bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advantage of High‐surface‐area Charcoal for Gastrointestinal Decontamination in a Human Acetaminophen Ingestion Model
Authors: Roberts James R. , Gracely Ed. J. , Schoffstall John M. 
Published: September 2008

ABSTRACTObjective: To compare the abilities of low‐surface‐area (LSA) vs 2 types of high‐surface‐area (HSA) activated charcoal given orally to adsorb acetaminophen in the gastrointestinal (GI) tract, as demonstrated by the impact of these agents on the serum levels and area under the curve (AUC) in a simulated human overdose model.Methods: The main arm of the study was a prospective double‐blind crossover trial in which 6 volunteers, serving as their own controls, ingested acetaminophen (50 mg/kg), followed randomly in 10 minutes by either powdered LSA charcoal (950 m2/g) or powdered HSA charcoal (2,000 m2/g) in a charcoal:drug ratio of 8:1. In a second arm of the study, 3 subjects additionally ingested an equal dose of a granular preparation of the HSA charcoal. Serial serum acetaminophen levels were analyzed at various intervals (30, 60, 90, 120, 180, 240, and 300 minutes postingestion), and a 5‐hour AUC was calculated. The subjects also rated the charcoal preparations for palatability.Results: Serum acetaminophen levels were lower at all measured times in the groups receiving both forms of the HSA charcoal vs the LSA product. With the powdered HSA charcoal, comparison serum levels were significantly lower at 120 minutes postingestion and all times thereafter (p < 0.05), reaching high significance at 4 and 5 hours (p < 0.001). The subjects receiving the granular HSA charcoal also had consistently lower serum acetaminophen levels than did those receiving the LSA product, and the difference in mean serum levels was significant at the 4‐ and 5‐hour sample (p = 0.012). Compared with the LSA charcoal, at the 4‐hour postingestion sample, serum acetaminophen levels were reduced by 44% to 85% by the powdered HSA charcoal. The total AUC for the 5‐hour study period was also significantly reduced by the powdered HSA product (p = 0.005) and the granular HSA product (p = 0.043). All the subjects rated the powdered HSA charcoal to be more palatable and easier to drink than the powdered LSA charcoal.Conclusion: The surface area of oral activated charcoal is a major determining factor in its ability to limit acetaminophen absorption and to fulfill its adsorptive role in GI decontamination. In a human acetaminophen overdose model, 2 types of HSA charcoal, when compared with equal doses of LSA charcoal, significantly reduced serum levels and total acetaminophen absorption as measured by the AUC.
Enhancement of Lithium Elimination by Multiple‐dose Sodium Polystyrene Sulfonate
Authors: Linakis James G. , Hull Keith M. , Lacouture Peter G. , Lockhart Gregory R. , Lewander William J. , Maher Timothy J. 
Published: September 2008

ABSTRACTObjective: To determine whether multiple doses of sodium polystyrene sulfonate (SPS) enhance the elimination of IV‐administered lithium (Li).Methods: The study was a placebo‐controlled, investigator‐unblinded, murine trial of multiple doses of SPS on serum Li concentrations. Seventy‐five male CD‐1 mice were given IV pretreatment with LiCl (125 mg/ kg) followed by gavage treatments with SPS (5 g/kg/dose) 20, 40, 90, 150, and 210 minutes after LiCl (experimental group) or deionized water at equivalent times (control group). Subgroups of each treatment group were sacrificed at 1, 2, 4, and 6 hours after LiCl administration and blood was collected for Li analysis.Results: Statistical analyses indicated that the SPS group had lower serum Li concentrations overall than did the control animals. This difference was apparent at the 2‐, 4‐, and 6‐hour time points.Conclusion: In this murine model, repetitive doses of orogastric SPS enhanced the elimination of parenterally administered Li.
Prevalence of Positive Serology for Acute Chlamydia pneumoniae Infection in Emergency Department Patients with Persistent Cough
Authors: Wright Seth W. , Edwards Kathryn M. , Decker Michael D. , Grayston J. Thomas , Wang Sanpin 
Published: September 2008

