensive care
EMTREE MEDICAL INDEX TERMS
child
human
intravenous drug administration
oral drug administration
priority journal
standardization
DRUG TRADE NAMES
dilantin
isuprel
narcan
nipride
pavulon
valium
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
insulin (9004-10-8)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
pancuronium bromide (15500-66-0)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1989237620
MEDLINE PMID
2619802 (http://www.ncbi.nlm.nih.gov/pubmed/2619802)
PUI
L19237578
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1463
TITLE
Intoxications - what antidotes must be available to the physician providing
emergency medical care?
ORIGINAL (NON-ENGLISH) TITLE
INTOXIKATIONEN: WELCHE ANTIDOTA SIND IM RETTUNGSDIENST NOTWENDIG?
AUTHOR NAMES
Harloff M.
AUTHOR ADDRESSES
(Harloff M.) Medizinische Klinik C, Klinikum der Stadt Ludwigshafen,
Ludwigshafen
CORRESPONDENCE ADDRESS
Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen
SOURCE
Notfall Medizin (1989) 15:8 (519-526). Date of Publication: 1989
ISSN
0341-2903
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 dimethylaminophenol (adverse drug reaction)
apomorphine (adverse drug reaction, drug dose)
atropine (drug dose)
biperiden
charcoal
cortisone
flumazenil
naloxone
obidoxime
physostigmine salicylate
sodium thiosulfate
tolonium chloride
EMTREE DRUG INDEX TERMS
apomorphin woelm
dexamethasone isonicotinate
physostigmine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication (drug therapy, therapy)
EMTREE MEDICAL INDEX TERMS
drug indication
hemolysis (side effect)
human
hypotension (side effect)
short survey
DRUG TRADE NAMES
akineton
anexate
anticholium
apomorphin woelm
auxiloson
narcanti
toxogonin
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
charcoal (16291-96-6)
cortisone (53-06-5)
dexamethasone isonicotinate (2265-64-7)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
obidoxime (114-90-9, 7683-36-5)
physostigmine salicylate (57-64-7, 71214-04-5)
physostigmine (57-47-6, 64-47-1)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
tolonium chloride (92-31-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989219518
PUI
L19219476
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1464
TITLE
Septic shock in the oncology patient
AUTHOR NAMES
Hartnett S.
AUTHOR ADDRESSES
(Hartnett S.) Mercer Medical Center, Trenton, NJ
CORRESPONDENCE ADDRESS
Mercer Medical Center, Trenton, NJ
SOURCE
Cancer Nursing (1989) 12:4 (191-201). Date of Publication: 1989
ISSN
0162-220X
BOOK PUBLISHER
Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United
States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antibiotic agent (drug therapy)
corticosteroid (drug therapy)
endotoxin
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cancer patient
emergency treatment
nursing
septic shock (epidemiology, prevention)
EMTREE MEDICAL INDEX TERMS
human
review
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Microbiology: Bacteriology, Mycology, Parasitology and Virology (4)
Internal Medicine (6)
Cancer (16)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1989211840
MEDLINE PMID
2670198 (http://www.ncbi.nlm.nih.gov/pubmed/2670198)
PUI
L19211798
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1465
TITLE
Quantitative experimental analysis of the emergence of opiate dependence
AUTHOR NAMES
Villarreal J.E.
Salazar L.A.
Cruz S.L.
AUTHOR ADDRESSES
(Villarreal J.E.; Salazar L.A.; Cruz S.L.) Departamento de Farmacologia y
Toxicologia, Centro de Investigacion de Estudio Avanzados, Instituto
Politechnico Nacional, 14370 Mexico
CORRESPONDENCE ADDRESS
Departamento de Farmacologia y Toxicologia, Centro de Investigacion de
Estudio Avanzados, Instituto Politechnico Nacional, 14370 Mexico
SOURCE
Proceedings of the Western Pharmacology Society (1989) 32 (137-140). Date of
Publication: 1989
ISSN
0083-8969
BOOK PUBLISHER
Western Pharmacology Society, 1664 N. Virginia Street, Mail Stop 318, Reno,
United States.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
morphine (pharmacology)
naloxone (pharmacology)
opiate receptor
EMTREE DRUG INDEX TERMS
nicotine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abstinence
ileum
opiate addiction
EMTREE MEDICAL INDEX TERMS
animal cell
drug concentration
guinea pig
model
nonhuman
CAS REGISTRY NUMBERS
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1989189230
MEDLINE PMID
2780577 (http://www.ncbi.nlm.nih.gov/pubmed/2780577)
PUI
L19189188
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1466
TITLE
Psychiatric emergencies
ORIGINAL (NON-ENGLISH) TITLE
PSYCHIATRISCHE NOTFALLE
AUTHOR NAMES
Bas H.
AUTHOR ADDRESSES
(Bas H.)
SOURCE
Ars Medici (1989) 79:6 (338-349). Date of Publication: 1989
ISSN
0004-2897
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
benzodiazepine derivative (drug therapy)
biperiden (drug therapy)
bromocriptine (drug therapy)
clomethiazole (drug therapy)
imipramine (drug therapy)
lithium (drug therapy)
naloxone (drug therapy)
neuroleptic agent (drug therapy)
propranolol (drug therapy)
trihexyphenidyl (drug therapy)
EMTREE DRUG INDEX TERMS
bromocriptine mesilate
chlordiazepoxide
clozapine
diazepam
haloperidol
levomepromazine
lithium carbonate
lithium citrate
lithium sulfate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
aggression
anxiety
delirium (drug therapy)
depression (drug therapy)
psychosis (drug therapy)
stupor (drug therapy)
suicide (drug therapy)
EMTREE MEDICAL INDEX TERMS
book
drug therapy
human
psychological aspect
DRUG TRADE NAMES
akineton
artane
bedranol
distraneurin
haldol
hemineurin
inderal
leponex
librium
litarex
lithiofor
minozinan
narcan
nozinan
paceum
parlodel
psychopax
quilonorm
serocryptin
sigaperidol
stesolid
tofranil
valium
CAS REGISTRY NUMBERS
biperiden (1235-82-1, 514-65-8)
bromocriptine mesilate (22260-51-1)
bromocriptine (25614-03-3)
chlordiazepoxide (438-41-5, 58-25-3)
clomethiazole (1867-58-9, 533-45-9)
clozapine (5786-21-0)
diazepam (439-14-5)
haloperidol (52-86-8)
imipramine (113-52-0, 50-49-7)
levomepromazine (1236-99-3, 60-99-1, 7104-38-3)
lithium carbonate (554-13-2)
lithium citrate (919-16-4)
lithium sulfate (10377-48-7)
lithium (7439-93-2)
naloxone (357-08-4, 465-65-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
trihexyphenidyl (144-11-6, 52-49-3)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1989156760
PUI
L19156718
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1467
TITLE
Pediatric emergencies in office practices: Prevalence and office
preparedness
AUTHOR NAMES
Fuchs S.
Jaffe D.M.
Christoffel K.K.
AUTHOR ADDRESSES
(Fuchs S.; Jaffe D.M.; Christoffel K.K.) Department of Pediatrics,
University of Pittsburgh Medical School, Children's Hospital, Pittsburgh, PA
CORRESPONDENCE ADDRESS
Department of Pediatrics, University of Pittsburgh Medical School,
Children's Hospital, Pittsburgh, PA
SOURCE
Pediatrics (1989) 83:6 (931-939). Date of Publication: 1989
ISSN
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
Because of a nationally apparent increased interest in emergency medical
services for children and the need for a greater understanding of the
relationship between office pediatric and emergency department care of
children, a questionnaire was mailed to practitioners to (1) describe office
physician involvement with emergent conditions, and (2) evaluate physician
office preparedness for pediatric emergencies. Responses were received from
280 pediatricians and family practitioners, including information regarding
the availability of equipment and medication, physician training, and
practice characteristics. Of the responding physicians, 62% reported that
they assessed in their offices more than one child each week who required
hospitalization or urgent treatment. A preparedness score was developed and
multiple regression analysis was used to investigate the relationship
between this score and physician and practice characteristics. The mean
overall preparedness score was 53.7 of a possible 156 (range 5 to 136, SD =
31.3). Characteristics related to this score were type of practice and
advanced cardiac life support certification. Large multispecialty practices
and practices with physicians trained in advanced cardiac life support
tended to have better preparedness scores. Family practitioners tended to
have more complete stock of medications than pediatricians. The data
presented suggested that critically ill children who enter the medical
system via the office setting may have a better than even change of finding
the office unprepared to treat the emergency: in fewer than one third of the
offices in which it was reported that at least one patient was seen weekly
with asthma, anaphylaxis, sickle cell vasoocclusive crisis, status
epilepticus, and sepsis were they fully equipped to treat emergencies
related to these conditions. This finding suggests a need for further study
of office-based care of life-threatening conditions and for the development
of guidelines for office emergency preparedness.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
aminophylline
antibiotic agent
atropine
bicarbonate
calcium chloride
corticosteroid
diazepam
digoxin
dobutamine
dopamine
epinephrine
furosemide
glucagon
gluconate calcium
glycerol
heparin
insulin
isoprenaline
lidocaine
mannitol
naloxone
phenobarbital
phenytoin
potassium chloride
propranolol
theophylline
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug storage
emergency treatment
pediatrics
EMTREE MEDICAL INDEX TERMS
general practitioner
human
methodology
pediatrician
priority journal
questionnaire
theoretical study
DRUG TRADE NAMES
dilantin
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
gluconate calcium (299-28-5)
glycerol (56-81-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
insulin (9004-10-8)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
potassium chloride (7447-40-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989154704
MEDLINE PMID
2726348 (http://www.ncbi.nlm.nih.gov/pubmed/2726348)
PUI
L19154662
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1468
TITLE
The safety of fentanyl use in the Emergency Department
AUTHOR NAMES
Chudnofsky C.R.
Wright S.W.
Dronen S.C.
Borron S.W.
Wright M.B.
AUTHOR ADDRESSES
(Chudnofsky C.R.; Wright S.W.; Dronen S.C.; Borron S.W.; Wright M.B.)
Department of Emergency Medicine, University of Cincinnati Medical Center,
Cincinnati, OH 45267-0769
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, University of Cincinnati Medical Center,
Cincinnati, OH 45267-0769
SOURCE
Annals of Emergency Medicine (1989) 18:6 (635-639). Date of Publication:
1989
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Fentanyl citrate is a synthetic narcotic 1,000 times as potent as
meperidine. It produces minimal hemodynamic effects and is characterized by
a rapid onset of sedation and analgesia, a relatively short duration of
action (approximately 30 to 40 minutes) and rapid reversal with opiate
antagonists. These properties make fentanyl an ideal drug for emergency
department use. The safety of fentanyl use in an adult ED population has not
previously been studied. We retrospectively reviewed the charts of 841
patients who received fentanyl at the University of Cincinnati Center for
Emergency Care between January 1985 and June 1988. The study population
included 497 (59%) men and 344 (41%) women, with an average age of 33 years.
The average dose of fentanyl was 180 μg (range, 25 to 1,400 μg). Six
patients (1%) experienced mild side effects including nausea (one), emesis
(two), urticaria (one), and pruritis (two). Nine patients (1%) developed
more serious complications including six cases (0.7%) of respiratory
depression and three cases (0.4%) of hypotension. Two of 183 patients (1%)
who received midazolam and two of nine patients (22%) who received
haloperidol developed respiratory depression. Four of the six patients with
respiratory depression and two of the three patients with hypotension were
intoxicated. All of the complications were transient, and none resulted in
hospitalization. We conclude that fentanyl is a safe drug for use in the ED.
To maximize safety, we recommend careful dosing and titration, close patient
monitoring, and the availability of naloxone hydrochloride and resuscitation
equipment. In addition, we suggest cautious use in the intoxicated patient
and in patients receiving other drugs with central nervous system or
respiratory depressant activity.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (adverse drug reaction, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
emergency medicine
EMTREE MEDICAL INDEX TERMS
drug safety
human
hypotension (side effect)
intravenous drug administration
major clinical study
priority journal
respiration depression (side effect)
urticaria (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989140915
MEDLINE PMID
2729688 (http://www.ncbi.nlm.nih.gov/pubmed/2729688)
PUI
L19140873
DOI
10.1016/S0196-0644(89)80517-7
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(89)80517-7
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1469
TITLE
Three fatal sodium azide poisonings
AUTHOR NAMES
Klein-Schwartz W.
Gorman R.L.
Oderda G.M.
Massaro B.P.
Kurt T.L.
Garriott J.C.
AUTHOR ADDRESSES
(Klein-Schwartz W.; Gorman R.L.; Oderda G.M.; Massaro B.P.; Kurt T.L.;
Garriott J.C.) Maryland Poison Center, University of Maryland School of
Pharmacy, Baltimore, MD
CORRESPONDENCE ADDRESS
Maryland Poison Center, University of Maryland School of Pharmacy,
Baltimore, MD
SOURCE
Medical Toxicology and Adverse Drug Experience (1989) 4:3 (219-227). Date of
Publication: 1989
ISSN
0113-5244
BOOK PUBLISHER
Adis International Ltd, 41 Centorian Drive, Private Bag 65901, Mairangi Bay,
Auckland 10, New Zealand.
ABSTRACT
We report 3 cases and review the published literature on sodium azide
ingestion. A 38-year-old man intentionally ingested 2 tablespoonsful of
sodium azide in water and developed seizures, coma, hypotension and fatal
ventricular arrhythmias within 2 hours. A 33-year-old male ingested an
unknown quantity of sodium azide. In the emergency department he was
unconscious and underwent immediate intubation and gastric lavage. Nitrite
therapy was instituted without improvement. He remained acidotic despite
bicarbonate therapy and developed hypotension which was unresponsive to
pressor agents. He died approximately 8 hours after admission despite
resuscitative efforts. A 52-year-old male ingested 1.5 to 2g of sodium azide
and survived for 40 hours. Nitrite therapy was ineffective. The role of
sodium nitrite in treating sodium azide toxicity by producing methaemoglobin
which complexes with axide is discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bicarbonate (drug therapy)
sodium azide
sodium nitrite (drug therapy)
sodium thiosulfate (drug therapy)
EMTREE DRUG INDEX TERMS
atropine
dopamine
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
heart ventricle arrhythmia
hypotension
seizure
EMTREE MEDICAL INDEX TERMS
acidosis
adult
case report
fatality
human
intoxication
male
short survey
stomach lavage
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
dopamine (51-61-6, 62-31-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
sodium azide (26628-22-8)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989134565
MEDLINE PMID
2818717 (http://www.ncbi.nlm.nih.gov/pubmed/2818717)
PUI
L19134523
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1470
TITLE
Intramuscular meperidine, promethazine, and chlorpromazine: Analysis of use
and complications in 487 pediatric emergency department patients
AUTHOR NAMES
Terndrup T.E.
Cantor R.M.
Madden C.M.
AUTHOR ADDRESSES
(Terndrup T.E.; Cantor R.M.; Madden C.M.) Department of Pediatrics &
Critical Care, SUNY Health Science Center, Syracuse, NY 13210
CORRESPONDENCE ADDRESS
Department of Pediatrics & Critical Care, SUNY Health Science Center,
Syracuse, NY 13210
SOURCE
Annals of Emergency Medicine (1989) 18:5 (528-533). Date of Publication:
1989
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Despite widespread use of a parenterally administered mixture of meperidine,
promethazine, and chlorpromazine (Demerol®, Phenergan®, and Thorazine®,
DPT), there has been no systematic evaluation of its efficacy and
complications in emergency department patients. We reviewed the medical
records of all patients less than 16 years old who received DPT in our ED
during the 24-month period ending December 31, 1987. Of 487 patients who
received DPT, the maximum dose was 50/25/25 mg, respectively. Wound repair
(69%) and fracture reduction (12%) were the two most common indications.
Lacerations most commonly involved the face (65%) or digits (20%). Efficacy
was not directly reported, but only eight patients received repeat sedation.
Head injuries and a lower mean initial meperidine dosage were more prevalent
in patients requiring repeat sedation (P < .05). Three patients (0.6%)
experienced significant complications. All had respiratory depression and
received IV naloxone. An abnormal initial mental status examination or an
underlying neurologic abnormality was significantly associated with
complications (P < .05). DPT appears to be a safe and relatively effective
sedative for selected pediatric ED patients when administered as a ratio of
2:1:1 mg/kg, respectively. Complications are increased in patients with
acute or underlying neurologic abnormalities.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
chlorpromazine (adverse drug reaction, drug combination, drug therapy)
pethidine (adverse drug reaction, drug combination, drug therapy)
promethazine (adverse drug reaction, drug combination, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
face injury (drug therapy)
fracture reduction
wound healing
EMTREE MEDICAL INDEX TERMS
adolescent
child
drug efficacy
emergency ward
finger injury
human
intramuscular drug administration
major clinical study
neurologic disease
priority journal
respiration depression (side effect)
sedation
DRUG TRADE NAMES
demerol
phenergan
thorazine
CAS REGISTRY NUMBERS
chlorpromazine (50-53-3, 69-09-0)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989127731
MEDLINE PMID
2719364 (http://www.ncbi.nlm.nih.gov/pubmed/2719364)
PUI
L19127692
DOI
10.1016/S0196-0644(89)80838-8
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(89)80838-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1471
TITLE
Emergency drug doses for infants and children and naloxone use in newborns:
Clarification
AUTHOR ADDRESSES
SOURCE
Pediatrics (1989) 83:5 (803). Date of Publication: 1989
ISSN
0031-4005
ABSTRACT
Dose: (Intoxification with opiates) IV, intratracheal - 0.1 mg/kg from birth
(including premature infants) until age 5 years or 20 kg of weight, at which
time a minimum 2-mg dose should be used. These doses may be repeated as
needed to maintain opiate reversal.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration, drug dose, drug therapy)
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
human
inhalational drug administration
intravenous drug administration
newborn
priority journal
theoretical study
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989120571
PUI
L19120532
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1472
TITLE
American Academy of Pediatrics. Emergency drug doses for infants and
children and naloxone use in newborns: clarification.
AUTHOR ADDRESSES
SOURCE
Pediatrics (1989) 83:5 (803). Date of Publication: May 1989
ISSN
0031-4005
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (drug administration)
EMTREE DRUG INDEX TERMS
narcotic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS
article
human
newborn
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
2717301 (http://www.ncbi.nlm.nih.gov/pubmed/2717301)
PUI
L19419263
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1473
TITLE
Management of neonatal emergencies in the delivery room
AUTHOR NAMES
Ringer S.A.
Stark A.R.
AUTHOR ADDRESSES
(Ringer S.A.; Stark A.R.) Joint Program in Neonatology, Brigham and Women's
Hospital, Boston, MA 02115
CORRESPONDENCE ADDRESS
Joint Program in Neonatology, Brigham and Women's Hospital, Boston, MA 02115
SOURCE
Clinics in Perinatology (1989) 16:1 (23-41). Date of Publication: 1989
ISSN
0095-5108
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Emergencies in the delivery room are best handled by anticipation and a team
approach. Basic principles of resuscitation should be applied in all cases
by a team skilled in airway management and ventilatory and circulatory
support. Specialized management schemes are described for rapid treatment
and effective stabilization of infants with air leak syndromes, hydrops
fetalis, disorders of the airway, and diaphragmatic and abdominal wall
defects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug dose, drug therapy)
bicarbonate (drug dose, drug therapy)
epinephrine (drug dose, drug therapy)
gluconate calcium (drug dose, drug therapy)
glucose (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal wall defect (congenital disorder)
diaphragm hernia (congenital disorder)
emergency medicine
esophagus atresia (congenital disorder)
newborn care
newborn disease
obstetric delivery
respiratory distress syndrome (congenital disorder)
resuscitation
EMTREE MEDICAL INDEX TERMS
human
newborn
prenatal diagnosis
prognosis
short survey
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Obstetrics and Gynecology (10)
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989088684
MEDLINE PMID
2656063 (http://www.ncbi.nlm.nih.gov/pubmed/2656063)
PUI
L19088645
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1474
TITLE
Duration of antagonistic effects of nalmefene and naloxone in opiate-induced
sedation for emergency department procedures
AUTHOR NAMES
Barsan W.G.
Seger D.
Danzl D.F.
Ling L.J.
Bartlett R.
Buncher R.
Bryan C.
AUTHOR ADDRESSES
(Barsan W.G.; Seger D.; Danzl D.F.; Ling L.J.; Bartlett R.; Buncher R.;
Bryan C.) Department of Emergency Medicine, University of Cincinnati College
of Medicine, Cincinnati, OH 45267-0769
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, University of Cincinnati College of
Medicine, Cincinnati, OH 45267-0769
SOURCE
American Journal of Emergency Medicine (1989) 7:2 (155-161). Date of
Publication: 1989
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
Naloxone is an effective opiate antagonist, but its short half-life limits
its usefulness. For outpatient procedures, a longer acting opiate antagonist
could eliminate two to four hours of nursing observation in patients
postoperatively. A controlled, randomized, double-blind trial comparing the
effects of nalmefene, naloxone, and placebo in reversing opiate-induced
sedation was carried out to determine efficacy, duration of action, and
adverse effects in patients undergoing outpatient procedures. Each patient
received 1.5 to 3.0 mg/kg meperidine intravenously before the procedure.
After the procedure, each patient received either nalmefene, 1.0 mg;
naloxone, 1.0 mg; or saline, 1.0 mL intravenously. Vital signs and
assessments for alertness were performed for four hours. Naloxone
significantly reversed sedation for only 15 minutes, whereas nalmefene was
significantly effective (P < .05) for up to 210 minutes. Nalmefene was
significantly more effective than naloxone in reversing sedation at 60, 90,
and 120 minutes. Nalmefene is an affective agent for the reversal of
opiate-induced sedation after outpatient procedures.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
nalmefene (adverse drug reaction, clinical trial, drug combination, drug
comparison, pharmacology)
naloxone (adverse drug reaction, clinical trial, drug combination, drug
comparison, pharmacology)
pethidine (adverse drug reaction, drug combination, pharmacology)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
sedation
EMTREE MEDICAL INDEX TERMS
drug efficacy
human
intravenous drug administration
major clinical study
nausea (side effect)
vertigo (side effect)
vomiting (side effect)
CAS REGISTRY NUMBERS
nalmefene (55096-26-9)
naloxone (357-08-4, 465-65-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989087559
MEDLINE PMID
2645889 (http://www.ncbi.nlm.nih.gov/pubmed/2645889)
PUI
L19087520
DOI
10.1016/0735-6757(89)90128-9
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(89)90128-9
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1475
TITLE
Emergencies in winter. Traffic accident in winter: Pain therapy (II)
ORIGINAL (NON-ENGLISH) TITLE
NOTFALLE IM WINTER. AUTOUNFALL IM WINTER: SCHMERZBEHANDLUNG II
AUTHOR NAMES
Rossi R.
AUTHOR ADDRESSES
(Rossi R.) Universitatsklinik fur Anasthesiologie, Klinikum der Universitat
Ulm, 7900 Ulm
CORRESPONDENCE ADDRESS
Universitatsklinik fur Anasthesiologie, Klinikum der Universitat Ulm, 7900
Ulm
SOURCE
Munchener Medizinische Wochenschrift (1989) 131:8 (65-71). Date of
Publication: 1989
ISSN
0341-3098
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diazepam
ketamine
opiate
scopolamine butyl bromide
triflupromazine
EMTREE DRUG INDEX TERMS
buprenorphine
fentanyl
ketamine
morphine
naloxone
pentazocine
pethidine
piritramide
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
pain (drug therapy)
EMTREE MEDICAL INDEX TERMS
human
injury
DRUG TRADE NAMES
buscopan
dipidolor
dolantin
fortral
ketanest
narcanti
psyquil
temgesic
tramal
valium
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
diazepam (439-14-5)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
piritramide (302-41-0)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
tramadol (27203-92-5, 36282-47-0)
triflupromazine (1098-60-8, 146-54-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1989065997
PUI
L19065995
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1476
TITLE
Thermal stability of prehospital medications
AUTHOR NAMES
Valenzuela T.D.
Criss E.A.
Hammargren W.M.
Schram K.H.
Spaite D.W.
Meislin H.W.
Clark J.B.
AUTHOR ADDRESSES
(Valenzuela T.D.; Criss E.A.; Hammargren W.M.; Schram K.H.; Spaite D.W.;
Meislin H.W.; Clark J.B.) Section of Emergency Medicine, Arizona Health
Sciences Center, Tucson, AZ 85724
CORRESPONDENCE ADDRESS
Section of Emergency Medicine, Arizona Health Sciences Center, Tucson, AZ
85724
SOURCE
Annals of Emergency Medicine (1989) 18:2 (173-176). Date of Publication:
1989
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
To evaluate the effect of prolonged environmental extremes on common
prehospital medications, four identical sets of 23 drugs were placed in a
simulated environment for up to four weeks. Subsequently, the samples were
analyzed by gas chromatography-mass spectrometry for evidence of degradation
byproducts. Twenty-one of the 23 samples showed no break-down products;
however, isoproterenol demonstrated 11% loss of parent compound after four
weeks of environmental exposure. Epinephrine manifested a change in its
ionized state after exposure to heat; the physiologic effect of this change
was not determined. Our results suggest that rural and suburban emergency
medical services providers, whose medications may not be replaced until they
are used in patient care, must monitor their drug boxes' duration of
exposure to uncontrolled conditions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline (pharmaceutics)
atropine (pharmaceutics)
bicarbonate (pharmaceutics)
bretylium tosylate (pharmaceutics)
calcium chloride (pharmaceutics)
dexamethasone (pharmaceutics)
diazepam (pharmaceutics)
diphenhydramine (pharmaceutics)
dopamine (pharmaceutics)
epinephrine (pharmaceutics)
furosemide (pharmaceutics)
glucose (pharmaceutics)
glyceryl trinitrate (pharmaceutics)
isoetarine (pharmaceutics)
isoprenaline (pharmaceutics)
lidocaine (pharmaceutics)
metoprolol tartrate (pharmaceutics)
morphine (pharmaceutics)
naloxone (pharmaceutics)
nifedipine (pharmaceutics)
phenobarbital (pharmaceutics)
thiamine (pharmaceutics)
verapamil (pharmaceutics)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug decomposition
drug stability
environmental exposure
ionization
thermal exposure
thermostability
EMTREE MEDICAL INDEX TERMS
economic aspect
human
organization and management
priority journal
DRUG TRADE NAMES
lopressor
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium tosylate (61-75-6)
calcium chloride (10043-52-4)
dexamethasone (50-02-2)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
isoetarine (50-96-4, 530-08-5, 63550-80-1)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoprolol tartrate (56392-17-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
thiamine (59-43-8, 67-03-8)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989053790
MEDLINE PMID
2916782 (http://www.ncbi.nlm.nih.gov/pubmed/2916782)
PUI
L19053788
DOI
10.1016/S0196-0644(89)80109-X
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(89)80109-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1477
TITLE
Sleeping beauty: a case of pickwickian syndrome.
AUTHOR NAMES
Hartzell C.W.
AUTHOR ADDRESSES
(Hartzell C.W.)
CORRESPONDENCE ADDRESS
C.W. Hartzell,
SOURCE
Journal of emergency nursing: JEN : official publication of the Emergency
Department Nurses Association (1989) 15:1 (8-11). Date of Publication: 1989
Jan-Feb
ISSN
0099-1767
ABSTRACT
The patient arriving at the emergency department with somnolence must be
evaluated quickly, efficiently, and with a definite goal in mind. Head and
neck trauma should always be suspected and protective steps taken in the
unconscious patient. The coma mnemonic, AEIOU TIPS, (alcohol, epilepsy,
insulin, overdose, uremia, trauma, infection, psychiatric, stroke) provides
an excellent memory tool for the evaluation of decreased level of
consciousness in the emergency setting. Interventions that provide
diagnostic and therapeutic results (naloxone and 50% dextrose) should be
initiated immediately while blood samples are drawn for pretreatment
documentation. Each of the possible causes of lethargy or somnolence needs
to be evaluated with the understanding that a multitude of factors may be
present in the patient whose condition precludes a thorough history; the
depressed diabetic may have taken an overdose of medications in addition to
his insulin. Social preconceptions may also effect the outcome. The
intoxicated patient described herein was allowed to "sleep it off" in the
emergency department under the watchful eyes (and ears) of a nursing staff
who faithfully recorded vital signs and pupil reactivity as the patient's
blood gas values deteriorated.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
obesity hypoventilation syndrome (diagnosis, therapy)
EMTREE MEDICAL INDEX TERMS
adult
alcohol intoxication (diagnosis, therapy)
article
case report
emergency
human
intensive care
male
multimodality cancer therapy
LANGUAGE OF ARTICLE
English
MEDLINE PMID
2664315 (http://www.ncbi.nlm.nih.gov/pubmed/2664315)
PUI
L19462993
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1478
TITLE
Survival following massive arsenic ingestion
AUTHOR NAMES
Fesmire F.M.
Schauben J.L.
Roberge R.J.
AUTHOR ADDRESSES
(Fesmire F.M.; Schauben J.L.; Roberge R.J.) Clinical Toxicology Service,
University Hospital of Jacksonville, Jacksonville, FL 32209
CORRESPONDENCE ADDRESS
Clinical Toxicology Service, University Hospital of Jacksonville,
Jacksonville, FL 32209
SOURCE
American Journal of Emergency Medicine (1988) 6:6 (602-606). Date of
Publication: 1988
ISSN
0735-6757
BOOK PUBLISHER
W.B. Saunders, Independence Square West, Philadelphia, United States.
ABSTRACT
A case of a 30-year-old man who ingested a massive quantity of arsenic
(approximately 2,150 mg) in an apparent suicide attempt is presented.
Aggressive initial therapy, including fluid resuscitation, chelation
therapy, and hemodialysis, resulted in the patient's survival. The
successful management of arsenic intoxication requires both prompt
recognition and the initiation of specific and aggressive therapeutic
modalities.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon (drug therapy)
arsenic
dimercaprol (drug therapy)
magnesium sulfate (drug therapy)
naloxone (drug therapy)
rodenticide
EMTREE DRUG INDEX TERMS
hydralazine
penicillamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
chelation
emergency treatment
hemodialysis
intoxication (therapy)
suicide attempt
EMTREE MEDICAL INDEX TERMS
adult
case report
human cell
intensive care
intramuscular drug administration
intravenous drug administration
male
oral drug administration
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
arsenic (7440-38-2)
dimercaprol (59-52-9)
hydralazine (304-20-1, 86-54-4)
magnesium sulfate (7487-88-9)
naloxone (357-08-4, 465-65-6)
penicillamine (2219-30-9, 52-67-5)
EMBASE CLASSIFICATIONS
Internal Medicine (6)
Anesthesiology (24)
Urology and Nephrology (28)
Forensic Science Abstracts (49)
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988280271
MEDLINE PMID
3178956 (http://www.ncbi.nlm.nih.gov/pubmed/3178956)
PUI
L18280267
DOI
10.1016/0735-6757(88)90101-5
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(88)90101-5
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1479
TITLE
Identification and entry of the patient with acute cerebral infarction
AUTHOR NAMES
Barsan W.G.
Brott T.G.
Olinger C.P.
Adams Jr. H.P.
Haley Jr. E.C.
Levy D.E.
AUTHOR ADDRESSES
(Barsan W.G.; Brott T.G.; Olinger C.P.; Adams Jr. H.P.; Haley Jr. E.C.; Levy
D.E.) Department of Emergency Medicine, University Hospital, Cincinnati, OH
45267-0769
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, University Hospital, Cincinnati, OH
45267-0769
SOURCE
Annals of Emergency Medicine (1988) 17:11 (1192-1195). Date of Publication:
1988
ISSN
0196-0644
BOOK PUBLISHER
Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States.
ABSTRACT
Although time has been recognized as a critical factor in the treatment of
other arterial occlusive disorders, it has been an underemphasized variable
in the treatment of acute stroke. Animal models of cerebral arterial
occlusion have demonstrated that neurologic recovery is more likely the
shorter the duration of occlusion. Complete recovery does not occur if the
occlusion persists for more than six hours. Prior trials have only rarely
begun treatment within six hours of stroke onset. Over the past five years,
we have participated in three stroke trials and have tried to identify
factors that lead to delays in treatment. Factors that affect the time from
stroke onset to arrival at the hospital include recognition of acute stroke
by the patient, prehospital care personnel, and physicians. After arrival at
the hospital, factors that can significantly delay treatment include the
time to obtain computed tomography and the site of treatment (emergency
department vs ICU). With proper attention, the time from patient arrival
until treatment should be less than one hour. Future efforts should be
directed toward reducing the time from stroke onset until arrival at the
hospital. Education of the public, high-risk patients, prehospital care
providers, and physicians may aid in these efforts.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
ancrod (clinical trial, drug therapy)
naloxone (clinical trial, drug therapy)
tissue plasminogen activator (clinical trial, drug therapy)
EMTREE DRUG INDEX TERMS
heparin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
brain infarction (diagnosis, drug therapy)
cerebrovascular accident (diagnosis, drug therapy)
EMTREE MEDICAL INDEX TERMS
emergency ward
human
intravenous drug administration
priority journal
CAS REGISTRY NUMBERS
ancrod (9046-56-4)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
naloxone (357-08-4, 465-65-6)
tissue plasminogen activator (105913-11-9)
EMBASE CLASSIFICATIONS
Neurology and Neurosurgery (8)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988279285
MEDLINE PMID
3142316 (http://www.ncbi.nlm.nih.gov/pubmed/3142316)
PUI
L18279281
DOI
10.1016/S0196-0644(88)80067-2
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(88)80067-2
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1480
TITLE
Emergence and development of stress-induced analgesia and concomitant
behavioral changes in mice exposed to social conflict
AUTHOR NAMES
Frischknecht H.-R.
