Biomedical subjects

B S Dean

Publications and source records attributed to B S Dean.

At least 19 recordsLinked to original sources

PubMed1994

Ceramic lead glaze ingestions in nursing home residents with dementia.

Three cases of acute lead ceramic glaze ingestions that occurred in elderly patients during art therapy classes in nursing homes are reported. Initial blood lead levels were 109 micrograms/dL (5.23 mumol/L), 259 micrograms/dL (10.43 mumol/L), and 85 micrograms/dL (4.08 mumol/L), respectively, and all patients underwent chelation therapy. Two individuals tolerated therapy well and showed no discernable changes from baseline state. One patient with a lead encephalopathy died and is, to the best of our knowledge, the first report of a death directly related to a ceramic lead glaze ingestion. Ceramic lead glaze ingestions among institutionalized patients may be more common than generally appreciated and occasionally are associated with significant morbidity or, rarely, mortality. Simple preventive measures could eliminate the majority of such occurrences.

Acute Disease↗

PubMed1994

Poison center funding--who should pay?

To illustrate costs associated with poison center closure a survey of lay callers to the poison center and emergency department costs was conducted. For 21 days all callers to a Regional Poison Information Center receiving home treatment were asked the type of health insurance coverage the patient had. This information was documented on the medical record and tabulated. Health care costs were determined by surveying local hospitals. Of the callers, 1,276 (43%) provided insurance information: 928 (73%) of the patients were covered by private insurers; 258 (20%) received state medical assistance and 90 (7%) had no medical coverage. The average emergency department cost of an ingestion exposure was $210.75, ocular $172.22, and inhalation $298.03. In the absence of a Regional Poison Information Center responding to 61,000 calls annually, the state would incur a debt ranging from 1.27 to 2.20 million dollars if 60% of those covered under state assistance went to the emergency department. Private insurers would forfeit 4.58 to 7.93 million dollars per year. These cost estimates consider only the emergency department charges, not unnecessary admissions. State government and private insurers clearly are the financial beneficiaries of poison center services which save several times their operating costs.

Cost-Benefit Analysis↗

PubMed1994

A demographic profile of the Specialist in Poison Information.

In 1983 the first certification examination was administered to Specialists in Poison Information (SPI). This marked the first attempt to validate the status of professionals working in poison centers as a separate entity in the field of medicine and toxicology. Not all specialists are certified, therefore the process characterizes only a portion of those currently practicing. To establish a demographic profile of all SPI's currently practicing in poison centers, a questionnaire was developed and sent to all SPI utilizing the American Association of Poison Control Center's (AAPCC) mailing list. A 57-response survey encompassing a variety of topics affecting SPI's was developed and mailed to 607 currently practicing SPI's (288 Certified SPI's and 319 SPI's). Among the requested information were demographics such as age, educational degrees, years worked at the poison center, and percent of time spent answering poison calls. SPI's were also asked to identify whether their center was certified. Responses were then tabulated and analyzed. One-hundred eighty-three surveys were completed and returned. One-hundred twenty-nine (70%) were Certified SPI's and 54 (30%) were not, although 11 had taken the examination unsuccessfully. Fifty and three-tenths percent of the respondents had worked 1-5 y at a poison center, 35% 5-10 y and 14.7% had greater than 10 y experience. Fifty-six and three-tenths were nurses, 36.1% pharmacists, and 7.6% were classified as "other". This category included MD's, EMT's and those having educational degrees other than the aforementioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

The cost of employee turnover to a regional poison information center.

The quality and effectiveness of a regional poison information center (RPIC) are directly related to the skills and experience of the professional staff of specialists in poison information and to having the appropriate number of individuals in order to accurately and concisely respond to the thousands of telephone calls concerning acute/chronic poisoning emergencies. Since RPICs are traditionally small departments, the loss of even 1 key staff member can cause devastating results. A realistic appraisal of the actual costs associated with employee turnover was done at our RPIC and considered the following items: Advertising and recruiting expenses; interviewing expenses; processing costs; orientation and training expenses; and overtime costs including fringe benefits and premium shift differentials. The over-all tangible costs related to turnover of an individual who is certified or qualified to be certified as a specialist in poison information is approximately $17,486. The specific cost categories included advertising/recruiting, $326; interviewing expenses, $360; orientation and training, $9,250; processing, $350; overtime monies, $7,200. The less tangible effects of turnover cannot be strictly measured in dollars, but can be reflected in reduced quality assurance factors, increased sick time, and decreased morale. While staff salaries and benefits usually account for 75% to 85% of a RPIC's operating budget, and since external sources of revenue do not offset the operational expenses, it is becoming increasingly difficult to remain competitive in today's current professional salary climate. While the loss of talent and its cumulative effect on quality is impossible to quantitatively measure, we have attempted to calculate the real financial burden associated with replacing personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Advertising↗

PubMed1993

Coma reversal with cerebral dysfunction recovery after repetitive hyperbaric oxygen therapy for severe carbon monoxide poisoning.

