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Biomedical subjects

Kennon Heard

Publications and source records attributed to Kennon Heard.

At least 19 recordsLinked to original sources
PubMed2006

Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.

Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.

Aged↗
PubMed2006

Overuse of over-the-counter analgesics by emergency department patients.

STUDY OBJECTIVE: The purpose of this study is to determine the prevalence of over-the-counter analgesic overuse in a sample of emergency department (ED) patients. METHODS: We conducted a survey of a convenience sample of patients presenting to an urban, academic ED. Research associates questioned patients about the use of pain or cold medications containing ibuprofen, acetaminophen, naproxen, or aspirin. Patients who reported using medications with these ingredients in the 72 hours before their visit were asked about the specific medications, daily dose, and reason for medication use. The daily dose of these 4 analgesics was determined and classified as within or above the manufacturers' recommended over-the-counter dose range. RESULTS: Three hundred seven of 546 (56%) surveyed patients had reported using a medication containing one of these ingredients. Thirty-seven patients (6.2%; 95% confidence interval 4.5% to 8.6%) reported exceeding the manufacturer's recommended daily dose at some point in the 3 days preceding their ED visit. CONCLUSION: Although our study was limited by the use of a convenience sample, we found a potentially significant rate of patients who reported taking excessive doses of over-the-counter analgesics.

Acetaminophen↗
PubMed2006

Prescribing to older ED patients.

The purpose of this article is to assist emergency physicians in selecting safe and effective drug therapy for seniors. Because safer alternatives exist, medications on the Beers list of potentially inappropriate medications should generally be avoided. We also review risks associated with several classes of medications: nonsteroidal anti-inflammatory drugs, benzodiazepines, and anticholinergic medications. They are associated with adverse outcomes when taken by older adults and should be used with caution. We also address the use of opioid medications in seniors. Although they are not without risk, opioids are generally safe with slow titration, precautions, and a bowel regimen to prevent constipation. Prescribers should also consider the need for estimating creatinine clearance when prescribing medications that require dosage adjustment in the setting of renal insufficiency. Two areas in need of research are identifying the proper dosing and safety of medications in seniors and prescribing with electronic decision support to assist in prescribing decisions.

Aged↗
PubMed2006

Inhalational abuse of methanol products: elevated methanol and formate levels without vision loss.

Inhalant abuse of methanol-containing products has increased over the last decade. We performed a prospective observational study of 7 subjects who presented to an ED after inhalant abuse of methanol-containing hydrocarbon products. Four patients had a methanol level greater than 24 mg/dL and 2 had an anion gap greater than 17 mEq/L. The mean formic acid level was 71 microg/mL, and 1 patient had a level considered high enough to induce retinal toxicity (>200 microg/mL). No patient had an abnormal ophthalmologic examination. All patients were treated with intravenous folate, 2 received alcohol dehydrogenase blockade, and no patient received hemodialysis or intravenous bicarbonate. All patients' acidosis resolved within 4 hours. The methanol and formic acid levels are lower than those reported after methanol ingestion. These preliminary data suggest that inhalant abusers of methanol products may have significantly elevated methanol and formic acid levels, but are at low risk for methanol induced complications of visual dysfunction and refractory acidosis.

Acidosis↗
PubMed2006

The changing indications of gastrointestinal decontamination in poisonings.

Gastrointestinal (GI) decontamination is commonly used in the treatment of the poisoned patient. Although the practice is widely accepted, the science behind the recommendations is limited. This article describes commonly used techniques for GI decontamination and critically reviews the studies evaluating these treatments.

Charcoal↗
PubMed2006

Prehospital interventions to improve neurological outcome following cardiac arrest.

As many cases of cardiac arrest occur outside of the health care setting, prehospital treatment may dramatically affect patient outcomes. The three major interventions that have been studied are chest compressions and ventilation, electrical defibrillation, and medications. Recent studies show that increasing the rate of cardiopulmonary resuscitation (CPR), decreasing the rate of ventilation, and initiation of CPR prior to defibrillation may result in improved survival. Biphasic defibrillators can restore perfusing rhythms while minimizing myocardial injury. Public access to automatic defibrillators has been shown to increase the survival of cardiac arrest patients. Medications such as amiodarone, vasopressin, and thrombolytics also may have a role in the prehospital treatment of cardiac arrest. Recent advances in these areas will be reviewed with a discussion of the effect of each intervention on the restoration of circulation and neurological outcomes.

Anti-Arrhythmia Agents↗
PubMed2006

A preliminary study of tricyclic antidepressant (TCA) ovine FAB for TCA toxicity.