Siegfried B.
AUTHOR ADDRESSES
(Frischknecht H.-R.; Siegfried B.) Institute of Pharmacology, University of
Zurich, CH-8006 Zurich
CORRESPONDENCE ADDRESS
Institute of Pharmacology, University of Zurich, CH-8006 Zurich
SOURCE
Physiology and Behavior (1988) 44:3 (383-388). Date of Publication: 1988
ISSN
0031-9384
BOOK PUBLISHER
Elsevier Inc., 360 Park Avenue South, New York, United States.
ABSTRACT
Mice of the inbred strain DBA/2, when exposed to a social conflict,
developed a low intensity, naloxone-insensitive analgesia after 15 bites,
and a more pronounced, naloxone-sensitive analgesia after 45 bites. The
effective inhibition of the antinociceptive response following low and high
number of bites by the alkylating opiate antagonist β-chlornaltrexamine
suggests participation of opioid mechanisms at both stress levels. Emergence
of an increased tail-flick latency was indicated by the occurrence of
defensive upright postures upon contact with the opponent, while animals
displaying full analgesic response during the period of bite 31-45 increased
their escape reactions without being in contact with the aggressor.
Suppression of social conflict analgesia in mice by pretreatment with opiate
antagonists facilitated the occurrence of these escape reactions. The
display of panic escape responses is discussed in the context of increased
fear and helplessness that developed under conditions of sustained attacks.
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
fear
nociception
social behavior
stress
EMTREE MEDICAL INDEX TERMS
animal experiment
controlled study
male
mouse
nonhuman
priority journal
psychological aspect
subcutaneous drug administration
EMBASE CLASSIFICATIONS
Physiology (2)
Neurology and Neurosurgery (8)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1989006988
MEDLINE PMID
2851847 (http://www.ncbi.nlm.nih.gov/pubmed/2851847)
PUI
L19006988
DOI
10.1016/0031-9384(88)90041-8
FULL TEXT LINK
http://dx.doi.org/10.1016/0031-9384(88)90041-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1481
TITLE
Medicines in emergency treatment: Consciousness disturbances
ORIGINAL (NON-ENGLISH) TITLE
MEDIKAMENTOSE NOTFALLBEHANDLUNG IN DER PRAXIS-5. TEIL: BEWUSSTSEINSSTORUNGEN
AUTHOR NAMES
Bas H.
AUTHOR ADDRESSES
(Bas H.)
SOURCE
Ars Medici (1988) 78:11 (536-541). Date of Publication: 1988
ISSN
0004-2897
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
carbamazepine (drug therapy)
diazepam (drug therapy)
flumazenil (drug therapy)
naloxone (drug therapy)
phenobarbital (drug therapy)
EMTREE DRUG INDEX TERMS
clonazepam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cerebrovascular disease (drug therapy)
unconsciousness
EMTREE MEDICAL INDEX TERMS
case report
human
intramuscular drug administration
intravenous drug administration
short survey
DRUG TRADE NAMES
anexate
luminal
narcan
rivotril
valium
CAS REGISTRY NUMBERS
carbamazepine (298-46-4, 8047-84-5)
clonazepam (1622-61-3)
diazepam (439-14-5)
flumazenil (78755-81-4)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1988279688
PUI
L18279684
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1482
TITLE
Emergency drug administration via the endotracheal route
AUTHOR NAMES
Greenberg M.I.
AUTHOR ADDRESSES
(Greenberg M.I.) Department of Emergency Medicine, The Medical College of
Pennsylvania, Philadelphia, PA 19129
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, The Medical College of Pennsylvania,
Philadelphia, PA 19129
SOURCE
Military Medicine (1988) 153:10 (509-513). Date of Publication: 1988
ISSN
0026-4075
BOOK PUBLISHER
Association of Military Surgeons of the US, 9320 Old Georgetown Road,
Bethesda, United States.
ABSTRACT
The establishment of an intravenous lifeline for the administration of
emergency medications is often difficult or impossible in both the
pre-hospital and in-hospital setting. The administration of emergency drugs
via the endotracheal route can be life-saving. Epinephrine, naloxone,
atropine, diazepam, and lidocaine can be administered successfully via the
endotracheal route. All physicians, corpsmen, and nurses who treat
emergencies should be aware of how the endotracheal route can be used in
life-threatening situations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug administration, drug comparison)
diazepam (drug administration, drug comparison)
epinephrine (drug administration, drug comparison)
lidocaine (drug administration, drug comparison)
naloxone (drug administration, drug comparison)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug administration
emergency health service
endotracheal intubation
soldier
EMTREE MEDICAL INDEX TERMS
education
human
organization and management
short survey
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Health Policy, Economics and Management (36)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988245146
MEDLINE PMID
3143934 (http://www.ncbi.nlm.nih.gov/pubmed/3143934)
PUI
L18245142
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1483
TITLE
Differentiation of cocaine toxicity: role of the toxicology drug screen
AUTHOR NAMES
Quandt C.M.
Sommi Jr. R.W.
Pipkin T.
McCallum M.H.
AUTHOR ADDRESSES
(Quandt C.M.; Sommi Jr. R.W.; Pipkin T.; McCallum M.H.) Mt. Sinai Medical
Center, Department of Pharmacy, New York, NY 10029
CORRESPONDENCE ADDRESS
Mt. Sinai Medical Center, Department of Pharmacy, New York, NY 10029
SOURCE
Drug Intelligence and Clinical Pharmacy (1988) 22:7-8 (582-587). Date of
Publication: 1988
ISSN
0012-6578
BOOK PUBLISHER
Harvey Whitney Books Company, 8044 Montgomery Road, Suite 415, Cincinnati,
United States.
ABSTRACT
Fifteen cases of presumed cocaine intoxication were evaluated in the
emergency room (ER) at a city hospital over a four-day period. This series
is unique in that many of these patients were from a similar area of the
city, in some cases had the same street address, were regular abusers of
cocaine, and presented to the ER with similar symptoms of tachycardia,
dilated pupils, marked confusion, bizarre and sometimes violent behavior,
psychosis, and hallucinations. Many of these symptoms were present several
hours after drug use. Samples of a white powder presumed by the patients to
be cocaine were obtained from two patients and analyzed by gas-liquid
chromatography. Neither sample contained cocaine, but rather revealed
atropine, benzocaine, and procaine. The signs and symptoms of cocaine,
amphetamine, and atropine intoxication are reviewed and the problems of drug
analysis and differential diagnosis of drug intoxication are discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amphetamine (drug toxicity)
atropine (drug toxicity)
cocaine (drug analysis, drug toxicity)
EMTREE DRUG INDEX TERMS
diazepam
haloperidol
hydroxyzine
lorazepam
naloxone
physostigmine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
confusion
drug abuse
hallucination
hypertension
psychosis
tachycardia
EMTREE MEDICAL INDEX TERMS
adult
case report
clinical article
female
human
male
priority journal
psychological aspect
CAS REGISTRY NUMBERS
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
haloperidol (52-86-8)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988203423
MEDLINE PMID
3416745 (http://www.ncbi.nlm.nih.gov/pubmed/3416745)
PUI
L18203423
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1484
TITLE
Emergency drug dosage guides
AUTHOR NAMES
Okstein C.J.
Odal M.
Kelly R.W.
AUTHOR ADDRESSES
(Okstein C.J.; Odal M.; Kelly R.W.) Department of Pediatrics, Windham
Community Memorial Hospital, Willimantic, CT
CORRESPONDENCE ADDRESS
Department of Pediatrics, Windham Community Memorial Hospital, Willimantic,
CT
SOURCE
Pediatrics (1988) 82:1 (119-121). Date of Publication: 1988
ISSN
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
One factor complicating resuscitation of pediatric patients is that dosages
of emergency medications must be adjusted accurately and quickly for each
patient's body weight. In a crisis situation, the possibility of a serious
error in calculating dosage of medication exists. In a community hospital,
this problem is complicated by the fact that initial cardiopulmonary
resuscitation may be administered by physicians who are not specialists in
pediatrics. Although those physicians may have familiarity with the
pharmacologic basis for medication therapy, they are frequently unfamiliar
with pediatric dosage schedules or with differing concentrations of
medication used in pediatrics. Various methods of dealing with this problem
have been suggested, including the preparation of emergency drug charts with
precalculated dosages for children of different body weights and the use of
emergency drug cards which are to be attached to each patient's medical
recorded on admission. For this latter plan, an outline of the recommended
drugs is given in addition to space for calculating the correct dosage for
each patient based on boy weight.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug dose, drug therapy)
bicarbonate (drug dose, drug therapy)
calcium chloride (drug dose, drug therapy)
diazepam (drug dose, drug therapy)
dopamine (drug dose, drug therapy)
epinephrine (drug dose, drug therapy)
isoprenaline (drug dose, drug therapy)
lidocaine (drug dose, drug therapy)
naloxone (drug dose, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dose
emergency
emergency health service
emergency medicine
emergency treatment
emergency ward
EMTREE MEDICAL INDEX TERMS
body weight
child
human
priority journal
review
DRUG TRADE NAMES
narcan
valium
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Surgery (9)
Anesthesiology (24)
Health Policy, Economics and Management (36)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988164089
MEDLINE PMID
3380593 (http://www.ncbi.nlm.nih.gov/pubmed/3380593)
PUI
L18164089
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1485
TITLE
Complications of naloxone.
AUTHOR NAMES
Neal J.M.
AUTHOR ADDRESSES
(Neal J.M.)
CORRESPONDENCE ADDRESS
J.M. Neal,
SOURCE
Annals of emergency medicine (1988) 17:7 (765-766). Date of Publication: Jul
1988
ISSN
0196-0644
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone (adverse drug reaction, drug administration)
EMTREE DRUG INDEX TERMS
narcotic agent (drug toxicity)
EMTREE MEDICAL INDEX TERMS
emergency health service
human
letter
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
3382089 (http://www.ncbi.nlm.nih.gov/pubmed/3382089)
PUI
L18772804
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1486
TITLE
Emergency drug doses for infants and chldren
AUTHOR NAMES
Roberts R.J.
Kauffman R.E.
Mirkin B.L.
Rumack B.H.
Snodgrass W.
Spielberg S.P.
Bennett D.R.
Kaufman P.
Freeman M.M.
Pernoll M.L.
Licata S.A.
Lund Mortensen M.
Yaffe S.J.
Berlin C.M.
Temple A.R.
AUTHOR ADDRESSES
(Roberts R.J.; Kauffman R.E.; Mirkin B.L.; Rumack B.H.; Snodgrass W.;
Spielberg S.P.; Bennett D.R.; Kaufman P.; Freeman M.M.; Pernoll M.L.; Licata
S.A.; Lund Mortensen M.; Yaffe S.J.; Berlin C.M.; Temple A.R.)
SOURCE
Pediatrics (1988) 81:3 (462-465). Date of Publication: 1988
ISSN
0031-4005
BOOK PUBLISHER
American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk
Grove Village, United States.
ABSTRACT
This guideline for emergency drug dosing has been prepared for physicians
requiring assistance with drug doses for pediatric patients. The drugs
included are not intended to be exhaustive; therefore, this guideline should
not be construed as an endorsement of the drugs selected. Information on
drug indications and side effects has been purposely limited. In
anticipation of future updates of this guideline, the Committee on Drugs
invites comments and suggestions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
calcium chloride
diazepam
diazoxide
digoxin
diphenhydramine
dobutamine
dopamine
epinephrine
furosemide
glucagon
glucose
hydralazine
insulin
isoprenaline
lidocaine
mannitol
morphine sulfate
naloxone
nitroprusside sodium
noradrenalin
pancuronium
paraldehyde
phenobarbital
phenytoin
procainamide
propranolol
EMTREE DRUG INDEX TERMS
morphine
pancuronium bromide
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug dose
emergency treatment
EMTREE MEDICAL INDEX TERMS
child
human
priority journal
review
theoretical study
DRUG TRADE NAMES
apresoline
benadryl
dilantin
dobutrex
hyperstat
inderal
intropin
isuprel
lanoxin
lasix
narcan
nipride
pavulon
pronestyl
valium
xylocaine
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
diazepam (439-14-5)
diazoxide (364-98-7)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
hydralazine (304-20-1, 86-54-4)
insulin (9004-10-8)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
morphine (52-26-6, 57-27-2)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
pancuronium bromide (15500-66-0)
paraldehyde (123-63-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
procainamide (51-06-9, 614-39-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
Pediatrics and Pediatric Surgery (7)
Drug Literature Index (37)
Adverse Reactions Titles (38)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988095053
PUI
L18095053
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1487
TITLE
Fentanyl-induced rigidity at the emergence from anesthesia. Description of a
case
ORIGINAL (NON-ENGLISH) TITLE
RIGIDTA DA FENTANYL ALL'EMERGENZA DELL'ANESTESIA. DESCRIZIONE DI UN CASO
CLINCIO
AUTHOR NAMES
Tommasino C.
Scafuro M.
Di Gregorio A.M.
Miele E.
Cafaggi G.
AUTHOR ADDRESSES
(Tommasino C.; Scafuro M.; Di Gregorio A.M.; Miele E.; Cafaggi G.) Cattedra
'R', Istituto di Anestesiologia e Rianimazione, I Facolta di Medicina e
Chirurgia, Universita degli Studi di Napoli, Napoli
CORRESPONDENCE ADDRESS
Cattedra 'R', Istituto di Anestesiologia e Rianimazione, I Facolta di
Medicina e Chirurgia, Universita degli Studi di Napoli, Napoli
SOURCE
Minerva Anestesiologica (1987) 53:5 (325-327). Date of Publication: 1987
ISSN
0375-9393
BOOK PUBLISHER
Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Torino, Italy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
fentanyl (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
abdominal wall
anesthesia
muscle rigidity
neuroleptanalgesia
EMTREE MEDICAL INDEX TERMS
case report
digestive system
human
muscle
preliminary communication
therapy
CAS REGISTRY NUMBERS
fentanyl (437-38-7)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1987235097
MEDLINE PMID
3438022 (http://www.ncbi.nlm.nih.gov/pubmed/3438022)
PUI
L17167597
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1488
TITLE
Use of skin surface sampling and ion mobility spectrometry as a preliminary
screening method for drug detection in an emergency room
AUTHOR NAMES
Nanji A.A.
Lawrence A.H.
Mikhael N.Z.
AUTHOR ADDRESSES
(Nanji A.A.; Lawrence A.H.; Mikhael N.Z.) Department of Pathology and
Laboratory Medicine, University of Ottawa, Ottawa, Ont. K1H 8L6
CORRESPONDENCE ADDRESS
Department of Pathology and Laboratory Medicine, University of Ottawa,
Ottawa, Ont. K1H 8L6
SOURCE
Journal of Toxicology - Clinical Toxicology (1987) 25:6 (501-515). Date of
Publication: 1987
ISSN
0731-3810
BOOK PUBLISHER
Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia PA, United
States.
ABSTRACT
We have evaluated the use of a novel method for detecting drug residues on
the hands of emergency patients suspected of drug overdose. The residues are
collected by means of a suction probe and subsequently analyzed by thermal
desorption directly into an ion mobility spectrometer. All patients admitted
to the Emergency Room had their palms, fingers and nostrils sampled. Of the
101 drug related ingestions, 50 were related to tablets, 47 to film or
sugar-coated tablets and 4 to cocaine powder. Positive identification was
possible in 42% of tablet related ingestions, 29% of coated tablet or
capsule ingestions and in all patients using cocaine. In 53% of the cases
where positive drug identification was made, sampling had been carried out
within 30 minutes of the patient's arrival at the Emergency Room.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alprazolam (drug analysis)
amitriptyline (drug analysis)
cocaine (drug analysis)
doxepin (drug analysis)
drug residue
perphenazine (drug analysis)
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug determination
ion mobility spectrometry
skin surface
EMTREE MEDICAL INDEX TERMS
case report
drug overdose
drug screening
human
methodology
CAS REGISTRY NUMBERS
alprazolam (28981-97-7)
amitriptyline (50-48-6, 549-18-8)
cocaine (50-36-2, 53-21-4, 5937-29-1)
doxepin (1229-29-4, 1668-19-5)
naloxone (357-08-4, 465-65-6)
perphenazine (58-39-9)
EMBASE CLASSIFICATIONS
Clinical and Experimental Biochemistry (29)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
Toxicology (52)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988085898
MEDLINE PMID
3441017 (http://www.ncbi.nlm.nih.gov/pubmed/3441017)
PUI
L18085898
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1489
TITLE
Use of opiates in the emergency ambulance service
ORIGINAL (NON-ENGLISH) TITLE
EINSATZ VON BETAUBUNGSMITTELN IM RETTUNGSDIENST
AUTHOR NAMES
Blumenberg D.
Sefrin P.
AUTHOR ADDRESSES
(Blumenberg D.; Sefrin P.) Institut fur Anaesthesiologie der Universitat
Wurzburg, D-8700 Wurzburg
CORRESPONDENCE ADDRESS
Institut fur Anaesthesiologie der Universitat Wurzburg, D-8700 Wurzburg
SOURCE
Notarzt (1987) 3:4 ( 134-136). Date of Publication: 1987
ISSN
0177-2304
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
ambulance
emergency health service
EMTREE MEDICAL INDEX TERMS
emergency care
Germany
human
legal aspect
methodology
organization and management
questionnaire
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1988083843
PUI
L18083843
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1490
TITLE
Antidotes in the pre-hospital phase
ORIGINAL (NON-ENGLISH) TITLE
ANTIDOTA IN DER PRAHOSPITALPHASE
AUTHOR NAMES
Harloff M.
Riemann J.F.
AUTHOR ADDRESSES
(Harloff M.; Riemann J.F.) Medizinische Klinik C, Klinikum der Stadt, 6700
Ludwigshafen/Rhein
CORRESPONDENCE ADDRESS
Medizinische Klinik C, Klinikum der Stadt, 6700 Ludwigshafen/Rhein
SOURCE
Intensivmedizin und Notfallmedizin (1987) 24:8 (433- 436). Date of
Publication: 1987
ISSN
0175-3851
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
apomorphine
atropine
cortisone
dimethylaminophenol
physostigmine
sodium thiosulfate
tolonium chloride
EMTREE DRUG INDEX TERMS
antidote
biperiden
naloxone
obidoxime
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency care
emergency treatment
intoxication
EMTREE MEDICAL INDEX TERMS
human
short survey
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
cortisone (53-06-5)
naloxone (357-08-4, 465-65-6)
obidoxime (114-90-9, 7683-36-5)
physostigmine (57-47-6, 64-47-1)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
tolonium chloride (92-31-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1988003923
PUI
L18003923
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1491
TITLE
The impact of the addition of naloxone on the use and abuse of pentazocine
AUTHOR NAMES
Baum C.
Hsu J.P.
Nelson R.C.
AUTHOR ADDRESSES
(Baum C.; Hsu J.P.; Nelson R.C.) Surveillance Section, HFN-737, Division of
Epidemiology and Surveillance, Food and Drug Administration, Rockville, MD
20857
CORRESPONDENCE ADDRESS
Surveillance Section, HFN-737, Division of Epidemiology and Surveillance,
Food and Drug Administration, Rockville, MD 20857
SOURCE
Public Health Reports (1987) 102:4 (426-429). Date of Publication: 1987
ISSN
0090-2818
BOOK PUBLISHER
Association of Schools of Public Health, 1101 15th Street NW Suite 910,
Washington, United States.
ABSTRACT
An epidemic of abuse with 'T's and blues' began in the late 1970's in which
pentazocine - Talwin tablets ('T') - and the antihistamine tripelennamine
(known as blues) were crushed, dissolved together, filtered, and injected
intravenously. The resulting high was reported to be similar to that of
heroin. In 1981, the manufacturer and the Food and Drug Administration met
to discuss a possible solution. As a result, 0.5 mg of naloxone
hydrochloride, a narcotic antagonist that is pharmacologically inactive at
that dose orally but active if administered parenterally, was added to the
tablet formulation. The reformulated product, Talwin Nx, was approved for
marketing in late 1982 and introduced in the second quarter of 1983.
Distribution of Talwin tablets in the United States was discontinued. The
Drug Abuse Warning Network (DAWN) of the National Institue of Drug Abuse and
IMS America's National Prescription Audit were used to review the use and
abuse patterns of pentazocine before and after the naloxone intervention.
The number of prescriptions dispensed quarterly for pentazocine products
remained fairly stable from 1981 through the first quarter of 1983 and
increased after the introduction of Talwin Nx. In contrast, DAWN emergency
room and medical examiner mentions decreased after the product
reformulation. The rates of both emergency room and medical examiner
mentions per million prescriptions were substantially lower in the 2 years
following the introduction of Talwin Nx (decreases of 70 percent by
emergency rooms and 71 percent by medical examiners), indicating that the
product reformulation successfully reduced pentazocine abuse.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
pentazocine
tripelennamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug abuse
EMTREE MEDICAL INDEX TERMS
drug formulation
epidemiology
human
intoxication
prevention
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
tripelennamine (154-69-8, 91-81-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987212039
MEDLINE PMID
3112855 (http://www.ncbi.nlm.nih.gov/pubmed/3112855)
PUI
L17144539
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1492
TITLE
Legal problems of the use of opioids in the rescue service
ORIGINAL (NON-ENGLISH) TITLE
Rechtliche Probleme beim Einsatz der Opioide im Rettungsdienst.
AUTHOR NAMES
Sefrin P.
Lippert H.D.
AUTHOR ADDRESSES
(Sefrin P.; Lippert H.D.) Institut für Anästhesiologie der Universität,
Würzburg.
CORRESPONDENCE ADDRESS
P. Sefrin, Institut für Anästhesiologie der Universität, Würzburg.
SOURCE
Deutsche medizinische Wochenschrift (1946) (1987) 112:43 (1675-1677). Date
of Publication: 23 Oct 1987
ISSN
0012-0472
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency health service
EMTREE MEDICAL INDEX TERMS
article
drug legislation
German Federal Republic
human
legal aspect
LANGUAGE OF ARTICLE
German
MEDLINE PMID
2889589 (http://www.ncbi.nlm.nih.gov/pubmed/2889589)
PUI
L17805967
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1493
TITLE
Naltrexone treatment for postconcussional syndrome
AUTHOR NAMES
Tennant Jr. F.S.
Wild J.
AUTHOR ADDRESSES
(Tennant Jr. F.S.; Wild J.) Research and Education Division, Community
Health Projects, Inc., West Covina, CA 91790
CORRESPONDENCE ADDRESS
Research and Education Division, Community Health Projects, Inc., West
Covina, CA 91790
SOURCE
American Journal of Psychiatry (1987) 144:6 (813-814). Date of Publication:
1987
ISSN
0002-953X
ABSTRACT
Two patients with postconcussional syndrome whose most severe symptoms were
blackouts, headaches, and amnesia episodes appeared to respond to
naltrexone. Because life-saving emergency trauma services are widely
available, it is likely that the incidence of postconcussional syndrome will
increase.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
naltrexone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
amnesia
drug efficacy
drug therapy
headache
postconcussion syndrome
EMTREE MEDICAL INDEX TERMS
case report
central nervous system
human
oral drug administration
priority journal
subcutaneous drug administration
therapy
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
naltrexone (16590-41-3, 16676-29-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987154370
MEDLINE PMID
3592007 (http://www.ncbi.nlm.nih.gov/pubmed/3592007)
PUI
L17086870
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1494
TITLE
Initial management of adolescent overdoses
AUTHOR NAMES
Sacchetti A.D.
Ramoska E.A.
Montone H.
Carraccio C.
AUTHOR ADDRESSES
(Sacchetti A.D.; Ramoska E.A.; Montone H.; Carraccio C.) Department of
Emergency Medicine, Methodist Hospital, Philadelphia, PA 19148
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, Methodist Hospital, Philadelphia, PA 19148
SOURCE
Pediatric Emergency Care (1987) 3:1 (5-9). Date of Publication: 1987
ISSN
0749-5161
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
alcohol
amphetamine
barbituric acid derivative
benzodiazepine derivative
bicarbonate
cannabis
cocaine
ipecac
lysergide
naloxone
paracetamol
phenylpropanolamine
salicylic acid
thiamine
EMTREE DRUG INDEX TERMS
benzodiazepine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adolescence
drug overdose
drug toxicity
intoxication
suicide
EMTREE MEDICAL INDEX TERMS
adolescent
central nervous system
clinical article
emergency treatment
human
intravenous drug administration
oral drug administration
therapy
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
benzodiazepine (12794-10-4)
bicarbonate (144-55-8, 71-52-3)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
ipecac (8012-96-2)
lysergide (50-37-3)
naloxone (357-08-4, 465-65-6)
paracetamol (103-90-2)
phenylpropanolamine (14838-15-4, 154-41-6, 4345-16-8, 48115-38-4)
salicylic acid (63-36-5, 69-72-7)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987126617
MEDLINE PMID
2882492 (http://www.ncbi.nlm.nih.gov/pubmed/2882492)
PUI
L17059117
DOI
10.1097/00006565-198703000-00002
FULL TEXT LINK
http://dx.doi.org/10.1097/00006565-198703000-00002
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1495
TITLE
Emergency treatment of overdose
ORIGINAL (NON-ENGLISH) TITLE
Traitement d'urgence de l'overdose.
AUTHOR NAMES
Baud F.J.
Bismuth C.
AUTHOR ADDRESSES
(Baud F.J.; Bismuth C.)
CORRESPONDENCE ADDRESS
F.J. Baud,
SOURCE
La Revue du praticien (1987) 37:29 (1723-1727). Date of Publication: 21 May
1987
ISSN
0035-2640
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
respiratory failure (etiology, therapy)
EMTREE MEDICAL INDEX TERMS
article
artificial ventilation
coma (therapy)
emergency
human
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
French
MEDLINE PMID
3589439 (http://www.ncbi.nlm.nih.gov/pubmed/3589439)
PUI
L17741428
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1496
TITLE
Pain relief for the pediatric surgical patient
AUTHOR NAMES
Dilworth N.M.
MacKellar A.
AUTHOR ADDRESSES
(Dilworth N.M.; MacKellar A.) Division of Surgery and Department of
Anaesthesia, Princess Margaret Hospital for Children, Perth WA
CORRESPONDENCE ADDRESS
Division of Surgery and Department of Anaesthesia, Princess Margaret
Hospital for Children, Perth WA
SOURCE
Journal of Pediatric Surgery (1987) 22:3 (264-266). Date of Publication:
1987
ISSN
0022-3468
ABSTRACT
Modern techniques available for the relief of pain following major surgical
procedures or trauma in childhood receive scant attention in pediatric
surgical textbooks. A range of options for pain relief have been offered to
children in our hospital, which include: (1) regional analgesia; (2)
appropriate use of intermittent intramuscular narcotic injections; and (3)
variable-rate intravenous narcotic infusions. Since 1982 regional analgesia
has been used in more than 2,000 patients following operations on the penis
and in the inguinoscrotal region. Two hundred forty five children with
fractured femora have been managed using femoral nerve blocks. Intermittent
intramuscular narcotic injections are the most common method of pain relief.
However, the variable nature of children's pain frequently results in an
unsatisfactory outcome. Variable-rate intravenous narcotic infusions were
introduced in 1982 and the first 155 infusions in 144 patients have been
analyzed. The protocol and method of administration are described along with
the dosage and problems encountered during the introduction of the
technique. It has now been employed postoperatively in 242 more patients and
many infusions have been commenced in the emergency department, intensive
care, and neonatal units bringing the total number of infusions to more than
600. Assessment of effective pain relief has been made on the basis of
observation and comment by parents and patients and by medical and nursing
staff. The steady increase in demand for the use of this technique is an
index of its value. It is concluded that there is a real need to improve
pain relief for children by beter education of medical and nursing staff and
inclusion of this important subject in pediatric surgical text books.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bupivacaine
morphine
naloxone
narcotic analgesic agent
opiate
pethidine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
analgesia
confusion
drug administration
drug efficacy
drug therapy
femoral nerve block
gastrointestinal toxicity
local analgesia
nausea
newborn
nursing education
pediatric surgery
penis surgery
postoperative care
pruritus
respiration depression
scrotum
surgery
vomiting
EMTREE MEDICAL INDEX TERMS
central nervous system
child
human
intoxication
intramuscular drug administration
intravenous drug administration
major clinical study
male genital system
priority journal
psychological aspect
respiratory system
therapy
DRUG TRADE NAMES
omnopon
CAS REGISTRY NUMBERS
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Pediatrics and Pediatric Surgery (7)
Surgery (9)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987092060
MEDLINE PMID
2881992 (http://www.ncbi.nlm.nih.gov/pubmed/2881992)
PUI
L17024560
DOI
10.1016/S0022-3468(87)80343-3
FULL TEXT LINK
http://dx.doi.org/10.1016/S0022-3468(87)80343-3
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1497
TITLE
Predicting the clinical course in intentional drug overdose. Implications
for use of the intensive care unit
AUTHOR NAMES
Brett A.S.
Rothschild N.
Gray R.
Perry M.
AUTHOR ADDRESSES
(Brett A.S.; Rothschild N.; Gray R.; Perry M.) Department of Medicine, New
England Deaconess Hospital and Harvard Medical School, Boston
CORRESPONDENCE ADDRESS
Department of Medicine, New England Deaconess Hospital and Harvard Medical
School, Boston
SOURCE
Archives of Internal Medicine (1987) 147:1 (133-137). Date of Publication:
1987
ISSN
0003-9926
ABSTRACT
Many patients admitted for observation to the intensive care unit after a
drug overdose do not ultimately require intensive care interventions. We
retrospectively analyzed data on 209 overdose cases to determine whether
clinical assessment in the emergency room could identify patients at risk
for complications. Patients were classified as low risk when none of the
following high-risk criteria were present in the emergency room: need for
intubation; seizures; unresponsiveness to verbal stimuli; arterial carbon
dioxide pressure (tension) greater than or equal to 45 mm Hg; any rhythm
except sinus; second- or third-degree atrioventricular block; QRS greater
than or equal to 0.12 s; or systolic pressure less than 80 mm Hg. Of 151
low-risk patients, none developed a high-risk condition after admission, and
none required an intensive care intervention. The use of these predictive
criteria in our patient population would have eliminated over half the
intensive care days without compromising quality of care.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
activated carbon
alcohol
antiarrhythmic agent
anticonvulsive agent
barbituric acid derivative
benzodiazepine derivative
ipecac
laxative
naloxone
opiate
phenothiazine derivative
tricyclic antidepressant agent
vasoconstrictor agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
atrioventricular block
blood pressure
cardiotoxicity
coma
convulsion
drug overdose
heart arrhythmia
hypotension
intensive care
neurotoxicity
QRS complex
respiration depression
seizure
suicide attempt
EMTREE MEDICAL INDEX TERMS
cardiovascular system
central nervous system
diagnosis
disease course
heart
human
intensive care unit
intoxication
major clinical study
nervous system
priority journal
respiratory system
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987078273
MEDLINE PMID
3800515 (http://www.ncbi.nlm.nih.gov/pubmed/3800515)
PUI
L17010773
DOI
10.1001/archinte.147.1.133
FULL TEXT LINK
http://dx.doi.org/10.1001/archinte.147.1.133
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1498
TITLE
'Out' for opiates in emergency medical services?
ORIGINAL (NON-ENGLISH) TITLE
DAS 'AUS' FUR OPIATE IM RETTUNGSDIENST?
AUTHOR NAMES
Lippert H.-D.
AUTHOR ADDRESSES
(Lippert H.-D.)
SOURCE
Notfall Medizin (1987) 13:1 (8). Date of Publication: 1987
ISSN
0341-2903
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1987070431
PUI
L17002931
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1499
TITLE
Neurologic emergencies
AUTHOR NAMES
Bleck T.P.
Klawans H.L.