ABSTRACTObjective: To determine the prevalence of acute Chlamydia pneumoniae infection in ED patients presenting with a persistent cough.Methods: This was a case series consisting of a convenience sample of 65 patients ≥18 years of age who presented with a chief complaint of a cough lasting ≥2 weeks. Patients were treated in the ED of an urban university hospital. Patients with immunosuppression, lung disease, pneumonia, or a cough lasting ≥3 months were excluded. Acute and convalescent sera were assayed for antibody to C. pneumoniae. Subjects with C. pneumoniae antibody titers showing a fourfold rise in either immunoglobin M (IgM) or immunoglobin G (IgG) antibody, an IgM titer of ≥16, or an IgG titer of≥512 were considered to have evidence of acute C. pneumoniae infection.Results: Thirteen (20%; 95% CI, 11% to 32%) of the 65 subjects had serologic evidence of acute C. pneumoniae infection. Except for an increased rate of fever, clinical signs and symptoms and laboratory studies did not differentiate those who had C. pneumoniae from those who did not have the disease. Patients diagnosed as having Bordetella pertussis or Mycoplasma pneumoniae infection did not have serologic evidence of concurrent C. pneumoniae infection.Conclusions: C. pneumoniae infection appears to be associated with a persistent cough in ED patients. Clinicians should consider this organism when evaluating these patients. It is unclear whether antibiotic therapy is indicated for these patients. If antibiotics are used, a tetracycline or macrolide antibiotic would be most appropriate.
Prospective Crossover Study of the Effect of Phlebotomy and Intravenous Crystalloid on Hematocrit
Authors: Kass Lawrence E. , Tien Irene Y. , Ushkow Bruce S. , Snyder Howard S. 
Published: September 2008

ABSTRACTObjective: To compare the changes in hematocrit (Hct) between phlebotomized and nonphlebotomized individuals given IV crystalloid.Methods: A prospective, crossover volunteer study was performed comparing Hct changes immediately and 30 minutes after IV crystalloid bolus in 20 healthy adults with and without prebolus phlebotomy. In the control portion, volunteers were given a 15‐mL/kg bolus of normal saline over 30 minutes with Hct determination before (H1), immediately after (H2), and 30 minutes after (H3) crystalloid infusion. At least 7 days later, the same subjects were phlebotomized 1 unit of blood and then administered a 15‐mL/kg IV bolus of normal saline 30 minutes later. Hcts were obtained before (H4) and 30 minutes after (H5) phlebotomy (immediately prior to crystalloid infusion). Hcts were also obtained immediately after (H6) and 30 minutes after (H7) crystalloid infusion. A post‐hoc test performance analysis was then performed to determine the Hct drop thresholds that would yield the maximal sensitivity and specificity for 500 mL of blood loss (via phlebotomy) in this population.Results: The Hct (%) drops in the nonphlebotomized individuals receiving IV fluids averaged 4.5 ±1.3 immediately and 3.2 ± 1.3 30 minutes after infusion. These drops were different (p < 0.05) from the Hct drop in individuals receiving IV fluids after phlebotomy, which averaged 6.6 ± 1.5 and 5.7 ± 1.1, respectively. Post‐hoc analysis revealed that Hct drops of 5.4 immediately, or 4.3 at 30 minutes after infusion, had a sensitivity of >90% and a specificity of 75% for identification of patients in the phlebotomy group.Conclusions: The practice of measuring serial Hcts may be helpful to identify trauma patients with occult blood loss. A prospective clinical trial is needed to validate these Hct drop thresholds (immediate and 30 minutes postinfusion) in crystalloid‐resuscitated trauma patients.
Using Age‐appropriate Prolactin Levels to Diagnose Children with Seizures in the Emergency Department
Authors: Fein Joel A. , Lavelle Jane M. , Clancy Robert R. 
Published: September 2008

ABSTRACTObjective: To assess the utility of serum and cerebrospinal fluid (CSF) prolactin levels for identifying children who have experienced seizures.Methods: A prospective cohort study was performed in a pediatric ED at an urban children's hospital. A convenience sample of children underwent blood and CSF analyses in the ED over a 2‐year period.Results: Thirty‐five children (aged 3 months‐15 years) with generalized tonic‐clonic seizures and 48 ill control patients were studied. Both groups included febrile and afebrile patients. The patient characteristics in the seizure and control groups were similar with respect to age, fever, current medications, and blood, urine, and CSF cultures. When serum prolactin levels were assigned age‐adjusted dichotomous values of “elevated” or “normal,” the rates of elevation between the seizure and control patients were different (p < 0.001). The positive and negative predictive values of these age‐adjusted levels were 68% (95% CI 47–85%) and 76% (95% CI 61–87%), respectively. The mean CSF prolactin levels of the seizure and control groups were not significantly different. In addition, there was no single threshold CSF prolactin level that could delineate seizure patients from control patients.Conclusions: Age‐adjusted serum prolactin levels are useful only as an adjunct in the prospective evaluation of the individual pediatric patient for epileptic seizure activity. CSF prolactin levels are not useful in the diagnosis of generalized seizures in children in the acute care setting.
Cranial Computed Tomography in the Emergency Evaluation of Adult Patients without a Recent History of Head Trauma: A Prospective Analysis
Authors: Rothrock Steven G. , Buchanan Carlton , Green Steven M. , Bullard Tim , Falk Jay L. , Langen Michael 
Published: September 2008