The accepted beneficial effects of hyperbaric oxygen (HBO) include a greatly diminished carboxyhemoglobin (COHgb) half-life, enhanced tissue clearance of residual carbon monoxide (CO), reduced cerebral edema, and reversal of cytochrome oxidase inhibition, and prevention of central nervous system lipid peroxidation. Debate regarding the criteria for selection of HBO versus 100% normobaric oxygen therapy continues, and frequently is based solely on the level of COHgb saturation. Patients who manifest signs of serious CO intoxication (unconsciousness, neuropsychiatric symptoms, cardiac or hemodynamic instability) warrant immediate HBO therapy. An unresponsive 33-year-old woman was found in a closed garage, inside her automobile with the ignition on. Her husband admitted to seeing her 6 hours before discovery. 100% normobaric oxygen was administered in the prehospital and emergency department settings. The patient had an initial COHgb saturation of 46.7%, a Glasgow coma score of 3, and was transferred for HBO therapy. Before HBO therapy, the patient remained unresponsive and demonstrated decerebrate posturing and a positive doll's eyes (negative oculocephalic reflex). The electroencephalogram pattern suggested bilateral cerebral dysfunction consistent with a toxic metabolic or hypoxic encephalopathy. The patient underwent HBO therapy at 2.4 ATA for 90 minutes twice a day for 3 consecutive days. On day 7, the patient began to awaken, was weaned from ventilatory support, and was not soon verbalizing appropriately. A Folstein mental status examination showed a score of 26 of 30. Neurological examination demonstrated mild residual left upper extremity weakness and a normal gait. There was no evidence of significant neurological sequelae at 1 month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Illiteracy: a contributing factor to poisoning.

It is estimated that over 60 million Americans (1/3 of the adult population) are functionally or marginally illiterate. To recognize and gain an understanding of illiteracy and its impact on poisoning, we determined if the illiterate in our community could recognize potential poisons. A prospective study involving 29 male and 21 female adult illiterates was undertaken. A personal interview was conducted to determine their ability to purchase medication and household products, their understanding of the uses and associated dangers of medications, and their manner of storage of these products in their homes. Of the participants, 66% were at reading levels of 0-3rd grade and 34% were at 3rd through 6th grade reading level. Each participant was shown 3 separate products and asked to distinguish and interpret caution statements and directions. In the 0-3rd grade group, 30% were unable to identify any of the products and none could explain the cautions or directions. In the second group (3rd-6th grade), all were able to identify the products and 76% could explain the cautions; everyone in this group correctly read the directions. We concluded that a large percentage of the adult population are potential poisoning victims due to their inability to read and comprehend label instructions. Poison Centers should recognize illiteracy as a contributing factor in poisonings and consider education and prevention programs for this segment of our population.

Adolescent↗

PubMed1992

Environmentally-induced methemoglobinemia in an infant.

Acquired methemoglobinemia results from the exposure to various chemicals and drugs able to oxidize hemoglobin at a rate exceeding the normal enzymatic capacity for hemoglobin reduction. Levels of methemoglobin exceeding 60-70% may be associated with coma and death. We describe a case of complete, uneventful recovery involving a 10 week-old infant who presented to the Emergency Department with profound sudden onset of cyanosis, irritability, metabolic acidosis, and a lethal methemoglobin level of 71.4%. Intravenous administration of 12 mg methylene blue resulted in immediate resolution of the cyanosis and reduction of measured methemoglobin to 1.3%. The carboxyhemoglobin was negative. Sodium bicarbonate successfully corrected the acidosis. RBC reductase measurement was within normal limits, ruling out congenital methemoglobinemia. Family history revealed a wood-burning stove which emitted pine tar fumes as the potential environmental methemoglobin-producing source. The infant's cradle was situated five feet from the stove. The infant was discharged on day three of hospitalization with a methemoglobin level of 0.2%.

Creosote↗

PubMed1992

Clinical evaluation of pediatric ethylene glycol monobutyl ether poisonings.