AUTHOR ADDRESSES
(Bleck T.P.; Klawans H.L.) Department of Neurological Sciences, Rush Medical
College, Chicago, IL 60612
CORRESPONDENCE ADDRESS
Department of Neurological Sciences, Rush Medical College, Chicago, IL 60612
SOURCE
Medical Clinics of North America (1986) 70:5 (1167-1184). Date of
Publication: 1986
ISSN
0025-7125
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bromocriptine
dantrolene
dexamethasone
DOPA
heparin
insulin
lidocaine
lorazepam
mannitol
metoclopramide
naloxone
neostigmine
nitroprusside sodium
paraldehyde
pentobarbital
pentoxifylline
phenytoin
pyridostigmine
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cerebrovascular accident
cerebrovascular accident
coma
drug dose
drug efficacy
drug indication
drug therapy
emergency health service
epileptic state
intracranial hypertension
neuromuscular system
spinal cord compression
EMTREE MEDICAL INDEX TERMS
central nervous system
clinical article
diagnosis
etiology
human
intravenous drug administration
muscle
neuroleptic malignant syndrome
oral drug administration
peripheral nervous system
peripheral vascular system
priority journal
therapy
CAS REGISTRY NUMBERS
DOPA (587-45-1)
atropine (51-55-8, 55-48-1)
bromocriptine (25614-03-3)
dantrolene (14663-23-1, 7261-97-4)
dexamethasone (50-02-2)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
insulin (9004-10-8)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lorazepam (846-49-1)
mannitol (69-65-8, 87-78-5)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
nitroprusside sodium (14402-89-2, 15078-28-1)
paraldehyde (123-63-7)
pentobarbital (57-33-0, 76-74-4)
pentoxifylline (6493-05-6)
phenytoin (57-41-0, 630-93-3)
pyridostigmine (101-26-8, 155-97-5)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
Epilepsy Abstracts (50)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986248266
MEDLINE PMID
3016427 (http://www.ncbi.nlm.nih.gov/pubmed/3016427)
PUI
L16000766
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1500
TITLE
Late death in tricyclic antidepressant overdose revisited
AUTHOR NAMES
McAlpine S.B.
Calabro J.J.
Robinson M.D.
Burkle Jr. F.M.
AUTHOR ADDRESSES
(McAlpine S.B.; Calabro J.J.; Robinson M.D.; Burkle Jr. F.M.) Emergency
Medicine Service, Letterman Army Medical Center, Presidio of San Francisco,
CA 94129
CORRESPONDENCE ADDRESS
Emergency Medicine Service, Letterman Army Medical Center, Presidio of San
Francisco, CA 94129
SOURCE
Annals of Emergency Medicine (1986) 15:11 (1349-1352). Date of Publication:
1986
ISSN
0196-0644
ABSTRACT
We report a late death following the ingestion of amitriptyline. A
46-year-old woman presented to the emergency department with coma,
hypotension, tachycardia, and a prolonged QRS interval after the ingestion
of a large quantity of Elavil®. She was managed with aggressive supportive
care, multiple doses of oral charcoal, and charcoal hemoperfusion. The
patient's ECG and hemodynamic status returned to normal within 24 hours.
Despite an apparent total recovery, she suddenly sustained a
cardiorespiratory arrest and died 33 hours after ECG normalization (at 57
hours after admission). This case brings into question the feasibility of
ceasing ECG monitoring in tricyclic antidepressant overdoses once the ECG
has stabilized, especially in patients with a history of chronic usage. A
possible explanation for late sequelae is the myocardial cell binding and
depressant effect of preexisting therapeutic TCA medication.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
amitriptyline
bicarbonate
dopamine
glucose
magnesium citrate
naloxone
noradrenalin
phenytoin
physostigmine
sodium chloride
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
autopsy
cardiopulmonary insufficiency
cardiotoxicity
coma
drug blood level
drug overdose
fatality
heart arrest
hypotension
perfusion
QRS complex
tachycardia
EMTREE MEDICAL INDEX TERMS
cardiovascular system
case report
central nervous system
diagnosis
electrocardiography
heart
human
intoxication
oral drug administration
priority journal
respiratory system
DRUG TRADE NAMES
elavil
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
bicarbonate (144-55-8, 71-52-3)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Anesthesiology (24)
Psychiatry (32)
Forensic Science Abstracts (49)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987016352
MEDLINE PMID
3777592 (http://www.ncbi.nlm.nih.gov/pubmed/3777592)
PUI
L17184497
DOI
10.1016/S0196-0644(86)80623-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(86)80623-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1501
TITLE
Intraoperative management during conscious sedation and general anesthesia:
Patient monitoring and emergency treatment
AUTHOR NAMES
Weaver J.M.
AUTHOR ADDRESSES
(Weaver J.M.) Section of Oral and Maxillofacial Surgery, Ohio State
University College of Dentistry, Department of Anesthesiology, Columbus, OH
CORRESPONDENCE ADDRESS
Section of Oral and Maxillofacial Surgery, Ohio State University College of
Dentistry, Department of Anesthesiology, Columbus, OH
SOURCE
Anesthesia Progress (1986) 33:4 (181-184). Date of Publication: 1986
ISSN
0003-3006
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
dantrolene
halothane
naloxone
suxamethonium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
pain
EMTREE MEDICAL INDEX TERMS
central nervous system
human
inhalational drug administration
intravenous drug administration
short survey
therapy
tooth
CAS REGISTRY NUMBERS
dantrolene (14663-23-1, 7261-97-4)
halothane (151-67-7, 66524-48-9)
naloxone (357-08-4, 465-65-6)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987028907
MEDLINE PMID
3465248 (http://www.ncbi.nlm.nih.gov/pubmed/3465248)
PUI
L17197052
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1502
TITLE
Drug overdose: Epidemiology, emergency, therapy
ORIGINAL (NON-ENGLISH) TITLE
ABSICHTLICHE ARZNEIMITTELINTOXIKATIONEN AUS EPIDEMIOLOGISCHER,
NOTFALLMEDIZINISCHER UND THERAPEUTISCHER SICHT
AUTHOR NAMES
Redlich M.
Hofer P.
Dubach U.C.
Kluppelberg J.
AUTHOR ADDRESSES
(Redlich M.; Hofer P.; Dubach U.C.; Kluppelberg J.) Departement fur Innere
Medizin, Medizinische Universitats-Poliklinik, Kantonsspital Basel, Basel
CORRESPONDENCE ADDRESS
Departement fur Innere Medizin, Medizinische Universitats-Poliklinik,
Kantonsspital Basel, Basel
SOURCE
Schweizerische Rundschau fur Medizin/Praxis (1986) 75:47 (1412-1415). Date
of Publication: 1986
ISSN
1013-2058
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
bromazepam
diazepam
flumazenil
flunitrazepam
flurazepam
lorazepam
methaqualone
nitrazepam
optalidon
oxazepam
tonopan
EMTREE DRUG INDEX TERMS
activated carbon
apomorphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism
drug abuse
drug overdose
drug therapy
drug withdrawal
stomach lavage
EMTREE MEDICAL INDEX TERMS
central nervous system
clinical article
drug mixture
emergency medicine
epidemiology
human
intoxication
intravenous drug administration
oral drug administration
stomach
therapy
DRUG TRADE NAMES
dalmadorm
lexotanil
mogadon
optalidon
ro 15 1788
rohypnol
seresta
temesta
tonopan
toquilone
valium
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
apomorphine (314-19-2, 58-00-4)
bromazepam (1812-30-2)
diazepam (439-14-5)
flumazenil (78755-81-4)
flunitrazepam (1622-62-4)
flurazepam (1172-18-5, 17617-23-1)
lorazepam (846-49-1)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
naloxone (357-08-4, 465-65-6)
nitrazepam (146-22-5)
optalidon (60382-50-5)
oxazepam (604-75-1)
tonopan (97883-63-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English, French
EMBASE ACCESSION NUMBER
1987037576
MEDLINE PMID
2879343 (http://www.ncbi.nlm.nih.gov/pubmed/2879343)
PUI
L17205721
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1503
TITLE
Retrospective review of ethanol concentration measurements in patients with
ethanol overdose treated with naloxone
AUTHOR NAMES
Rae H.G.
AUTHOR ADDRESSES
(Rae H.G.) Saratoga Springs Hospital, Emergency Medicine Department,
Saratoga Springs, NY
CORRESPONDENCE ADDRESS
Saratoga Springs Hospital, Emergency Medicine Department, Saratoga Springs,
NY
SOURCE
Current Therapeutic Research - Clinical and Experimental (1986) 40:5
(960-964). Date of Publication: 1986
ISSN
0011-393X
ABSTRACT
Use of naloxone in patients with ethanol overdose may improve the emergency
department physician's ability to obtain appropriate history and neurologic
examination data. Sixteen patients with impaired sensorium and suspected
drug overdose were treated with naloxone. In retrospect, all of these
patients had exclusive ethanol overdose and had clinical improvement in
sensorium following high-dose naloxone administration. The small decline in
the mean ethanol concentration following naloxone in these patients was
consistent with the known metabolism of ethanol and did not suggest an
ethanol-naloxone pharmacokinetic interaction underlying naloxone's clinical
effect.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol metabolism
drug blood level
drug efficacy
drug indication
drug interaction
drug overdose
EMTREE MEDICAL INDEX TERMS
case report
human
intoxication
intravenous drug administration
preliminary communication
priority journal
therapy
treatment
CAS REGISTRY NUMBERS
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987040452
PUI
L17208597
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1504
TITLE
Pediatric critical-care drugs: A systematic approach
AUTHOR NAMES
Baker M.D.
Dean J.M.
Gvozden C.
AUTHOR ADDRESSES
(Baker M.D.; Dean J.M.; Gvozden C.) Department of Pediatrics, The Johns
Hopkins Medical Institutions, Baltimore, MD 21205
CORRESPONDENCE ADDRESS
Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore,
MD 21205
SOURCE
American Journal of Emergency Medicine (1986) 4:3 (265-266). Date of
Publication: 1986
ISSN
0735-6757
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
calcium chloride
dobutamine
dopamine
epinephrine
glyceryl trinitrate
isoprenaline
lidocaine
naloxone
nitroprusside sodium
pancuronium bromide
suxamethonium
EMTREE DRUG INDEX TERMS
anesthetic agent
catecholamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
drug therapy
emergency treatment
EMTREE MEDICAL INDEX TERMS
central nervous system
child
drug dose
human
intravenous drug administration
management
pediatrics
peripheral nervous system
short survey
therapy
DRUG TRADE NAMES
narcan
nipride
pavulon
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
glyceryl trinitrate (55-63-0)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
pancuronium bromide (15500-66-0)
suxamethonium (306-40-1, 71-27-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Clinical and Experimental Pharmacology (30)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986235487
MEDLINE PMID
3964370 (http://www.ncbi.nlm.nih.gov/pubmed/3964370)
PUI
L16021426
DOI
10.1016/0735-6757(86)90082-3
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(86)90082-3
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1505
TITLE
Emergency treatment of poisoning: A current therapeutics guide
AUTHOR NAMES
Pond S.M.
AUTHOR ADDRESSES
(Pond S.M.) Department of Medicine, Princess Alexandra Hospital, Brisbane,
QLD
CORRESPONDENCE ADDRESS
Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD
SOURCE
Current Therapeutics (1986) 27:3 (45-48). Date of Publication: 1986
ISSN
0311-905X
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
activated carbon
alcohol
arsenic
carbon monoxide
cobalt edetate
cyanide
dimercaprol
ethylene glycol
iron
lead
lithium
menadione
mercury
methanol
methylene blue
naloxone
neostigmine
nitrite
opiate
organophosphorus compound
paracetamol
paraquat
penicillamine
phenobarbital
physostigmine
pralidoxime
salicylic acid derivative
theophylline
warfarin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug antagonism
drug efficacy
drug therapy
drug toxicity
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
clinical article
emergency medicine
heart
human
oral drug administration
survey
therapy
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
arsenic (7440-38-2)
carbon monoxide (630-08-0)
cobalt edetate (14931-83-0, 36499-65-7)
cyanide (57-12-5)
dimercaprol (59-52-9)
ethylene glycol (107-21-1)
iron (14093-02-8, 53858-86-9, 7439-89-6)
lead (13966-28-4, 7439-92-1)
lithium (7439-93-2)
menadione (58-27-5)
mercury (14302-87-5, 7439-97-6)
methanol (67-56-1)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
nitrite (14797-65-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
penicillamine (2219-30-9, 52-67-5)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
physostigmine (57-47-6, 64-47-1)
pralidoxime (6735-59-7)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986233371
PUI
L16019310
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1506
TITLE
Pufferfish poisoning: Emergency diagnosis and management of mild human
tetrodotoxication
AUTHOR NAMES
Sims J.K.
Ostman D.C.
AUTHOR ADDRESSES
(Sims J.K.; Ostman D.C.) Hawaii Medical Association Emergency Medical
Services Program, Honolulu, HI
CORRESPONDENCE ADDRESS
Hawaii Medical Association Emergency Medical Services Program, Honolulu, HI
SOURCE
Annals of Emergency Medicine (1986) 15:9 (1094-1098). Date of Publication:
1986
ISSN
0196-0644
ABSTRACT
A 45-year-old man ate the liver of the toxic pufferfish (Diodron hystrix)
and developed mild retrodotoxication consisting of hyperemesis, bradycardia,
hypotension, generalized numbness, and a generalized paresis. He was treated
with atropine, normal saline IV infusions, nasogastric suction, and oxygen,
and he recovered after six days.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
cysteine
edrophonium
fish venom
hexobarbital
morphine
naloxone
neostigmine
pyridostigmine
tetrodotoxin
EMTREE DRUG INDEX TERMS
oxygen
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bradycardia
drug antagonism
drug therapy
drug toxicity
food poisoning
hyperemesis
hypotension
paresis
puffer fish
EMTREE MEDICAL INDEX TERMS
cardiovascular system
case report
diagnosis
digestive system
gastric suction
heart
human
intoxication
intravenous drug administration
nervous system
oral drug administration
peripheral nervous system
priority journal
therapy
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
cysteine (4371-52-2, 52-89-1, 52-90-4)
edrophonium (312-48-1)
fish venom (55013-21-3)
hexobarbital (1335-39-3, 50-09-9, 56-29-1, 73543-95-0)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
oxygen (7782-44-7)
pyridostigmine (101-26-8, 155-97-5)
sodium chloride (7647-14-5)
tetrodotoxin (4368-28-9, 4664-41-9)
EMBASE CLASSIFICATIONS
Toxicology (52)
Anesthesiology (24)
Surgery (9)
Forensic Science Abstracts (49)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986231830
MEDLINE PMID
3740600 (http://www.ncbi.nlm.nih.gov/pubmed/3740600)
PUI
L16017769
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1507
TITLE
The effect of thioridizine on the Automatic Clinical Analyzer serum
tricyclic anti-depressant screen
AUTHOR NAMES
Ryder K.W.
Glick M.R.
AUTHOR ADDRESSES
(Ryder K.W.; Glick M.R.) Department of Pathology, Wishard Memorial Hospital,
Indianapolis, IA 46202
CORRESPONDENCE ADDRESS
Department of Pathology, Wishard Memorial Hospital, Indianapolis, IA 46202
SOURCE
American Journal of Clinical Pathology (1986) 86:2 (248-249). Date of
Publication: 1986
ISSN
0002-9173
ABSTRACT
A patient who had ingested thioridizine and flurazepam was brought to the
authors' emergency department. Initial laboratory evaluation included a
positive result for a serum screening test for tricyclic anti-depressants
performed with the DuPont® Automatic Clinical Analyzer. This false positive
test result caused considerable unnecessary treatment and expense for the
patient. The authors have found that a serum thioridizine concentration of
125 ng/mL (within the usual therapeutic range for this drug) will produce a
false positive automatic clinical analyzer serum tricyclic anti-depressant
screen result. Because thioridizine is the most widely used phenothiazine
and is prescribed more frequently than the most widely used tricyclic
anti-depressant, it is important to recognize this cause of a false positive
result.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
flurazepam
thioridazine
tricyclic antidepressant agent
EMTREE DRUG INDEX TERMS
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
autoanalyzer
cost
drug blood level
drug interaction
drug monitoring
drug therapy
emergency
interference
laboratory diagnosis
EMTREE MEDICAL INDEX TERMS
central nervous system
computer analysis
diagnosis
economic aspect
human
oral drug administration
priority journal
therapy
DRUG TRADE NAMES
dalmane
mellaril
narcon
DRUG MANUFACTURERS
(United States)DuPont de Nemours
(United States)Hoffmann La Roche
(United States)Sandoz
CAS REGISTRY NUMBERS
flurazepam (1172-18-5, 17617-23-1)
naloxone (357-08-4, 465-65-6)
thioridazine (130-61-0, 50-52-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Clinical and Experimental Biochemistry (29)
Biophysics, Bioengineering and Medical Instrumentation (27)
General Pathology and Pathological Anatomy (5)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986196369
MEDLINE PMID
3739974 (http://www.ncbi.nlm.nih.gov/pubmed/3739974)
PUI
L16072308
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1508
TITLE
Diphenhydramine-induced toxic psychosis
AUTHOR NAMES
Jones J.
Dougherty J.
Cannon L.
AUTHOR ADDRESSES
(Jones J.; Dougherty J.; Cannon L.) Department of Emergency Medicine, Akron
General Medical Center, Northeastern Ohio Universities College of Medicine,
Akron, OH 44307
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, Akron General Medical Center, Northeastern
Ohio Universities College of Medicine, Akron, OH 44307
SOURCE
American Journal of Emergency Medicine (1986) 4:4 (369-373). Date of
Publication: 1986
ISSN
0735-6757
ABSTRACT
A 24-year-old man presented to the emergency department with acute
anticholinergic symptoms, hallucinations, and bizarre behavior following a
large ingestion of diphenhydramine (Benadryl®). Because of the large number
of nonprescription preparations containing this antihistamine, similar
ingestions are becoming increasingly frequent. Minor anticholinergic side
effects associated with diphenhydramine are general medical knowledge. The
effects of overdosage are less well known. The clinical presentation of
toxic psychosis, its differential diagnosis, and its subsequent treatment
are discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
diphenhydramine
ipecac
magnesium citrate
naloxone
EMTREE DRUG INDEX TERMS
calcium bromolactate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug overdose
drug therapy
hallucination
neurotoxicity
psychosis
EMTREE MEDICAL INDEX TERMS
adult
anticholinergic effect
case report
central nervous system
human
intoxication
nervous system
oral drug administration
psychological aspect
therapy
DRUG TRADE NAMES
benadryl
nytol
DRUG MANUFACTURERS
(United States)Block Drug
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
diphenhydramine (147-24-0, 58-73-1)
ipecac (8012-96-2)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Toxicology (52)
Adverse Reactions Titles (38)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986185274
MEDLINE PMID
3718632 (http://www.ncbi.nlm.nih.gov/pubmed/3718632)
PUI
L16061213
DOI
10.1016/0735-6757(86)90312-8
FULL TEXT LINK
http://dx.doi.org/10.1016/0735-6757(86)90312-8
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1509
TITLE
Use of opiates and other restricted substances in the emergency service. An
enquiry of the association of Southwest German emergency service doctors
ORIGINAL (NON-ENGLISH) TITLE
UMFRAGE DER AGSWN ZUR VERWENDUNG BETAUBUNGSMITTEL-GESETZPFLICHTIGER
SUBSTANZEN IM NOTARZTDIENST
AUTHOR NAMES
Lippert H.-D.
Mihatsch-Lippert C.
AUTHOR ADDRESSES
(Lippert H.-D.; Mihatsch-Lippert C.) Von-Stadion-Str. 1, 7906
Blaustein-Arnegg
CORRESPONDENCE ADDRESS
Von-Stadion-Str. 1, 7906 Blaustein-Arnegg
SOURCE
Notarzt (1986) 2:4 (113-114). Date of Publication: 1986
ISSN
0177-2309
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
baralgin
buprenorphine
dipyrone
droperidol
droperidol plus fentanyl
fentanyl
ketamine
ketamine
morphine
opiate
pentazocine
pethidine
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency health service
pain
EMTREE MEDICAL INDEX TERMS
central nervous system
human
intramuscular drug administration
short survey
therapy
DRUG TRADE NAMES
baralgin
dolantin
fortral
ketanest
novalgin
temgesic
thalamonal
tramal
CAS REGISTRY NUMBERS
baralgin (8067-07-0)
buprenorphine (52485-79-7, 53152-21-9)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
droperidol plus fentanyl (8004-27-1, 8067-59-2)
droperidol (548-73-2)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1986178237
PUI
L16099176
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1510
TITLE
Opiates and sedatives in disaster and emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
BETAUBUNGSMITTEL IN RETTUNGS- UND NOTARZTDIENST
AUTHOR NAMES
Lippert H.D.
AUTHOR ADDRESSES
(Lippert H.D.) Von-Stadion-Str. 1, D-7906 Blaustein
CORRESPONDENCE ADDRESS
Von-Stadion-Str. 1, D-7906 Blaustein
SOURCE
Notarzt (1986) 2:3 (83-86). Date of Publication: 1986
ISSN
0177-2309
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
codeine
cyclobarbital
fentanyl
hydrocodone bitartrate
hydromorphone
ketobemidone
levomethadone
lorazepam
mazindol
meprobamate
methadone
methamphetamine
methaqualone
methyprylon
morphine
opiate
pentobarbital
pethidine
phenobarbital
piritramide
premethadone
prepethidine
sedative agent
tilidine
EMTREE DRUG INDEX TERMS
hydrocodone
nodular
norminox
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coca
drug comparison
drug efficacy
drug therapy
emergency medicine
papaver bracteatum
Papaver somniferum
EMTREE MEDICAL INDEX TERMS
central nervous system
human
peripheral nervous system
short survey
therapy
DRUG TRADE NAMES
aneural
cliradon
cyrpon
dicodid
dilaudid
dipidolor
dolantin
luminal
meprosan
miltaun
nodular
norminox
pervitin
phanodorm
polamidon
pro dorm
revonal
teronac
valoron
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
cyclobarbital (143-76-0, 52-31-3)
fentanyl (437-38-7)
hydrocodone bitartrate (143-71-5, 8013-91-0)
hydrocodone (125-29-1, 25968-91-6, 34366-67-1)
hydromorphone (466-99-9, 71-68-1)
ketobemidone (469-79-4)
levomethadone (125-58-6)
lorazepam (846-49-1)
mazindol (22232-71-9)
meprobamate (57-53-4)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
methyprylon (125-64-4)
morphine (52-26-6, 57-27-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
piritramide (302-41-0)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Surgery (9)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1986170526
PUI
L16091465
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1511
TITLE
Endotracheal administration of emergency medications
AUTHOR NAMES
Smith R.C.
AUTHOR ADDRESSES
(Smith R.C.) El Cajon Valley Hospital Pharmacy, El Cajon, CA 92021
CORRESPONDENCE ADDRESS
El Cajon Valley Hospital Pharmacy, El Cajon, CA 92021
SOURCE
Drug Intelligence and Clinical Pharmacy (1986) 20:6 (440-441). Date of
Publication: 1986
ISSN
0012-6578
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
diazepam
epinephrine
isoprenaline
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dog
drug efficacy
drug therapy
emergency treatment
endotracheal intubation
intratracheal drug administration
EMTREE MEDICAL INDEX TERMS
cardiovascular system
editorial
methodology
nonhuman
priority journal
respiratory system
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
diazepam (439-14-5)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986159744
PUI
L16080683
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1512
TITLE
Drugs for the emergency ambulance service
ORIGINAL (NON-ENGLISH) TITLE
ARZNEIMITTEL FUR DEN NOTARZTDIENST
AUTHOR NAMES
Voeltz P.
AUTHOR ADDRESSES
(Voeltz P.) Anasthesieabteilung des Allgemeinen Krankenhauses Altona, 2000
Hamburg 50
CORRESPONDENCE ADDRESS
Anasthesieabteilung des Allgemeinen Krankenhauses Altona, 2000 Hamburg 50
SOURCE
Notarzt (1986) 2:1 (1-3). Date of Publication: 1986
ISSN
0177-2309
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 dimethylaminophenol
activated carbon
aminophylline
atropine
biperiden
cafedrine
cafedrine plus theodrenaline
clemastine fumarate
dexamethasone isonicotinate
diazepam
dobutamine
dopamine
droperidol
epinephrine
etomidate
fenoterol
fentanyl
furosemide
glyceryl trinitrate
ketamine
ketamine
lidocaine
metoclopramide
midazolam maleate
naloxone
nifedipine
orciprenaline
paraffin
phenobarbital
physostigmine
potassium bicarbonate
potassium chloride
promethazine
sodium thiosulfate
terbutaline
theodrenaline
thiamazole
tolonium chloride
triamcinolone acetonide
triflupromazine
vecuronium
verapamil
EMTREE DRUG INDEX TERMS
unclassified drug
xyloraine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug indication
drug therapy
EMTREE MEDICAL INDEX TERMS
human
inhalational drug administration
intravenous drug administration
methodology
oral drug administration
organization and management
review
theoretical study
therapy
DRUG TRADE NAMES
adalat
akineton
akrinor
alupent
anticholium
atosil
auxiloson
berotec
bricanyl
dobutrex
dormicum
euphyllin
favistan
hypnomidate
isoptin
ketanest
lasix
luminal
narcanti
nitrolingual
partusisten
paspertin
psyquil
suprarenin
tavegil
volon a
xyloraine
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
activated carbon (64365-11-3, 82228-96-4)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
biperiden (1235-82-1, 514-65-8)
cafedrine (58166-83-9)
cafedrine plus theodrenaline (69910-62-9, 8004-31-7)
clemastine fumarate (14976-57-9)
dexamethasone isonicotinate (2265-64-7)
diazepam (439-14-5)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
droperidol (548-73-2)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fenoterol (13392-18-2, 1944-12-3)
fentanyl (437-38-7)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
midazolam maleate (59467-94-6, 65506-68-5)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
orciprenaline (586-06-1, 5874-97-5)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
physostigmine (57-47-6, 64-47-1)
potassium bicarbonate (298-14-6)
potassium chloride (7447-40-7)
promethazine (58-33-3, 60-87-7)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
terbutaline (23031-25-6)
theodrenaline (13460-98-5)
thiamazole (60-56-0)
tolonium chloride (92-31-9)
triamcinolone acetonide (76-25-5)
triflupromazine (1098-60-8, 146-54-3)
vecuronium (50700-72-6)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1986103120
PUI
L16159059
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1513
TITLE
The endotracheal use of emergency drugs
AUTHOR NAMES
Hasegawa E.A.J.
AUTHOR ADDRESSES
(Hasegawa E.A.J.) Department of Pharmaceutical Services, St. Joseph Mercy
Hospital of the Catherine McAuley Health Center, Ann Arbor, MI 48106
CORRESPONDENCE ADDRESS
Department of Pharmaceutical Services, St. Joseph Mercy Hospital of the
Catherine McAuley Health Center, Ann Arbor, MI 48106
SOURCE
Heart and Lung: Journal of Acute and Critical Care (1986) 15:1 (60-63). Date
of Publication: 1986
ISSN
0147-9563
ABSTRACT
The endotracheal route for medication is useful in emergency situations.
Epinephrine, atropine, and naloxone have proved to be effective when
administered by this route. Experience with lidocaine is largely anecdotal,
but the available information and the drug's chemical properties indicate
that endotracheal lidocaine may be considered if necessary. Drugs that
should not be given by the endotracheal route include bretylium, diazepam,
calcium salts, isoproterenol, norephinephrine, and sodium bicarbonate.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
bretylium tosylate
diazepam
epinephrine
isoprenaline
lidocaine
naloxone
noradrenalin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug administration
drug comparison
drug efficacy
endotracheal intubation
EMTREE MEDICAL INDEX TERMS
clinical article
human
intratracheal drug administration
priority journal
respiratory system
short survey
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
bretylium tosylate (61-75-6)
diazepam (439-14-5)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986104122
MEDLINE PMID
3632968 (http://www.ncbi.nlm.nih.gov/pubmed/3632968)
PUI
L16160061
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1514
TITLE
Analgesia and anaesthesia in emergency patients
ORIGINAL (NON-ENGLISH) TITLE
ANALGESIE UND ANASTHESIE BEI NOTFALLPATIENTEN
AUTHOR NAMES
Dick W.
Gervais H.
AUTHOR ADDRESSES
(Dick W.; Gervais H.) Institut fur Anasthesiologie der
Johannes-Gutenburg-Universitat, Mainz
CORRESPONDENCE ADDRESS
Institut fur Anasthesiologie der Johannes-Gutenburg-Universitat, Mainz
SOURCE
Anasthesiologie und Intensivmedizin (1986) 27:1 (1-8). Date of Publication:
1986
ISSN
0170-5334
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
buprenorphine
doxapram
enflurane
etomidate
fentanyl
halothane
ketamine
levallorphan
methadone
morphine
nalorphine
naloxone
nefopam
nitrous oxide
pentazocine
pethidine
piritramide
thiopental
tilidine
tramadol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
anesthesia
drug comparison
drug indication
drug mechanism
emergency medicine
EMTREE MEDICAL INDEX TERMS
clinical article
human
inhalational drug administration
intravenous drug administration
methodology
short survey
therapy
DRUG TRADE NAMES
ethrane
fortral
CAS REGISTRY NUMBERS
buprenorphine (52485-79-7, 53152-21-9)
doxapram (113-07-5, 309-29-5, 7081-53-0)
enflurane (13838-16-9)
etomidate (15301-65-2, 33125-97-2, 51919-80-3)
fentanyl (437-38-7)
halothane (151-67-7, 66524-48-9)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
levallorphan (13075-35-9, 152-02-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
nefopam (13669-70-0, 23327-57-3)
nitrous oxide (10024-97-2)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
piritramide (302-41-0)
thiopental (71-73-8, 76-75-5)
tilidine (20380-58-9, 27107-79-5)
tramadol (27203-92-5, 36282-47-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Surgery (9)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1986083576
PUI
L16184515
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1515
TITLE
Emergency medication in disturbances of respiratory function
ORIGINAL (NON-ENGLISH) TITLE
NOTFALLMEDIKAMENTE BEI STORUNGEN DER RESPIRATORISCHEN FUNKTION
AUTHOR NAMES
Kilian J.
AUTHOR ADDRESSES
(Kilian J.) Zentrum fur Anasthesiologie, Klinikum der Universitat Ulm, 7900
Ulm
CORRESPONDENCE ADDRESS
Zentrum fur Anasthesiologie, Klinikum der Universitat Ulm, 7900 Ulm
SOURCE
Therapiewoche (1986) 36:1 (11-15). Date of Publication: 1986
ISSN
0040-5973
ABSTRACT
Specific and nonspecific measures are of almost identical importance in the
primary therapy of respiratory emergencies. Very important are the oxygen
application and the mechanical measures, which have to be supported by drugs
with peripheral or central effects. Desired effects of
beta-2-sympatholytics, theophyllines, glucocorticoids, opiate antagonists,
and opiates render their application worthwile, but require an exact
supervision of the state of the patient due to their undesired effects.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline
amiphenazole
beclometasone
dexamethasone isonicotinate
doxapram
epinephrine
fenoterol
ipratropium bromide
morphine
naloxone
orciprenaline
salbutamol
terbutaline
theophylline
EMTREE DRUG INDEX TERMS
beclometasone dipropionate
beta 2 adrenergic receptor stimulating agent
glucocorticoid
opiate
opiate antagonist
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
bronchospasm
drug therapy
emergency treatment
respiratory system
EMTREE MEDICAL INDEX TERMS
devices
etiology
human
intravenous drug administration
oxygen breathing
priority journal
therapy
DRUG TRADE NAMES
alupent
atrovent
auxiloson
berotec
bricanyl
daptazile
dopram
euphylline
narcanti
sanasthmyl
sultanol
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
amiphenazole (490-55-1)
beclometasone dipropionate (5534-09-8)
beclometasone (4419-39-0)
dexamethasone isonicotinate (2265-64-7)
doxapram (113-07-5, 309-29-5, 7081-53-0)
fenoterol (13392-18-2, 1944-12-3)
ipratropium bromide (22254-24-6)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
orciprenaline (586-06-1, 5874-97-5)
salbutamol (18559-94-9)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1986063997
PUI
L16209936
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1516
TITLE
Immediate diagnosis and treatment of poisoning
ORIGINAL (NON-ENGLISH) TITLE
SOFORTDIAGNOSTIK UND -THERAPIE BEI INTOXIKATIONEN
AUTHOR NAMES
Harloff M.
