Biomedical subjects

E J Lucid

Publications and source records attributed to E J Lucid.

5 recordsLinked to original sources

PubMed1993

Social work technician program.

The increasing use of US emergency departments has resulted in increased patient delays and resultant dissatisfaction on the part of the patients and their families. Furthermore, recent studies have indicated that these delays may jeopardize the health of the ED patient. We describe a program designed to address these concerns. The Social Work Technician Program employs social work students nearing graduation as liaisons between medical personnel and ED patients and their families. This program has been found to promote patient satisfaction and welfare while providing the students with a valuable educational experience.

Clinical Clerkship↗

PubMed1991

China White epidemic: an eastern United States emergency department experience.

STUDY OBJECTIVE: The purpose of this study was to isolate significant clinical or demographic findings concerning overdose patients treated during a China White (3-methyl fentanyl) epidemic and compare them with data for all unintentional narcotic overdose patients during a 24-month period. DESIGN: We reviewed charts from 85,246 patient visits to our emergency department during the 24-month period of January 1987 through December 1988 to study this narcotic epidemic. Data from the Allegheny County Coroner's Office pertaining to unintentional drug overdose deaths that occurred during this same period also were reviewed. SETTING: The first outbreak of narcotic overdoses in the eastern United States involving China White occurred in Allegheny County, Pennsylvania, in 1988. TYPE OF PARTICIPANTS: Patients were included if they met the criteria of a suspected unintentional narcotic overdose, but excluded if they were not given naloxone. INTERVENTIONS: Emergency physicians became suspicious of China White use after an unusual increase in narcotic overdoses presenting to the ED coupled with "routine drug of abuse" screens negative for opiates despite dramatic patient responses to naloxone. In most of the cases in which specific testing was done, there were positive indicators of fentanyl derivatives. Investigations found China White present in street drugs and paraphernalia. MEASUREMENTS AND MAIN RESULTS: A cluster was defined as a time period with a statistically significant increase in overdoses over the expected number for an interval of equal length. Although there were no significant clinical differences in case presentation during the 24-month period, there was a statistically significant 13-fold increase in overdoses during the September through November 1988 cluster (mean, 13 vs 0.95 per month, P less than .001 by Wilcoxon rank-sum test). A dramatic increase in unintentional drug overdose deaths occurred in the county during this cluster. A total of 18 fentanyl-positive unintentional drug overdose deaths, predominantly male (89%) and black (56%), with an age range of 19 to 44 years (mean, 34.9 years), were reported by the county coroner (13 during the cluster). Narcotic overdoses and unintentional drug overdose deaths declined sharply with confiscation of a clandestine China White laboratory. CONCLUSIONS: China White was responsible for a dramatic rise in unintentional drug overdose deaths in Allegheny County in 1988. There were no significant clinical differences between China White overdose survivors and other unintentional narcotic overdose victims. Overdoses responsive to naloxone with inconsistent routine toxicologic screens may be due to a fentanyl analogue.

Adult↗

PubMed1987

Management of varicella-zoster virus-exposed hospital employees.

Emergency physicians frequently manage hospital employee health services. A common hospital infection control problem is varicella-zoster virus infection. We reviewed the literature to determine a rational basis for the management of the varicella-zoster virus-exposed hospital employee. Exposed employees include those with direct face-to-face contact with an infected person. The immune status should be determined in those employees with a negative or uncertain history of varicella infection by using a sensitive and specific technique such as the FAMA or ELISA tests. Employees with a positive history or a positive titer are immune and can return to work. Those with a negative titer are susceptible and should avoid patient contact from day eight to 21 following exposure. High-risk, susceptible contacts should be given varicella-zoster immune globulin. Varicella infection will become much less common after the release of varicella vaccine.

Adult↗

PubMed1985

Neuroleptic malignant syndrome.

We present the case of a 35-year-old man who developed symptoms of the neuroleptic malignant syndrome (NMS) after taking prescribed, moderately high, therapeutic doses of haloperidol. When brought to the emergency department, he was comatose, hypotensive, and had rigid muscle tone and a core body temperature of 42.2 C. Although initial treatment was supportive, intubation, ventilator support, and further care in the intensive care unit were necessary. Ensuing disseminated intravascular coagulation was treated successfully and the patient was weaned from the ventilator on the third day after admission. He was discharged from the hospital 11 days after admission. Recently recognized drug therapy for NMS, such as bromocriptine mesylate and dantrolene sodium, was not used in this case.

Adult↗

PubMedDate not supplied

Sphenoid sinusitis, a cause of debilitating headache.

We present a case of sphenoid sinusitis resulting in a debilitating headache refractory to both oral and intramuscular analgesics. Despite an aggressive evaluation in the emergency department, the correct diagnosis and appropriate treatment were delayed. Recognition of sphenoid sinusitis, the complications associated with it, and the need for aggressive management are addressed.

Adult↗