ABSTRACTObjectives: To examine the pattern of nontrauma cranial CT use in an urban ED, to identify the rate of significant CT abnormalities in this setting, and to develop criteria for restricting the ordering of CT scans. Methods: A prospective, observational study of a case series of adults who underwent cranial CT scanning for nontraumatic cases was performed at the EDs of an urban teaching hospital and an affiliated community hospital with a combined annual census of 110,000. Clinically significant CT scans were defined as: 1) acute stroke, 2) CNS malignancy, 3) acute hydrocephalus, 4) intracranial bleeding, or 5) intracranial infection, χ2 recursive partitioning was used to derive a decision rule to restrict ordering of CT scans. Results: Only 61 (8%) of 806 CT scans revealed clinically significant abnormalities. The presence of any of the following: age ≥60 years, focal neurologic deficit, headache with vomiting, or altered mental status, was 100% sensitive (95% CI: 94–100%) and 31% specific (95% CI: 28–33%) in detecting clinically significant CT scans. This set of features had positive and negative predictive values of 11% (95% CI: 8–13%) and 100% (95% CI: 98–100%), respectively. If these criteria had been used to restrict cranial CT use, 229 fewer patients (28%) would have had CT scans obtained and no clinically significant abnormalities would have been missed.Conclusion: Clinically significant CT abnormalities were uncommon in this study population, suggesting that current criteria for ordering nontrauma cranial CT scans may be too liberal. In this study, a set of clinical criteria was derived that may be useful at separating patients into high‐ and low‐risk categories for clinically significant cranial CT abnormalities. Before these results are applied clinically, these criteria should be validated in larger, prospective studies.
Blood‐Brain Barrier Water Permeability and Brain Osmolyte Content during Edema Development
Authors: Olson James E. , Banks Mark , Dimlich Ruth V. W. , Evers Julie 
Published: September 2008

ABSTRACTObjective: To determine mechanisms that limit changes in brain water content during acute edema development.Methods: A controlled, laboratory investigation of the physiologic and biochemical correlates of osmotic edema was performed in rats. Hypoosmotic hyponatremia was induced by intraperitoneal injection of distilled water. Serum osmolality and electrolytes and regional blood‐brain barrier water permeability surface area (P · S) product, osmolyte contents, and capillary size were determined during 120 minutes of hypoosmotic brain edema development. Cerebral water content predicted from these data using a mathematical model of brain water movements was compared with measured changes in brain water content.Results: Fifteen minutes after distilled water injection, mean ± SEM blood serum osmolality and sodium concentration decreased from 291 ± 3 mOsm and 131 ± 13 mmol/L to 267 ± 3 mOsm and 102 ± 9 mmol/L, respectively. Specific gravity of cerebral gray matter, cerebral white matter, and basal ganglia decreased throughout the hypoosmotic exposure period and, for gray and white matter, correlated with blood serum osmolality and sodium plus potassium content. Glutamate, but not glutamine, glycine, or taurine, decreased 120 minutes after water injection. The regional water P · S product decreased by 40% to 60% within 60 minutes of the water injection, while capillary diameters in gray and white matter were unchanged. Brain water movements calculated from the mathematical model correctly predicted actual brain water content only if the hydraulic conductivity of the blood‐brain barrier was allowed to vary in proportion to the measured P · S product and the measured loss of brain osmolytes was incorporated into the formulation. Conclusions: During the first hours of hypoosmotic hyponatremia, changes in brain volume are limited by increased resistance to osmotic flux of water into the brain and reduction in the brain content of inorganic and, to a smaller degree, organic osmolytes.
Comparative Efficacy of Hemodialysis and Hemoperfusion in Severe Theophylline Intoxication
Authors: Shannon Michael W. 
Published: September 2008

