- Email: [email protected]
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Research Forum Abstracts
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Awareness of “ICE” (In Case of Emergency) on Cell Phones and Willingness to Allow “ICE” to Be Added to a Cell Phone While in the Emergency Department
McKenna DP, Triner W, Little A, Dunn M/Albany Medical Center, Albany, NY
Study Objectives: Inserting the letters “ICE” in front of the name chosen as an emergency contact on a cell phone (phone) enables emergency workers to quickly access the desired contact. The purpose of this study was to determine the degree to which patients and visitors in the ED have placed the acronym ICE on their phone and whether they would do it while they are in the ED. Methods: This was a cross sectional, observational based study of a consecutive sample of patients presenting to the ED. All patients and anyone accompanying them were approached during their ED visit and requested to complete a short, anonymous survey that asked about their awareness of putting ICE on their phone. The survey also collected demographic information including gender, age, ethnicity and education. Exclusion criteria were inability to complete the survey and incarceration. Those people who had not already placed ICE on their phone were offered education about the importance of this personal health initiative. Those that listened to the information about ICE were offered help with the process of putting ICE on their phone while in the ED. Or, if their preference was to place ICE on their phone themselves, this information was collected. The outcomes were recorded in the survey. Results: 556 people were approached during the period of the study and 13 people left the ED prior to being offered a survey. 438 people returned the survey, and 423 surveys were completed correctly. Of the 423 persons with completed surveys, 285 people owned a cell phone. Of those, 76 had heard of ICE and 26 (9%) reported to have already placed ICE on their phone. There were 259 people who had never heard of ICE or had heard of it but had not put it on their phone. 196 of these reported to have their phone with them and 178 of those people agreed to listen to the short educational session on the importance of ICE. Of those, 129 agreed to have ICE loaded on their phone while in the ED. These 129 people represented 66% of those people who reported to have their phone with them and did not already have ICE on their phone. They also represented 45% of all people in the survey who owned a cell phone. Of the 129 who placed ICE on their phone in the ED, 58 did it themselves, 36 had a family member do it and 35 allowed the researcher to do it for them. Logistic regression demonstrated that the combination of higher education, female gender and non-white race increased the likelihood of placing ICE on their phone. Conclusions: Having ICE on a phone may improve the likelihood of reaching an emergency contact of a patient when they are in the ED. Only a small fraction of cell phone owners reported having ICE on their phone. ED staff can convince a majority of ED patients and visitors who own a cell phone and have their cell phone with them to put ICE on their phone while in the ED if they listen to a short educational session on the importance of ICE.
262
Serum Glucose Concentrations as a Marker of Severity in Calcium Channel Blocker Overdose
Levine M, Thomas S, Geib A, Thomsen T, Pozner C/Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Childrens Hospital Boston, Boston, MA; Mount Auburn Hospital, Cambridge, MA; Brigham and Women’s Hospital, Boston, MA
Study Objectives: Significant calcium channel blocker overdose commonly results in hyperglycemia, which is thought to be due to the blockade of the pancreatic L-type calcium channels and the development of insulin resistance. The implications of hyperglycemia in this setting have yet to be established. We attempted to ascertain whether the level of hyperglycemia correlates with the clinical severity of the overdose. Methods: We conducted a multi-center, retrospective review of verapamil and diltiazem overdoses at three university-affiliated teaching hospitals. Patients were identified via a computerized search of discharge diagnoses. Adults (age 18 years) admitted between 1 January 1993 and 31 December 2005 whose discharge diagnosis included ingestion of either verapamil or diltiazem were included. Patients whose overdose included insulin or a sulfonylurea agent were excluded. We abstracted vital signs, initial and peak blood glucose concentration, treatment rendered, and mortality. We compared the initial and peak blood glucose concentrations with a composite endpoint of in-hospital mortality, need for mechanical ventilation, need for vasopressors, and need for a temporary pacemaker. Results: Twenty-three patients met inclusion criteria. Seven of these patients also
S80 Annals of Emergency Medicine
met the composite endpoint. The mean minimum heart rate observed for those who met the composite endpoint was 41 beats per minute, compared with 53 beats per minute for those who did not meet the composite endpoint. The initial blood glucose for those who did and did not meet the composite endpoint was 229 (⫹/⫺ 90) mg/ dL and 146 (⫹/⫺ 58) mg/dL, respectively (p ⬍ 0.05). The peak serum glucose for those who did and did not meet the composite endpoints were 345 (⫹/⫺ 102) mg/ dL and 157 (⫹/⫺ 81) mg/dL, respectively (p ⬍ 0.05). When evaluating the relationship between the initial serum glucose and composite endpoints, the area under the ROC curve was 0.787. When the peak serum glucose was substituted for the initial serum glucose concentration, the area under the ROC curve was 0.948. Of the 7 patients who met the composite endpoints, 6 had peak serum glucose concentrations greater than 250 mg/dL. Of the 16 patients not meeting the composite endpoint, only 2 patients (one of whom was a diabetic) had serum glucose concentrations above 250 mg/dL. Conclusion: In this multi-center, retrospective study of verapamil and diltiazem overdoses, elevation of serum glucose was directly associated with the clinical severity of the overdose. Serum glucose concentrations may be a useful prognostic indicator of morbidity or mortality. A larger study confirming this finding would support the early initiation of aggressive therapy (e.g. hyperinsulinemic euglycemic therapy) based on the determination of the serum glucose level.
