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Biomedical subjects

E A Ramoska

Publications and source records attributed to E A Ramoska.

15 recordsLinked to original sources
PubMed1998

Information sharing can reduce laboratory use by emergency physicians.

This study analyzed the effect information sharing through physician profiling would have on emergency physician behavior. It is a before-and-after audit of laboratory use in a community hospital. A 9-month control period was followed by a 15-month period in which the physicians' laboratory use was presented and discussed at monthly meetings. The laboratory use decreased 17.8%, from a mean of 2.36 studies per patient during the control period to 1.94 during the final quarter of the study. The actual laboratory costs per month decreased 17.7%, from a mean of $32,415 per month to $26,687 per month. There was only one possible adverse outcome out of 34,320 patients seen. There were no adverse changes in other quality improvement indicators. Information sharing can result in a decrease in the number and cost of laboratories studies ordered by emergency physicians without an adverse change in routine quality improvement indicators.

Clinical Laboratory Techniques↗
PubMed1994

Bupropion overdose: a 3-year multi-center retrospective analysis.

Bupropion (Wellbutrin; Burroughs Welcome Co, Research Triangle Park, NC) is a unique monocyclic antidepressant about which there is limited overdose information. A retrospective analysis of all bupropion ingestions reported to five regional poison control centers from 1989 through 1991 was conducted. There were 58 cases of bupropion ingestion and nine cases of combined bupropion and benzodiazepine ingestion. Sinus tachycardia was the only toxic cardiovascular effect noted, except for one case of hypotension in the bupropioin and benzodiazepine group. Neurological toxicity was commonly encountered and included lethargy, tremors, and seizures. Both benzodiazepines and phenytoin were efficacious in controlling seizures. Five cases of pure bupropion overdose had electrolytes reported. Serum potassium ranged from 2.6 to 4.2 mEq/L (mean, 3.3 mEq/L). In overdose, bupropion seems to lack major cardiovascular toxicity; however, it does manifest significant neurological toxicity.

Adolescent↗
PubMed1993

A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment.

STUDY OBJECTIVE: To examine the cardiovascular toxicity of calcium channel blockers and the efficacy of various treatments. DESIGN: Case series collected prospectively over one year. SETTING: Three regional poison control centers. TYPE OF PARTICIPANTS: One hundred thirty-nine hospitalized patients who had ingested a calcium channel blocker. INTERVENTIONS: Calcium, dopamine, atropine, isoproterenol, glucagon, and pacemakers. MAIN RESULTS: Hypotension, sinus node suppression, and dysrhythmias often occur with calcium channel blocker overdoses, but atrioventricular nodal block occurs more often with verapamil (chi 2 test, P < .025). Calcium was administered to 23 patients and was efficacious in reversing depression of cardiac conduction and increasing blood pressure. Dopamine was administered to ten patients and was efficacious in increasing blood pressure. Atropine was administered to eight patients, but only two had a positive response. CONCLUSION: Atrioventricular nodal depression is more common with verapamil overdoses. Calcium and dopamine are useful in treating toxicity from calcium channel blocker overdose, whereas atropine is sometimes useful.

Adolescent↗
PubMed1993

Propranolol treatment of albuterol poisoning in two asthmatic patients.

The cases of two asthmatic adolescents who overdosed on albuterol are presented. Both patients were tremulous, tachycardic, and hypokalemic. Both were treated successfully with IV propranolol. Neither patient developed bronchospasm. The toxicity of albuterol overdoses and its treatment are discussed.

Adolescent↗
PubMed1993

A two-year retrospective study of accidental pediatric albuterol ingestions.

A two-year retrospective review of accidental albuterol ingestions in children less than 12 years old was performed to assess overdose toxicity and to investigate a dose-effect relationship. One hundred twelve exposures were located. Seventeen cases were excluded owing to coingestants, leaving 95 cases for evaluation. Twenty-nine children (30%) remained at home without intervention or telephone followup because of an ingestion of less than 0.6 mg/kg. Twenty-eight patients (30%) were followed at home by telephone (12 of whom received ipecac). Dosages ranged from 1 to 27 mg, with dose/weight ratios of 0.1 to 1.9 mg/kg. Two children experienced transient mild symptoms (irritability, brief nausea, and vomiting). The remaining 26 children were asymptomatic. Thirty eight cases (40%) were treated in an emergency department. Ingestions ranged from 2 to 96 mg, with dose/weight ratios of 0.3 to 6.3 mg/kg. Ages ranged from one to 11 years. Transient restlessness or irritability was observed in 16 patients, tachycardia in 15, tremors in six, and a widened pulse pressure in one. No serious events occurred in this series, and no patient required treatment beyond gastrointestinal decontamination. For ingestions of 0.6 mg/kg or less, treatment at home with observation may be sufficient. For larger ingestions, eg, greater than 0.6 mg/kg, consideration should be given to direct medical evaluation and gastrointestinal decontamination.

Accidents, Home↗
PubMed1993

Isradipine ingestion in a two-year-old child.

We reported the first case of accidental or intentional overdose with isradipine. A 2 y-old male accidentally ingested 2.5 mg of isradipine. A drop in arterial pressure responded to fluids. No other symptoms were noted. The child recovered without sequelae.