Ethylene glycol butyl ether, CAS 111-76-2, an ingredient in many popular commercial window/glass cleaners, is known to produce equal if not greater toxicity than ethylene glycol when administered to animals. Treatment recommendations for human poisonings are based upon animal data and include the use of ethanol therapy to inhibit the production of toxic metabolites. No human experiential data exist to accurately assess human toxicity or to verify treatment modalities. A 5 month retrospective review of all glass cleaner ingestions reported to a regional poison information center disclosed 24 pediatric patients, ages 7 mo to 9 y, who ingested 5-300 mL of a liquid glass cleaning product containing ethylene glycol butyl ether. All ingestions were reported within 5 min of ingestion, and all 24 children were asymptomatic at that time and subsequently. The product concentrations of ethylene glycol butyl ether ranged from 0.5% to 9.9%. Two of the 24 children ingested > 15 mL and were treated by gastric emptying and 24 h hospital observation. Neither hospitalized child suffered symptoms consistent with hemolysis, nervous system depression, acidosis, or renal compromise. Dilution with oral fluids at home is considered appropriate treatment of pediatric ingestions of < 10 mL of a commercial liquid glass/window cleaners containing < 10% ethylene glycol butyl ether.

Accidents↗

PubMed1992

Orthotopic liver transplants necessitated by acetaminophen-induced hepatotoxicity.

BACKGROUND: Acetaminophen-induced hepatotoxicity has been recognized since 1966. Patients experiencing a massive hepatic insult due to acetaminophen (APAP) may recover with minimal residual complications or develop fulminant hepatic necrosis. We report 3 patients with hepatic failure due to an APAP overdose who received orthotopic liver transplants and survived. CASE REPORTS: An 18-y-o female ingested 60 500 mg APAP tablets (30 g). She presented with tachycardia and lethargy stating that she had taken amoxipine, carbamazepine, and lorazepam. She began to recover but on day 2 experienced an upper gastrointestinal bleed and became hypotensive and hyperpyrexic. She developed hepatic encephalopathy and it was then determined she had ingested APAP. Her APAP level was 13 micrograms/ml 96 h post-ingestion. She was successfully transplanted 19 d post-ingestion with recovery. A 40-y-o female was admitted for flu-like symptoms persisting for 7 d. She was jaundiced, hyperventilating and hypotensive. She admitted ingesting approximately 17 g APAP over 36 h. Her APAP level was 12.2 micrograms/ml. Her condition worsened and on day 3 she was in grade IV coma. She was successfully transplanted 4 d post-arrival with recovery. A 16-y-o female ingested an unknown amount of APAP. She presented approximately 24 h post-ingestion with a serum APAP level of 130 micrograms/ml. Her condition deteriorated and she became encephalopathic with grade IV coma. She was successfully transplanted on day 7 post-arrival. DISCUSSION: Hepatotoxicity can occur as a result of either acute or chronic APAP overdose. Although n-acetylcysteine (NAC) is effective antidotal therapy, it must be used within 8-12 h post-ingestion to be optimally effective. Inaccurate patient histories may prevent NAC administration resulting in hepatotoxicity. CONCLUSION: Liver transplantation is a viable option to be considered in those APAP overdose patients who experience rapidly progressing encephalopathy, hemolysis, and hepato-renal failure.

Acetaminophen↗

PubMed1992

A ten-step quality assurance program for regional poison information centers.

BACKGROUND: Our regional poison information center (RPIC) has developed and implemented an ongoing quality assurance (QA) initiative, using performance indicators and evaluation thresholds to permit a planned and systematic process for monitoring the quality, appropriateness and effectiveness of service. METHODS: A 10-step QA plan was designed that included delineating the scope of care, identifying the most important aspects of care, identifying indicators and thresholds to monitor performance and outcomes, and establishing a formal medical audit review process to resolve questions and/or problems. RESULTS: This QA program has resulted in verification of the validity of the RPIC's data and services. Threshold indicators (the incidence of accidental poisoning in children less than 6 y, incidence of intentional poisoning among children less than 18 y, appropriateness of home versus hospital management, and reduction in major/mortal outcomes in children less than 6 y) have all been successfully met during the past 12 mo. A medical audit committee objectively reviews and meets to discuss all unique poison exposures or those suffering major/mortal outcomes. Examples of identified problems include the lack of utilizing standard abbreviations during documentation and the need to standardize indications for consulting medical back-up. DISCUSSION: RPICs are innovative health services with unique and increasing responsibilities and liabilities. A QA program, designed to objectively and systematically monitor and evaluate the quality and appropriateness of care rendered the poisoned patient, can improve care and resolve identified problems in a timely manner. CONCLUSIONS: A formalized QA program is essential for all RPICs.

Pennsylvania↗

PubMed1992

A regional poison center's experience with poisoning exposures occurring in schools.