ABSTRACTObjective: To determine the comparative efficacy of hemoperfusion and hemodialysis for severe theophylline toxicity in concurrent case series.Methods: A 10‐year, prospective, observational study was performed of consecutive patients referred to a regional poison control center with severe theophylline intoxication in whom either hemodialysis or hemoperfusion was used. The primary outcomes were 1) incidence of major theophylline toxicity (convulsions or life‐threatening cardiac dysrhythmias) during or after each procedure, 2) calculated theophylline clearance, and 3) procedure‐related complications.Results: Over the study period, 56 patients underwent hemodialysis or hemoperfusion as treatment of severe theophylline intoxication. Overall mean age was 40. 5 ± 22. 9 years. Mean peak serum theophylline concentration was 103. 3 ± 39. 1 μ g/mL (range 36 to 245 μ g/mL). Thirty patients (54%) were victims of acute theophylline intoxication, while 18 (32%) had chronic overmedication and 8 (14%) had acute‐on‐therapeutic intoxication. Thirty‐nine patients (70%) underwent hemodialysis, while 17 (30%) underwent hemoperfusion. There were no significant intergroup differences in age (39. 4 vs 43. 0 yr), peak serum theophylline concentration (99. 5 vs 112. 1 μ g/mL), time to procedure (8. 4 vs 6. 3 hr), or duration of procedure (4. 1 vs 3. 7 hr). Thirty‐three percent of the patients undergoing hemodialysis had major toxicity during or after the procedure, compared with 18% of those who received hemoperfusion (p = NS). Post‐procedure serum theophylline concentrations were 26. 9 vs 30. 4 μ g/mL, corresponding to drug clearance rates of 185. 1 and 294. 8 mL/kg/hr (p = 0. 03). Procedural complications occurred in 3 patients who received hemoperfusion and consisted of bleeding diatheses and hypocalcemia. No complications occurred in patients receiving hemodialysis (p = 0. 007).Conclusions: These data confirm that hemoperfusion provides a higher theophylline clearance rate than hemodialysis. However, hemodialysis appears to have comparable efficacy in reducing the morbidity of severe theophylline intoxication and is associated with a lower rate of procedural complications.
Pilot Study of Cytokines in Emergency Department Patients with Systemic Inflammatory Response Syndrome
Authors: Terregino Carol A. , Quinn James V. , Slotman Gus J. 
Published: September 2008

ABSTRACTObjective: To determine the potential utility of cytokine and arachidonic acid metabolite levels in ED patients with systemic inflammatory response syndrome (SIRS) as a predictor of progression to severe sepsis. Methods: A prospective, observational study of test performance was performed using convenience samples of adult control subjects and admitted patients. The latter patients were identified in the ED as having signs of SIRS. Levels of cytokines and arachidonic acid metabolites measured from specimens obtained in the ED were compared between groups and associated with the progression of sepsis within 24 hours in the SIRS patients.Results: There were 30 control patients and 29 SIRS patients. There were 8 SIRS subjects who progressed to severe sepsis within 24 hours using the following criteria (hypotension, n = 5; hypoperfusion, n = 1; and organ dysfunction, n = 2). Of the 21 SIRS subjects who did not progress to severe sepsis, 11 had resolution of SIRS criteria at 24 hours. There were no significant differences in mean mediator levels between the SIRS patients who progressed to severe sepsis and those who did not. Of the 11 patients with resolution of SIRS criteria at 24 hours, the mean interleukin‐6 (IL‐6) level was significantly lower than that for the patients who did not recover or who progressed at 24 hours (n = 18); 65.4 ± 49.1 vs 230 ±112 pg/mL, p = 0.001). Six of 15 subjects with IL‐6 >150 pg/mL progressed to severe sepsis (p = NS). Using threshold values based on the range of levels for normals, the sensitivity of an abnormal marker for the development of severe sepsis within 24 hours varied from 50% to 87%, while the specificity varied from 11% to 84%. Conclusion: While mean levels were significantly elevated when compared with those of normal control subjects, they had limited ability to predict the subset of patients likely to progress to severe sepsis. However, initial low levels of cytokines may have exclusionary prognostic value. Prospective validation of the latter finding is warranted.
New‐onset Bronchospasm or Recrudescence of Asthma Associated with Cocaine Abuse
Authors: Osborn Harold H. , Tang Mark , Bradley Keith , Duncan Brian R. 
Published: September 2008