Child, Preschool↗
PubMed1990

Calcium channel blocker toxicity.

A retrospective review was conducted of all patients who were reported to a regional poison control center after "overdose" of a calcium channel blocker during a two-year period (1987 and 1988). An analysis of 91 patient cases is presented after excluding allergic reactions, cases involving coingestants, and patients lost to follow-up. Patients who developed any symptoms after ingestion were defined as manifesting toxicity. There were 38 cases of verapamil ingestion with toxicity developing in 18 patients. The mean nontoxic dose was 320 mg, whereas the mean toxic ingestion was 3.2 g. Nine patients became hypotensive, 13 developed conduction system abnormalities (sinus node suppression, atrioventricular nodal block, or bundle branch block), and 11 manifested arrhythmias. Ten developed neurological symptoms. There were 31 cases of nifedipine ingestion with toxicity developing in seven patients. The mean nontoxic dose was 19 mg, while the mean toxic ingestion was 340 mg. Four patients were hypotensive, only one developed cardiac conduction abnormalities, and four developed arrhythmias. Three had neurological symptoms. There were 24 cases of diltiazem ingestion with only minor toxicity developing in four patients. There was no statistically significant difference in the frequency of hypotension, arrhythmias, or neurological symptoms in patients who overdosed with verapamil as compared with nifedipine (by Fisher's exact test). However, conduction system abnormalities were more common with verapamil ingestion (P less than .05). Toxic manifestations after diltiazem over-dose were uncommon in our study. Eighteen of the 29 patients who developed toxicity required treatment in excess of gastrointestinal decontamination. Calcium was administered to 14 patients and was helpful in five.

Adolescent↗
PubMed1989

Reliability of patient history in determining the possibility of pregnancy.

In an effort to assess the reliability of patient history in excluding pregnancy, we studied the correlation between specific historical factors and the presence of a positive qualitative serum beta-human chorionic gonadotropin assay. Two hundred eight patients were studied, and information was collected prospectively on a variety of historical criteria. Three historical variables were statistically less likely to be associated with pregnancy: last menstrual period that was on time, the patient thinking she was not pregnant, and the patient stating there was no chance she could be pregnant (P less than .001). There was, however, still at least a 10% chance of the patient being pregnant. Combinations of historical criteria were likewise unsuccessful at totally excluding pregnancy. These data support the contention that patient history is an unreliable method of excluding pregnancy in emergency department patients and supports the liberal use of pregnancy tests.

Adolescent↗
PubMed1988

Acute digoxin overdose: use of digoxin-specific antibody fragments.

An acute ingestion of 6 to 7 mg digoxin as a suicidal gesture in a 76-year-old man with chronic heart disease is presented. The patient arrived in the emergency department approximately 5 hours after ingestion with a normal serum potassium and increasing numbers of multifocal premature ventricular contractions. Digoxin-specific antibody fragments were administered. The patient developed ventricular tachycardia and ventricular fibrillation and was eventually stabilized 35 minutes after the Fab fragments were infused. A review of the pharmacology and indications for use of digoxin-immune Fab fragments is also presented.

Aged↗
PubMed1987

Traumatic hip dislocation in a child.

Traumatic dislocation of the hip joint is relatively uncommon in children. The trauma required to produce a dislocation can vary from minimal to severe, high-energy force. We report a case of posterior hip dislocation in a 9-year-old boy who received relatively minor trauma to his leg but who did not seek medical attention for more than 24 hours. The child's hip was reduced without significant sequelae. Delay in reduction greatly increases the likelihood of later complications, including avascular necrosis of the femoral head.

Child↗
PubMed1987

Initial management of adolescent overdoses.

A retrospective study of pediatric patients presenting to a community hospital emergency department with acute intentional toxidromes was conducted. The characteristics of these patients and their initial medical management were reviewed. Forty-six patients were included in this study with 35 recreational overdoses and 11 suicide attempts or gestures. The mean age of these patients was 15.8 (range 10 to 18 years). The most commonly abused substance was ethanol, followed in frequency by benzodiazepines and barbiturates. Initial management centered on active airway management, gastrointestinal decontamination, and extended observation. Ten patients were intubated, lavaged, extubated, and subsequently discharged from the emergency department. Only one patient required hospital admission. The value of toxicologic screens, emergency department endotracheal intubations, gastric lavage, and charcoal/cathartic therapy is discussed.

Adolescent↗
PubMedDate not supplied

Midazolam use in the emergency department.

Midazolam is a new imidazobenzodiazepine derivative that is two to three times as potent as diazepam, is water-soluble, has a rapid onset and short duration of action, and produces a profound amnestic effect. These properties make it an extremely useful drug for outpatient sedation. We performed retrospective review of midazolam use in a general emergency department over a one-year period. Midazolam was used in 120 patients, 71 men and 49 women, with an average age of 46 years. The average dose given was 3.4 mg, with a range of 1 to 10 mg. In 69 of the cases (57%) other drugs were administered, most commonly an opiate. There were only four adverse reactions. One patient developed urinary retention, one patient vomited, and two patients were somnolent for a prolonged period of time. There were no serious cardiovascular or respiratory problems. We conclude that midazolam is a safe drug to use in the emergency department. Close monitoring of the patient and the availability of airway support equipment are mandatory.

Adolescent↗