AUTHOR ADDRESSES
(Harloff M.) Medizinische Klinik C der Stadtischen Krankenanstalten, D-6700
Ludwigshafen/Rhein
CORRESPONDENCE ADDRESS
Medizinische Klinik C der Stadtischen Krankenanstalten, D-6700
Ludwigshafen/Rhein
SOURCE
Therapiewoche (1986) 36:1 (16-23). Date of Publication: 1986
ISSN
0040-5973
ABSTRACT
Acute exogenous intoxication represents a substantial proportion of the
total number of emergency cases. Appropriate therapy can contribute to
reducing to a minimum organic damage and possible complications. So many
different poisons are available that it is impossible to predict the kind,
quantity or combination of poison taken, or how long it may take until the
intoxication has any effect; neither can any predictions be made about the
kind of application of the poison. Therefore, no rigid rules can be laid
down as to the intervention of the emergency physician or the patient's
hospitalization. Possible indication criterias are disturbance of or acute
danger for the vital functions; disturbance of consciousness; intoxications
which may be neutralized by immediate detoxication or application of
antidote; patients whose apparent state of illness is not due to
intoxications. The emergency physician's duties are reactivation and control
of the vital functions; investigation of the exact case history including
the determination of poison; neutralization of the poison by removing,
deactivating or applying antidotes and preservation; indispensable antidotes
in the prehospital phase are: apomorphine, atropine, 4-DMAP, dexamethasone,
active charcoal, naloxone, and sodiumthiosulfate. Statistically, severe drug
intoxication ranks highests followed by fatal intoxication with insecticides
and herbicides. Severe emergency cases of intoxication with vegetable or
animal poisons are rather the exception in the Federal Republic of Germany.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
activated carbon
ammonium chloride
apomorphine
atropine
bispyridinium derivative
carbon monoxide
carbromal
chlorpromazine
dexamethasone isonicotinate
digitalis
diphenhydramine
diquat
glutethimide
hydrogen cyanide
imipramine
ipecac
methaqualone
naloxone
norfenefrine
opiate
organophosphate
paracetamol
paraquat
phenacetin
phenobarbital
physostigmine
sodium thiosulfate
solvent
strychnine
venom
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
coma
drug overdose
drug therapy
emergency treatment
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
diagnosis
halbmond
human
intravenous drug administration
oral drug administration
priority journal
short survey
therapy
DRUG TRADE NAMES
adalin
auxiloson
doriden
halbmond
luminal
novadral
revonal
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
ammonium chloride (12125-02-9)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
carbromal (77-65-6)
chlorpromazine (50-53-3, 69-09-0)
dexamethasone isonicotinate (2265-64-7)
digitalis (8031-42-3, 8053-83-6)
diphenhydramine (147-24-0, 58-73-1)
diquat (2764-72-9, 4032-26-2, 85-00-7)
glutethimide (77-21-4)
hydrogen cyanide (74-90-8)
imipramine (113-52-0, 50-49-7)
ipecac (8012-96-2)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
naloxone (357-08-4, 465-65-6)
norfenefrine (15308-34-6, 4779-94-6, 536-21-0, 636-87-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraquat (1910-42-5, 3240-78-6, 4685-14-7)
phenacetin (62-44-2)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
physostigmine (57-47-6, 64-47-1)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
strychnine (1421-86-9, 57-24-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1986063998
PUI
L16209937
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1517
TITLE
The toxicologic emergency case; an acute drug emergency
ORIGINAL (NON-ENGLISH) TITLE
DER TOXIKOLOGISCHE NOTFALL: AKUTER DROGENNOTFALL
AUTHOR NAMES
Felgenhauer N.
Haegler H.
AUTHOR ADDRESSES
(Felgenhauer N.; Haegler H.) Toxikologische Abteilung der II. Medizinischen
Klinik rechts der Isar der Technischen Universitat, D 8000 Munchen
CORRESPONDENCE ADDRESS
Toxikologische Abteilung der II. Medizinischen Klinik rechts der Isar der
Technischen Universitat, D 8000 Munchen
SOURCE
Notarzt (1985) 1:5 (111-112). Date of Publication: 1985
ISSN
0177-2309
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency treatment
intoxication
EMTREE MEDICAL INDEX TERMS
case report
human
therapy
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1986054527
PUI
L16200466
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1518
TITLE
Acute management of common illicit drug intoxications
AUTHOR NAMES
Hall A.H.
Kulig K.W.
Rumack B.H.
AUTHOR ADDRESSES
(Hall A.H.; Kulig K.W.; Rumack B.H.) Rocky Mountain Poison Center,
University of Colorado School of Medicine, Denver General Hospital, Denver,
CO
CORRESPONDENCE ADDRESS
Rocky Mountain Poison Center, University of Colorado School of Medicine,
Denver General Hospital, Denver, CO
SOURCE
Seminars in Adolescent Medicine (1985) 1:4 (259-269). Date of Publication:
1985
ISSN
0748-6480
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
alcohol
amphetamine
atropine
barbituric acid derivative
caffeine
cannabis
chlorpromazine
cocaine
diazepam
dopamine
doxapram
ethchlorvynol
glutethimide
haloperidol
hydralazine
ipecac
lysergide
magnesium stearate
magnesium sulfate
methaqualone
methylphenidate
methyprylon
naloxone
noradrenalin
pethidine
phencyclidine
phentolamine
phenytoin
physostigmine
picrotoxin
pralidoxime
sodium sulfate
sorbitol
thiamine
EMTREE DRUG INDEX TERMS
nadulat
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adolescence
alcoholism
drug overdose
drug therapy
intoxication
mushroom
EMTREE MEDICAL INDEX TERMS
adolescent
central nervous system
diagnosis
drug absorption
emergency treatment
human
intravenous drug administration
pharmacokinetics
prevention
short survey
therapy
DRUG TRADE NAMES
demerol
doriden
levophed
nadulat
narcan
placidyl
protopam
quaalude
ritalin
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
caffeine (58-08-2)
cannabis (8001-45-4, 8063-14-7)
chlorpromazine (50-53-3, 69-09-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
dopamine (51-61-6, 62-31-7)
doxapram (113-07-5, 309-29-5, 7081-53-0)
ethchlorvynol (113-18-8)
glutethimide (77-21-4)
haloperidol (52-86-8)
hydralazine (304-20-1, 86-54-4)
ipecac (8012-96-2)
lysergide (50-37-3)
magnesium stearate (557-04-0)
magnesium sulfate (7487-88-9)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
methylphenidate (113-45-1, 298-59-9)
methyprylon (125-64-4)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phencyclidine (77-10-1, 956-90-1)
phentolamine (50-60-2, 73-05-2)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
picrotoxin (124-87-8)
pralidoxime (6735-59-7)
sodium sulfate (7757-82-6)
sorbitol (26566-34-7, 50-70-4, 53469-19-5)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1987000771
MEDLINE PMID
3843490 (http://www.ncbi.nlm.nih.gov/pubmed/3843490)
PUI
L17168916
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1519
TITLE
Medical emergencies: The cardiac ambulance
ORIGINAL (NON-ENGLISH) TITLE
URGENCES MEDICALES: CARDIOMOBILE
AUTHOR NAMES
Cereda J.-M.
AUTHOR ADDRESSES
(Cereda J.-M.) Clinique Medicale, Hopital Cantonal Universitaire, Geneve
CORRESPONDENCE ADDRESS
Clinique Medicale, Hopital Cantonal Universitaire, Geneve
SOURCE
Medecine et Hygiene (1985) 43:1631 (3397-3400). Date of Publication: 1985
ISSN
0025-6749
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
ajmaline
aminophylline
atropine
baralgin
bretylium tosylate
bromazepam
calcium chloride
diazepam
digoxin
dopamine
epinephrine
furosemide
glucagon
glucose
glyceryl trinitrate
hydrocortisone
isoprenaline
lidocaine
metoclopramide
morphine
naloxone
pentazocine
phenobarbital
phenytoin
procainamide
promazine
salbutamol
sodium chloride
verapamil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
heart infarction
EMTREE MEDICAL INDEX TERMS
heart
human
intravenous drug administration
review
therapy
DRUG TRADE NAMES
baralgin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
ajmaline (4360-12-7, 73089-81-3)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
baralgin (8067-07-0)
bretylium tosylate (61-75-6)
bromazepam (1812-30-2)
calcium chloride (10043-52-4)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
hydrocortisone (50-23-7)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
procainamide (51-06-9, 614-39-1)
promazine (53-60-1, 58-40-2)
salbutamol (18559-94-9)
sodium chloride (7647-14-5)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1986030278
PUI
L16221217
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1520
TITLE
Calcium channel blockers and the emergency care kit in the dental office
AUTHOR NAMES
Kosmac T.
AUTHOR ADDRESSES
(Kosmac T.) University of Pittsburgh School of Dental Medicine, Pittsburgh,
PA
CORRESPONDENCE ADDRESS
University of Pittsburgh School of Dental Medicine, Pittsburgh, PA
SOURCE
Anesthesia Progress (1985) 32:5 (189-193). Date of Publication: 1985
ISSN
0003-3006
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline
atropine
beta adrenergic receptor blocking agent
calcium channel blocking agent
chlorpheniramine
diazepam
digitalis
diltiazem
diphenhydramine
epinephrine
glyceryl trinitrate
hydrocortisone sodium succinate
mephentermine
metaraminol
morphine sulfate
naloxone
nifedipine
orciprenaline
quinidine
verapamil
EMTREE DRUG INDEX TERMS
bicarbonate
calcium chloride
colecalciferol
lidocaine
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
anxiety
cardiotoxicity
dentistry
drug interaction
heart arrest
heart ventricle fibrillation
hypotension
pharmacokinetics
tachycardia
EMTREE MEDICAL INDEX TERMS
cardiovascular system
heart
human
intoxication
psychological aspect
short survey
tooth
DRUG TRADE NAMES
calan
cardizem
isoptin
procardia
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
chlorpheniramine (132-22-9)
colecalciferol (1406-16-2, 67-97-0)
diazepam (439-14-5)
digitalis (8031-42-3, 8053-83-6)
diltiazem (33286-22-5, 42399-41-7)
diphenhydramine (147-24-0, 58-73-1)
glyceryl trinitrate (55-63-0)
hydrocortisone sodium succinate (125-04-2, 2203-97-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mephentermine (100-92-5, 1212-72-2)
metaraminol (33402-03-8, 54-49-9)
morphine sulfate (23095-84-3, 35764-55-7, 64-31-3)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
orciprenaline (586-06-1, 5874-97-5)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
quinidine (56-54-2)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986040945
MEDLINE PMID
3866501 (http://www.ncbi.nlm.nih.gov/pubmed/3866501)
PUI
L16231884
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1521
TITLE
Evaluation of 516 cardiopulmonary resuscitation attempts
AUTHOR NAMES
Batenhorst R.L.
Clifton G.D.
Booth D.C.
AUTHOR ADDRESSES
(Batenhorst R.L.; Clifton G.D.; Booth D.C.) Drug Information Center,
University of Illinois Hospital, Chicago, IL 60612
CORRESPONDENCE ADDRESS
Drug Information Center, University of Illinois Hospital, Chicago, IL 60612
SOURCE
American Journal of Hospital Pharmacy (1985) 42:11 (2478-2483). Date of
Publication: 1985
ISSN
0002-9289
ABSTRACT
All adult cardiopulmonary resuscitations attended by the pharmacy department
at a 486-bed tertiary-care institution were analyzed over a 24-month period.
Data describing patient demographics, drug and equipment use, and patient
survival were collected on 516 consecutive adult arrests. These data were
recorded on a report form by a pharmacy technician and were classified as
cardiac, respiratory, trauma, or other. Trauma included arrests caused by
motor-vehicle accidents and gunshot wounds, and other included arrests
caused by anaphylaxis or seizures. The majority of arrests (70%) were
classified as cardiac, 24% as respiratory, and 6% as other. Overall, 54.5%
of the patients suffering from arrests were resuscitated successfully. There
was an equal distribution of arrests throughout the day. The mean duration
of the resuscitation efforts was 38 minutes with a trend toward greater
patient survival when resuscitation efforst lasted less than 15 minutes.
Arterial blood-gas determinations were made in 81% of the arrests,
defibrillations in 40%, and pacemaker or chest tube insertion in less than
10%. Sodium bicarbonate was the most frequently administered medication,
followed by calcium salts and atropine sulfate. Lidocaine was used in 83% of
the cases requiring antiarrhythmic therapy. Pressor support was required in
44.6% of the cases; norepinephrine bitartrate was the first-line pressor
agent. Drugs not categorized as essential according to the Americal Heart
Association's Advanced Cardiac Life Support (ACLS) standards were
administered infrequently. Hospitals may benefit from arrest data in
assessing their equipment and supply needs, staffing patterns, and personnel
training programs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline
atropine
bicarbonate
calcium chloride
dexamethasone
diazepam
digoxin
dopamine
drug
epinephrine
furosemide
gluconate calcium
isoprenaline
lidocaine
mannitol
naloxone
nitroprusside sodium
noradrenalin
phenylephrine
physostigmine
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency health service
heart arrest
resuscitation
EMTREE MEDICAL INDEX TERMS
cardiovascular system
clinical article
heart
hospital pharmacy
human
intravenous drug administration
priority journal
respiratory system
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
dexamethasone (50-02-2)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
gluconate calcium (299-28-5)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
nitroprusside sodium (14402-89-2, 15078-28-1)
noradrenalin (1407-84-7, 51-41-2)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
physostigmine (57-47-6, 64-47-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Health Policy, Economics and Management (36)
Anesthesiology (24)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1986016078
MEDLINE PMID
4073065 (http://www.ncbi.nlm.nih.gov/pubmed/4073065)
PUI
L16252017
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1522
TITLE
Impact of Talwin NX
AUTHOR NAMES
Senay E.C.
Clara J.R.
AUTHOR ADDRESSES
(Senay E.C.; Clara J.R.) University of Chicago, Chicago, IL
CORRESPONDENCE ADDRESS
University of Chicago, Chicago, IL
SOURCE
NIDA Research Monograph Series (1985) NO. 55 (170-177). Date of Publication:
1985
ISSN
1046-9516
ABSTRACT
During the decade of the seventies, remarkable changes occurred in the
heroin scene in the Chicago area. White heroin, with a distribution network
centered in the black ghetto, was replaced with brown heroin, with the
distribution network now shifted to the hispanic community. During this
decade Chicago area treatment programs experienced such a dramatic rise in
the intravenous use of pentazocine and tripelennamine, known as 'T's and
Blues', that by the end of this time, almost one half of the heroin addicts
in treatment were frequent users of 'T's and Blues'. By 1978, pentazocine
ranked fifth among drugs coming to attention in Chicago area emergency
rooms. Illinois reacted to this dramatic increase in abuse by scheduling
pentazocine as a schedule two drug in 1979. Sterling-Winthrop reacted by
formulating Talwin Nx, a combination of pentazocine, 50 mg. and naloxone,
0.5 mg. The data obtained in this study suggests that the inclusion of a
small dose of naloxone substantially alters the street patterns of abuse of
the Talwin and Pyribenzamine combination. The demand for treatment for
primary abuse of this combination declined dramatically following the
introduction of Talwin Nx in the Spring of 1983. There were also marked
changes in the experiences obtained from the use of T's and Blues and in the
frequency with which this combination was used as a primary source of
intoxication.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
naloxone plus pentazocine
pentazocine
tripelennamine
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug abuse
drug dependence
drug therapy
drug use
self medication
EMTREE MEDICAL INDEX TERMS
central nervous system
diagnosis
human
major clinical study
methodology
nervous system
theoretical study
therapy
United States
DRUG TRADE NAMES
talwin nx
talwin
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
tripelennamine (154-69-8, 91-81-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Psychiatry (32)
Clinical and Experimental Pharmacology (30)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985224249
MEDLINE PMID
6443375 (http://www.ncbi.nlm.nih.gov/pubmed/6443375)
PUI
L15024249
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1523
TITLE
Complications after overdose with tricyclic antidepressants
AUTHOR NAMES
Stern T.A.
O'Gara P.T.
Mulley A.G.
AUTHOR ADDRESSES
(Stern T.A.; O'Gara P.T.; Mulley A.G.) Department of Psychiatry,
Massachusetts General Hospital, Boston, MA 02114
CORRESPONDENCE ADDRESS
Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
SOURCE
Critical Care Medicine (1985) 13:8 (672-674). Date of Publication: 1985
ISSN
0090-3493
ABSTRACT
We reviewed 72 consecutive cases of tricyclic antidepressant (TCA) overdose
(OD) admitted from the emergency ward (EW) to the ICU between 1977 and 1982.
Most patients were seriously ill before ICU admission: 70% were comatose;
68% were intubated, including 61% in need of mechanical ventilation; and 30%
were hypothermic. One patient died after ICU admission. ECG abnormalities
were present in 37 (51%) patients in the EW. These abnormalities were
associated with higher TCA plasma levels, but not with either acidosis or
hypoxemia. Of 14 patients without ECG abnormalities or the need for
intubation in the EW, none developed new ECG abnormalities or required
ventilatory support. No patient had a late complication after transfer from
the ICU, after a mean stay of 2.1 days. Late, unexpected complications in
TCA OD are very rare. Our study suggests that TCA OD patients who do not
have an abnormal ECG and do not require ventilatory support at the time of
initial evaluation may not need ICU admission simply for intensive
observation.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
amitriptyline
desipramine
doxepin
imipramine
ipecac
naloxone
thiamine
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
drug overdose
drug therapy
electrocardiography
heart arrhythmia
respiration depression
EMTREE MEDICAL INDEX TERMS
artificial ventilation
central nervous system
clinical article
diagnosis
heart
human
hypothermia
intoxication
intravenous drug administration
nervous system
priority journal
respiratory system
therapy
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
amitriptyline (50-48-6, 549-18-8)
desipramine (50-47-5, 58-28-6)
doxepin (1229-29-4, 1668-19-5)
imipramine (113-52-0, 50-49-7)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Psychiatry (32)
Cardiovascular Diseases and Cardiovascular Surgery (18)
Toxicology (52)
Forensic Science Abstracts (49)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985193101
MEDLINE PMID
4017597 (http://www.ncbi.nlm.nih.gov/pubmed/4017597)
PUI
L15043101
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1524
TITLE
An acute hypertensive response after intravenous use of a new pentazocine
formulation
AUTHOR NAMES
Reinhart S.
Barrett S.M.
AUTHOR ADDRESSES
(Reinhart S.; Barrett S.M.) Section of Emergency Medicine and Trauma,
Department of Surgery, University of Oklahoma Health Sciences Center,
Oklahoma City, OK
CORRESPONDENCE ADDRESS
Section of Emergency Medicine and Trauma, Department of Surgery, University
of Oklahoma Health Sciences Center, Oklahoma City, OK
SOURCE
Annals of Emergency Medicine (1985) 14:6 (591-593). Date of Publication:
1985
ISSN
0196-0644
ABSTRACT
We present the case of a 27-year-old woman with a history of drug abuse.
Following her routine intravenous (IV) injection of solubilized pentazocine
and tripelennamine tablets ('Ts and Blues'), the patient developed severe
hypotension, a finding not characteristic of either drug alone or of the
combination. The manufacturers of Talwin (pentazocine) recently have added
naloxone to the tablets to discourage IV abuse of this oral preparation. Our
patient unknowingly had injected the new pentazocine formulation, and she
subsequently developed narcotic withdrawal symptoms. Here hypertension was
treated, and she was discharged from the emergency department. We report the
case as an 'unusual reaction' that may develop in frequent abusers of
pentazocine and its combinations.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
naloxone plus pentazocine
pentazocine
tripelennamine
EMTREE DRUG INDEX TERMS
clonidine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug abuse
drug formulation
hypertension
hypotension
t's and blues
EMTREE MEDICAL INDEX TERMS
article
cardiovascular system
case report
human
intoxication
intravenous drug administration
priority journal
DRUG TRADE NAMES
talwin nx
talwin
DRUG MANUFACTURERS
Sterling Winthrop
CAS REGISTRY NUMBERS
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
tripelennamine (154-69-8, 91-81-6)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
Anesthesiology (24)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985190410
MEDLINE PMID
3994086 (http://www.ncbi.nlm.nih.gov/pubmed/3994086)
PUI
L15040410
DOI
10.1016/S0196-0644(85)80788-5
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(85)80788-5
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1525
TITLE
Ventricular fibrillation with a tricyclic antidepressant overdose. Case
history
AUTHOR NAMES
Roberts J.R.
AUTHOR ADDRESSES
(Roberts J.R.)
SOURCE
Cardiovascular Medicine (1985) 10:4 (45-47). Date of Publication: 1985
ISSN
0199-6614
ABSTRACT
A 30-year old woman was brought to the emergency department in a
semicomatose state about six hours after taking an overdose of an unknown
amount of desipramine (Norpramin). The patient, who had a hsitory of
previous suicide attempts, was found with an empty vodka bottle and an empty
pill bottle. CPR was initiated, and the young woman was intubated and
hyperventilated. Two ampules of NaHCO(3) (100 mEq) were administered, and
the patient was shocked with 200 Watt-seconds of DC current. The patient
regained consciousness in 12 hours, was extubated, and was discharged three
days later to the psychiatric service without apparent sequelae.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
bicarbonate
bretylium
charcoal
desipramine
dopamine
glucose
lidocaine
magnesium citrate
naloxone
noradrenalin
oxygen
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
cardiotoxicity
drug overdose
heart ventricle fibrillation
suicide attempt
EMTREE MEDICAL INDEX TERMS
case report
heart
human
intoxication
oral drug administration
therapy
DRUG TRADE NAMES
norpramin
CAS REGISTRY NUMBERS
alcohol (64-17-5)
bicarbonate (144-55-8, 71-52-3)
bretylium (59-41-6)
charcoal (16291-96-6)
desipramine (50-47-5, 58-28-6)
dopamine (51-61-6, 62-31-7)
glucose (50-99-7, 84778-64-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
magnesium citrate (144-23-0, 3344-18-1, 7779-25-1)
naloxone (357-08-4, 465-65-6)
noradrenalin (1407-84-7, 51-41-2)
oxygen (7782-44-7)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Toxicology (52)
Adverse Reactions Titles (38)
Drug Literature Index (37)
Psychiatry (32)
Clinical and Experimental Pharmacology (30)
Anesthesiology (24)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985114022
PUI
L15114022
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1526
TITLE
Catatonia in the emergency department
AUTHOR NAMES
Valenstein M.
Maltbie A.
Kaplan P.
AUTHOR ADDRESSES
(Valenstein M.; Maltbie A.; Kaplan P.) Department of Psychiatry, Duke
University Medical Center, Durham, NC 27710
CORRESPONDENCE ADDRESS
Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
SOURCE
Annals of Emergency Medicine (1985) 14:4 (359-361). Date of Publication:
1985
ISSN
0196-0644
ABSTRACT
The emergency physician should be able to identify the striking clinical
picture of catatonia and should be cognizant of the wide variety of
disorders that give rise to this constellation. Catatonia may not be as
common as it was 80 years ago; however, our experience in a large emergency
facility indicates that a physician may see several cases a year if he
remains alert to the characteristic complex of signs.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amantadine
haloperidol
mepyramine maleate
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
catatonia
dementia
drug therapy
EMTREE MEDICAL INDEX TERMS
case report
central nervous system
diagnosis
emergency ward
human
priority journal
therapy
CAS REGISTRY NUMBERS
amantadine (665-66-7, 768-94-5)
haloperidol (52-86-8)
mepyramine maleate (59-33-6)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Psychiatry (32)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985107205
MEDLINE PMID
3985450 (http://www.ncbi.nlm.nih.gov/pubmed/3985450)
PUI
L15107205
DOI
10.1016/S0196-0644(85)80105-0
FULL TEXT LINK
http://dx.doi.org/10.1016/S0196-0644(85)80105-0
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1527
TITLE
The use of physostigmine in heroin overdose
AUTHOR NAMES
Rupreht J.
Dworacek B.
Valkenburg M.
Oosthoek H.
AUTHOR ADDRESSES
(Rupreht J.; Dworacek B.; Valkenburg M.; Oosthoek H.) Department of
Anaesthesiology, Erasmus University Rotterdam, 3000 DR Rotterdam
CORRESPONDENCE ADDRESS
Department of Anaesthesiology, Erasmus University Rotterdam, 3000 DR
Rotterdam
SOURCE
Archives of Toxicology (1984) 55:SUPPL. 7 (467). Date of Publication: 1984
ISSN
0340-5761
ABSTRACT
Two groups of 10 patients who were brought into the emergency room for a
heroin-overdose respiratory depression were treated aselectively with 0.003
mg/kg naloxone intravenously (i.v.) or 0.04 mg/kg physostigmine salicylate
i.v. Blood gases, consciousness, heart rate, blood pressure, pupil diameter
and subjective well-being were recorded. Patients treated either with
naloxone or physostigmine awoke from coma within 10 min. The important
difference between the two groups was in the subjective feeling of
well-being: naloxone caused opiate withdrawal and the patients felt 'rotten'
while patients after physostigmine felt 'fine'. The effect of physostigmine,
however, wore off within 40 min.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone
physostigmine
physostigmine salicylate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug comparison
drug efficacy
drug indication
drug overdose
drug therapy
drug withdrawal
respiration depression
EMTREE MEDICAL INDEX TERMS
human
human experiment
intoxication
intravenous drug administration
methodology
respiratory system
therapy
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
physostigmine salicylate (57-64-7, 71214-04-5)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984249493
PUI
L14024649
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1528
TITLE
Analgesia in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
L'ANALGESIE EN MEDECINE D'URGENCE
AUTHOR NAMES
Virenque Ch.
AUTHOR ADDRESSES
(Virenque Ch.) Service de Reanimation Respiratoire C.H.U. Rangueil, 31054
Toulouse Cedex
CORRESPONDENCE ADDRESS
Service de Reanimation Respiratoire C.H.U. Rangueil, 31054 Toulouse Cedex
SOURCE
Convergences Medicales (1984) 3:5 (429-434). Date of Publication: 1984
ISSN
0750-0785
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
atropine
bupivacaine
ketoprofen
lidocaine
lysine acetylsalicylate
methoxyflurane
morphine
naloxone
nitrous oxide
noradrenalin
papaverine
pentazocine
pethidine
phenylbutazone
phloroglucinol
scopolamine
scopolamine butyl bromide
tiemonium iodide
EMTREE DRUG INDEX TERMS
nitrous oxide plus oxygen
phloroglucinol plus trimethylphloroglucinol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
drug therapy
emergency medicine
pain
Viscum album
EMTREE MEDICAL INDEX TERMS
central nervous system
human
injury
review
therapy
DRUG TRADE NAMES
aspegic
aspirin
buscopan
dolosal
entonox
fortral
marcaine
narcan
penthrane
profenid
spasfon
visceralgine
DRUG MANUFACTURERS
Delagrange
DuPont de Nemours
Theracom
Lafon
Midy
Riom
Specia
Winthrop
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
atropine (51-55-8, 55-48-1)
bupivacaine (18010-40-7, 2180-92-9, 55750-21-5)
ketoprofen (22071-15-4, 57495-14-4)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lysine acetylsalicylate (34220-70-7, 37933-78-1, 62952-06-1, 77337-52-1)
methoxyflurane (56274-14-7, 76-38-0)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide plus oxygen (54510-89-3)
nitrous oxide (10024-97-2)
noradrenalin (1407-84-7, 51-41-2)
papaverine (58-74-2, 61-25-6)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenylbutazone (129-18-0, 50-33-9, 8054-70-4)
phloroglucinol (108-73-6)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
scopolamine (138-12-5, 51-34-3, 55-16-3)
spasfon (92739-09-8)
tiemonium iodide (144-12-7, 6252-92-2)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1984247321
PUI
L14022477
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1529
TITLE
Toxicologic emergencies
ORIGINAL (NON-ENGLISH) TITLE
LES URGENCES TOXICOLOGIQUES
AUTHOR NAMES
Conso F.
Filiu E.
Pasteyer J.
AUTHOR ADDRESSES
(Conso F.; Filiu E.; Pasteyer J.) Service Medecine Interne, Hopital
Raymond-Poincare, 92380 Garches
CORRESPONDENCE ADDRESS
Service Medecine Interne, Hopital Raymond-Poincare, 92380 Garches
SOURCE
Semaine des Hopitaux (1984) 60:36-37 (2535-2537). Date of Publication: 1984
ISSN
0037-1777
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
apomorphine
atropine
barbituric acid derivative
benzodiazepine derivative
carbon monoxide
ipecac
naloxone
opiate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug antagonism
drug toxicity
emergency
intoxication
EMTREE MEDICAL INDEX TERMS
human
short survey
therapy
CAS REGISTRY NUMBERS
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1984245196
PUI
L14020352
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1530
TITLE
Emergency psychopharmacology
AUTHOR NAMES
O'Shanick G.J.
AUTHOR ADDRESSES
(O'Shanick G.J.) Department of Psychiatry, The University of Texas Health
Science Center at Houston, TX 77025
CORRESPONDENCE ADDRESS
Department of Psychiatry, The University of Texas Health Science Center at
Houston, TX 77025
SOURCE
American Journal of Emergency Medicine (1984) 2:2 (164-170). Date of
Publication: 1984
ISSN
0735-6757
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
alprazolam
amobarbital
cannabis
chlordiazepoxide
chlorpromazine
clorazepate
desipramine
diazepam
fluphenazine
halazepam
haloperidol
infusion fluid
lorazepam
loxapine succinate
molindone
naloxone
nortriptyline
oxazepam
pentobarbital
perphenazine
phencyclidine
phenobarbital
prazepam
thioridazine
tiotixene
trazodone
tricyclic antidepressant agent
trifluoperazine
vitamin
EMTREE DRUG INDEX TERMS
clorazepate dipotassium
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
agitation
behavior disorder
drug therapy
nutrient
psychopharmacology
stupor
suicide attempt
EMTREE MEDICAL INDEX TERMS
central nervous system
drug choice
human
psychological aspect
review
therapy
DRUG TRADE NAMES
amytal
ativan
centrax
haldol
librium
loxitane
mellaril
moban
navane
paxipam
prolixin
serax
stelazine
thorazine
tranxene
trilafon
valium
xanax
CAS REGISTRY NUMBERS
alcohol (64-17-5)
alprazolam (28981-97-7)
amobarbital (57-43-2, 64-43-7)
cannabis (8001-45-4, 8063-14-7)
chlordiazepoxide (438-41-5, 58-25-3)
chlorpromazine (50-53-3, 69-09-0)
clorazepate (20432-69-3, 23887-31-2)
clorazepate dipotassium (57109-90-7)
desipramine (50-47-5, 58-28-6)
diazepam (439-14-5)
fluphenazine (146-56-5, 69-23-8)
halazepam (23092-17-3)
haloperidol (52-86-8)
lorazepam (846-49-1)
loxapine succinate (27833-64-3)
molindone (15622-65-8, 7416-34-4)
naloxone (357-08-4, 465-65-6)
nortriptyline (72-69-5, 894-71-3)
oxazepam (604-75-1)
pentobarbital (57-33-0, 76-74-4)
perphenazine (58-39-9)
phencyclidine (77-10-1, 956-90-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
prazepam (2955-38-6)
thioridazine (130-61-0, 50-52-2)
tiotixene (5591-45-7)
trazodone (19794-93-5, 25332-39-2)
trifluoperazine (117-89-5, 440-17-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Clinical and Experimental Pharmacology (30)
Pediatrics and Pediatric Surgery (7)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984240788
MEDLINE PMID
6151398 (http://www.ncbi.nlm.nih.gov/pubmed/6151398)
PUI
L14015944
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1531
TITLE
Emergency cases in drug dependence
ORIGINAL (NON-ENGLISH) TITLE
DER AKUTE DROGEN-PATIENT
AUTHOR NAMES
Tegeler J.
AUTHOR ADDRESSES
(Tegeler J.) Psychiatrische Klinik der Universitat Dusseldorf, D-4000
Dusseldorf 12
CORRESPONDENCE ADDRESS
Psychiatrische Klinik der Universitat Dusseldorf, D-4000 Dusseldorf 12
SOURCE
Munchener Medizinische Wochenschrift (1984) 126:42 (1216-1217). Date of
Publication: 1984
ISSN
0341-3098
ABSTRACT
Emergency cases in drug dependence comprise acute intoxications, chronic
intoxications, and psychotic syndromes. Symptoms of these different
disorders are presented. Therapeutic possibilities with tranquilizers and
psychotherapeutic methods are discussed.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2,5 dimethoxy 4 methylamphetamine
amphetamine
cannabis
cocaine
diazepam
furosemide
haloperidol
levallorphan
lysergide
mescaline
naloxone
opiate
prednisolone sodium succinate
EMTREE DRUG INDEX TERMS
levallorphan tartrate
soludecortin
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
apnea
drug abuse
drug dependence
drug overdose
emergency treatment
psychosis
EMTREE MEDICAL INDEX TERMS
central nervous system
diagnosis
human
intoxication
psychological aspect
respiratory system
short survey
therapy
DRUG TRADE NAMES
lasix
lorfan
narcan
soludecortin
CAS REGISTRY NUMBERS
2,5 dimethoxy 4 methylamphetamine (15588-95-1, 26011-50-7)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
furosemide (54-31-9)
haloperidol (52-86-8)
levallorphan tartrate (71-82-9)
levallorphan (13075-35-9, 152-02-3)
lysergide (50-37-3)
mescaline (11006-96-5, 54-04-6, 832-92-8)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
prednisolone sodium succinate (1715-33-9)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1984246303
PUI
L14021459
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1532
TITLE
Emergency drugs: Agents used in the treatment of poisoning
AUTHOR NAMES
Meredith T.
Caisley J.
Volans G.
AUTHOR ADDRESSES
(Meredith T.; Caisley J.; Volans G.)
