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Biomedical subjects

F W Lavoie

Publications and source records attributed to F W Lavoie.

9 recordsLinked to original sources
PubMed1992

Consent, involuntary treatment, and the use of force in an urban emergency department.

STUDY OBJECTIVES: To determine the frequency of, and patient population requiring involuntary treatment orders in the emergency department. DESIGN: Retrospective review of all patients requiring involuntary treatment orders during a one-month study period. SETTING: An urban, university hospital, adult emergency department with 45,000 annual patient visits. RESULTS: Three hundred fourteen of 3,637 patients (8.5%) required involuntary treatment orders. Orders used were observation and detention (57%), seclusion only (9%), restraint only (26%), or seclusion plus restraint (7%). Forty-six percent of patients arrived through the emergency medical services system; the remainder were brought by police or family or were self-referred. More patients required these interventions on the second shift. Most detained and secluded patients had psychiatric diagnoses and dispositions, whereas 100% of restrained patients had medical or surgical diagnoses, and nearly 50% required medical or surgical admissions. CONCLUSION: The frequent need for involuntary treatment orders for patients in an urban ED is reported. The patient population described, especially among restrained patients, differs significantly from those of studies performed in psychiatric settings. Legal doctrines pertinent to involuntary treatment are reviewed.

Adult↗
PubMed1992

Emergency department external decontamination for hazardous chemical exposure.

Although external decontamination is an integral aspect of the emergency management of hazardous chemicals exposure, no standard protocol or report of human experience is available. We performed a retrospective review of all patients decontaminated in our emergency department over a 6-y period for hazardous chemicals exposure. Patients were treated by a universal substances protocol in a specially designed decontamination area. Ocular irrigation utilizing 1500 ml of normal saline po was employed in 27 patients. Oral mucosal irrigation utilizing 1500 ml water was employed in 2 patients. All 72 patients received skin and hair decontamination. Skin was washed 3 times with detergent and cornmeal mixture, and water irrigation or shower for 3 min. Hair was shampooed 3 times with mild soap for 3 min. A subset of patients (n = 31) received pre-decontamination and post-decontamination skin swabbing. Swabs were analyzed by a certified analytical chemistry laboratory utilizing gas chromatography/mass spectrometry. Positive pre-decontamination swabs were seen for pesticides and PCBs. All post-decontamination swab analyses were negative, indicating that the method utilized was effective.

Clinical Protocols↗
PubMed1990

Value of initial ECG findings and plasma drug levels in cyclic antidepressant overdose.

Electrocardiographic changes and quantitative plasma drug levels associated with cyclic antidepressant (TCA) overdose have been the subject of many reports in the medical literature. Heart rate, QRS duration, QT interval, and most recently, the terminal 40 ms QRS (T40) axis have been reported to be valuable indicators in TCA overdose. The value of plasma drug levels and their ability to predict complications has been debated. To evaluate the discriminant and predictive abilities of ECG parameters and quantitative drug levels in a large series of TCA overdoses, we retrospectively reviewed the charts of all overdose patients admitted to ICU in our facility during a 30-month study period. The TCA-positive group (187) had statistically significant differences (P less than .001) from the TCA-negative group (171) in heart rate, QRS duration, QTc, and T40 axis. However, none of these parameters could correctly classify more than 66% of cases. The sensitivity and specificity of the T40 axis were found to be only 29% and 83%, respectively. Correlation coefficients for plasma quantitative TCA levels by ECG parameter yielded an R of less than .33 in all cases. QRS duration of 100 ms or more and heart rate of 100 or more, or TCA level of 1,000 ng/mL or more, were present in all of a few patients with complications. We conclude that ECG parameters cannot be relied on to include or exclude the diagnosis of TCA overdose and that TCA levels do not correlate with ECG parameters.

Adult↗
PubMed1988

Emergency department violence in United States teaching hospitals.

Violence in the emergency department is a common concern. However, most aspects of this problem remain unstudied because no organization or government agency tracks such data and no regulatory or administrative guidelines adequately address its management. We surveyed 170 US teaching hospital ED medical directors with respect to violence and security issues and received responses from 127 (74.7%). Among other findings, 41 institutions report at least one verbal threat each day, and 23 report at least one threat with a weapon each month. Four-point physical restraint is used by 125 of the 127 facilities. Personnel in 32 of these facilities restrain at least one patient each day. Seventeen institutions report having significantly injured a patient during restraint in the last five years, resulting in one death. Twenty institutions report involvement with litigation with respect to restraint. Only 51 institutions provide ED nurses with formal training in recognition and management of aggression and violence, and only 79 institutions have security personnel present in the ED 24 hours a day. A sizable number of facilities receiving frequent threats and batteries are not among those with 24-hour-a-day security personnel. A preventative, risk-management approach that addresses environmental factors, training policies, restraint, security arrangements, and legal precedents is suggested.

Data Collection↗
PubMedDate not supplied

Fatal nicotine ingestion.

Nicotine is one of the most readily available and commonly abused drugs in modern society. However, serious or fatal overdoses of this agent are rare. We present a case of intentional fatal ingestion of nicotine alkaloid solution. This diagnosis may be elusive since nicotine is commonly qualitatively identified on urine toxicology screens, but is seldom quantified. Clinicians should be knowledgeable about the nature of this agent and its pathophysiologic presentations since recognition of the toxidrome is often necessary to make this diagnosis.

Adolescent↗