ABSTRACTObjective: To determine whether the occurrence of new‐onset bronchospasm or the recrudescence of asthma is associated with the use of cocaine.Methods: A consecutive sample of patients presenting to an inner‐city adult ED with new‐onset bronchospasm or recrudescence of bronchospasm after >5 years were prospectively enrolled in a case‐control prevalence study. The bronchospasm patients were queried as to their exposure to illicit drugs, and urine was obtained to screen for cocaine and its metabolite, benzoylecgonine. An age‐ and sex‐matched control group was composed of randomly chosen subjects without respiratory complaints or a history of asthma. The control group was also screened by urine toxicology for cocaine and its metabolite, benzoylecgonine. Results: In the asthma group, 21/59 (36%) had a urine toxicologic screen positive for cocaine metabolite (benzoylecgonine). Of the 21 with a positive screen for cocaine, 8 denied illicit drug abuse. Among the 13 patients reporting drug use, 10 said that they smoked crack and 3 snorted cocaine. In the control group, 8/53 (15%) were positive. Multivariate logistic regression analysis, with adjustment for age and sex, indicated that the use of cocaine was associated with a 3‐fold higher prevalence of new‐onset bronchospasm or recrudescence of asthma (OR = 3.28, 95% CI: 1.26 to 8.50).Conclusions: There appears to be an association between cocaine use and new‐onset bronchospasm or recrudescence of asthma in this inner‐city ED population. Further study is necessary to determine the basis for this association.
Differences between Chest Pain Observation Service Patients and Admitted “Rule‐out Myocardial Infarction” Patients
Authors: Dallara John , Severance Harry W. , Davis Barbara , Schulz Gail 
Published: September 2008

ABSTRACTObjective: To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for “rule‐out acute myocardial infarction” (R/O MI).Methods: This was a retrospective, cross‐sectional comparison of adult patients considered at relatively low risk for cardiac ischemia and who were evaluated in 1 of 2 settings: a short‐term observation service and an inpatient monitored bed. All patients had an ED final diagnosis of “chest pain,” “R/O MI,” or “unstable angina” during the 7‐month study period. Demographic features and presenting clinical features were examined as a function of site of patient evaluation.Results: Of 531 study patients, 265 (50%) were assigned to the observation service. Younger age (OR = 1.75, 95% CI 1.26, 2.44, for each decrement of 20 years), the complaint of “chest pain” (OR = 2.35, 95% CI 1.34, 4.12), and the absence of prior known coronary artery disease (OR = 1.64, 95% CI 1.13, 2.38) were the principal independent factors associated with assignment to a chest pain observation service bed. Conclusions: Patients evaluated in a chest pain observation service appear to have different clinical characteristics than other individuals admitted to a monitored inpatient bed for “R/O MI.” Investigators should address differences in clinical characteristics when making outcome comparisons between these 2 patient groups.
Morningness‐Eveningness Preferences of Emergency Medicine Residents Are Skewed toward Eveningness
Authors: Steele Mark T. , McNamara Robert M. , Smith‐Coggins Rebecca , Watson William A. 
Published: September 2008

ABSTRACTObjective: To determine the morningness‐eveningness (ME) distribution of emergency medicine (EM) residents.Method: A voluntary, modified ME questionnaire was administered to all EM residents in the United States at the time of the 1995 American Board of Emergency Medicine's annual In‐Training Examination. Results: Seventy‐eight percent (2,047/2,614) of the surveys were returned. ME scores ranged from 24 to 76, with a median score of 49 (interquartile range 44, 56). The scores were distributed differently from those of the normal population (p < 0.001), being skewed toward eveningness. There was a correlation (r = 0.13, p < 0.0001) between resident age and ME score, with older residents being more morning‐oriented. Males were more morning‐oriented than females (p = 0.005), and respondents with children living at home also were significantly more morning‐oriented (p < 0.001). Stepwise logistic regression showed that the influence of age, gender, and children was cumulative (r = 0.19) but accounted for only 4% of the observed variability. Conclusion: EM residents are distributed differently from the normal population in terms of their ME preferences, tending slightly toward eveningness. The importance of this distribution in EM residents is unknown. A longitudinal follow‐up of this cohort may help to determine the association of ME preference with overall practice satisfaction, tolerance of shift work, and career longevity.The authors thank Barbara McClusky and Jayna Ross for data entry and management, Linda L. Smith for manuscript preparation, James C. Impara, PhD, and Ted Carter, Buros Institute of Mental Measurements, University of Nebraska‐Lincoln, for their statistical assistance, and the staff at SAEM (particularly Mary Ann Schropp). This study was performed under the authorization of the Inservice Examination Survey Task Force of SAEM.