SOURCE
British Medical Journal (1984) 289:6447 (742-748). Date of Publication: 1984
ISSN
0959-8146
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
aminophylline
ammonium chloride
amyl nitrite
antidote
apomorphine
atropine
chlorpheniramine
chlorpromazine
cimetidine
clomethiazole
diazepam
dobutamine
epinephrine
furosemide
glucagon
heparin
hydrocortisone
ipecac
levallorphan
lidocaine
mercaptamine
metaraminol
nalorphine
naloxone
neostigmine
nitroprusside sodium
paraldehyde
penicillin G
phentolamine
physostigmine
propranolol
ranitidine
venom antiserum
vitamin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug antagonism
drug indication
drug therapy
drug toxicity
heart arrhythmia
intoxication
EMTREE MEDICAL INDEX TERMS
heart
human
intravenous drug administration
review
therapy
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
ammonium chloride (12125-02-9)
amyl nitrite (463-04-7)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
chlorpheniramine (132-22-9)
chlorpromazine (50-53-3, 69-09-0)
cimetidine (51481-61-9, 70059-30-2)
clomethiazole (1867-58-9, 533-45-9)
diazepam (439-14-5)
dobutamine (34368-04-2, 52663-81-7)
furosemide (54-31-9)
glucagon (11140-85-5, 62340-29-8, 9007-92-5)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
hydrocortisone (50-23-7)
ipecac (8012-96-2)
levallorphan (13075-35-9, 152-02-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mercaptamine (156-57-0, 60-23-1)
metaraminol (33402-03-8, 54-49-9)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
nitroprusside sodium (14402-89-2, 15078-28-1)
paraldehyde (123-63-7)
penicillin G (1406-05-9, 61-33-6)
phentolamine (50-60-2, 73-05-2)
physostigmine (57-47-6, 64-47-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
ranitidine (66357-35-5, 66357-59-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984234747
MEDLINE PMID
6434065 (http://www.ncbi.nlm.nih.gov/pubmed/6434065)
PUI
L14009903
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1533
TITLE
Massive accidental oral poisoning with opiates. Case description and
treatment. Use of naloxone in an emergency situation
ORIGINAL (NON-ENGLISH) TITLE
INTOXICATION PER-ORALE MASSIVE, ACCIDENTELLE, AUX OPIACES. PARTICULARITE ET
TRAITEMENT. UTILISATION DE LA NALOXONE EN SITUATION D'URGENCE
AUTHOR NAMES
Paccaud D.
AUTHOR ADDRESSES
(Paccaud D.) Service de Medicine, Hopital du District, Moutier
CORRESPONDENCE ADDRESS
Service de Medicine, Hopital du District, Moutier
SOURCE
Revue Medicale de la Suisse Romande (1984) 104:9 (721-723). Date of
Publication: 1984
ISSN
0035-3655
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
cocaine
diamorphine
morphine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
drug overdose
drug toxicity
EMTREE MEDICAL INDEX TERMS
case report
central nervous system
human
intoxication
oral drug administration
respiratory system
therapy
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
cocaine (50-36-2, 53-21-4, 5937-29-1)
diamorphine (1502-95-0, 561-27-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1985004313
MEDLINE PMID
6505476 (http://www.ncbi.nlm.nih.gov/pubmed/6505476)
PUI
L15204313
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1534
TITLE
The use of endotracheal medication in cardiac emergencies
AUTHOR NAMES
Greenberg M.I.
AUTHOR ADDRESSES
(Greenberg M.I.) Division of Emergency Medicine, Medical College of
Pennsylvania, Philadelphia, PA 19129
CORRESPONDENCE ADDRESS
Division of Emergency Medicine, Medical College of Pennsylvania,
Philadelphia, PA 19129
SOURCE
Resuscitation (1984) 12:3 (155-165). Date of Publication: 1984
ISSN
0300-9572
ABSTRACT
The endotracheal route for drug administration provides a rapid means of
accessing the systemic circulation when intravenous routes cannot be
establised in emergent situations. This route is relatively free of
significant complications and has been documented as being successful
numerous times in various clinical settings. Currently, the following drugs
have been studied by this route: epinephrine, atropine, lidocaine, naloxone,
bretylium, and diazepam. The paper reviews the current state of the art of
endotracheal drug administration.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bretylium
diazepam
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency medicine
heart resuscitation
intratracheal drug administration
shock
EMTREE MEDICAL INDEX TERMS
cardiovascular system
human
inhalational drug administration
intravenous drug administration
priority journal
respiratory system
review
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bretylium (59-41-6)
diazepam (439-14-5)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985002309
MEDLINE PMID
6096940 (http://www.ncbi.nlm.nih.gov/pubmed/6096940)
PUI
L15202309
DOI
10.1016/0300-9572(84)90001-7
FULL TEXT LINK
http://dx.doi.org/10.1016/0300-9572(84)90001-7
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1535
TITLE
Urgent management in intoxications and toxic manifestations
ORIGINAL (NON-ENGLISH) TITLE
INTOXICACIONES Y MANIFESTACIONES TOXICAS DE URGENTE TRATAMIENTO
AUTHOR NAMES
Guerra C.
Mosto H.A.
Gabach R.
AUTHOR ADDRESSES
(Guerra C.; Mosto H.A.; Gabach R.) Catedra de Toxicologia, Facultad de
Medicina, U.B.A., Buenos Aires
CORRESPONDENCE ADDRESS
Catedra de Toxicologia, Facultad de Medicina, U.B.A., Buenos Aires
SOURCE
Prensa Medica Argentina (1984) 71:15 (679-685). Date of Publication: 1984
ISSN
0032-745X
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
ammonia
apomorphine
ascorbic acid
barbituric acid derivative
bicarbonate
caustic agent
chlordiazepoxide
chlorpromazine
clonidine
corticosteroid
detergent
diazepam
furosemide
hypochlorous acid
magnesium sulfate
menadione
meprobamate
methanol
naloxone
salicylic acid derivative
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
drug toxicity
emergency treatment
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
coma
delirium tremens
human
review
therapy
CAS REGISTRY NUMBERS
alcohol (64-17-5)
ammonia (14798-03-9, 51847-23-5, 7664-41-7)
apomorphine (314-19-2, 58-00-4)
ascorbic acid (134-03-2, 15421-15-5, 50-81-7)
bicarbonate (144-55-8, 71-52-3)
chlordiazepoxide (438-41-5, 58-25-3)
chlorpromazine (50-53-3, 69-09-0)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
diazepam (439-14-5)
furosemide (54-31-9)
hypochlorous acid (7790-92-3)
magnesium sulfate (7487-88-9)
menadione (58-27-5)
meprobamate (57-53-4)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Spanish
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1985111636
PUI
L15111636
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1536
TITLE
Alcoholic intoxication and naloxone
ORIGINAL (NON-ENGLISH) TITLE
INTOXICATION ETHYLIQUE AIGUE ET NALOXONE
AUTHOR NAMES
Claud B.
Tourret J.
Defay G.
AUTHOR ADDRESSES
(Claud B.; Tourret J.; Defay G.) Departement d'Anesthesie-Reanimation,
Centre Hospitalier Emile Roux, 43012 Le Puy
CORRESPONDENCE ADDRESS
Departement d'Anesthesie-Reanimation, Centre Hospitalier Emile Roux, 43012
Le Puy
SOURCE
Convergences Medicales (1984) 3:6 (555-560). Date of Publication: 1984
ISSN
0750-0785
ABSTRACT
26 comas having a presumed alcoholic origin were studied at their arrival in
the emergency department. 9 of them were associated with cranial trauma or
'medicinal poisoning'. On those patients, naloxone was efficient in 33% of
cases (but series are not important enough). The other 17 were only due to
alcoholism. Average alcoholemia was of 2.41 g.l(-1) and the average dose of
naloxone of 1.81 mg. Awakening was obtained in 94 p. 100 of cases. It seems
then, that naloxone deserves to be tried in every alcoholic coma, allowing
that way to avoid the complications of coma.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
naloxone
EMTREE DRUG INDEX TERMS
clomipramine
clorazepate
clorazepate dipotassium
flunitrazepam
lorazepam
triazolam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
alcoholism
coma
drug antagonism
drug therapy
head injury
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
clinical article
human
injury
therapy
DRUG TRADE NAMES
anafranil
halcion
rohypnol
temesta
tranxene
CAS REGISTRY NUMBERS
alcohol (64-17-5)
clomipramine (17321-77-6, 303-49-1)
clorazepate dipotassium (57109-90-7)
clorazepate (20432-69-3, 23887-31-2)
flunitrazepam (1622-62-4)
lorazepam (846-49-1)
naloxone (357-08-4, 465-65-6)
triazolam (28911-01-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1985056894
PUI
L15156894
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1537
TITLE
Role of the emergency physician in treatment of poisoned patients
AUTHOR NAMES
Guzzardi L.J.
AUTHOR ADDRESSES
(Guzzardi L.J.) Department of Emergency Medicine, York Hospital, York, PA
17405
CORRESPONDENCE ADDRESS
Department of Emergency Medicine, York Hospital, York, PA 17405
SOURCE
Clinics in Laboratory Medicine (1984) 4:3 (615-625). Date of Publication:
1984
ISSN
0272-2712
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
activated carbon
alcohol
atropine
bethanechol
carboxylic acid
chlorpromazine
cresol
cyanide
deferoxamine
diphenhydramine
ethylene glycol
fluphenazine
glucose
haloperidol
heavy metal
hydrofluoric acid
iron
loxapine
malathion
methacholine
methanol
methylene blue
molindone
naloxone
neostigmine
paracetamol
parathion
phenol
phosphorus
physostigmine
pilocarpine
pralidoxime
pyridostigmine
sodium nitrite
sodium thiosulfate
thiamine
thioridazine
EMTREE DRUG INDEX TERMS
loxapine succinate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug antagonism
drug therapy
drug toxicity
emergency medicine
hospital
intoxication
lung
EMTREE MEDICAL INDEX TERMS
diagnosis
human
respiratory system
short survey
therapy
United States
DRUG TRADE NAMES
haldol
loxitane
mellaril
prolixin
thorazine
tylenol
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
bethanechol (590-63-6, 674-38-4, 91609-06-2)
chlorpromazine (50-53-3, 69-09-0)
cresol (1319-77-3)
cyanide (57-12-5)
deferoxamine (70-51-9)
diphenhydramine (147-24-0, 58-73-1)
ethylene glycol (107-21-1)
fluphenazine (146-56-5, 69-23-8)
glucose (50-99-7, 84778-64-3)
haloperidol (52-86-8)
hydrofluoric acid (7664-39-3)
iron (14093-02-8, 53858-86-9, 7439-89-6)
loxapine (1977-10-2)
loxapine succinate (27833-64-3)
malathion (121-75-5)
methacholine (55-92-5)
methanol (67-56-1)
methylene blue (61-73-4)
molindone (15622-65-8, 7416-34-4)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
paracetamol (103-90-2)
parathion (3270-86-8, 56-38-2, 597-88-6)
phenol (108-95-2, 3229-70-7)
phosphorus (7723-14-0)
physostigmine (57-47-6, 64-47-1)
pilocarpine (148-72-1, 54-71-7, 92-13-7)
pralidoxime (6735-59-7)
pyridostigmine (101-26-8, 155-97-5)
sodium nitrite (7632-00-0)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
thiamine (59-43-8, 67-03-8)
thioridazine (130-61-0, 50-52-2)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Toxicology (52)
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984222641
MEDLINE PMID
6148172 (http://www.ncbi.nlm.nih.gov/pubmed/6148172)
PUI
L14047694
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1538
TITLE
Toxicologic emergencies in general practice, emergency service and hospital
ORIGINAL (NON-ENGLISH) TITLE
DER TOXIKOLOGISCHE NOTFALL BEIM HAUSARZT, BEIM NOTARZT UND IN DER KLINIK
AUTHOR NAMES
Daunderer M.
AUTHOR ADDRESSES
(Daunderer M.) Weinstrasse 1, 8000 Munchen 2
CORRESPONDENCE ADDRESS
Weinstrasse 1, 8000 Munchen 2
SOURCE
Deutsches Arzteblatt (1984) 81:25-26 (2003-2016). Date of Publication: 1984
ISSN
0012-1207
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
4 dimethylaminophenol
aminophylline
antidote
apomorphine
atropine
bicarbonate
biperiden
charcoal
deferoxamine
dexamethasone isonicotinate
diazepam
digoxin
dimercaprol
dipyrone
dopamine
doxepin
epinephrine
flumetasone pivalate
furosemide
gluconate calcium
glyceryl trinitrate
lidocaine
naloxone
nicotinamide
norfenefrine
obidoxime
orciprenaline
paraffin
pentazocine
physostigmine
polygeline
proxymetacaine
roticlean
sodium chloride
sodium sulfate
sodium thiosulfate
suxamethonium
thiopental
tolonium chloride
triamcinolone
triflupromazine
unithiol
EMTREE DRUG INDEX TERMS
antidotum thallii
chibrokercain
deferoxamine mesylate
gelafundin
isogutt
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
drug therapy
drug toxicity
emergency
intoxication
therapy
toxicology
EMTREE MEDICAL INDEX TERMS
diagnosis
human
organization and management
review
DRUG TRADE NAMES
akineton
alupent
antidotum thallii
aponal
auxiloson
chibrokercain
desferal
dimaval
euphyllin
fortral
gelafundin
isogutt
lanicor
lasix
locacorten
narcanti
nitrolingual
novadral
roticlean
sulfactin
DRUG MANUFACTURERS
Boehringer Ingelheim
Braun
Byk
Chibret
Ciba Geigy
Giulini Pharma
Koehler
Phytopharma
Pohl
Boehringer Ingelheim
Woelm
CAS REGISTRY NUMBERS
4 dimethylaminophenol (5882-48-4, 619-60-3)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
biperiden (1235-82-1, 514-65-8)
charcoal (16291-96-6)
deferoxamine mesylate (138-14-7, 5115-09-3)
deferoxamine (70-51-9)
dexamethasone isonicotinate (2265-64-7)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
dimercaprol (59-52-9)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
dopamine (51-61-6, 62-31-7)
doxepin (1229-29-4, 1668-19-5)
flumetasone pivalate (2002-29-1)
furosemide (54-31-9)
gluconate calcium (299-28-5)
glyceryl trinitrate (55-63-0)
isogutt (62253-34-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
nicotinamide (11032-50-1, 98-92-0)
norfenefrine (15308-34-6, 4779-94-6, 536-21-0, 636-87-3)
obidoxime (114-90-9, 7683-36-5)
orciprenaline (586-06-1, 5874-97-5)
pentazocine (359-83-1, 64024-15-3)
physostigmine (57-47-6, 64-47-1)
polygeline (66455-30-9)
proxymetacaine (499-67-2, 5875-06-9)
sodium chloride (7647-14-5)
sodium sulfate (7757-82-6)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
suxamethonium (306-40-1, 71-27-2)
thiopental (71-73-8, 76-75-5)
tolonium chloride (92-31-9)
triamcinolone (124-94-7)
triflupromazine (1098-60-8, 146-54-3)
unithiol (4076-02-2, 74-61-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1984189528
PUI
L14064581
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1539
TITLE
Naloxone in shock, a new field of application in emergency care medicine
ORIGINAL (NON-ENGLISH) TITLE
NALOXON BEI SCHOCK: EIN NEUER ANWENDUNGSBEREICH IN DER NOTFALLMEDIZIN
AUTHOR NAMES
Gervais H.
AUTHOR ADDRESSES
(Gervais H.) Johannes Gutenberg Universitat, D 6500 Mainz
CORRESPONDENCE ADDRESS
Johannes Gutenberg Universitat, D 6500 Mainz
SOURCE
Notfall Medizin (1984) 10:4 (541-548). Date of Publication: 1984
ISSN
0341-2903
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
levallorphan
morphine
nalorphine
naloxone
pentazocine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug indication
drug therapy
shock
EMTREE MEDICAL INDEX TERMS
cardiovascular system
human
injury
intravenous drug administration
short survey
therapy
DRUG TRADE NAMES
narcanti
CAS REGISTRY NUMBERS
levallorphan (13075-35-9, 152-02-3)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
EMBASE CLASSIFICATIONS
Surgery (9)
Forensic Science Abstracts (49)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Drug Literature Index (37)
Clinical and Experimental Pharmacology (30)
Anesthesiology (24)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1984157678
PUI
L14082731
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1540
TITLE
Clinical pharmacology of opioid analgesics.
AUTHOR NAMES
Moore P.A.
AUTHOR ADDRESSES
(Moore P.A.)
CORRESPONDENCE ADDRESS
P.A. Moore,
SOURCE
Dental clinics of North America (1984) 28:3 (389-400). Date of Publication:
Jul 1984
ISSN
0011-8532
ABSTRACT
Opioid analgesics continue to be the most important drugs in modifying the
response to pain. Their versatility is attested by their frequent use in
both postoperative and intraoperative management of pain. Recent findings
regarding the mechanism of action of opioids may signal the introduction of
newer, more effective, and less addictive agents. So far, this has not
occurred. However, opioids with mixed agonist-antagonist properties have
offered some utility. The adverse effects of nausea and dysphoria and the
more serious effects of respiratory depression continue to be a problem, as
does the possibility of abuse. Nonetheless, the clinical experience with
opioids in control of pain is uncontested. Until better drugs are developed,
opioids will form the basis for the control of acute pain by the dental
practitioner.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
narcotic analgesic agent (drug administration, drug therapy, pharmacology)
EMTREE DRUG INDEX TERMS
endorphin
narcotic agent (drug administration, pharmacology)
opiate receptor
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
dental procedure
EMTREE MEDICAL INDEX TERMS
adult
ambulatory care
article
child
dental anesthesia
drug antagonism
drug interaction
emergency health service
general anesthesia
hospitalization
human
physiology
CAS REGISTRY NUMBERS
endorphin (60118-07-2)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
6146539 (http://www.ncbi.nlm.nih.gov/pubmed/6146539)
PUI
L14781009
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1541
TITLE
Toxicology of drug abuse
AUTHOR NAMES
McGuigan M.A.
AUTHOR ADDRESSES
(McGuigan M.A.) Poison Control Centre, Hospital for Sick Children, Toronto,
Ont. M5G 1XB
CORRESPONDENCE ADDRESS
Poison Control Centre, Hospital for Sick Children, Toronto, Ont. M5G 1XB
SOURCE
Emergency Medicine Clinics of North America (1984) 2:1 (87-101). Date of
Publication: 1984
ISSN
0733-8627
ABSTRACT
The clinical presentation of intoxication with the drugs of abuse is often
confusing and variable. Not only is there a large interindividual variation
in sensitivity to the effects, but the illicitly purchased drugs are not
pure. Identification of these patients by the emergency department staff
required a high level of suspicion. Routine biochemical and hematologic
determinations rarely help in identifying the specific toxin. Almost all of
the illicit drugs can be identified in bodily fluids and attempts should be
made to do so. The value of these specific drug assays lies in the
retrospective documentation of intoxication and not in aiding in the
emergency management of an acutely intoxicated patient. Finally, there are
no specific 'antidotes' for these drugs of abuse. Symptomatic detailed
medical care is the cornerstone to the successful management of the patient.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetone
amphetamine
amyl nitrite
benzocaine
butyl nitrite
caffeine
cannabis
central stimulant agent
cocaine
dexamphetamine
dronabinol
ephedrine
isobutyl nitrite
lidocaine
lysergide
nitrite
organic solvent
phencyclidine
phenylpropanolamine
procaine
pseudoephedrine
psychedelic agent
solvent
tetracaine
toluene
EMTREE DRUG INDEX TERMS
activated carbon
ammonium chloride
chlorpromazine
diazepam
diazoxide
haloperidol
ipecac
methylene blue
naloxone
nitroprusside sodium
oxygen
phentolamine
phenytoin
propranolol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug abuse
drug overdose
drug toxicity
toxicology
EMTREE MEDICAL INDEX TERMS
article
emergency health service
human
intoxication
review
CAS REGISTRY NUMBERS
acetone (67-64-1)
activated carbon (64365-11-3, 82228-96-4)
ammonium chloride (12125-02-9)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
amyl nitrite (463-04-7)
benzocaine (1333-08-0, 94-09-7)
butyl nitrite (544-16-1)
caffeine (58-08-2)
cannabis (8001-45-4, 8063-14-7)
chlorpromazine (50-53-3, 69-09-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dexamphetamine (1462-73-3, 51-63-8, 51-64-9)
diazepam (439-14-5)
diazoxide (364-98-7)
dronabinol (7663-50-5)
ephedrine (299-42-3, 50-98-6)
haloperidol (52-86-8)
ipecac (8012-96-2)
isobutyl nitrite (542-56-3)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lysergide (50-37-3)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
nitrite (14797-65-0)
nitroprusside sodium (14402-89-2, 15078-28-1)
oxygen (7782-44-7)
phencyclidine (77-10-1, 956-90-1)
phentolamine (50-60-2, 73-05-2)
phenylpropanolamine (14838-15-4, 154-41-6, 4345-16-8, 48115-38-4)
phenytoin (57-41-0, 630-93-3)
procaine (51-05-8, 59-46-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
pseudoephedrine (345-78-8, 7460-12-0, 90-82-4)
tetracaine (136-47-0, 94-24-6)
toluene (108-88-3)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
Anesthesiology (24)
Psychiatry (32)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984111132
MEDLINE PMID
6519024 (http://www.ncbi.nlm.nih.gov/pubmed/6519024)
PUI
L14136184
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1542
TITLE
Endotracheal administration of emergency medications
AUTHOR NAMES
Powers R.D.
Donowitz L.G.
AUTHOR ADDRESSES
(Powers R.D.; Donowitz L.G.) Department of Internal Medicine, University of
Virginia School of Medicine, Charlottesville, VA
CORRESPONDENCE ADDRESS
Department of Internal Medicine, University of Virginia School of Medicine,
Charlottesville, VA
SOURCE
Southern Medical Journal (1984) 77:3 (340-341). Date of Publication: 1984
ISSN
0038-4348
ABSTRACT
When vascular access is delayed or unreliable in emergency situations, an
endotracheal tube provides a rapid and reliable route for administration of
medication. Epinephrine, lidocaine, and atropine have shown clinical
efficacy when given by the endotracheal route. There is evidence that other
medications including naloxone and diazepam may also be suitable for
endotracheal use, but clear-cut recommendations await further studies of
pharmacokinetics and toxicity.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
epinephrine
lidocaine
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug absorption
drug therapy
emergency medicine
endotracheal intubation
pharmacokinetics
shock
trachea
EMTREE MEDICAL INDEX TERMS
cardiovascular system
human
injury
intoxication
respiratory system
review
therapy
toxicity
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Clinical and Experimental Pharmacology (30)
Chest Diseases, Thoracic Surgery and Tuberculosis (15)
Anesthesiology (24)
Internal Medicine (6)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984091739
MEDLINE PMID
6322354 (http://www.ncbi.nlm.nih.gov/pubmed/6322354)
PUI
L14166791
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1543
TITLE
Antagonists of benzodiazepines
AUTHOR NAMES
Haefely W.
AUTHOR ADDRESSES
(Haefely W.) Pharmaceutical Research Department, F. Hoffmann-La Roche, Ltd.,
Basel
CORRESPONDENCE ADDRESS
Pharmaceutical Research Department, F. Hoffmann-La Roche, Ltd., Basel
SOURCE
Encephale (1983) 9:4 SUPPL. 2 (143B-150B). Date of Publication: 1983
ISSN
0013-7006
ABSTRACT
Benzodiazepines (BDZ) interact with specific receptors (R), whose activation
improves Cl-channel gating by the GABA receptor (GABA-R). Neurones, whose
GABAergic input has a certain level of activity, will be more inhibited in
the presence of BDZ (primary target neurones for BDZ). Secondarily, neurones
dependent on the activity of primary target neurones will also be effected.
Drugs that interact with GABAergic functions (except the BDZ-R) or with the
function of primary or secondary target neurones may inhibit some or all BDZ
effects; these are nonspecific BDZ antagonists (e.g. GABApantagonists,
cholinesterase inhibitors, naloxone, methylxanthines). Specific BDZ
antagonists inhibit the action of BDZ by blocking competitively the BDZ-R.
Ro 15-1788 is the best investigated specific BDZ antagonist. Virtually
devoid of any pharmacological action by itself, the compound blocks all
typical effects of BDZ. It is well tolerated also in man and will find
application in anaesthesiology to shorten the sedative and muscle relaxant
effect of BDZ and in emergency services to reverse comatose states after BDZ
overdosage. Recently drugs have been found that produce effects opposite to
the BDZ tranquilizers by inducing a conformation of the BDZ-R which
depresses GABA-mediated Cl-channel gating. The effects of these inverse
agonists (e.g. proconvulsant, convulsant, anxiogenic) are blocked by pure
competitive BDZ-R blockers, such as Ro 15-1788.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
2 phenyl 5h pyrazolo[4,3 c]quinolin 3 one
4 aminobutyric acid
5 hydroxytryptophan
amphetamine
benzodiazepine derivative
benzodiazepine receptor blocking agent
bicuculline
caffeine
cholinesterase inhibitor
flumazenil
isoniazid
methylxanthine
naloxone
picrotoxin
theophylline
thiosemicarbazide
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
drug antagonism
drug indication
drug therapy
EMTREE MEDICAL INDEX TERMS
central nervous system
human
intravenous drug administration
review
therapy
DRUG TRADE NAMES
cgs 8216
ro 15 1788
CAS REGISTRY NUMBERS
2 phenyl 5h pyrazolo[4,3 c]quinolin 3 one (77779-60-3)
4 aminobutyric acid (28805-76-7, 56-12-2)
5 hydroxytryptophan (4350-09-8, 56-69-9)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
bicuculline (485-49-4)
caffeine (58-08-2)
flumazenil (78755-81-4)
isoniazid (54-85-3, 62229-51-0, 65979-32-0)
methylxanthine (28109-92-4)
naloxone (357-08-4, 465-65-6)
picrotoxin (124-87-8)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiosemicarbazide (79-19-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Psychiatry (32)
Clinical and Experimental Pharmacology (30)
Neurology and Neurosurgery (8)
Nuclear Medicine (23)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
French
EMBASE ACCESSION NUMBER
1984108426
MEDLINE PMID
6144509 (http://www.ncbi.nlm.nih.gov/pubmed/6144509)
PUI
L14133478
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1544
TITLE
Physostigmine versus naloxone in heroin-overdose
AUTHOR NAMES
Rupreht J.
Dworacek B.
AUTHOR ADDRESSES
(Rupreht J.; Dworacek B.) Department of Anesthesiology, Erasmus University,
Medical Faculty, 3000 DR Rotterdam
CORRESPONDENCE ADDRESS
Department of Anesthesiology, Erasmus University, Medical Faculty, 3000 DR
Rotterdam
SOURCE
Journal of Toxicology - Clinical Toxicology (1983/1984) 21:3 (387-397). Date
of Publication: 1983
ISSN
0731-3810
ABSTRACT
Two groups of 10 chronically heroin addicted patients who were admitted to
the emergency ward because of hypoventilation and coma, were treated random
- a selectively with naloxone, 3 μg kg(-1) BW iv, or with physostigmine
salicylate 0.04 mg kg(-1) BW iv. Patients in both groups completely regained
consciousness and breathed spontaneously, regularly and adequately within 10
minutes. One essential difference in the treatment was that physostigmine
caused no signs of acute opiate withdrawal, the patients felt fine and
stayed for further examination, in contrast with naloxone where the patients
felt bad and occasionally escaped prematurely from the ward. Another
difference is that the beneficial effects of one dose of physostigmine is
shorter lived than that of naloxone. The authors emphasise the fact that
treatment of heroin overdose in an addict need not jeopardize the patient's
well-being by a withdrawal syndrome.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine
naloxone
physostigmine
physostigmine salicylate
EMTREE DRUG INDEX TERMS
antidote
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
coma
drug comparison
drug overdose
drug therapy
drug withdrawal
hypoventilation
neurotoxicity
respiration depression
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
central nervous system
clinical article
human
intoxication
intravenous drug administration
nervous system
priority journal
respiratory system
therapy
DRUG MANUFACTURERS
Endo
Koehler
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
physostigmine salicylate (57-64-7, 71214-04-5)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
Toxicology (52)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Clinical and Experimental Pharmacology (30)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1985040599
MEDLINE PMID
6676478 (http://www.ncbi.nlm.nih.gov/pubmed/6676478)
PUI
L15190599
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1545
TITLE
General management of drug overdose and poisoning
AUTHOR NAMES
Byth P.L.
AUTHOR ADDRESSES
(Byth P.L.) Intensive Care Unit, St. Vincent's Hosp., Sydney
CORRESPONDENCE ADDRESS
Intensive Care Unit, St. Vincent's Hosp., Sydney
SOURCE
Current Therapeutics (1983) 24:7 (99-115). Date of Publication: 1983
ISSN
0311-905X
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
bretylium
carbamazepine
chloral hydrate
colchicine
diazepam
digoxin
disopyramide
dobutamine
dopamine
glutethimide
isoprenaline
lidocaine
lithium carbonate
naloxone
phenytoin
propranolol
quinidine
theophylline
thiopental
EMTREE DRUG INDEX TERMS
bretylium tosylate
chloradorm
chloralix
colchicine
diazepam
disopyramide phosphate
dormel
lamoxin
lithcarb
quincardine
quinidine sulfate
quinidoxim
revimine
rythnodan
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
breathing
drug overdose
drug therapy
drug toxicity
emergency health service
intoxication
EMTREE MEDICAL INDEX TERMS
human
methodology
oral drug administration
respiratory system
short survey
therapy
DRUG TRADE NAMES
bretylate
camcolit
cardinol
chloradorm
chloralix
colgout
convuline
dilantin
dobutrex
doriden
dormel
ducene
inderal
intraval
intropin
isuprel
lamoxin
lithcarb
mucomyst
narcan
noctec
norpace
nuelin
parvolex
pentothal
priadel
propam
quincardine
quinidex
quinidoxim
revimine
rythnodan
saventrine
tegretol
theodur
valium
xylocaine
xylocard
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
bretylium (59-41-6)
bretylium tosylate (61-75-6)
carbamazepine (298-46-4, 8047-84-5)
chloral hydrate (302-17-0)
colchicine (64-86-8)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
disopyramide (3737-09-5)
disopyramide phosphate (22059-60-5)
dobutamine (34368-04-2, 52663-81-7)
dopamine (51-61-6, 62-31-7)
glutethimide (77-21-4)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
lithium carbonate (554-13-2)
naloxone (357-08-4, 465-65-6)
phenytoin (57-41-0, 630-93-3)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
quinidine (56-54-2)
quinidine sulfate (50-54-4, 6591-63-5)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
thiopental (71-73-8, 76-75-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984000589
PUI
L14225641
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1546
TITLE
The immediate management of overdose
AUTHOR NAMES
Nicolson D.P.
AUTHOR ADDRESSES
(Nicolson D.P.) Pulmonary Division, Veterans Adminstration Medical Center,
Little Rock, AR 72206
CORRESPONDENCE ADDRESS
Pulmonary Division, Veterans Adminstration Medical Center, Little Rock, AR
72206
SOURCE
Medical Clinics of North America (1983) 67:6 (1279-1293). Date of
Publication: 1983
ISSN
0025-7125
ABSTRACT
Suicide is the third ranked cause of death in individuals between the ages
of 15 and 24 years (11.8 cases per 100,000), following closely on accident
and homicide. More suicides occur than are reported. Some violent or
drug-related deaths represent suicide equivalents, as many accidents from
drunken driving, dangerous motorcycling, and single driver collisions. Many
patients who present to the emergency room because of overdose may belong to
this category. Approximately 5 million poisonings occur each year, with 5000
(0.5 per cent) deaths. The circumstances are often hectic, confused, and
bizarre, and may be associated with accidents, injuries (including gunshot
wounds), or an episode of near drowning. Unfortunately, the victim of
self-poisoning may be resented by the professional staff, despite the
evident pathos of the situation and the rarity of repetition. In surveying
the attitudes of professional staff to various emergency room encounters,
Patel found that victims of overdose are the least popular, followed by
victims of asthma, cerebrovascular accident, and gastrointestinal bleeding.