BACKGROUND: Animal studies suggest that tricyclic antidepressant antibody fragments (TCA Fab) may be a useful therapy for tricyclic antidepressant poisoning. The objective of this study is to determine if TCA Fab increases total serum TCA levels without raising free serum TCA levels in human overdose patients, indicating that TCA Fab effectively binds TCA. METHODS: This was a prospective, dose escalation study of patients with mild to moderate TCA poisoning. Patients were treated with an escalating intravenous infusion totaling 7 or 14 gm of TCA Fab. The outcomes of interest were serum TCA levels (total and free), worsening of TCA toxicity, and adverse effects. RESULTS: Seven patients were treated with Fab. Infusion of TCA Fab was associated with a dramatic increase in total serum TCA levels, while free TCA levels fell in both dosing groups. There were no significant changes in QRS duration, heart rate or mean arterial pressure associated with the Fab Infusion. Worsening of TCA toxicity did not occur despite marked elevation of total serum TCA concentrations. The two patients with the greatest prolongation of QRS showed a prompt shortening in their QRS duration temporally associated with the Fab infusion. Mild wheezing was observed in one asthmatic patient. CONCLUSIONS: 1) TCA Fab raises total serum TCA levels while lowering free levels in TCA poisoned patients; 2) no toxic effects were associated with the increase in TCA levels and no severe adverse effects were observed during the hospital course following Fab infusion.

Adult↗
PubMed2005

Gastrointestinal decontamination.

Overall, no conclusive data support the use of gastric decontamination in the routine management of the poisoned patient. Studies of asymptomatic patients suggest that no treatment is required, and, given the complications that have been reported, this may be a reasonable approach to' most patients. Even in symptomatic patients, the only demonstrable benefit was found in a post-hoc subgroup analysis and involved an outcome of questionable clinical importance. Given these data, it would be easy to conclude that GI decontamination has no role in the management of the poisoned patient. This conclusion is valid when considering poisoned patients as a group, but all poisoned patients are not the same. Patients with trivial ingestion do well without treatment, and their greatest risk is an iatrogenic complication. Even patients with more serious ingestions usually have good outcomes with supportive care alone. It is no longer sufficient to justify GL or forced administration of AC with the supposition that "the patient could have taken something bad." However,there are some overdoses where limiting the systemic absorption of the poison may limit the toxic effects and prevent serious toxicity. After careful consideration of the risks, GI decontamination should be targeted at patients who, in the opinion of the treating physician, have a potentially life-threatening exposure.

Charcoal↗
PubMed2005

Ziprasidone pretreatment attenuates the lethal effects of cocaine in a mouse model.

BACKGROUND: Cocaine intoxication is a common cause of agitation in emergency department patients. Ziprasidone, an atypical antipsychotic, is being increasingly used for sedation of agitated patients in the emergency department. OBJECTIVES: To provide preliminary animal data on the efficacy of ziprasidone for the treatment of acute cocaine poisoning. METHODS: This was a randomized, blinded comparison of ziprasidone and placebo for the prevention of seizures and apparent lethality in a mouse model of cocaine intoxication. Animals were assigned to either placebo or 0.4 mg/kg or 1.2 mg/m(2) of ziprasidone intraperitoneally 30 minutes prior to administration of 105 mg/kg of cocaine. Study outcomes were the proportions of animals having seizures and the apparent lethality. RESULTS: 1.2 mg/m(2) of ziprasidone decreased the lethal effects of cocaine by 50%, while 0.4 mg/kg decreased lethality by 13%. There was no effect on seizures at either dose. CONCLUSIONS: Ziprasidone pretreatment decreased lethality in this mouse model of severe cocaine intoxication.

Acute Disease↗
PubMed2005

Impact of the Final Rule on the rate of clinical cardiac arrest research in the United States.

BACKGROUND: The federal government placed a moratorium on human emergency resuscitation research in 1993 due to concerns related to informed consent. In 1996, the Food and Drug Administration introduced the Final Rule in order to allow clinical resuscitation research to proceed in special cases without prospective informed consent. It is unclear, however, how this change has impacted the performance of this research. OBJECTIVES: To measure the potential impact of the Final Rule by determining the number of clinical cardiac arrest studies performed in the United States (US) before and after 1993, and to compare it with the number of studies performed in the European Union (EU) during the same periods. METHODS: A MEDLINE search was performed for cardiac arrest studies that were prospective, interventional, randomized, and performed in the US or EU from 1983 through 2003. RESULTS: Of the 3,115 cardiac arrest publications identified, 66 (2%) met inclusion criteria. Of the 40 studies conducted in the US, 24 (60%) were published prior to or during 1993, whereas of the 27 studies conducted in the EU, six (22%) were published prior to or during 1993 (odds ratio = 0.5; 95% confidence interval = 0.3 to 0.8). CONCLUSIONS: There has been a significant decrease in the number of published clinical cardiac arrest trials in the US since 1993. In contrast, there has been a significant increase in the number of published EU trials since 1993. The current informed consent requirements may have reduced the number of clinical cardiac arrest studies performed in the US.

Data Collection↗
PubMed2004

Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion.