263 264 265 266
Abstract Withdrawn Abstract Withdrawn Abstract Withdrawn Inhalation of Methanol-Containing Products: A Significant Source of Possible Toxicity
Givens ML, Kalbfleisch K, Bryson S/Madigan Army Medical Center, Tacoma, WA
Study Objectives: Methanol poisoning by ingestion of various commercially available products is well represented in current emergency medicine literature. Much less described, however, is poisoning via intentional inhalation of methanolcontaining products such as carburetor cleaner. This study intends to explore the exposure routes and treatment patterns of methanol cases reported to Texas Poison Centers. Methods: All cases of methanol exposures from January 2003 to May 2005 were collected from the Texas Poison Center Network database “Toxicall.” Inclusion criteria were 1) methanol as primary exposure, 2) documented route of exposure. Exclusion criteria were unknown, dermal, and eye exposures. Data was extracted from documented calls to Texas Poison Centers and analyzed using descriptive statistics. Results: A total of 203 cases were collected from 6 regional Poison Centers. Eight unknown exposures, 5 dermal, and 22 eye exposures were excluded. Eighty seven of the remaining cases were inhalational and 81 were methanol ingestions. Carburetor cleaner was responsible for nearly all the inhalational cases (97%) while ingestions involved mostly windshield washer fluid (48%) and carburetor cleaner (25%). The mean age of the ingestion group was 19 (range ⬍ 1 to 70 years, with 12 patients under the age of 6), while the mean age of the inhalation group was 28 (range 2-62 years with one patient under the age of 6). Seventy-six percent of the inhalational exposures were intentional while most of the ingestions were accidental (60%) and suicidal (22%). An anion gap was documented in 36% of the inhalational cases and in 12% of the ingestions. Dialysis was documented more frequently in the inhalational group (10%) than in the ingestion group (6%) along with more frequent use of 4-methylpyrazole in the inhalational group (24%) versus those ingesting methanol (20%). Six patients in the inhalational group suffered visual loss and 2 in the ingestion group. Fifty-one percent of the inhalational group were admitted compared to 38% of the ingestion group. Conclusion: We propose that the results obtained from our review show inhalational exposure involving methanol (ie, “huffing”) represents a significant source of toxicity in the studied population. This is in contrast to previous literature that proposed inhalational toxicity was rare and aggressive treatment usually not necessary in cases of inhalation of methanol containing carburetor cleaners. Although awareness of toxicity from methanol ingestion has been highlighted for years in emergency medicine literature, this is one of the few studies looking at inhalational exposures. Emergency physicians need to be cognizant of the potential for toxicity in cases of inhalational abuse of methanol containing products.