Doctors and nurses show a preference for patients with physical illness,
such as myocardial infarction, since such patients represent a model of
those who are 'physically ill, passive, appreciative, and grateful'. The
patient often feels guilt and resentment after an episode of attempted self
construction; medical professionals should regard the event with empathy and
as an overreaction to a short-lived crisis that usually resolves. Indeed,
with an improvement in attitude, junior medical staff members are capable of
managing the psychiatric situation themselves.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetazolamide
acetylcysteine
acetylsalicylic acid
activated carbon
alcohol
atropine
barbituric acid derivative
carbon monoxide
cyanide
hydroxocobalamin
ipecac
methanol
naloxone
opiate
organophosphate
paracetamol
paraldehyde
phencyclidine
pralidoxime
propranolol
propylene glycol
sodium thiosulfate
tricyclic antidepressant agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug overdose
drug therapy
intoxication
suicide
EMTREE MEDICAL INDEX TERMS
human
major clinical study
management
short survey
survey
therapy
DRUG TRADE NAMES
aspirin
diamox
mucomyst
CAS REGISTRY NUMBERS
acetazolamide (1424-27-7, 59-66-5)
acetylcysteine (616-91-1)
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
cyanide (57-12-5)
hydroxocobalamin (13422-51-0, 13422-52-1)
ipecac (8012-96-2)
methanol (67-56-1)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
paraldehyde (123-63-7)
phencyclidine (77-10-1, 956-90-1)
pralidoxime (6735-59-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
propylene glycol (57-55-6)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
Anesthesiology (24)
Toxicology (52)
Forensic Science Abstracts (49)
Psychiatry (32)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1984016259
MEDLINE PMID
6355686 (http://www.ncbi.nlm.nih.gov/pubmed/6355686)
PUI
L14241311
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1547
TITLE
Emergency equipment, emergency treatment from the view of internal medicine:
Drugs
ORIGINAL (NON-ENGLISH) TITLE
DIE NOTFALL-TASCHE AUS DER SICHT DES INTERNISTEN: MEDIKAMENTE - EMPFEHLUNGEN
FUR DEN ARZT IN DER PRAXIS
AUTHOR NAMES
Bartels O.
AUTHOR ADDRESSES
(Bartels O.) Med. Klin., Poliklin., Univ. Erlangen-Nurnberg, 8520 Erlangen
CORRESPONDENCE ADDRESS
Med. Klin., Poliklin., Univ. Erlangen-Nurnberg, 8520 Erlangen
SOURCE
Fortschritte der Medizin (1983) 101:24 (1125-1126). Date of Publication:
1983
ISSN
0015-8178
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
apomorphine
buprenorphine
cafedrine
clemastine
clonidine
dexamethasone
diazepam
diazoxide
dihydroergotoxine
epinephrine
furosemide
gluconate calcium
glucose
glyceryl trinitrate
haloperidol
heparin
insulin
ipratropium bromide
lidocaine
metildigoxin
mexiletine
morphine
naloxone
nifedipine
norfenefrine
orciprenaline
pentazocine
pindolol
scopolamine
terbutaline
theophylline
verapamil
EMTREE DRUG INDEX TERMS
aminophylline
cafedrine plus theodrenaline
clemastine fumarate
dexamethasone isonicotinate
dihydroergotamine mesilate
dimenhydrinate
drug
fenoterol
hypertoralum
mucosoloan
noleptan
scopolamine butyl bromide
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug indication
drug therapy
emergency medicine
internal medicine
EMTREE MEDICAL INDEX TERMS
article
human
review
therapy
DRUG TRADE NAMES
adalat
akrinor
alupent
aspisol
atrovent
auxiloson
berotec
bricanyl
buscopan
catapresan
dihydergot
euphyllin
fortecortin
fortral
haldol
hypertoralum
isoptin
itrop
lanitop
lasix
liquemin
mexitil
mucosoloan
nitrolingual
noleptan
novadral
tavegil
temgesic
valium
visken
vomex a
xylocaine
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
apomorphine (314-19-2, 58-00-4)
buprenorphine (52485-79-7, 53152-21-9)
cafedrine (58166-83-9)
cafedrine plus theodrenaline (69910-62-9, 8004-31-7)
clemastine (15686-51-8)
clemastine fumarate (14976-57-9)
clonidine (4205-90-7, 4205-91-8, 57066-25-8)
dexamethasone (50-02-2)
dexamethasone isonicotinate (2265-64-7)
diazepam (439-14-5)
diazoxide (364-98-7)
dihydroergotamine mesilate (6190-39-2)
dihydroergotoxine (11032-41-0, 8039-60-9)
dimenhydrinate (523-87-5)
fenoterol (13392-18-2, 1944-12-3)
furosemide (54-31-9)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
glyceryl trinitrate (55-63-0)
haloperidol (52-86-8)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
insulin (9004-10-8)
ipratropium bromide (22254-24-6)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metildigoxin (30685-43-9)
mexiletine (31828-71-4, 5370-01-4)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nifedipine (21829-25-4)
norfenefrine (15308-34-6, 4779-94-6, 536-21-0, 636-87-3)
orciprenaline (586-06-1, 5874-97-5)
pentazocine (359-83-1, 64024-15-3)
pindolol (13523-86-9, 21870-06-4)
scopolamine (138-12-5, 51-34-3, 55-16-3)
scopolamine butyl bromide (149-64-4, 7182-53-8, 73156-19-1)
terbutaline (23031-25-6)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1983178365
MEDLINE PMID
6884945 (http://www.ncbi.nlm.nih.gov/pubmed/6884945)
PUI
L13053522
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1548
TITLE
The burned patient
AUTHOR NAMES
Khan M.
AUTHOR ADDRESSES
(Khan M.) Albert Einstein Coll. Med., Bronx, NY
CORRESPONDENCE ADDRESS
Albert Einstein Coll. Med., Bronx, NY
SOURCE
International Anesthesiology Clinics (1983) 21:1 (127-137). Date of
Publication: 1983
ISSN
0020-5907
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
barbituric acid derivative
calcium chloride
enflurane
epinephrine
halothane
infusion fluid
ketamine
mafenide
methylphenidate
morphine
naloxone
oxygen
pethidine
scopolamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
anesthesia
burn
emergency health service
lung function
plastic surgery
resuscitation
EMTREE MEDICAL INDEX TERMS
cardiovascular system
central nervous system
human
injury
respiratory system
short survey
therapy
DRUG TRADE NAMES
sulfamylon
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
calcium chloride (10043-52-4)
enflurane (13838-16-9)
halothane (151-67-7, 66524-48-9)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
mafenide (138-37-4, 138-39-6)
methylphenidate (113-45-1, 298-59-9)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
oxygen (7782-44-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
scopolamine (138-12-5, 51-34-3, 55-16-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Surgery (9)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1983155180
MEDLINE PMID
6343251 (http://www.ncbi.nlm.nih.gov/pubmed/6343251)
PUI
L13086330
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1549
TITLE
What antidotes should the doctor's bag contain?
ORIGINAL (NON-ENGLISH) TITLE
WELCHE ANTIDOTE SOLLEN IN DIE ARZTTASCHE?
AUTHOR NAMES
Harloff M.
AUTHOR ADDRESSES
(Harloff M.)
SOURCE
Notfall Medizin (1983) 9:4 (381). Date of Publication: 1983
ISSN
0341-2903
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
antidote
apomorphine
atropine
cobalt edetate
cortisone
diuretic agent
gerbic acid
ipecac
magnesium oxide
naloxone
paraffin
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
drug therapy
emergency health service
intoxication
EMTREE MEDICAL INDEX TERMS
central nervous system
human
short survey
therapy
DRUG TRADE NAMES
kelocyanor
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
cobalt edetate (14931-83-0, 36499-65-7)
cortisone (53-06-5)
ipecac (8012-96-2)
magnesium oxide (1309-48-4, 1317-74-4)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1983148457
PUI
L13079607
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1550
TITLE
Naloxone in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
NALOXON IN DER NOTFALLMEDICIN
AUTHOR NAMES
Volans G.N.
AUTHOR ADDRESSES
(Volans G.N.) New Cross Hosp., London
CORRESPONDENCE ADDRESS
New Cross Hosp., London
SOURCE
Therapiewoche (1983) 33:15 (2095-2105). Date of Publication: 1983
ISSN
0040-5973
ABSTRACT
Naloxon is the medicament of choice in the therapy of overdosage of opiates;
for the symptom triad of myosis, respiratory depression and coma it is the
characteristic cure. In severe respiratory depression and cardiac
complications, above all the maintenance of vital functions must be assured
(artificial respiration, resuscitation). Thus adults receive 0.8 to 1.2 mg
of naloxon i.v. Even in coma of unclear genesis this dose should be given
insofar as an opiate intoxication is noticeable. Naloxone has a diagnostic
as well as a therapeutic function. If after 3 minutes there is no complete
abolition of the symptoms (size of the pupils, respiratory rate, state of
consciousness), a further dose is given. In adults a total of 4 to 6 mg may
be necessary. In severe cases (multiple intoxications) a naloxon infusion is
justifiable (5 mg/h). When there are signs of overdosage in the course of
therapy with opiates giving 0.4 mg naloxon is desirable. Newborns and
children receive, under the corresponding indication, at first 0.2 mg or 0.2
to 0.4 mg. In treatment of medicinal intoxication it is necessary always to
bear in mind the possibility of action by several drugs (combination
preparations). For this reason in most cases the plasma level of
acetylsalicylic acid and paracetamol should be determined. Furthermore,
active, centrally inhibiting drugs may inhibit the use of naxolon by the
patients. Aside from the rare hypersensitivity reaction, there is no
absolute contraindication for therapy with naloxon.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
buprenorphine
codeine
colestyramine
dextromoramide
dextropropoxyphene
diamorphine
dihydrocodeine
dimoxyline
diphenoxylate
dipipanone
etorphine
hydromorphone
methadone
morphine
naloxone
opiate
oxymorphone
papaverine
pentazocine
pethidine
phenazocine
EMTREE DRUG INDEX TERMS
antidote
atropine plus diphenoxylate
recombinant erythropoietin
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
coma
drug dependence
drug intoxication
drug therapy
drug toxicity
emergency
neurotoxicity
EMTREE MEDICAL INDEX TERMS
central nervous system
human
intoxication
nervous system
short survey
therapy
DRUG TRADE NAMES
artegodan
cuemid
develin
erantin
fortral
palfium
panergon
paracodin
paverone
polamidon
quantalan
reasec
remedacen
temgesic
CAS REGISTRY NUMBERS
atropine plus diphenoxylate (55840-97-6)
atropine (51-55-8, 55-48-1)
buprenorphine (52485-79-7, 53152-21-9)
codeine (76-57-3)
colestyramine (11041-12-6, 58391-37-0)
dextromoramide (2922-44-3, 357-56-2)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
dihydrocodeine (125-28-0, 24204-13-5, 5965-13-9)
dimoxyline (147-27-3, 5667-46-9)
diphenoxylate (3810-80-8, 915-30-0)
dipipanone (467-83-4)
etorphine (13764-49-3, 14521-96-1)
hydromorphone (466-99-9, 71-68-1)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxymorphone (357-07-3, 76-41-5)
papaverine (58-74-2, 61-25-6)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenazocine (1239-04-9, 127-35-5)
recombinant erythropoietin (113427-24-0, 122312-54-3, 130455-76-4)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Toxicology (52)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1983120512
PUI
L13109662
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1551
TITLE
Treatment of pain in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
DIE SCHMERZTHERAPIE IN DER NOTFALLMEDIZIN
AUTHOR NAMES
Dick W.
AUTHOR ADDRESSES
(Dick W.) Zent. Anasthesiol., Univ. Ulm, 7900 Ulm
CORRESPONDENCE ADDRESS
Zent. Anasthesiol., Univ. Ulm, 7900 Ulm
SOURCE
Therapiewoche (1983) 33:15 (2066-2082). Date of Publication: 1983
ISSN
0040-5973
ABSTRACT
Effective analgesia must be considered as an integral part of any kind of
emergency treatment. In order to obtain rapid onset of analgesia, analgesic
drugs must be administered intravenously. Even in this respect, some
analgesics differ from others. Two major groups of analgesics may be of
importance. 1. pure analgesics (Novaminsulfone®, Aspirin® etc.), 2.
morphinominetics (Morphine, Pethidine etc.). The drugs of the first group
are characterized by moderate analgesic efficacy and minor side effects, the
drugs of group 2 by severe analgesia, but not infrequently more pronounced
side effects. Thus, pure analgesics or antispasmodics can be probably
administered to emergency patients, suffering from moderate pain, with
sufficient efficacy, whereas particularly traumatized patients or those
suffering from myocardial infarction require hypnoanalgesics.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
buprenorphine
dipyrone
fentanyl
morphine
naloxone
pentazocine
pethidine
piritramide
tilidine
tramadol
zomepirac
EMTREE DRUG INDEX TERMS
nefopam
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
drug therapy
emergency
intensive care
pain
EMTREE MEDICAL INDEX TERMS
central nervous system
human
review
therapy
DRUG TRADE NAMES
ajan
aspirin
aspisol
dipidolor
dolantin
fortral
temgesic
tramal
valoron
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
buprenorphine (52485-79-7, 53152-21-9)
dipyrone (50567-35-6, 5907-38-0, 68-89-3)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
nefopam (13669-70-0, 23327-57-3)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
piritramide (302-41-0)
tilidine (20380-58-9, 27107-79-5)
tramadol (27203-92-5, 36282-47-0)
zomepirac (33369-31-2, 64092-48-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1983120509
PUI
L13109659
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1552
TITLE
Hospital pharmacist and emergency toxicology
ORIGINAL (NON-ENGLISH) TITLE
POSSIBILITES D'INTERVENTION DU PHARMACIEN HOSPITALIER EN TOXICOLOGIE
D'URGENCE
AUTHOR NAMES
Rochaix T.
AUTHOR ADDRESSES
(Rochaix T.) Serv. Pharm., 05105 Briancon Cedex
CORRESPONDENCE ADDRESS
Serv. Pharm., 05105 Briancon Cedex
SOURCE
Pharmacie Hospitaliere Francaise (1982) No. 60 (95-97). Date of Publication:
1982
ISSN
0369-9579
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
activated carbon
alcohol
bicarbonate
calcium chloride
cobalt edetate
deferoxamine
dimercaprol
edetic acid
folinate calcium
lactate sodium
methylene blue
naloxone
phenytoin
phytomenadione
pralidoxime
sodium thiosulfate
EMTREE DRUG INDEX TERMS
deferoxamine mesylate
hyposulphene
pralidoxime mesilate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug determination
drug identification
drug intoxication
drug overdose
drug toxicity
information
prevention
toxicology
EMTREE MEDICAL INDEX TERMS
drug analysis
human
intoxication
pharmacist
short survey
DRUG TRADE NAMES
contrathion
desferal
dilantin
hyposulphene
kelocyanor
narcan
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
cobalt edetate (14931-83-0, 36499-65-7)
deferoxamine mesylate (138-14-7, 5115-09-3)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
edetic acid (150-43-6, 60-00-4)
folinate calcium (1492-18-8, 51057-63-7)
lactate sodium (72-17-3)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
phenytoin (57-41-0, 630-93-3)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime mesilate (154-97-2)
pralidoxime (6735-59-7)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Toxicology (52)
LANGUAGE OF ARTICLE
French
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1983238546
PUI
L13007546
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1553
TITLE
General emergency treatment of acute poisoning
AUTHOR NAMES
Woo Hyung Lee
AUTHOR ADDRESSES
(Woo Hyung Lee) Dep. Intern. Med., Coll. Med., Ewha Womans Univ., Seoul
CORRESPONDENCE ADDRESS
Dep. Intern. Med., Coll. Med., Ewha Womans Univ., Seoul
SOURCE
Journal of the Korean Medical Association (1982) 25:5 (414-418). Date of
Publication: 1982
ISSN
0023-4028
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
activated carbon
alcohol
antidepressant agent
antidote
antimony
apomorphine
arsenic
atropine
barbituric acid derivative
camphor
chloroquine
chlorpheniramine
clopamide
cocaine
colchicine
dexamphetamine
dextropropoxyphene
digitalis
emetic agent
glutethimide
iodine
ipecac
malathion
mepacrine
meprobamate
mercuric chloride
metaraminol
morphine
noradrenalin
opiate receptor
penicillin G
phenothiazine
phentolamine
physostigmine
primaquine
probenecid
quinidine
quinine
salicylic acid
salicylic acid methyl ester
selenium
silver
sodium sulfate
strychnine
sulfonamide
EMTREE DRUG INDEX TERMS
hydrocortisone
larfon
levallorphan
methionine
nalorphine
naloxone
nicotine
opiate
paracetamol
parathion
pentazocine
phenol
phenytoin
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blood transfusion
drug intoxication
drug therapy
drug toxicity
perfusion
EMTREE MEDICAL INDEX TERMS
intoxication
nervous system
short survey
therapy
DRUG TRADE NAMES
larfon
nalline
CAS REGISTRY NUMBERS
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
antimony (14374-79-9, 7440-36-0)
apomorphine (314-19-2, 58-00-4)
arsenic (7440-38-2)
atropine (51-55-8, 55-48-1)
camphor (464-49-3, 76-22-2, 8008-51-3)
chloroquine (132-73-0, 3545-67-3, 50-63-5, 54-05-7)
chlorpheniramine (132-22-9)
clopamide (636-54-4)
cocaine (50-36-2, 53-21-4, 5937-29-1)
colchicine (64-86-8)
dexamphetamine (1462-73-3, 51-63-8, 51-64-9)
dextropropoxyphene (1639-60-7, 469-62-5)
digitalis (8031-42-3, 8053-83-6)
glutethimide (77-21-4)
hydrocortisone (50-23-7)
iodine (7553-56-2)
ipecac (8012-96-2)
levallorphan (13075-35-9, 152-02-3)
malathion (121-75-5)
mepacrine (69-05-6, 83-89-6)
meprobamate (57-53-4)
mercuric chloride (7487-94-7)
metaraminol (33402-03-8, 54-49-9)
methionine (59-51-8, 63-68-3, 7005-18-7)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
noradrenalin (1407-84-7, 51-41-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
parathion (3270-86-8, 56-38-2, 597-88-6)
penicillin G (1406-05-9, 61-33-6)
pentazocine (359-83-1, 64024-15-3)
phenol (108-95-2, 3229-70-7)
phenothiazine (92-84-2)
phentolamine (50-60-2, 73-05-2)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
primaquine (90-34-6)
probenecid (57-66-9)
quinidine (56-54-2)
quinine (130-89-2, 130-95-0, 14358-44-2, 549-48-4, 549-49-5, 60-93-5,
7549-43-1)
salicylic acid (63-36-5, 69-72-7)
salicylic acid methyl ester (119-36-8)
selenium (7782-49-2)
silver (7440-22-4)
sodium sulfate (7757-82-6)
strychnine (1421-86-9, 57-24-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Korean
EMBASE ACCESSION NUMBER
1983020452
PUI
L13246602
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1554
TITLE
Naloxone treatment of acute alcoholic or benzodiazepine intoxication
AUTHOR NAMES
Malizia E.
Cerbo R.
Ambrosini M.
AUTHOR ADDRESSES
(Malizia E.; Cerbo R.; Ambrosini M.) Poison Contr. Cent., Univ. Med. Sch.,
Rome
CORRESPONDENCE ADDRESS
Poison Contr. Cent., Univ. Med. Sch., Rome
SOURCE
Journal of Applied Toxicology (1982) 2:1 (39-41). Date of Publication: 1982
ISSN
0260-437X
ABSTRACT
Naloxone (0.8-1.6 mg i.v.) effectively counteracted the clinical signs
associated with benzodiazepine intoxication in 9 out of 10 emergency room
patients. Naloxone (0.8-2.8 mg i.v.) also-favorably influenced the state of
consciousness in 9 out of 9 alcohol-intoxicated patients. In cases of acute
narcotic overdose, the action of naloxone is almost immediate. Since a
longer time was required for naloxone to counteract benzodiazepine or
alcohol intoxication, the mechanism of action may be different from that
implied in narcotic overdose. In the present cases, naloxone may have acted
directly on the respiratory or consciousness centres of the brain.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
benzodiazepine
naloxone
EMTREE DRUG INDEX TERMS
amitriptyline
antidote
mannitol
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism
central nervous system
drug efficacy
drug intoxication
drug therapy
drug toxicity
intoxication
EMTREE MEDICAL INDEX TERMS
clinical article
human
intravenous drug administration
therapy
DRUG TRADE NAMES
narcan
DRUG MANUFACTURERS
(United States)Endo
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
benzodiazepine (12794-10-4)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Occupational Health and Industrial Medicine (35)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Forensic Science Abstracts (49)
Toxicology (52)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1983070613
PUI
L13176763
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1555
TITLE
Use of naloxone in emergency situations
ORIGINAL (NON-ENGLISH) TITLE
IMPIEGO DEL NALOXONE IN PRONTO SOCCORSO
AUTHOR NAMES
Accettella U.
Ambrosi F.
Russo L.
AUTHOR ADDRESSES
(Accettella U.; Ambrosi F.; Russo L.) Clin. Chir. Urgenza Pronto Soccorso,
Univ. Roma, Roma
CORRESPONDENCE ADDRESS
Clin. Chir. Urgenza Pronto Soccorso, Univ. Roma, Roma
SOURCE
Clinica Terapeutica (1982) 102:2 (197-201). Date of Publication: 1982
ISSN
0009-9074
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug indication
drug intoxication
drug therapy
emergency
injury
multiple trauma
EMTREE MEDICAL INDEX TERMS
heart
heart failure
human
intoxication
respiratory failure
respiratory system
therapy
CAS REGISTRY NUMBERS
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Toxicology (52)
LANGUAGE OF ARTICLE
Italian
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1983199252
MEDLINE PMID
7140177 (http://www.ncbi.nlm.nih.gov/pubmed/7140177)
PUI
L13074402
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1556
TITLE
Drugs of addiction: A problem for the emergency doctor
ORIGINAL (NON-ENGLISH) TITLE
DROGEN EIN PROBLEM FUR DEN NOTARZT
AUTHOR NAMES
Berzewski H.
AUTHOR ADDRESSES
(Berzewski H.) Neurochir. Neurol. Klin., Klin. Steglitz, Freie Univ., 1000
Berlin 45
CORRESPONDENCE ADDRESS
Neurochir. Neurol. Klin., Klin. Steglitz, Freie Univ., 1000 Berlin 45
SOURCE
Monatskurse fur die Arztliche Fortbildung (1982) 32:8 (112-120). Date of
Publication: 1982
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
amiphenazole
amphetamine
antidepressant agent
antiparkinson agent
barbituric acid derivative
beta adrenergic receptor blocking agent
cannabis
clomethiazole
cocaine
diazepam
epinephrine
levallorphan
naloxone
neuroleptic agent
opiate
psychedelic agent
scopolamine
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
crisis intervention
drug dependence
emergency health service
EMTREE MEDICAL INDEX TERMS
central nervous system
short survey
therapy
DRUG TRADE NAMES
daptazile
distraneurin
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
alcohol (64-17-5)
amiphenazole (490-55-1)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
cannabis (8001-45-4, 8063-14-7)
clomethiazole (1867-58-9, 533-45-9)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
levallorphan (13075-35-9, 152-02-3)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
scopolamine (138-12-5, 51-34-3, 55-16-3)
EMBASE CLASSIFICATIONS
Psychiatry (32)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1982187604
PUI
L12039720
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1557
TITLE
Neonatal emergency transport drug box
AUTHOR NAMES
Zenk K.E.
Amlie R.N.
AUTHOR ADDRESSES
(Zenk K.E.; Amlie R.N.) Univ. California Irvine Med. Cent., Orange, CA 92668
CORRESPONDENCE ADDRESS
Univ. California Irvine Med. Cent., Orange, CA 92668
SOURCE
Drug Intelligence and Clinical Pharmacy (1982) 16:2 (122-125). Date of
Publication: 1982
ISSN
0012-6578
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
albumin
atropine
bicarbonate
digoxin
dopamine
epinephrine
furosemide
gluconate calcium
glucose
heparin
isoprenaline
lidocaine
naloxone
phenobarbital
phytomenadione
potassium chloride
sodium chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
newborn
EMTREE MEDICAL INDEX TERMS
editorial
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
digoxin (20830-75-5, 57285-89-9)
dopamine (51-61-6, 62-31-7)
furosemide (54-31-9)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
naloxone (357-08-4, 465-65-6)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phytomenadione (11104-38-4, 84-80-0)
potassium chloride (7447-40-7)
sodium chloride (7647-14-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1982180779
MEDLINE PMID
7075462 (http://www.ncbi.nlm.nih.gov/pubmed/7075462)
PUI
L12094873
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1558
TITLE
Anticholinergic poisoning
AUTHOR NAMES
Goldfrank L.
Flomenbaum N.
Lewin N.
AUTHOR ADDRESSES
(Goldfrank L.; Flomenbaum N.; Lewin N.) Emerg. Med. Serv., Bellevue Hosp.,
New York, NY 10016
CORRESPONDENCE ADDRESS
Emerg. Med. Serv., Bellevue Hosp., New York, NY 10016
SOURCE
Clinical Toxicology (1982) 19:1 (17-25). Date of Publication: 1982
ISSN
0009-9309
ABSTRACT
Since the fall of 1979 numerous patients have been brought to emergency
departments in New York City after being poisoned with an alcoholic
beverage. On admission to the emergency services, they were noted to
manifest significant anticholinergic toxicity. An analysis of the case
histories, clinical presentations and laboratory data suggests that
scopolamine eyedrops were deliberately used to poison these patients.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
cholinergic receptor blocking agent
scopolamine
EMTREE DRUG INDEX TERMS
naloxone
physostigmine
thiamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
disorientation
drug intoxication
dry skin
flushing
hallucination
psychosis
tachycardia
urine retention
EMTREE MEDICAL INDEX TERMS
bladder
case report
heart
intoxication
oral drug administration
therapy
urinary tract
CAS REGISTRY NUMBERS
alcohol (64-17-5)
naloxone (357-08-4, 465-65-6)
physostigmine (57-47-6, 64-47-1)
scopolamine (138-12-5, 51-34-3, 55-16-3)
thiamine (59-43-8, 67-03-8)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Anesthesiology (24)
Neurology and Neurosurgery (8)
Forensic Science Abstracts (49)
Adverse Reactions Titles (38)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1982178094
MEDLINE PMID
7154138 (http://www.ncbi.nlm.nih.gov/pubmed/7154138)
PUI
L12092188
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1559
TITLE
Emergency drugs for metabolic and circulatory problems in neonates
ORIGINAL (NON-ENGLISH) TITLE
STOFFWECHSEL- UND KREISLAUFPROBLEME: DIESE NOTFALLMEDIKAMENTE BEIM
NEUGEBORENEN EINSETZEN
AUTHOR ADDRESSES
SOURCE
Notfall Medizin (1982) 8:1 (67-72). Date of Publication: 1982
ISSN
0341-2903
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
albumin
atropine
bicarbonate
calcium chloride
calcium gluceptate
epinephrine
gluconate calcium
glucose
naloxone
EMTREE DRUG INDEX TERMS
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
circulation
emergency medicine
metabolic disorder
newborn
EMTREE MEDICAL INDEX TERMS
cardiovascular system
therapy
DRUG TRADE NAMES
suprarenin
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
calcium gluceptate (29039-00-7, 86173-22-0)
gluconate calcium (299-28-5)
glucose (50-99-7, 84778-64-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Cardiovascular Diseases and Cardiovascular Surgery (18)
Clinical and Experimental Biochemistry (29)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1982152957
PUI
L12129031
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1560
TITLE
Prehospital management of the poisoned patient
AUTHOR NAMES
Marcum L.N.
Berve M.O.
AUTHOR ADDRESSES
(Marcum L.N.; Berve M.O.) Mobile Emergency Med. Serv., San Juan Reg. Med.
Cent. Farmington, NM
CORRESPONDENCE ADDRESS
Mobile Emergency Med. Serv., San Juan Reg. Med. Cent. Farmington, NM
SOURCE
Critical Care Quarterly (1982) 4:4 (25-31). Date of Publication: 1982
ISSN
0160-2551
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
anticonvulsive agent
diazepam
edrophonium
glucose
malathion
naloxone
neostigmine
parathion
physostigmine
EMTREE DRUG INDEX TERMS
physostigmine salicylate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
cardiovascular system
drug intoxication
emergency health service
first aid
intoxication
respiratory system
resuscitation
seizure
vomiting
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
central nervous system
methodology
short survey
therapy
DRUG TRADE NAMES
antilirium
CAS REGISTRY NUMBERS
diazepam (439-14-5)
edrophonium (312-48-1)
glucose (50-99-7, 84778-64-3)
malathion (121-75-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
parathion (3270-86-8, 56-38-2, 597-88-6)
physostigmine salicylate (57-64-7, 71214-04-5)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1982127960
PUI
L12104054
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1561
TITLE
How to antagonize ethanol-induced inebriation
AUTHOR NAMES
Linnoila M.
Mattila M.J.
AUTHOR ADDRESSES
(Linnoila M.; Mattila M.J.) Clin. Psychobiol. Branch, Nat. Inst. Ment. Hlth,
Bethesda, MD 20205
CORRESPONDENCE ADDRESS
Clin. Psychobiol. Branch, Nat. Inst. Ment. Hlth, Bethesda, MD 20205
SOURCE
Pharmacology and Therapeutics (1981) 15:1 (99-109). Date of Publication:
1981
ISSN
0163-7258
ABSTRACT
Ethanol, the most common recreational drug in the Western societies,
produces an appalling toll of casualties. If a potent antagonist to the
inebriating effects of ethanol were available, it would benefit the whole
health care system and the general public in road traffic. An effective
ethanol antagonist is unlikely to be found. For particular circumstances,
such as diving (hyperbaric oxygen), driving under the influence (behavioral
means, nonspecific stimulants, prostaglandin synthetase antagonists), and
arousing inebriated patients in emergency rooms (naloxone, physostigmine),
partial solutions are available. Acceleration of the metabolism of ethanol
by fructose might lead to blood-alcohol concentrations which are below the
'legal' limit the next morning. If these partial solutions are even slightly
successful they can make significant savings both in human suffering and
material resources. A particular caveat for researchers in this field seems
to be the inability to generalize results from rodents to man. Healthy young
individuals as experimental subjects are a satisfactory model for occasional
alcohol users but their results may not be generalized to chronic alcoholics
who have developed some tolerance to ethanol effects, as well as concomitant
alterations in the turn-over of various neurotransmitter amines and/or
peptides.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
aminophylline
amphetamine
apomorphine
caffeine
carbidopa
chlordiazepoxide
diazepam
doxapram
fenmetozole
indometacin
levodopa
naloxone
nicotine
phenylbutazone
physostigmine
placebo
protirelin
pyritinol
serotonin
vasopressin
vitamin
EMTREE DRUG INDEX TERMS
adrenergic receptor stimulating agent
benzodiazepine derivative
central stimulant agent
cholinergic receptor stimulating agent
clomethiazole
fructose
neuropeptide
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcohol intoxication
alcoholism
coma
drug antagonism
drug metabolism
intoxication
pharmacokinetics
EMTREE MEDICAL INDEX TERMS
central nervous system
hyperbaric oxygen therapy
review
short survey
therapy
CAS REGISTRY NUMBERS
alcohol (64-17-5)
aminophylline (317-34-0)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
apomorphine (314-19-2, 58-00-4)
caffeine (58-08-2)
carbidopa (28860-95-9)
chlordiazepoxide (438-41-5, 58-25-3)
clomethiazole (1867-58-9, 533-45-9)
diazepam (439-14-5)
doxapram (113-07-5, 309-29-5, 7081-53-0)
fenmetozole (23712-05-2, 41473-09-0)
fructose (30237-26-4, 57-48-7, 7660-25-5, 77907-44-9)
indometacin (53-86-1, 74252-25-8, 7681-54-1)
levodopa (59-92-7)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
phenylbutazone (129-18-0, 50-33-9, 8054-70-4)
physostigmine (57-47-6, 64-47-1)
protirelin (24305-27-9)
pyritinol (10049-83-9, 1098-97-1)
serotonin (50-67-9)
vasopressin (11000-17-2)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1982237292
MEDLINE PMID
6801705 (http://www.ncbi.nlm.nih.gov/pubmed/6801705)
PUI
L12027408
DOI
10.1016/0163-7258(81)90019-X
FULL TEXT LINK
http://dx.doi.org/10.1016/0163-7258(81)90019-X
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1562
TITLE
Cardiac emergencies
AUTHOR NAMES
Mather H.G.
AUTHOR ADDRESSES
(Mather H.G.) Southmead Hosp., Bristol
CORRESPONDENCE ADDRESS
Southmead Hosp., Bristol
SOURCE
Practitioner (1981) 225:1358 (1093-1096). Date of Publication: 1981
ISSN
0032-6518
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline
antacid agent
antihypertensive agent
atropine
bicarbonate
calcium chloride
cyclizine
diamorphine
epinephrine
furosemide
glyceryl trinitrate
hydrocortisone
lidocaine
metoclopramide
morphine
naloxone
practolol
procainamide
verapamil
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
angina pectoris
collapse
dyspnea
emergency
emergency medicine
faintness
heart arrest
heart infarction
heart ventricle fibrillation
lung embolism
thorax pain
EMTREE MEDICAL INDEX TERMS
cardiovascular system
drug therapy
heart
intravenous drug administration
respiratory system
therapy
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
calcium chloride (10043-52-4)
cyclizine (303-25-3, 5897-18-7, 82-92-8)
diamorphine (1502-95-0, 561-27-3)
furosemide (54-31-9)
glyceryl trinitrate (55-63-0)
hydrocortisone (50-23-7)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
metoclopramide (12707-59-4, 2576-84-3, 364-62-5, 7232-21-5)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
practolol (6673-35-4)
procainamide (51-06-9, 614-39-1)
verapamil (152-11-4, 52-53-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Cardiovascular Diseases and Cardiovascular Surgery (18)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1981231952
MEDLINE PMID
7323002 (http://www.ncbi.nlm.nih.gov/pubmed/7323002)
PUI
L11007952
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1563
TITLE
Repeat anesthesia for emergency surgery in a patient suspected of having
malignant hyperpyrexia
AUTHOR NAMES
Hammer D.J.