STUDY OBJECTIVE: Repeated supratherapeutic ingestion of acetaminophen is potentially lethal but poorly described. We provide the first prospective description of the characteristics, course, and outcome of patients with repeated supratherapeutic ingestion of acetaminophen. METHODS: This was a prospective case series of consecutive patients aged 12 years and older with acetaminophen dosage greater than 4 g per 24 hours referred to our poison center. Acetylcysteine was recommended if serum acetaminophen level exceeded 10 mg/L or aspartate aminotransferase exceeded 50 IU/L. Acetaminophen dosage, demographic factors, treatment, and outcome were recorded using standardized methods. Minimum follow-up was 72 hours. RESULTS: Of 277 patients eligible, 249 patients were enrolled. At presentation, serum aspartate aminotransferase levels less than 50 IU/L were found in 126 patients, aspartate aminotransferase levels of 50 to 1,000 IU/L were present in 47 patients, and aspartate aminotransferase levels were above 1,000 IU/L in 37 patients. No aspartate aminotransferase data were available for 39 patients. No patient with an aspartate aminotransferase level below 50 IU/L at presentation developed hepatotoxicity (aminotransferase >1,000 IU/L). Seven (15%) patients with aspartate aminotransferase levels of 50 to 1,000 IU/L at presentation subsequently developed hepatotoxicity; 1 patient died. Six (16%) patients with aspartate aminotransferase levels above 1,000 IU/L at presentation died or received liver transplants. Study limitations included recall bias, incomplete patient follow-up, and the assumption that absence of clinical signs indicated insignificant liver injury. CONCLUSION: Our results suggest that the injury caused by acetaminophen repeated supratherapeutic ingestion is apparent at presentation and related to dose magnitude and duration. All patients who developed hepatotoxicity presented with aspartate aminotransferase above 50 IU/L. Determination of serum aspartate aminotransferase and acetaminophen concentrations may allow early discharge from the emergency department.

Acetaminophen↗
PubMed2004

A simple, safe, and efficient way to treat severe fluoride poisoning--oral calcium or magnesium.

PURPOSE: To examine the efficacy and safety of administration of calcium and magnesium orally and intraperitoneally to treat severe sodium fluoride intoxication. MATERIALS AND METHODS: Mice were initially gavaged a lethal dose of sodium fluoride (NaF) or water. Then, mice were treated with water or varying concentrations of calcium chloride (CaCl2) or magnesium sulfate (MgSO4) via intraperitoneal (IP) route or via oral route. Mice were monitored for 24 h, and the time of death was recorded. RESULTS: IP injections of large amounts of CaCl2 or MgSO4 were dangerous. All mice gavaged with water and then treated with oral CaCl2 or MgSO4 survived and displayed normal activity during the experiment. The survival rate of mice gavaged with a lethal dose of NaF and then treated with a high dose of oral CaCl2 or MgSO4 was significantly higher than those of using low dose. CONCLUSION: Oral administration of a high dose of CaCl2 or MgSO4 is a simple, safe, and effective adjunctive method for treating severe oral fluoride poisoning.

Administration, Oral↗
PubMed2004

Lack of toxic effects following acute overdose of cellcept (mycophenolate mofetil).

Mycophenolate mofetil is an immunosuppressive drug used for prevention of graft rejection following solid organ transplant and for treatment of autoimmune disorders. We report a case of a 24-year-old female with lupus nephritis that presented following ingestion of 10 grams of mycophenolate in a suicide gesture. Serum levels confirmed ingestion. The patient was treated with decontamination and supportive care and recovered with no adverse effect.

Adult↗
PubMed2004

Reliability of the Glasgow Coma Scale for the emergency department evaluation of poisoned patients.

UNLABELLED: The Glasgow Coma Scale (GCS) was developed for monitoring the mental status of head-injured patients in the intensive care unit. The purpose of this study is to determine the inter-rater reliability of the GCS for poisoning patients in the emergency department. METHODS: This was a prospective, observational study. Two observers used a standard assessment checklist to determine the GCS of suspected poisoning patients. Inter-rater reliability was assessed with a weighted Kappa score. RESULTS: A total of 39 patients were enrolled. Weighted kappa for the total GCS demonstrated excellent agreement. Agreement was also good for each component of the score. CONCLUSION: The GCS is a reliable tool for the evaluation of mental status of poisoning patients in the emergency department.

Adolescent↗
PubMed2003

Oral decontamination with calcium or magnesium salts does not improve survival following hydrofluoric acid ingestion.

Hydrofluoric acid (HF) ingestion may result in rapid death from systemic fluoride poisoning. Because fluoride binds calcium and magnesium, oral administration of calcium or magnesium salts has been suggested as useful therapy for HF ingestion. This study evaluates oral administration of calcium and magnesium salts for the prevention or attenuation of acute HF toxicity following oral exposure in a mouse model. Mixed breed CF-1 mice were randomized to treatment with a lethal-dose HF premixed with calcium chloride, magnesium sulfate, or deionized water by gavage. Average survival time for the three groups was the same. This study suggests that calcium- or magnesium-containing solutions do not alter the toxic effect of HF following oral exposure.

Animals↗