The nature of and response to poisonings in the school setting has not been characterized. To define these problems a retrospective review of calls to a Regional Poison Information Center (RPIC) involving school exposures was done for the 1988-89 academic year. 362 cases were reported; 74% were reported by school nurses, 10% by other school employees, 10% by parents, 5% by health care facilities, and 1% by students themselves. Ingestions accounted for 45% of exposures, dermal 24%, ocular 19%, inhalation 7%, with the remainder being combinations of routes. Correct treatment prior to RPIC consultation occurred in only 40% of the cases. None developed major symptoms, 23% had minor and 10% had moderate symptoms. High school students accounted for the greatest number (20) of suicide gestures, while middle schools reported more cases of substance abuse. School nurses often were unaware of situations until several hours later. 61% of suicide gestures were referred to an HCF; 7 of these developed moderate symptoms. Exposures to chemicals in science or vo-tech classes accounted for 102 cases; 28% were referred to a HCF and 15% had moderate symptoms. There was often a delay in evaluation by the school nurse and initial decontamination was inadequate or absent. Parents were often instructed by school personnel to contact the RPIC for information and then relay it to the school. These delays could have resulted in greater toxicity. School nurses should be targeted for educational programs by poison centers, but teachers and other school employees must also be included since often they are the first at the scene. Students should be instructed to report exposures to a teacher immediately.

Accidents↗

PubMed1992

Factors influencing non-compliance with poison center recommendations.

Non-compliance with prescribed therapies has long been recognized by medical practitioners in all fields as an important factor influencing the probability of a favorable outcome. Few references in the literature address this factor with regard to poisoning. Principles of assessing and improving compliance may also be applied to the advice given by poison information providers. Cases involving lay callers, who failed to comply with poison center recommendations, were studied. The type of advice, reason given for failing to comply, and outcome were assessed. 205 poisoning cases from the 12-mo period were analyzed involving 129 children and 76 adults. In 34 pediatric exposures of children where syrup of ipecac was recommended but not given, 29.4% of parents cited the influence of a family member in deciding not to comply; 47% indicated the potential risk of the exposure was not perceived accurately. In 90 cases of non-compliant referrals of children to emergency departments, 60% of parents minimized the threat of a serious outcome despite explanation of the expected risk. In 76 adult cases, 70 patients refused referral to an emergency department; 26% admitted to sociopsycological reasons, including public status, undisclosed drug abuse, or fear of reprisal. Sequelae developed in 31% of the children and 46% of the adults which may not have occurred if poison center recommendations had been followed. Willingness to comply with a recommended behavior is influenced by factors such as motivation, concern, perceived threat posed by the exposure, and perceived barriers. A compliance model relative to poisoning is needed to reduce risk and promote a favorable outcome.

Accidents↗

PubMed1992

Toxicology consultation fees to health care facilities: a successful revenue generating program for poison centers.

Poison information center funding is a continuous problem and is growing more critical as cost containment effects the health care industry. Although a limited number of poison centers are partially funded by governmental agencies, general poison center operational support is derived from a variety of sources, and there is significant pressure upon centers to identify alternative funding sources. Affiliated members of our member hospital treatment network have provided one revenue source, but not all hospitals within our service region have subscribed. Furthermore, hospitals outside of our service region have utilized the service without any financial responsibility despite recommendations to use their local center. Therefore, to provide an incentive for local hospitals to subscribe to the service and to dissuade hospitals from outside of the region from using the service, we implemented a toxicology consultative fee for service on all calls emanating from non-member hospitals. In just 19 mo, recruitment of 16 new member hospitals has generated $65,150 additional revenue. Non-member hospitals electing not to affiliate but to remunerate for toxicology consultations (226 cases) have generated $20,400 (98% collection rate). A startling 95% reduction in calls from hospital outside of region has resulted since this fiduciary initiative began. New revenue totaling $85,550 has been generated by establishment of a toxicology consultation fee, and our staff is now able to dedicate priceless time and resources to the poison information needs of the residents of our region.

Fees and Charges↗

PubMed1992

The poison center as a reservoir for antidotes for veterinary poisoning emergencies.

Animal poisonings account for a significant number of the cases responded to by poison centers. The majority of consultations involve small animals and do not necessitate the use of large amounts of pharmacologic antagonists, such as atropine to treat anticholinesterase pesticide poisonings. However, large animals such as cattle present unique management problems, since phenomenal amounts of antidotes may be needed to treat a herd of cattle, creating a significant economic impact. The most challenging dilemma is providing 24-h availability and a means of acquisition of sufficient quantities of antidotes to reduce the economic impact of large-animal poisonings. In conjunction with a state veterinary medical association, a RPIC serves as a depot for the storage and distribution of emergency veterinary antidotes. Sufficient quantities of atropine, methylene blue, calcium EDTA, sodium nitrite and thiosulfate, and activated charcoal are available via the RPIC to treat a herd of 200 cattle. The antidotes are available only for emergency treatment and with a veterinary prescription. The 24-h nature of the poison center makes it an ideal location to serve the needs of veterinarians.

