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 
30<sup>th</sup> 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 &quot;high-cost patients,&quot; 
and the remaining patients were classified as &quot;lower-cost 
patients.&quot; 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 &lt; 0.001) and more likely to be 
female (55.9[%] vs. 42.9[%]; P &lt; 0.001). They had a higher comorbidity 
burden at baseline, as reflected in the Charlson Comorbidity Index (0.8 vs. 
0.2; P &lt; 0.001), and rates of conditions such as chronic pulmonary 
disease (12.9[%] vs. 5.6[%]; P &lt; 0.001) and mild/moderate diabetes 
(8.4[%] vs. 3.4[%]; P &lt; 0.001). High-cost patients also had higher rates 
of nonopioid substance abuse diagnoses (12.4[%] vs. 8.9[%]; P &lt; 0.001) 
and psychotic disorders (26.5[%] vs. 13.6[%]; P &lt; 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 &lt; 0.001) and 
psychotic disorders (67.1[%] vs. 47.5[%]; P &lt; 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 &lt; 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 
&lt; 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 &#177; 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 &lt; 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 &lt; 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 
(PaO<inf>2</inf> to FiO<inf>2</inf> 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 
(PaO<inf>2</inf>/F<inf>i</inf>O<inf>2</inf> = 57) caused by aspiration 
following heroin overdose, using non-invasive ventilation with high positive 
end expiratory pressure 15-20 cm H<inf>2</inf>O) along with low pressure 
support (8 cm H<inf>2</inf>O) 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&#39;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.