No abstract

No abstract

No abstract

Objectives: The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 lg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration. Methods:The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 lg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 lg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 lg/mL line on the Rumack-Matthew nomogram.Results: Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 lg/mL between 1 and 4 hours, one patient (1.2%) had a ≥ 4-hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 lg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8% (95% confidence interval [CI] = 93.5% to 99.8%).Conclusions: An APAP concentration of <100 lg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false-negative rate of 6.5%.ACADEMIC EMERGENCY MEDICINE 2013; 20:1072-1075 © 2013 by the Society for Academic Emergency Medicine T here are approximately 50,000 patients who present to emergency departments (EDs) each year due to acetaminophen (APAP) exposure. 1 Those patients with acute ingestions are risk stratified by plotting their APAP concentrations on the RumackMatthew nomogram. 2 The nomogram is only validated for concentrations drawn 4 hours or later after acute APAP ingestions. The 4-hour starting point was chosen because of the initial available data at the time the nomogram was developed and to include the possibility of delayed absorption. 2 However, based on therapeutic dose pharmacokinetics, APAP concentrations should peak much earlier (within 1 hour), 3 suggesting that earlier concentrations may be predictive of toxicity.From the

No abstract

No abstract

The incidence and outcome of patients who undergo therapeutic hypothermia (TH) after toxin-induced cardiac arrest (TICA) is not previously described. Our study aimed to describe the incidence, epidemiologic characteristics, and outcomes of patients who experience TICA in a dedicated clinical pathway for post-cardiac arrest care between November 2007 and February 2013. All patients were treated in an evidencebased clinical pathway that included TH. Database and medical records were independently reviewed by investigators to ascertain TICA. TICA was defined as cardiac arrest (CA) directly and immediately caused by a xenobiotic exposure. All patients were enrolled at Carolinas Medical Center, an urban 874-bed teaching hospital that serves as a regional cardiac resuscitation center. All patients were adult victims of cardiac arrest who had obtained return of spontaneous circulation and were enrolled in a clinical pathway for post-cardiac arrest care that included TH. Three hundred eighty-nine patients underwent treatment following CA during the study period and 48 (12 %) were deemed TICA. Patients who suffered TICA were slightly younger, less likely to have an initial shockable rhythm, and less likely to receive bystander CPR as compared to non-toxic cases. TICA accounted for a significant proportion of patients in this study. Additional, larger studies are needed to fully elucidate the optimal role for TH in TICA.

No abstract