Animals↗

PubMed1992

In vivo evaluation of the adsorptive capacity of activated charcoal for camphor.

Camphor, a cyclic terpene, is the toxic ingredient in many over-the-counter (OTC) products. Early seizure activity due to camphor ingestion often contraindicates the use of traditional decontamination therapies in favor of oral activated charcoal use. No research data supports the affinity of activated charcoal for camphor. This study was conducted to evaluate the effectiveness of activated charcoal in preventing camphor absorption in a rat model. Camphor 40% in cottonseed oil (1 g/kg) was administered to 100 male Sprague-Dawley rats via oral gavage. Aqueous activated charcoal suspension (2 g/kg) was administered to the study group of 50 rats. Serum camphor concentrations were determined by gas chromatography at defined intervals over 10 h. No mortality occurred in either the control or activated charcoal-treated group. Area-under-the-curve bioavailability comparisons of each group revealed no significant differences (activated charcoal 421 micrograms x h/ml vs camphor 409 micrograms x h/ml). The absorption rate constants (Ka) and T 1/2 and elimination rate constants (Ke) and T 1/2 of each group were nearly identical and similar to those reported for humans. These preliminary data indicate the need for careful evaluation of the efficacy of oral activated charcoal administration as the sole means of preventing the absorption of camphor.

Adsorption↗

PubMed1991

Philodendron/dieffenbachia ingestions: are they a problem?

Ingestions involving the philodendron/dieffenbachia members of the Arum family are allegedly associated with the development of intense irritation of mucous membranes, resulting in swelling of the tongue, lips and palate. Although numerous literature citations promote their toxicity, there are few case reports which substantiate a cause-effect relationship between ingestion and resultant symptomatology. To assess the toxic manifestations associated with the ingestion of these plants, a retrospective review of such cases reported to a Regional Poison Information Center was performed. 188 cases were identified and the integrity of the leaf had been broken in all cases. Philodendrons accounted for 67.5% and dieffenbachias for 32.5% of the cases. 72.8% involved children aged 4-12 months. Only 2.1% (4) of the patients were symptomatic (dieffenbachia-3; philodendron-1). In all cases, the symptoms occurred within 5 minutes of the exposure and were of short duration and the outcome was classified as minor. In this 24 month senses of 188 exposures, severe oral complications and the delayed development of symptoms were not observed.

Adolescent↗

PubMed1991

Contaminant identification: the importance of thorough interviewing techniques.

The exact name of a contaminant is of extreme importance to the poison information specialist (SPI) in order to make a correct assessment of the poisoning exposure and to recommend proper treatment modalities. Incorrect contaminant information could lead to a serious and possibly fatal mistake on the part of the SPI. Thorough and effective interviewing techniques must be employed to avoid errors. We conducted a prospective study to determine how often misinformation is provided to the SPI at the time of the initial contact with the poison center. Over a 6-mo period 159 calls were identified in which the original caller mistakenly identified the contaminant. Fifty-two (33%) of these calls were received from health care professionals and 107 (67%) were from the lay public. Drug names were improperly reported in 80 cases, cleaning products in 26, cosmetics 14 times, general products 19, chemicals 7, rodenticides 8, and plants were incorrectly identified in 5 cases. In 110 of these cases, proper identification of the contaminant changed the assessment and also the treatment recommendations made by the SPI. Errors in contaminant identification occurs more frequently than is realized by poison center professionals. It is imperative to have the caller clarify the contaminant name by checking the container, when available, and supplying the SPI with as much information as possible. It is equally important that the SPI employ precise interviewing techniques to obtain information to avoid a serious error in assessment and treatment of the poisoned victim.

Drug Contamination↗

PubMed1990

Accidental childhood death from diphenhydramine overdosage.

A 15-month-old boy presented to an emergency department with tonic clonic jerking of all extremities and dancing eye movements. A history of instant coffee ingestion was obtained at that time. However, a routine blood analysis and toxicology screen showed a diphenhydramine level of 1.0 mg% (lethal, 0.5 mg%). Generalized tonic clonic seizures continued despite conventional therapy. A continuous thiopental infusion was used to control his seizure activity. This child never regained consciousness and was pronounced dead 7 days postingestion.

Diphenhydramine↗