The American journal of emergency medicine
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Comparative Study
Determination of tricyclic antidepressants for ED analysis.
Both the Biosite Triage (Biosite Diagnostics, San Diego, CA) method and the Du Pont aca (Du Pont Company, Wilmington, DE) method give qualitative tricyclic antidepressant (TCA) results to aid in the diagnosis of a TCA overdose. The Triage method uses urine samples and the aca uses serum samples. Although the cutoff values vary considerably between the two methods, the Triage results agreed well with the aca results. ⋯ Both urine and serum samples were obtained from 44 patients who were admitted to the emergency department with a diagnosis of "possible tricyclic overdose." Discrepancies between the two methods were resolved by thin layer chromatography (Toxi-Lab, Ansys, Inc, Irvine, CA). Both methods were in agreement with the exception of five patients' samples. In this study, the Triage method allowed for detection of TCA using urine that is simple for the user and yielded higher sensitivity and specificity results compared with the Du Pont aca method.
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An academic emergency group was surveyed to determine if scheduling night shifts in blocks ("floats") improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. ⋯ Physicians have different adaptability to night work. For some, concentrating night shifts is a useful strategy for improving shift work. This would require shorter shifts and larger groups than are now commonplace.
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Comparative Study
Absorption of liposome-encapsulated tetracaine versus nonliposome-encapsulated tetracaine from open wounds in rabbits.
The plasma tetracaine concentration versus time profiles for liposome-encapsulated tetracaine (LET) versus nonliposome-encapsulated tetracaine (NLET) were determined after topical application to open wounds in six rabbits (three in LET and three in NLET). H3-tetracaine preparations of LET or NLET were applied randomly to uniform dermal lacerations in anesthetized rabbits. Plasma tetracaine concentrations (ng/mL) of arterial blood samples obtained were measured at predetermined intervals (0.25, 0.5, 1.0, 2.0, and 24 hours) by isotope tracer assay. ⋯ Plasma tetracaine concentrations at all samples times were significantly lower for LET versus NLET. Liposome encapsulation of topically applied tetracaine significantly decreases both the peak and overall plasma tetracaine concentrations compared with the nonencapsulated form. The data suggest that liposome encapsulation of topically applied local anesthetics such as a solution of tetracaine, adrenaline, and cocaine, might reduce the potential systemic toxicity caused by rapid absorption of these compounds.
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The purpose of this study was to determine the prevalence of emergency department-based POISINDEX (Micromedex Inc, Denver, CO) and assess its perceived impact on use of poison control centers. Survey methodology was used. A written questionnaire was distributed to all emergency departments (EDs) in the state of New York. ⋯ Of the returned questionnaires, 42 of 180 (23%) have their own POISINDEX. In 32 of 42 (76%) of these EDs that have their own POISINDEX, it was perceived that ED-based POISINDEX decreased poison control center use. Use of ED-based POISINDEX may decrease ED use of poison control centers.