AUTHOR ADDRESSES
(Hammer D.J.) Dept. Anesthesiol., Hosp. Joint Dis., North Gen. Hosp., New
York, N.Y.
CORRESPONDENCE ADDRESS
Dept. Anesthesiol., Hosp. Joint Dis., North Gen. Hosp., New York, N.Y.
SOURCE
Anesthesiology Review (1981) 8:4 (37-39). Date of Publication: 1981
ISSN
0093-4437
ABSTRACT
When used to prepare patients known or suspected of being MH sensitive, oral
dantrolene sodium has been prescribed two to three days prior to surgery.
Described on this paper is the anesthetic management of a patient who had an
aborted hyperpyrexial episode, and returned months later for emergency
surgery.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
bicarbonate
dantrolene
droperidol
enflurane
fentanyl
furosemide
mannitol
naloxone
nitrous oxide
oxygen
pancuronium
pyridostigmine
suxamethonium
thiopental
tubocurarine chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
emergency
malignant hyperthermia
multiple anesthesia
surgery
EMTREE MEDICAL INDEX TERMS
case report
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
bicarbonate (144-55-8, 71-52-3)
dantrolene (14663-23-1, 7261-97-4)
droperidol (548-73-2)
enflurane (13838-16-9)
fentanyl (437-38-7)
furosemide (54-31-9)
mannitol (69-65-8, 87-78-5)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
oxygen (7782-44-7)
pyridostigmine (101-26-8, 155-97-5)
suxamethonium (306-40-1, 71-27-2)
thiopental (71-73-8, 76-75-5)
tubocurarine chloride (57-94-3, 57-95-4, 8006-51-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Drug Literature Index (37)
Neurology and Neurosurgery (8)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1981148773
PUI
L11116562
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1564
TITLE
Antidotes for use in emergency medicine
ORIGINAL (NON-ENGLISH) TITLE
ANTIDOTES POUR LA MEDECINE D'URGENCE
AUTHOR NAMES
Ducobu J.
Askenasi R.
AUTHOR ADDRESSES
(Ducobu J.; Askenasi R.) Serv. Med., Cent. Hosp. Tivoli, 7100 La Louviere
CORRESPONDENCE ADDRESS
Serv. Med., Cent. Hosp. Tivoli, 7100 La Louviere
SOURCE
Ars Medici Revue Internationale de Therapie Pratique (1981) 36:3 (281-285).
Date of Publication: 1981
ISSN
0374-5783
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
antidote
atropine
calcium glubionate
cobalt edetate
deferoxamine
dimercaprol
edetic acid
ethylbenztropine
ferric ferrocyanide
formaldehyde sodium sulfoxylate
fuller earth
menadione
methylene blue
naloxone
neostigmine
penicillamine
phenytoin
physostigmine
pralidoxime
protamine
pyridostigmine
pyridoxine
sodium thiosulfate
EMTREE DRUG INDEX TERMS
deferoxamine mesylate
edetate calcium disodium
kelocyamor
physostigmine salicylate
phytomenadione
ponalide
pralidoxime mesilate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
intoxication
EMTREE MEDICAL INDEX TERMS
drug therapy
short survey
therapy
DRUG TRADE NAMES
antilirium
benadon
contrathion
desferal
kelocyamor
konakion
mestinon
narcan
ponalide
prostigmine
rongalite
sormetal
CAS REGISTRY NUMBERS
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
calcium glubionate (12569-38-9)
cobalt edetate (14931-83-0, 36499-65-7)
deferoxamine mesylate (138-14-7, 5115-09-3)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
edetate calcium disodium (62-33-9)
edetic acid (150-43-6, 60-00-4)
ethylbenztropine (524-83-4)
ferric ferrocyanide (12240-15-2, 14038-43-8, 14433-93-3, 14460-02-7)
formaldehyde sodium sulfoxylate (149-44-0)
fuller earth (8031-18-3)
menadione (58-27-5)
methylene blue (61-73-4)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
penicillamine (2219-30-9, 52-67-5)
phenytoin (57-41-0, 630-93-3)
physostigmine salicylate (57-64-7, 71214-04-5)
physostigmine (57-47-6, 64-47-1)
phytomenadione (11104-38-4, 84-80-0)
pralidoxime mesilate (154-97-2)
pralidoxime (6735-59-7)
protamine (11061-43-1, 9007-31-2, 9012-00-4)
pyridostigmine (101-26-8, 155-97-5)
pyridoxine (12001-77-3, 58-56-0, 65-23-6, 8059-24-3)
sodium thiosulfate (10102-17-7, 7772-98-7, 8052-33-3)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1981101000
PUI
L11132787
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1565
TITLE
For the emergency bag: naloxone
ORIGINAL (NON-ENGLISH) TITLE
POUR LA TROUSSE D'URGENCE: LA NALOXONE
AUTHOR NAMES
Dangoumau J.
AUTHOR ADDRESSES
(Dangoumau J.)
SOURCE
Bordeaux Medical (1980) 13:14 (687). Date of Publication: 1980
ISSN
0021-7867
ABSTRACT
Even by definition, naloxone is devoid of peculiar pharmacological effects.
Given alone to the healthy individual, it does not cause any pharmacological
response. Although chemically related to morphia and its derivatives, it
does not have any of their properties; it is not analgesic, it does not
depress the respiration, it does not induce any drug addiction, and it does
not provoke dysphorias. On the contrary, it suppresses the effects of the
morphinomimetics, and it is here that its importance lies. It is indicated
in cases of overdosage with morphinomimetics (in particular, but not
exclusively in anaesthetic resuscitation). In a few instants it abolishes
respiratory depression and may re-establish consciousness. Naloxone is
better than nalorphine, that so far has been used for the same purpose. It
is therefore an indispensable product in an emergency bag.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
codeine
dextromoramide
dextropropoxyphene
diamorphine
fentanyl
morphine
naloxone
opiate
oxycodone
paregoric
pentazocine
pethidine
phenoperidine
EMTREE DRUG INDEX TERMS
eubispasme
fostamatinib
sedol
spasmalgin
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
emergency
emergency medicine
respiration depression
EMTREE MEDICAL INDEX TERMS
drug indication
intramuscular drug administration
intravenous drug administration
respiratory system
subcutaneous drug administration
DRUG TRADE NAMES
dolosal
eubine
eubispasme
fortal
palfium
r 406
sedol
spasmalgine
CAS REGISTRY NUMBERS
codeine (76-57-3)
dextromoramide (2922-44-3, 357-56-2)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
fentanyl (437-38-7)
morphine (52-26-6, 57-27-2)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxycodone (124-90-3, 76-42-6)
paregoric (8029-99-0)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenoperidine (3627-49-4, 562-26-5)
sedol (8060-47-7)
spasmalgin (8058-52-4)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
French
EMBASE ACCESSION NUMBER
1980221318
PUI
L10000118
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1566
TITLE
Anesthesia and analgesia in catastrophes: Doing without the usual aids
ORIGINAL (NON-ENGLISH) TITLE
AUF GEWOHNTE HILFSMITTEL UND VERFAHREN MUSS VERZICHTET WERDEN
AUTHOR NAMES
Walter F.
Wiemers K.
AUTHOR ADDRESSES
(Walter F.; Wiemers K.) Inst. Anasth., Univ., 7800 Freiburg
CORRESPONDENCE ADDRESS
Inst. Anasth., Univ., 7800 Freiburg
SOURCE
Notfall Medizin (1980) 6:12 (1201-1212). Date of Publication: 1980
ISSN
0341-2903
ABSTRACT
There is no pat solution for anesthetisation and pain alleviation in
disaster situations. There is no non-dangerous anesthetic procedure or drug
that can be applied without risk on every patient in every situation by
every person after a brief introduction. He must make do with simple means
in unfavorable conditions and get rid of any preconceptions derived from his
daily routine. Emergency and crisis situations can only be mastered if there
is freedom to improvise and if this is exercised responsibly. However,
improvisation is only successful if it is the product of profound knowledge
and ideas capable of being realized.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
aminophenazone
barbituric acid derivative
diazepam
droperidol
ketamine
levallorphan
local anesthetic agent
naloxone
nitrous oxide
opiate
phenacetin
pyrazolone
salicylic acid derivative
EMTREE DRUG INDEX TERMS
ketamine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
analgesia
anesthesia
disaster
emergency health service
EMTREE MEDICAL INDEX TERMS
central nervous system
drug comparison
peripheral nervous system
short survey
therapy
DRUG TRADE NAMES
ketanest
CAS REGISTRY NUMBERS
alcohol (64-17-5)
aminophenazone (58-15-1, 8058-63-7)
diazepam (439-14-5)
droperidol (548-73-2)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
levallorphan (13075-35-9, 152-02-3)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
phenacetin (62-44-2)
pyrazolone (137-44-0, 137-45-1, 39455-90-8)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Drug Literature Index (37)
Surgery (9)
LANGUAGE OF ARTICLE
German
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
1981069088
PUI
L11164875
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1567
TITLE
Addictive drug emergencies
ORIGINAL (NON-ENGLISH) TITLE
RAUSCHDROGEN-NOTFALL
AUTHOR NAMES
Faust V.
Rothenbacher H.
Leutner V.
AUTHOR ADDRESSES
(Faust V.; Rothenbacher H.; Leutner V.) Ber. Forschung Lehre, PLK
Weissenau-Ravensburg
CORRESPONDENCE ADDRESS
Ber. Forschung Lehre, PLK Weissenau-Ravensburg
SOURCE
Notfall Medizin (1980) 6:10 (928-940). Date of Publication: 1980
ISSN
0341-2903
ABSTRACT
The diagnosis and therapy of emergencies in drug addiction are summarized.
It is difficult to assess how often emergencies occur among users of
addictive drugs. In general, the addicts sort that out amongst themselves.
Nevertheless - depending on the area - one has to expect such incidents to
occur sooner or later. Though emergency intoxication cases are unpleasant
enough, the situation with respect to addictive drugs is even more
difficult, especially where the question of differential diagnosis is
concerned. In the exaggerated drama of such an occassion, it is advisable to
proceed systematically. Cool observation, quiet reflection and appropriate
action are the steps which are particularly advisable in dealing with such
cases in which far more is involved than just the intoxicant.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetone
amphetamine derivative
benzene
chloroform
cocaine
dimethoxymethyl amphetamine
ether
lysergic acid
lysergide
mescaline
opiate
psilocybine
psychedelic agent
tetrahydrocannabinol
EMTREE DRUG INDEX TERMS
amitriptyline
amitriptyline plus chlordiazepoxide
bromazepam
chlordiazepoxide
chlorpromazine
chlorprothixene
clobazam
clomethiazole
clorazepate
clorazepate dipotassium
diazepam
dihydroergotamine
dihydroergotamine mesilate
fluphenazine
fluphenazine decanoate
haloperidol
levallorphan
levallorphan tartrate
lortral
nalorphine
naloxone
narcantil
neurosil
norfenefrine
oxazepam
pentazocine
perphenazine
pethidine
promethazine
propranolol
reserpine
thioridazine
tilidine
unclassified drug
valorlon
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug abuse
drug dependence
drug overdose
emergency medicine
hallucination
Ipomoea
respiration depression
EMTREE MEDICAL INDEX TERMS
respiratory system
short survey
DRUG TRADE NAMES
adumbran
atosil
decentan
dihydergot
distraneurin
dociton
dolantin
frisium
haldol
laroxyl
lethidrone
lexotanil
librium
limbatril
lorfan
lortral
lyogen
megaphen
melleril
narcan
narcantil
neurosil
novadral
saroten
tranxilium
truxal
tryptizol
valium
valorlon
CAS REGISTRY NUMBERS
acetone (67-64-1)
amitriptyline (50-48-6, 549-18-8)
benzene (71-43-2)
bromazepam (1812-30-2)
chlordiazepoxide (438-41-5, 58-25-3)
chloroform (67-66-3)
chlorpromazine (50-53-3, 69-09-0)
chlorprothixene (113-59-7, 6469-93-8)
clobazam (22316-47-8)
clomethiazole (1867-58-9, 533-45-9)
clorazepate dipotassium (57109-90-7)
clorazepate (20432-69-3, 23887-31-2)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
dihydroergotamine mesilate (6190-39-2)
dihydroergotamine (511-12-6)
ether (60-29-7)
fluphenazine decanoate (5002-47-1)
fluphenazine (146-56-5, 69-23-8)
haloperidol (52-86-8)
levallorphan tartrate (71-82-9)
levallorphan (13075-35-9, 152-02-3)
limbitrol (51248-68-1, 68967-28-2)
lysergic acid (82-58-6)
lysergide (50-37-3)
mescaline (11006-96-5, 54-04-6, 832-92-8)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
norfenefrine (15308-34-6, 4779-94-6, 536-21-0, 636-87-3)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
oxazepam (604-75-1)
pentazocine (359-83-1, 64024-15-3)
perphenazine (58-39-9)
pethidine (28097-96-3, 50-13-5, 57-42-1)
promethazine (58-33-3, 60-87-7)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
psilocybine (520-52-5)
reserpine (50-55-5, 8001-95-4)
tetrahydrocannabinol (1972-08-3)
thioridazine (130-61-0, 50-52-2)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
Drug Literature Index (37)
Adverse Reactions Titles (38)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1981040981
PUI
L11200768
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1568
TITLE
Out-patient treatment and emergency therapy of drug-addicted young people
ORIGINAL (NON-ENGLISH) TITLE
AMBULANTE BEHANDLUNG UND NOTFALLTHERAPIE BEI JUGENDLICHEN DROGENABHANGIGEN
AUTHOR NAMES
Bron B.
AUTHOR ADDRESSES
(Bron B.) Univ. Nervenklin., 3400 Bonn
CORRESPONDENCE ADDRESS
Univ. Nervenklin., 3400 Bonn
SOURCE
Medizinische Welt (1980) 31:18 (678-683). Date of Publication: 1980
ISSN
0025-8512
ABSTRACT
The medical treatment of young drug addicts can only be carried out when
there is adequate cooperation between drug counselling centres, clinical
facilities, and self-help groups. The treatment of acute emergency and
crisis situations and diagnosis and therapy of accompanying or later illness
are important tasks for medical care. The doctor often enjoys a high degree
of confidence which could be utilised for therapy of drug addicts. The
special problems of a doctor-patient relationship and also a few basic
guidelines for pharmacotherapy of drug addicts must be taken into account.
Young drug addicts often show characteristic intoxication and withdrawal
syndromes with typical consequences. Particular difficulties often occur in
young fixers; they require a different approach, and other issues must be
taken into account.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
amphetamine
atropine
azapetine
cannabis
chlordiazepoxide
clorazepate
cocaine
diazepam
fenetylline
hypnotic agent
levallorphan
lorazepam
medazepam
methadone
methaqualone
methylphenidate
morphine
nalorphine
naloxone
neostigmine
oxazepam
pentazocine
psychedelic agent
solvent
tilidine
EMTREE DRUG INDEX TERMS
levallorphan tartrate
mandrax
tanxilium
unclassified drug
vitalin
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug dependence
drug dependence treatment
emergency medicine
EMTREE MEDICAL INDEX TERMS
adolescent
central nervous system
drug therapy
short survey
therapy
DRUG TRADE NAMES
captagon
fortral
ilidar
lethidrone
librium
lorfan
mandrax
narcanti
nobrium
polamidon
praxiten
prostigmine
tanxilium
tavor
valium
valoron
vitalin
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
atropine (51-55-8, 55-48-1)
azapetine (130-83-6, 146-36-1)
cannabis (8001-45-4, 8063-14-7)
chlordiazepoxide (438-41-5, 58-25-3)
clorazepate (20432-69-3, 23887-31-2)
cocaine (50-36-2, 53-21-4, 5937-29-1)
diazepam (439-14-5)
fenetylline (1892-80-4, 3736-08-1)
levallorphan (13075-35-9, 152-02-3)
levallorphan tartrate (71-82-9)
lorazepam (846-49-1)
mandrax (8076-99-1)
medazepam (2898-11-5, 2898-12-6)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
methylphenidate (113-45-1, 298-59-9)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
oxazepam (604-75-1)
pentazocine (359-83-1, 64024-15-3)
tilidine (20380-58-9, 27107-79-5)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Psychiatry (32)
Public Health, Social Medicine and Epidemiology (17)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1980179846
MEDLINE PMID
7402073 (http://www.ncbi.nlm.nih.gov/pubmed/7402073)
PUI
L10084243
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1569
TITLE
Iatrogenic anesthetic emergencies in nondomestic animals: Three case reports
AUTHOR NAMES
Robinson P.T.
Janssen D.L.
AUTHOR ADDRESSES
(Robinson P.T.; Janssen D.L.) Jennings Cent. Zool. Med., San Diego Zoo, San
Diego, Calif. 92112
CORRESPONDENCE ADDRESS
Jennings Cent. Zool. Med., San Diego Zoo, San Diego, Calif. 92112
SOURCE
Journal of the American Animal Hospital Association (1980) 16:2 (279-282).
Date of Publication: 1980
ISSN
0587-2871
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
halothane
ketamine
naloxone
nitrous oxide
oxygen
pethidine
xylazine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
absorption
anesthesia
anesthesia complication
atelectasis
emergency
pneumothorax
respiration depression
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
cat
central nervous system
drug overdose
Haplorhini
iatrogenic disease
inhalational drug administration
injury
intramuscular drug administration
respiratory system
DRUG TRADE NAMES
fluothane
ketaset
narcan
rompun
DRUG MANUFACTURERS
(United States)Ayerst
(United States)Bristol
(United States)Endo
(United States)Haver Lockhart
CAS REGISTRY NUMBERS
halothane (151-67-7, 66524-48-9)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
oxygen (7782-44-7)
pethidine (28097-96-3, 50-13-5, 57-42-1)
xylazine (23076-35-9, 7361-61-7)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980165670
PUI
L10070422
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1570
TITLE
Immobilizing drug emergencies in humans
AUTHOR NAMES
Haigh J.C.
Haigh J.M.
AUTHOR ADDRESSES
(Haigh J.C.; Haigh J.M.) Veter. Clin. Studies, West. Coll. Veter. Med.,
Univ. Saskatchewan, Saskatoon
CORRESPONDENCE ADDRESS
Veter. Clin. Studies, West. Coll. Veter. Med., Univ. Saskatchewan, Saskatoon
SOURCE
Veterinary and Human Toxicology (1980) 22:2 (94-98). Date of Publication:
1980
ISSN
0145-6296
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acepromazine
carfentanil citrate
etorphine
fentanyl citrate
ketamine
naloxone
nicotine
phencyclidine
suxamethonium
xylazine
EMTREE DRUG INDEX TERMS
bayvet
immobilon
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug information
drug overdose
drug toxicity
EMTREE MEDICAL INDEX TERMS
human
human cell
intoxication
normal human
review
DRUG TRADE NAMES
bayvet
immobilon
ketaset
m 99
r 33799
rompun
sublimaze
DRUG MANUFACTURERS
(United States)Cutter
(United States)DM Pharmaceuticals
(Belgium)Janssen
(Canada)McNeil
(United Kingdom)reckitt and collman
(Canada)Rogar
CAS REGISTRY NUMBERS
acepromazine (61-00-7)
carfentanil citrate (61380-27-6)
etorphine (13764-49-3, 14521-96-1)
fentanyl citrate (990-73-8)
immobilon (39456-60-5)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
phencyclidine (77-10-1, 956-90-1)
suxamethonium (306-40-1, 71-27-2)
xylazine (23076-35-9, 7361-61-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980162807
PUI
L10067566
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1571
TITLE
Immobilizing drug emergencies in humans
AUTHOR NAMES
Haigh J.C.
Haigh J.M.
AUTHOR ADDRESSES
(Haigh J.C.; Haigh J.M.) Veter. Clin. Stud., West. Coll. Veter. Med., Univ.
Saskatchewan
CORRESPONDENCE ADDRESS
Veter. Clin. Stud., West. Coll. Veter. Med., Univ. Saskatchewan
SOURCE
Veterinary and Human Toxicology (1980) 22:1 (1-6). Date of Publication: 1980
ISSN
0145-6296
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acepromazine
carfentanil citrate
diprenorphine
etorphine
fentanyl
ketamine
naloxone
nicotine
paraldehyde
phencyclidine
suxamethonium
xylazine
EMTREE DRUG INDEX TERMS
fentanyl citrate
sa imobilon
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
drug toxicity
immobilization
intoxication
EMTREE MEDICAL INDEX TERMS
drug comparison
drug mechanism
prevention
therapy
DRUG TRADE NAMES
m 99
sa imobilon
sublimaze
DRUG MANUFACTURERS
da pharmaceuticals
(Belgium)Janssen
mcniel
CAS REGISTRY NUMBERS
acepromazine (61-00-7)
carfentanil citrate (61380-27-6)
diprenorphine (14357-78-9, 16808-86-9)
etorphine (13764-49-3, 14521-96-1)
fentanyl (437-38-7)
fentanyl citrate (990-73-8)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
naloxone (357-08-4, 465-65-6)
nicotine (54-11-5)
paraldehyde (123-63-7)
phencyclidine (77-10-1, 956-90-1)
suxamethonium (306-40-1, 71-27-2)
xylazine (23076-35-9, 7361-61-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Clinical and Experimental Pharmacology (30)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980110687
MEDLINE PMID
6987804 (http://www.ncbi.nlm.nih.gov/pubmed/6987804)
PUI
L10141405
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1572
TITLE
Propoxyphene overdose
AUTHOR NAMES
Goldfrank L.
AUTHOR ADDRESSES
(Goldfrank L.) Montefiore Hosp. Med. Cent., Bronx, N.Y.
CORRESPONDENCE ADDRESS
Montefiore Hosp. Med. Cent., Bronx, N.Y.
SOURCE
Topics in Emergency Medicine (1979) 1:3 (51-55). Date of Publication: 1979
ABSTRACT
An emergency department with a strong supportive and nonjudgmental approach
is necessary to deal with overdose patients. If the staff is hostile,
patients are prone to 'sign out' against medical advice. Such dangerous,
self-destructive acts can be avoided by having emergency medicine clinicians
act in accord with a basic principle; namely, these patients merit the best
care no matter how frequently they come to the hospital or how abusive they
may be to the staff.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
dextropropoxyphene
glucose
naloxone
EMTREE DRUG INDEX TERMS
alcohol
codeine
diamorphine
levallorphan
levallorphan tartrate
methadone
nalorphine
pentazocine
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug dependence
drug overdose
drug therapy
hallucination
vertigo
vomiting
EMTREE MEDICAL INDEX TERMS
oral drug administration
short survey
therapy
DRUG TRADE NAMES
darvon
lorfan
nalline
narcan
talwin
CAS REGISTRY NUMBERS
alcohol (64-17-5)
codeine (76-57-3)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
glucose (50-99-7, 84778-64-3)
levallorphan tartrate (71-82-9)
levallorphan (13075-35-9, 152-02-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
pentazocine (359-83-1, 64024-15-3)
EMBASE CLASSIFICATIONS
Forensic Science Abstracts (49)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Adverse Reactions Titles (38)
Internal Medicine (6)
Drug Literature Index (37)
Clinical and Experimental Pharmacology (30)
Anesthesiology (24)
Psychiatry (32)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980093923
PUI
L10187159
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1573
TITLE
Emergency medical service systems and poison control
AUTHOR NAMES
Micik S.
AUTHOR ADDRESSES
(Micik S.) San Diego Reg. Poison Cent., San Diego, Calif.
CORRESPONDENCE ADDRESS
San Diego Reg. Poison Cent., San Diego, Calif.
SOURCE
Topics in Emergency Medicine (1979) 1:3 (129-137). Date of Publication: 1979
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
ipecac
naloxone
nitrile
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug intoxication
emergency health service
emergency medicine
toxicity
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
central nervous system
editorial
inhalational drug administration
intoxication
prevention
therapy
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Internal Medicine (6)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980093931
MEDLINE PMID
10244024 (http://www.ncbi.nlm.nih.gov/pubmed/10244024)
PUI
L10187167
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1574
TITLE
Therapeutics in the pediatric emergency room
AUTHOR NAMES
Bottenfield G.
Cohen S.N.
AUTHOR ADDRESSES
(Bottenfield G.; Cohen S.N.) Dept. Ped., Wayne State Univ. Sch. Med.,
Detroit, Mich.
CORRESPONDENCE ADDRESS
Dept. Ped., Wayne State Univ. Sch. Med., Detroit, Mich.
SOURCE
Pediatric Clinics of North America (1979) 26:4 (867-881). Date of
Publication: 1979
ISSN
0031-3955
ABSTRACT
Most patients who visit a pediatric emergency room located in a hospital in
an urban setting have acute but noncritical health problems for which they
seek medical care and various other services available at the institution.
The most frequent indications for drug therapy in such a setting are acute
infectious processes. (The use of therapeutic agents in an emergency room
setting for acute febrile illnesses suspected of being caused by bacterial
infection is discussed elsewhere in this volume.) The remainder of the
patients who require immediate therapeutic intervention with pharmacologic
agents constitute about 10 to 15% of the total patient population each year.
This group includes infants and children with convulsive disorders, acute
asthmatic attacks, poisoning, cardiac arrhythmias, angioneurotic edema, and
anaphylaxis.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
aminophylline
diazepam
digoxin
diphenhydramine
epinephrine
hydroxyzine
ipecac
isoetarine
isoprenaline
lidocaine
methoxamine
naloxone
neostigmine
paraldehyde
phenobarbital
phenothiazine derivative
phenylephrine
phenytoin
physostigmine
procainamide
propranolol
quinidine
theophylline
tricyclic antidepressant agent
EMTREE DRUG INDEX TERMS
bronkosil
hydroxyzine embonate
physostigmine salicylate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anaphylaxis
angioneurotic edema
asthma
child health care
emergency
emergency health service
heart arrhythmia
intoxication
EMTREE MEDICAL INDEX TERMS
child
drug therapy
heart
respiratory system
therapy
DRUG TRADE NAMES
antilirium
atarax
benadryl
bronkosil
isuprel
neosynephrine
prostigmine
vasoxyl
vistaril
CAS REGISTRY NUMBERS
adrenalin (51-43-4, 55-31-2, 6912-68-1)
aminophylline (317-34-0)
diazepam (439-14-5)
digoxin (20830-75-5, 57285-89-9)
diphenhydramine (147-24-0, 58-73-1)
hydroxyzine (2192-20-3, 64095-02-9, 68-88-2)
hydroxyzine embonate (10246-75-0)
ipecac (8012-96-2)
isoetarine (50-96-4, 530-08-5, 63550-80-1)
isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
methoxamine (390-28-3, 61-16-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
paraldehyde (123-63-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenylephrine (532-38-7, 59-42-7, 61-76-7)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
physostigmine salicylate (57-64-7, 71214-04-5)
procainamide (51-06-9, 614-39-1)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
quinidine (56-54-2)
theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1980066559
MEDLINE PMID
537852 (http://www.ncbi.nlm.nih.gov/pubmed/537852)
PUI
L10160437
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1575
TITLE
Emergency management of poisoning and overdose
AUTHOR NAMES
Rothstein R.J.
AUTHOR ADDRESSES
(Rothstein R.J.) Div. Emergency Med., Univ. Chicago Hosp. Clin., Chicago,
Ill.
CORRESPONDENCE ADDRESS
Div. Emergency Med., Univ. Chicago Hosp. Clin., Chicago, Ill.
SOURCE
Comprehensive Therapy (1979) 5:1 (7-14). Date of Publication: 1979
ISSN
0098-8243
ABSTRACT
Poisoning, whether accidental or suicidal, is a common problem facing the
emergency physician. Although various treatments and some specific antidotes
are available, the mainstay in the treatment of drug overdose is supportive
care. To save the patient much can be, and oftentimes must be, accomplished
in the initial few moments of the encounter.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylcysteine
activated carbon
alcohol
antidote
apomorphine
atropine
barbituric acid derivative
cystamine
ethchlorvynol
ethylene glycol
glucose
glutethimide
ipecac
meprobamate
methanol
methionine
naloxone
nitrate
nitrite
oxygen
phenobarbital
phenytoin
physostigmine
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug absorption
drug intoxication
drug overdose
drug therapy
emergency medicine
heart arrest
hypotension
intestine
intoxication
seizure
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
digestive system
heart
short survey
suicide
therapy
DRUG TRADE NAMES
narcan
CAS REGISTRY NUMBERS
acetylcysteine (616-91-1)
activated carbon (64365-11-3, 82228-96-4)
alcohol (64-17-5)
apomorphine (314-19-2, 58-00-4)
atropine (51-55-8, 55-48-1)
cystamine (51-85-4, 56-17-7)
ethchlorvynol (113-18-8)
ethylene glycol (107-21-1)
glucose (50-99-7, 84778-64-3)
glutethimide (77-21-4)
ipecac (8012-96-2)
meprobamate (57-53-4)
methanol (67-56-1)
methionine (59-51-8, 63-68-3, 7005-18-7)
naloxone (357-08-4, 465-65-6)
nitrate (14797-55-8)
nitrite (14797-65-0)
oxygen (7782-44-7)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
phenytoin (57-41-0, 630-93-3)
physostigmine (57-47-6, 64-47-1)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
Pediatrics and Pediatric Surgery (7)
Psychiatry (32)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1979106122
MEDLINE PMID
759083 (http://www.ncbi.nlm.nih.gov/pubmed/759083)
PUI
L9105855
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1576
TITLE
Medical emergencies: narcotic intoxications
ORIGINAL (NON-ENGLISH) TITLE
AKUTE NOTFALLSITUATIONEN: VERGIFTUNGEN MIT BETAUBUNGSMITTELN
AUTHOR NAMES
Kimbel K.H.
AUTHOR ADDRESSES
(Kimbel K.H.) Dtsch. Arzteschaft, 5000 Koln 41
CORRESPONDENCE ADDRESS
Dtsch. Arzteschaft, 5000 Koln 41
SOURCE
Monatskurse fur die Arztliche Fortbildung (1978) 28:13 (490-491). Date of
Publication: 1978
ABSTRACT
Symptoms in the diagnosis of narcotic poisoning are discussed and emergency
treatment by antagonists is summarized.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
amphetamine
barbituric acid derivative
chlorpromazine
cocaine
dextromoramide
diphenoxylate
hexobarbital
ketobemidone
levallorphan
methadone
morphine
nalorphine
naloxone
narcotic analgesic agent
normethadone
pethidine
phenobarbital
piritramide
EMTREE DRUG INDEX TERMS
levallorphan tartrate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diagnosis
drug intoxication
drug therapy
emergency
intoxication
EMTREE MEDICAL INDEX TERMS
major clinical study
therapy
DRUG TRADE NAMES
evipan
lethidrone
lorfan
megaphen
narcan
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
chlorpromazine (50-53-3, 69-09-0)
cocaine (50-36-2, 53-21-4, 5937-29-1)
dextromoramide (2922-44-3, 357-56-2)
diphenoxylate (3810-80-8, 915-30-0)
hexobarbital (1335-39-3, 50-09-9, 56-29-1, 73543-95-0)
ketobemidone (469-79-4)
levallorphan tartrate (71-82-9)
levallorphan (13075-35-9, 152-02-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
normethadone (467-85-6)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
piritramide (302-41-0)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1979001271
PUI
L9001264
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1577
TITLE
The drug emergency
ORIGINAL (NON-ENGLISH) TITLE
DER DROGEN-NOTFALL
AUTHOR NAMES
Schirop T.
Ibe K.
