Response to: To dive or not to dive? Use of hyperbaric oxygen therapy to prevent neurologic sequelae in patients acutely poisoned with carbon monoxide.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
Michael J Matteucci
Publications and source records attributed to Michael J Matteucci.
The Pittsburgh Decision Rule: triage nurse versus physician utilization in the emergency department.
The Pittsburgh Decision Rule (PDR) is a rule for ordering knee radiographs in patients with acute knee injuries. This study was designed to compare the utilization of the PDR between triage nurses and physicians. Consecutive patients presenting to the Emergency Department were enrolled. Nurses and physicians were blinded to each other's examinations. Of 182 subjects approached, 30 were excluded for incomplete data or refusal to obtain radiographs, leaving 152 subjects enrolled. Thirteen fractures (8.6%) were identified. Kappa scores were high for each component of the rule: mechanism of injury (fall or blunt trauma) kappa = 0.67, age (< 12 or > 50 years) kappa = 1, inability to ambulate kappa = 0.67 and overall kappa = 0.83. Four of 13 fractures (31%) would have been missed using the PDR, resulting in a sensitivity of 77% for both physicians and nurses, and a specificity of 57% for physicians and 58% for nurses. Triage nurses and physicians were able to apply the PDR to patients who presented with acute knee injuries with a high level of agreement. However, the PDR demonstrated poor sensitivity in this patient population.
Adolescent↗
Effect of oral calcium disodium EDTA on iron absorption in a human model of iron overdose.
OBJECTIVE: Anecdotal case reports and animal models have suggested that the administration of CaNa2EDTA (EDTA) may be effective in reducing the absorption of iron after an oral iron overdose. We designed this study to determine the effect of orally administrated EDTA with or without activated charcoal (AC) on iron absorption after a mild iron ingestion in healthy human volunteers. METHODS: A randomized, crossover study was conducted in eight healthy human volunteers. All subjects ingested 5 mg/kg of elemental iron in the form of ferrous sulfate. One hour post ingestion, subjects were randomized to receive 35 mg/kg EDTA, EDTA plus 50 grams of AC, or water. Serial iron levels were obtained at baseline and every hour for the first 6 hours, then at 8, 12, and 24 hours. A 2-week washout was used between study arms. The Kruskal-Wallis test was used for the following comparisons between treatment groups: baseline serum iron levels, area under time-concentration curves (AUCs) from baseline to 12 hours and baseline to 24 hours, and peak iron levels. RESULTS: Baseline serum iron levels did not differ among the three treatment groups (p = 0.844). AUCs were not different among groups (p = 0.746 for 12 hr, p = 0.925 for 24 hr). AUC medians (with 95% binomial confidence bounds) for control, EDTA, EDTA + AC groups, respectively, for 12 hr were: 2813 (2298, 3561), 2570 (1669, 3476), and 2654 (2125, 3600); and for 24 hr were: 4083 (3488,5314), 4139 (2666, 5547), and 4274 (3336, 5577). Peak serum iron levels did not differ among treatment groups (p = 0.481). Peak iron level medians in microg/dL (with 95% binomial confidence bounds) were for control: 329 (253, 382), for EDTA: 271 (184, 375), and for EDTA + AC: 285 (229, 352). CONCLUSION: Orally administered EDTA did not significantly reduce iron absorption when administered 1 hour post iron ingestion during the 12 or 24-hour period following the ingestion of 5 mg/kg of elemental iron in healthy human volunteers.
Administration, Oral↗
Herbal aconite tea and refractory ventricular tachycardia.
Explore the source record for details and available documents.
Aconitum↗
Response to Latrodectus-associated compartment syndrome.
Explore the source record for details and available documents.
Animals↗
One pill can kill: assessing the potential for fatal poisonings in children.
Antimalarials, camphor, clonidine, methyl salicylates, and sulfonylureas all may result in serious poisonings and are potentially fatal in small doses in toddlers. Early recognition and appropriate management, including antidotal and supportive care, may prevent poor outcomes in these patients.
Administration, Oral↗
Antidote use in the critically ill poisoned patient.
The proper use of antidotes in the intensive care setting when combined with appropriate general supportive care may reduce the morbidity and mortality associated with severe poisonings. The more commonly used antidotes that may be encountered in the intensive care unit (N-acetylcysteine, ethanol, fomepizole, physostigmine, naloxone, flumazenil, sodium bicarbonate, octreotide, pyridoxine, cyanide antidote kit, pralidoxime, atropine, digoxin immune Fab, glucagon, calcium gluconate and chloride, deferoxamine, phytonadione, botulism antitoxin, methylene blue, and Crotaline snake antivenom) are reviewed. Proper indications for their use and knowledge of the possible adverse effects accompanying antidotal therapy will allow the physician to appropriately manage the severely poisoned patient.
Antidotes↗