AUTHOR ADDRESSES
(Schirop T.; Ibe K.) Reanimat. Zent., Med. Klin., Freie Univ., Berlin
CORRESPONDENCE ADDRESS
Reanimat. Zent., Med. Klin., Freie Univ., Berlin
SOURCE
Fortschritte der Medizin (1978) 96:43 (2185-2189). Date of Publication: 1978
ISSN
0015-8178
ABSTRACT
Overdose symptoms and therapeutic measures in cases of drug emergencies are
discussed with particular reference to cocaine, hashish, morphine, and
amphetamine intoxication.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetone
amphetamine
amphetaminil
barbituric acid derivative
cannabis
cocaine
codeine
diamorphine
dimethoxymethyl amphetamine
fenetylline
haloperidol
levallorphan
lysergide
mescaline
methadone
methamphetamine
morphine
nalorphine
naloxone
opiate
pentazocine
pethidine
prolintane
psychedelic agent
sedative agent
tilidine
tranquilizer
trichloroethylene
EMTREE DRUG INDEX TERMS
polamidone
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
diagnosis
drug dependence
drug therapy
drug toxicity
intoxication
EMTREE MEDICAL INDEX TERMS
article
short survey
therapy
DRUG TRADE NAMES
an 1
captagon
dolantin
fortral
haldol
katovit
lethidrone
pervitin
polamidone
valoron
CAS REGISTRY NUMBERS
acetone (67-64-1)
amphetamine (1200-47-1, 139-10-6, 156-34-3, 2706-50-5, 300-62-9, 51-62-7,
60-13-9, 60-15-1)
amphetaminil (17590-01-1)
cannabis (8001-45-4, 8063-14-7)
cocaine (50-36-2, 53-21-4, 5937-29-1)
codeine (76-57-3)
diamorphine (1502-95-0, 561-27-3)
fenetylline (1892-80-4, 3736-08-1)
haloperidol (52-86-8)
levallorphan (13075-35-9, 152-02-3)
lysergide (50-37-3)
mescaline (11006-96-5, 54-04-6, 832-92-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methamphetamine (28297-73-6, 51-57-0, 537-46-2, 7632-10-2)
morphine (52-26-6, 57-27-2)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
pentazocine (359-83-1, 64024-15-3)
pethidine (28097-96-3, 50-13-5, 57-42-1)
prolintane (1211-28-5, 493-92-5)
tilidine (20380-58-9, 27107-79-5)
trichloroethylene (79-01-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Public Health, Social Medicine and Epidemiology (17)
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Internal Medicine (6)
LANGUAGE OF ARTICLE
German
EMBASE ACCESSION NUMBER
1979073025
MEDLINE PMID
711114 (http://www.ncbi.nlm.nih.gov/pubmed/711114)
PUI
L9072836
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1578
TITLE
Emergency medical services and poison control
AUTHOR NAMES
Micik S.
AUTHOR ADDRESSES
(Micik S.) Div. EMS, County San Diego, San Diego, Calif. 92101
CORRESPONDENCE ADDRESS
Div. EMS, County San Diego, San Diego, Calif. 92101
SOURCE
Clinical Toxicology (1978) 12:3 (309-317). Date of Publication: 1978
ISSN
0009-9309
ABSTRACT
Most EMS programs have been developing patient care systems for the cardiac,
trauma, high-risk mother and infant, burn, and CNS injury patient groups,
and have not yet effectively approached the problems of the poisoned
patient. This lower priority for poisoning is most likely due to the
relative lack in most regions of sophisticated information resources and
clinical toxicologists or physicians with special interests in the poisoned
patients who could serve as leadership for the EMS system planners. The time
has come for a national effort to coordinate and consolidate resources and
initiate planning for the systematic care of the poisoned patient. It is no
longer defensible for patients to be treated without the benefit of modern
clinical toxicology because of a lack of organization and regionalization.
The national EMS program provides an opportunity and framework whereby the
professional organizations, their members, and others interested in
improving the care of poisoned patients can develop such comprehensive
systems. These organizations should jointly establish standards for regional
poison centers, and competency and certification processes for their
personnel. They should sponsor training programs for physicians in clinical
toxicology and assist regional EMS planners in consolidating the many
existing centers into functioning units that meet the needs of both patients
and the professionals treating them.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine
cyanide
naloxone
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
emergency
emergency medicine
intoxication
poison center
toxicity
EMTREE MEDICAL INDEX TERMS
short survey
United States
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
cyanide (57-12-5)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1978392456
MEDLINE PMID
657751 (http://www.ncbi.nlm.nih.gov/pubmed/657751)
PUI
L8387396
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1579
TITLE
Emergency situations: overdose
AUTHOR NAMES
Locket S.
AUTHOR ADDRESSES
(Locket S.) N E Thames Reg. Poisons Cent., Oldchurch Hosp., Romford, Essex
CORRESPONDENCE ADDRESS
N E Thames Reg. Poisons Cent., Oldchurch Hosp., Romford, Essex
SOURCE
British Journal of Hospital Medicine (1978) 19:3 (200-212). Date of
Publication: 1978
ISSN
0007-1064
ABSTRACT
A clinical evaluation of poisoning would suggest that with a few exceptions
and in the absence of expert knowledge, if treatment makes any contribution
to survival it is due to the early institution of effective cardiopulmonary
resuscitative measures and supportive therapy.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
antihistaminic agent
atropine
barbituric acid derivative
cobalt edetate
dextropropoxyphene
diamorphine
dimercaprol
heavy metal
insecticide
lysergide
methaqualone
naloxone
neostigmine
nitrite
opiate
orphenadrine
paracetamol
phenothiazine derivative
pralidoxime
pyridostigmine
thiosulfate
tricyclic antidepressant agent
trihexyphenidyl
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug intoxication
drug overdose
drug therapy
emergency
intoxication
EMTREE MEDICAL INDEX TERMS
therapy
DRUG TRADE NAMES
artane
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
atropine (51-55-8, 55-48-1)
cobalt edetate (14931-83-0, 36499-65-7)
dextropropoxyphene (1639-60-7, 469-62-5)
diamorphine (1502-95-0, 561-27-3)
dimercaprol (59-52-9)
lysergide (50-37-3)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
naloxone (357-08-4, 465-65-6)
neostigmine (114-80-7, 588-17-0, 59-99-4, 8048-84-8)
nitrite (14797-65-0)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
orphenadrine (341-69-5, 83-98-7)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
pyridostigmine (101-26-8, 155-97-5)
thiosulfate (14383-50-7)
trihexyphenidyl (144-11-6, 52-49-3)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Psychiatry (32)
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1978283305
PUI
L8280490
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1580
TITLE
Diphenoxylate poisoning
ORIGINAL (NON-ENGLISH) TITLE
Intoxicación por difenoxilato.
AUTHOR NAMES
Villalobos Cuevas E.
Soto Oviedo F.
Arnaiz Toledo C.
Bonavides Mateos C.
Flores Pérez M.
Figueroa Tarango A.
AUTHOR ADDRESSES
(Villalobos Cuevas E.; Soto Oviedo F.; Arnaiz Toledo C.; Bonavides Mateos
C.; Flores Pérez M.; Figueroa Tarango A.)
CORRESPONDENCE ADDRESS
E. Villalobos Cuevas,
SOURCE
Boletín médico del Hospital Infantil de México (1978) 35:1 (189-196). Date
of Publication: 1978 Jan-Feb
ISSN
0539-6115
ABSTRACT
During the year 1976, 18 patients intoxicated with lomotil were admitted to
the Emergency Service of the Centro Medico La Raza, I.M.S.S. with ages
fluctuating between 4 months and 3 years; the average age was 22 mos. 88.8%
of intoxications were accidental. Initial manifestations of atropinism and
diphenoxylate showed the same proportion and 22% showed mixed symptoms.
There were no deaths. All patients were given stomach washings and it was
seen that the earlier the washing was given, the lesser the symptoms showed.
The specific treatment given was with naloxone chloride (Narcanti) at a dose
of 10 micrograms, per kilo and per dose intravenously and was repeated as
often as necessary. Response was spectacular with improvement within 15
seconds. No patient showed side-effects to the application of the
antagonist. Lomotil intoxication rated up to 15% of the total sum of
intoxications admitted.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diphenoxylate (drug toxicity)
isonipecotic acid (drug toxicity)
EMTREE DRUG INDEX TERMS
naloxone (drug administration, drug therapy)
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
home accident
EMTREE MEDICAL INDEX TERMS
article
comparative study
drug screening
female
human
infant
intoxication (drug therapy)
male
preschool child
stomach lavage
tablet
CAS REGISTRY NUMBERS
diphenoxylate (3810-80-8, 915-30-0)
isonipecotic acid (498-94-2)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
Spanish
MEDLINE PMID
619926 (http://www.ncbi.nlm.nih.gov/pubmed/619926)
PUI
L8651183
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1581
TITLE
Emergency treatment of common poisons: emptying stomach
AUTHOR NAMES
Goulding R.
Volans G.N.
AUTHOR ADDRESSES
(Goulding R.; Volans G.N.) Poisons Unit, Guy's Hosp., London
CORRESPONDENCE ADDRESS
Poisons Unit, Guy's Hosp., London
SOURCE
Proceedings of the Royal Society of Medicine (1977) 70:11 (766-770). Date of
Publication: 1977
ISSN
0035-9157
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
apomorphine
arsenic
atropine
carbon monoxide
copper sulfate
deferoxamine
dimercaprol
ipecac
iron
lithium
magnesium sulfate
mercaptamine
methionine
naloxone
opiate
paracetamol
pesticide
pralidoxime
sodium chloride
sodium sulfate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency
intoxication
stomach emptying
EMTREE MEDICAL INDEX TERMS
major clinical study
therapy
CAS REGISTRY NUMBERS
apomorphine (314-19-2, 58-00-4)
arsenic (7440-38-2)
atropine (51-55-8, 55-48-1)
carbon monoxide (630-08-0)
copper sulfate (7758-98-7, 7758-99-8)
deferoxamine (70-51-9)
dimercaprol (59-52-9)
ipecac (8012-96-2)
iron (14093-02-8, 53858-86-9, 7439-89-6)
lithium (7439-93-2)
magnesium sulfate (7487-88-9)
mercaptamine (156-57-0, 27761-19-9, 60-23-1)
methionine (59-51-8, 63-68-3, 7005-18-7)
naloxone (357-08-4, 465-65-6)
opiate (53663-61-9, 8002-76-4, 8008-60-4)
paracetamol (103-90-2)
pralidoxime (6735-59-7)
sodium chloride (7647-14-5)
sodium sulfate (7757-82-6)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
Pediatrics and Pediatric Surgery (7)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1978210195
MEDLINE PMID
23545 (http://www.ncbi.nlm.nih.gov/pubmed/23545)
PUI
L8209086
COPYRIGHT
Copyright 2011 Elsevier B.V., All rights reserved.
RECORD 1582
TITLE
Emergencies related to alcohol and drug abuse
AUTHOR NAMES
Whitlock F.A.
AUTHOR ADDRESSES
(Whitlock F.A.) Dept. Psychiat., Univ. Queensland, Brisbane
CORRESPONDENCE ADDRESS
Dept. Psychiat., Univ. Queensland, Brisbane
SOURCE
Australian Family Physician (1977) 6:suppl. A (10-14). Date of Publication:
1977
ABSTRACT
The following four types of undesirable consequences of drinking and drug
taking probably cover most of the symptoms and syndromes likely to be
encountered: acute overdose, withdrawal syndromes, unexpected and
undesirable physical and psychological effects, and drug interactions.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
acetylsalicylic acid
alcohol
antidepressant agent
atropine
barbituric acid derivative
cannabis
central stimulant agent
disulfiram
drug
furosemide
heparin
lysergide
mescaline
methadone
methyldopa
metronidazole
morphine
nalidixic acid
naloxone
narcotic agent
pheniramine
phenothiazine derivative
phenytoin
psilocybine
sedative agent
tolbutamide
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
alcoholism
crisis intervention
drug abuse
drug interaction
emergency
emergency medicine
withdrawal syndrome
EMTREE MEDICAL INDEX TERMS
major clinical study
DRUG TRADE NAMES
aspirin
CAS REGISTRY NUMBERS
acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1)
alcohol (64-17-5)
atropine (51-55-8, 55-48-1)
cannabis (8001-45-4, 8063-14-7)
disulfiram (97-77-8)
furosemide (54-31-9)
heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5)
lysergide (50-37-3)
mescaline (11006-96-5, 54-04-6, 832-92-8)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
methyldopa (555-29-3, 555-30-6)
metronidazole (39322-38-8, 443-48-1)
morphine (52-26-6, 57-27-2)
nalidixic acid (389-08-2)
naloxone (357-08-4, 465-65-6)
pheniramine (86-21-5)
phenytoin (57-41-0, 630-93-3)
psilocybine (520-52-5)
tolbutamide (473-41-6, 64-77-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Drug Dependence, Alcohol Abuse and Alcoholism (40)
Psychiatry (32)
Anesthesiology (24)
Public Health, Social Medicine and Epidemiology (17)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1978231909
MEDLINE PMID
20871 (http://www.ncbi.nlm.nih.gov/pubmed/20871)
PUI
L8229942
COPYRIGHT
Copyright 2012 Elsevier B.V., All rights reserved.
RECORD 1583
TITLE
Problems in general anaesthesia. Emergencies and trauma
AUTHOR NAMES
Robinson G.J.B.
AUTHOR ADDRESSES
(Robinson G.J.B.) Alfred Hosp., Melbourne
CORRESPONDENCE ADDRESS
Alfred Hosp., Melbourne
SOURCE
Australian Family Physician (1977) 6:4 (313-317). Date of Publication: 1977
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
althesin
furosemide
naloxone
pancuronium
phenoperidine
propanidid
suxamethonium
thiopental
tubocurarine chloride
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
anesthesia
breathing
heart output
hemodynamics
injury
lung edema
shock
EMTREE MEDICAL INDEX TERMS
therapy
DRUG TRADE NAMES
epontol
CAS REGISTRY NUMBERS
althesin (8067-82-1)
furosemide (54-31-9)
naloxone (357-08-4, 465-65-6)
phenoperidine (3627-49-4, 562-26-5)
propanidid (1421-14-3)
suxamethonium (306-40-1, 71-27-2)
thiopental (71-73-8, 76-75-5)
tubocurarine chloride (57-94-3, 57-95-4, 8006-51-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Anesthesiology (24)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1978119021
MEDLINE PMID
880136 (http://www.ncbi.nlm.nih.gov/pubmed/880136)
PUI
L8118453
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1584
TITLE
Analysis of 50 cases of Lomotil poisoning in children
ORIGINAL (NON-ENGLISH) TITLE
Análisis de cincuenta casos de intoxicación por Lomotil en niños
AUTHOR NAMES
Jiménez Rentería E.
Garza Villarreal G.
Porcayo Vergara F.A.
Serafín F.J.
AUTHOR ADDRESSES
(Jiménez Rentería E.; Garza Villarreal G.; Porcayo Vergara F.A.; Serafín
F.J.)
CORRESPONDENCE ADDRESS
E. Jiménez Rentería,
SOURCE
Boletín médico del Hospital Infantil de México (1977) 34:2 (519-526). Date
of Publication: 1977 Mar-Apr
ISSN
0539-6115
ABSTRACT
The authors reviewed the clinical histories of 50 children admitted to the
Emergency Department of Hospital de Pediatría, C.M.N., I.M.S.S. from 1971
through 1975, with the diagnosis of lomotil intoxication. No differences
were found as to sex. Frequency was greater at ages from 2 to 3 years from
accidental mechanism, which increased between 1973 to 1975. Lethality was
similar to that reported by other authors. In the clinical picture, the
depressive action of diphenoxylate and the anticholinergic action of
atropine were outstanding, without being possible to establish the limits
between the two, with somnolence and flushness as main symptoms. The
treatment given followed the purpose to eliminate the toxic: emesis, gastric
washing and in cases of respiratory depression, naloxone was given.
Therefore, it is concluded that since the value of lomotil in the treatment
of diarrhea has not been proved and that the risk of its administration is
greater than the benefit, this product should be proscribed, specially for
pediatric use.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
atropine (drug therapy, drug toxicity)
isonipecotic acid (drug therapy, drug toxicity)
EMTREE MEDICAL INDEX TERMS
article
drug combination
drug screening
human
infant
infantile diarrhea (drug therapy)
intoxication (drug therapy)
Mexico
oral drug administration
preschool child
stomach lavage
CAS REGISTRY NUMBERS
atropine (51-55-8, 55-48-1)
isonipecotic acid (498-94-2)
LANGUAGE OF ARTICLE
Spanish
MEDLINE PMID
843415 (http://www.ncbi.nlm.nih.gov/pubmed/843415)
PUI
L7502141
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1585
TITLE
Emergency treatment of the poisoned patient
AUTHOR NAMES
Gent A.E.
AUTHOR ADDRESSES
(Gent A.E.) Salisbury Gen. Infirm., Salisbury
CORRESPONDENCE ADDRESS
Salisbury Gen. Infirm., Salisbury
SOURCE
Update (1976) 13:2 (105-112). Date of Publication: 1976
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
amitriptyline
antidote
barbituric acid
benzatropine mesilate
benzodiazepine
clomipramine
dexamethasone
furosemide
glutethimide
heavy metal
lidocaine
metaraminol
methaqualone
morphine analog
nalorphine
naloxone
orphenadrine
pentazocine
phenelzine
practolol
propranolol
salicylic acid derivative
thioridazine
tranylcypromine
trifluoperazine
EMTREE DRUG INDEX TERMS
mandrax
prochlorperazine maleate
unclassified drug
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
drug therapy
emergency
heart arrest
heart failure
intoxication
respiratory failure
EMTREE MEDICAL INDEX TERMS
therapy
DRUG TRADE NAMES
anafranil
aramine
cogentin
decadron
disipal
doriden
eraldin
fortral
inderal
lasix
lethidrone
mandrax
melleril
narcan
nardil
parnate
stemetil
tryptizol
xylocard
CAS REGISTRY NUMBERS
amitriptyline (50-48-6, 549-18-8)
barbituric acid (6191-25-9, 67-52-7)
benzatropine mesilate (132-17-2)
benzodiazepine (12794-10-4)
clomipramine (17321-77-6, 303-49-1)
dexamethasone (50-02-2)
furosemide (54-31-9)
glutethimide (77-21-4)
lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9)
mandrax (8076-99-1)
metaraminol (33402-03-8, 54-49-9)
methaqualone (340-56-7, 72-44-6, 8056-67-5)
nalorphine (1041-90-3, 57-29-4, 62-67-9)
naloxone (357-08-4, 465-65-6)
orphenadrine (341-69-5, 83-98-7)
pentazocine (359-83-1, 64024-15-3)
phenelzine (156-51-4, 51-71-8)
practolol (6673-35-4)
prochlorperazine maleate (84-02-6)
propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6)
thioridazine (130-61-0, 50-52-2)
tranylcypromine (13492-01-8, 155-09-9, 54-97-7)
trifluoperazine (117-89-5, 440-17-5)
EMBASE CLASSIFICATIONS
Anesthesiology (24)
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1977125521
PUI
L7125468
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1586
TITLE
Methadone overdoses in a New York City hospital
AUTHOR NAMES
Persky V.W.
Goldfrank L.R.
AUTHOR ADDRESSES
(Persky V.W.; Goldfrank L.R.) Dept. Med., Morrisania Montefiore Affiliat.,
Bronx, N.Y. 10452
CORRESPONDENCE ADDRESS
Dept. Med., Morrisania Montefiore Affiliat., Bronx, N.Y. 10452
SOURCE
Journal of the American College of Emergency Physicians and the Univ. Ass.
for Emergency Med. Services (1976) 5:2 (111-113). Date of Publication: 1976
ABSTRACT
Charts of the 81 methadone overdose patients admitted to Morrisania City
Hospital from the Emergency Department during the eight month period between
June, 1973 and January, 1974 were reviewed. There were 87 overdose cases in
the 81 patients. All were treated successfully with naloxone hydrochloride
administered intravenously. Four patients had pulmonary edema. In more than
half, liver and muscle function studies showed abnormalities. Ninety percent
(79) of the overdoses were associated with a combination of methadone and
other non opiate drugs, including alcohol.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
alcohol
antidote
barbituric acid derivative
creatine kinase
diazepam
methadone
naloxone
EMTREE DRUG INDEX TERMS
amitriptyline
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
drug control
drug mixture
drug overdose
drug therapy
liver toxicity
lung edema
muscle disease
EMTREE MEDICAL INDEX TERMS
intoxication
intravenous drug administration
oral drug administration
therapy
DRUG TRADE NAMES
elavil
narcan
valium
CAS REGISTRY NUMBERS
alcohol (64-17-5)
amitriptyline (50-48-6, 549-18-8)
creatine kinase (9001-15-4)
diazepam (439-14-5)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
EMBASE CLASSIFICATIONS
Adverse Reactions Titles (38)
Drug Literature Index (37)
Public Health, Social Medicine and Epidemiology (17)
Psychiatry (32)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1977015362
MEDLINE PMID
933393 (http://www.ncbi.nlm.nih.gov/pubmed/933393)
PUI
L7015352
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1587
TITLE
Treating heroin overdose.
AUTHOR NAMES
Neaderthal R.L.
Calabro J.J.
AUTHOR ADDRESSES
(Neaderthal R.L.; Calabro J.J.)
CORRESPONDENCE ADDRESS
R.L. Neaderthal,
SOURCE
American family physician (1975) 11:2 (141-145). Date of Publication: Feb
1975
ISSN
0002-838X
ABSTRACT
Immediate attention must be given to the respiratory system of the heroin
abuser; then he should be given naloxone HCl. Search for evidence of use of
additional drugs, which may compound problems. Pulmonary edema, aspiration
pneumonia and pulmonary embolization are the most common complications.
Infections, particularly endocarditis, and cardiac arrhythmia also occur
with heroin overdose. Hepatitis is common. Treatment must include not only
attention to the presenting symptoms but also referral to a rehabilitation
center when possible.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
diamorphine (drug toxicity)
EMTREE DRUG INDEX TERMS
methadone (drug therapy)
naloxone (drug therapy)
EMTREE MEDICAL INDEX TERMS
article
chemically induced disorder
dose response
emergency health service
endocarditis
female
gynecologic disease (complication)
heart arrhythmia
heroin dependence (complication, therapy)
human
infection (etiology)
lung edema
male
newborn
newborn disease
respiratory failure
toxic hepatitis (etiology)
CAS REGISTRY NUMBERS
diamorphine (1502-95-0, 561-27-3)
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
MEDLINE PMID
1124710 (http://www.ncbi.nlm.nih.gov/pubmed/1124710)
PUI
L5498820
COPYRIGHT
MEDLINE® is the source for the citation and abstract of this record.
RECORD 1588
TITLE
Physostigmine in drug overdose
AUTHOR NAMES
Brashares Z.A.
Conley W.R.
AUTHOR ADDRESSES
(Brashares Z.A.; Conley W.R.) Emergency Dept., W.A. Foote Mem. Hosp.,
Jackson, Mich. 49201
CORRESPONDENCE ADDRESS
Emergency Dept., W.A. Foote Mem. Hosp., Jackson, Mich. 49201
SOURCE
Journal of the American College of Emergency Physicians and the Univ. Ass.
for Emergency Med. Services (1975) 4:1 (46-48). Date of Publication: 1975
ABSTRACT
The use of physostigmine to combat the effect of barbiturates and certain
anticholinergic drugs in six cases is described. The significance of being
able to bring the patient to full consciousness and carry out effective and
safe emesis or lavage, combined with the usual supportive treatment, is
emphasized. Physostigmine should be available to physicians working in all
hospital emergency departments.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
antidote
barbituric acid derivative
chlordiazepoxide
cholinergic receptor
cholinergic receptor blocking agent
diazepam
diphenhydramine
glutethimide
ipecac
naloxone
perphenazine
phenobarbital
physostigmine
secobarbital
thioridazine
trihexyphenidyl
EMTREE DRUG INDEX TERMS
physostigmine salicylate
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
blood
clinical study
consciousness
drug comparison
drug dependence
drug determination
drug interaction
drug intoxication
drug mixture
drug overdose
drug therapy
drug toxicity
EMTREE MEDICAL INDEX TERMS
drug blood level
intravenous drug administration
major clinical study
oral drug administration
therapy
DRUG TRADE NAMES
antilirium
artane
doriden
ipecac
librium
mellaril
narcon
seconal
trilafon
valium
CAS REGISTRY NUMBERS
chlordiazepoxide (438-41-5, 58-25-3)
diazepam (439-14-5)
diphenhydramine (147-24-0, 58-73-1)
glutethimide (77-21-4)
ipecac (8012-96-2)
naloxone (357-08-4, 465-65-6)
perphenazine (58-39-9)
phenobarbital (50-06-6, 57-30-7, 8028-68-0)
physostigmine salicylate (57-64-7, 71214-04-5)
physostigmine (57-47-6, 64-47-1)
secobarbital (309-43-3, 76-73-3)
thioridazine (130-61-0, 50-52-2)
trihexyphenidyl (144-11-6, 52-49-3)
EMBASE CLASSIFICATIONS
Clinical and Experimental Pharmacology (30)
Drug Literature Index (37)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1975189833
PUI
L5189748
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1589
TITLE
Emergencies and complications from sedation modalities
AUTHOR NAMES
Trieger N.
AUTHOR ADDRESSES
(Trieger N.) Dept. Dent. Oral Surg., Montefiore Hosp., Bronx, N.Y.
CORRESPONDENCE ADDRESS
Dept. Dent. Oral Surg., Montefiore Hosp., Bronx, N.Y.
SOURCE
Dental Clinics of North America (1973) 17:3 (429-442). Date of Publication:
1973
ISSN
0011-8532
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
analgesic agent
barbituric acid derivative
chlorpromazine
cholinergic receptor blocking agent
diazepam
drug
isocarboxazid
local anesthetic agent
naloxone
nitrous oxide
pethidine
phenelzine
promethazine
secobarbital
tranylcypromine
EMTREE DRUG INDEX TERMS
pentobarbital
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
adverse drug reaction
anesthesia
dental procedure
drug interaction
hypotension
oral surgery
sedation
vasodilatation
vein thrombosis
EMTREE MEDICAL INDEX TERMS
autopsy
inhalational drug administration
intramuscular drug administration
intravenous drug administration
oral drug administration
review
therapy
DRUG TRADE NAMES
demerol
marplan
narcan
nardil
nembutal
parnate
phenergan
seconal
thorazine
valium
CAS REGISTRY NUMBERS
chlorpromazine (50-53-3, 69-09-0)
diazepam (439-14-5)
isocarboxazid (59-63-2)
naloxone (357-08-4, 465-65-6)
nitrous oxide (10024-97-2)
pentobarbital (57-33-0, 76-74-4)
pethidine (28097-96-3, 50-13-5, 57-42-1)
phenelzine (156-51-4, 51-71-8)
promethazine (58-33-3, 60-87-7)
secobarbital (309-43-3, 76-73-3)
tranylcypromine (13492-01-8, 155-09-9, 54-97-7)
EMBASE CLASSIFICATIONS
Drug Literature Index (37)
Adverse Reactions Titles (38)
Otorhinolaryngology (11)
LANGUAGE OF ARTICLE
English
EMBASE ACCESSION NUMBER
1974019950
MEDLINE PMID
4513763 (http://www.ncbi.nlm.nih.gov/pubmed/4513763)
PUI
L4019923
COPYRIGHT
Copyright 2009 Elsevier B.V., All rights reserved.
RECORD 1590
TITLE
Neuroleptanalgesia and dissociative drugs
AUTHOR NAMES
Greenfield W.
AUTHOR ADDRESSES
(Greenfield W.) Mt. Sinai Sch. Med., New York, NY, United States.
CORRESPONDENCE ADDRESS
W. Greenfield, Mt. Sinai Sch. Med., New York, NY, United States.
SOURCE
Dent. Clin. N. Amer. (1973) 17:2 (263-274). Date of Publication: 1973
ABSTRACT
A review of background material leading to the advent of dissociation
analgesia and neiuoleptanalgesia (NLA) is presented. The use of ketamine as
adapted to the ambulatory patient is outlined, together with revised weight
dosage guidelines for such use. Under these conditions, the drug is safe,
rapidly effective, easily administered, does not impair vital functions and
has a short duration of effect Additionally, it should prove useful in many
emergency room procedures and in restorative dentistry for certain
categories of patients. Of the techniques for producing NLA, a review of the
use of fentanyl and droperidol is given, together with suggested revisions
for the use of these drugs in ambulatory patients. They are valuable
additions to the available armamentarium for patient management In this
regard, the potential use of a new narcotic antagonist (naloxone) is noted,
which because of its very favorable properties may greatly expand the field
of usefulness of narcotics such as fentanyL In reviewing the various
dissociative and neuroleptic drugs, it would appear that ketamine has its
greatest usefulness in children and young adolescents under 100 lbs. of body
weight, while fentanyl and droperidol are most useful in adults and those
above 100 lbs. of body weight. A note of caution should be added with regard
to the apparent ease of administration of the neuroleptic and dissociative
drugs. It has been said that ketamine is so safe that it is dangerous, in
that unqualified individuals may be lured into using the drug for short
procedures. It must be stressed that these drugs should not be used by
anyone without adequate background and training in general anesthesia.
EMTREE DRUG INDEX TERMS
droperidol
fentanyl
ketamine
naloxone
narcotic agent
narcotic antagonist
neuroleptic agent
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
neuroleptanalgesia
EMTREE MEDICAL INDEX TERMS
adolescent
adult
analgesia
anesthesia
body weight
child
dentistry
dissociation
emergency ward
general anesthesia
outpatient
patient
patient care
weight
CAS REGISTRY NUMBERS
droperidol (548-73-2)
fentanyl (437-38-7)
ketamine (1867-66-9, 6740-88-1, 81771-21-3)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008745599
PUI
L293115607
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1591
TITLE
Apomorphine naloxone controlled rapid emesis
AUTHOR NAMES
Rausten D.S.
Ochs M.A.
AUTHOR ADDRESSES
(Rausten D.S.; Ochs M.A.) 840 Third Ave., Chula Vista, CA 92011, United
States.
CORRESPONDENCE ADDRESS
D.S. Rausten, 840 Third Ave., Chula Vista, CA 92011, United States.
SOURCE
JACEP (1973) 2:1 (44-45). Date of Publication: 1973
ISSN
0361-1124
ABSTRACT
The emergency treatment of most ingestion problems involves gastric lavage
or induction of emesis. Forceful emesis, superior to lavage, is usually
induced by syrup of ipecac. A more rapid, efficient and controlled method
utilizing apomorphine hydrochloride and a narcotic antagonist has not been
popular because of difficulties in determining dosage in addition to the
problems raised by the depressant properties of both the apomorphine and its
antagonists. The absence of depressant effects with the newer antagonist,
naloxone hydrochloride, renders it safer for use in terminating emesis
induced by apomorphine. A dose calculated schedule, based on a level of
0.066 mg/kg for apomorphine and 0.01 mg/kg naloxone is provided along with a
single protocol for the mixing and administration of the drugs in
emergencies.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
apomorphine
naloxone
EMTREE DRUG INDEX TERMS
ipecac
narcotic antagonist
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
vomiting
EMTREE MEDICAL INDEX TERMS
emergency
emergency treatment
ingestion
intoxication
lavage
stomach lavage
CAS REGISTRY NUMBERS
apomorphine (314-19-2, 58-00-4)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008746202
PUI
L293116210
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.
RECORD 1592
TITLE
Naloxone reversal of methadone poisoning
AUTHOR NAMES
Buchner L.H.
Cimino J.A.
Raybin H.W.
Stewart B.
AUTHOR ADDRESSES
(Buchner L.H.; Cimino J.A.; Raybin H.W.; Stewart B.) Poison Contr. Cent.,
City Dept. Hlth., New York, NY 10016, United States.
CORRESPONDENCE ADDRESS
L.H. Buchner, Poison Contr. Cent., City Dept. Hlth., New York, NY 10016,
United States.
SOURCE
New York State Journal of Medicine (1972) 72:18 (2305-2309). Date of
Publication: 1972
ISSN
0028-7628
ABSTRACT
Clinical data are presented indicating that naloxone is the antidote of
choice for methadone and suspected other narcotic poisoning. It will reverse
the respiratory depression of methadone poisoning but will not precipitate
respiratory failure as other narcotic antagonists (nalorphine and
levallorphan) may, if the poisoning drug proves to be a non narcotic
respiratory depressant. When used in the emergency treatment of methadone
poisoning, 0.01 mg. per kilo of naloxone is administered intravenously. A
maximum response is observed in 2 to 3 min: pupils dilate, subnormal blood
pressure rises, respiratory rate increases, and the level of consciousness
improves. If the respiratory depression persists, the 0.01 mg. per kg dose
is repeated in five minutes. Patients should be observed in the hospital for
at least 48 hr and additional doses given, if necessary, to prevent relapse.
Naloxone provides safe, effective, and rapid reversal of methadone
poisoning.
EMTREE DRUG INDEX TERMS (MAJOR FOCUS)
methadone
naloxone
EMTREE DRUG INDEX TERMS
analgesic agent
antidote
levallorphan
nalorphine
narcotic agent
narcotic analgesic agent
narcotic antagonist
EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS)
intoxication
EMTREE MEDICAL INDEX TERMS
adverse drug reaction
blood pressure
breathing rate
clinical study
consciousness
emergency treatment
hospital
patient
relapse
respiration depression
respiratory failure
therapy
CAS REGISTRY NUMBERS
methadone (1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3)
naloxone (357-08-4, 465-65-6)
LANGUAGE OF ARTICLE
English
LANGUAGE OF SUMMARY
English
EMBASE ACCESSION NUMBER
2008848509
PUI
L293148369
COPYRIGHT
Copyright 2007 Elsevier B.V., All rights reserved.