Volume , . : October
261
Awareness of “ICE” (In Case of Emergency) on Cell Phones and Willingness to Allow “ICE” to Be Added to a Cell Phone While in the Emergency Department
McKenna DP, Triner W, Little A, Dunn M/Albany Medical Center, Albany, NY
Study Objectives: Inserting the letters “ICE” in front of the name chosen as an emergency contact on a cell phone (phone) enables emergency workers to quickly access the desired contact. The purpose of this study was to determine the degree to which patients and visitors in the ED have placed the acronym ICE on their phone and whether they would do it while they are in the ED. Methods: This was a cross sectional, observational based study of a consecutive sample of patients presenting to the ED. All patients and anyone accompanying them were approached during their ED visit and requested to complete a short, anonymous survey that asked about their awareness of putting ICE on their phone. The survey also collected demographic information including gender, age, ethnicity and education. Exclusion criteria were inability to complete the survey and incarceration. Those people who had not already placed ICE on their phone were offered education about the importance of this personal health initiative. Those that listened to the information about ICE were offered help with the process of putting ICE on their phone while in the ED. Or, if their preference was to place ICE on their phone themselves, this information was collected. The outcomes were recorded in the survey. Results: 556 people were approached during the period of the study and 13 people left the ED prior to being offered a survey. 438 people returned the survey, and 423 surveys were completed correctly. Of the 423 persons with completed surveys, 285 people owned a cell phone. Of those, 76 had heard of ICE and 26 (9%) reported to have already placed ICE on their phone. There were 259 people who had never heard of ICE or had heard of it but had not put it on their phone. 196 of these reported to have their phone with them and 178 of those people agreed to listen to the short educational session on the importance of ICE. Of those, 129 agreed to have ICE loaded on their phone while in the ED. These 129 people represented 66% of those people who reported to have their phone with them and did not already have ICE on their phone. They also represented 45% of all people in the survey who owned a cell phone. Of the 129 who placed ICE on their phone in the ED, 58 did it themselves, 36 had a family member do it and 35 allowed the researcher to do it for them. Logistic regression demonstrated that the combination of higher education, female gender and non-white race increased the likelihood of placing ICE on their phone. Conclusions: Having ICE on a phone may improve the likelihood of reaching an emergency contact of a patient when they are in the ED. Only a small fraction of cell phone owners reported having ICE on their phone. ED staff can convince a majority of ED patients and visitors who own a cell phone and have their cell phone with them to put ICE on their phone while in the ED if they listen to a short educational session on the importance of ICE.
262
Serum Glucose Concentrations as a Marker of Severity in Calcium Channel Blocker Overdose
Levine M, Thomas S, Geib A, Thomsen T, Pozner C/Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Childrens Hospital Boston, Boston, MA; Mount Auburn Hospital, Cambridge, MA; Brigham and Women’s Hospital, Boston, MA
Study Objectives: Significant calcium channel blocker overdose commonly results in hyperglycemia, which is thought to be due to the blockade of the pancreatic L-type calcium channels and the development of insulin resistance. The implications of hyperglycemia in this setting have yet to be established. We attempted to ascertain whether the level of hyperglycemia correlates with the clinical severity of the overdose. Methods: We conducted a multi-center, retrospective review of verapamil and diltiazem overdoses at three university-affiliated teaching hospitals. Patients were identified via a computerized search of discharge diagnoses. Adults (age 18 years) admitted between 1 January 1993 and 31 December 2005 whose discharge diagnosis included ingestion of either verapamil or diltiazem were included. Patients whose overdose included insulin or a sulfonylurea agent were excluded. We abstracted vital signs, initial and peak blood glucose concentration, treatment rendered, and mortality. We compared the initial and peak blood glucose concentrations with a composite endpoint of in-hospital mortality, need for mechanical ventilation, need for vasopressors, and need for a temporary pacemaker. Results: Twenty-three patients met inclusion criteria. Seven of these patients also
S80 Annals of Emergency Medicine
met the composite endpoint. The mean minimum heart rate observed for those who met the composite endpoint was 41 beats per minute, compared with 53 beats per minute for those who did not meet the composite endpoint. The initial blood glucose for those who did and did not meet the composite endpoint was 229 (⫹/⫺ 90) mg/ dL and 146 (⫹/⫺ 58) mg/dL, respectively (p ⬍ 0.05). The peak serum glucose for those who did and did not meet the composite endpoints were 345 (⫹/⫺ 102) mg/ dL and 157 (⫹/⫺ 81) mg/dL, respectively (p ⬍ 0.05). When evaluating the relationship between the initial serum glucose and composite endpoints, the area under the ROC curve was 0.787. When the peak serum glucose was substituted for the initial serum glucose concentration, the area under the ROC curve was 0.948. Of the 7 patients who met the composite endpoints, 6 had peak serum glucose concentrations greater than 250 mg/dL. Of the 16 patients not meeting the composite endpoint, only 2 patients (one of whom was a diabetic) had serum glucose concentrations above 250 mg/dL. Conclusion: In this multi-center, retrospective study of verapamil and diltiazem overdoses, elevation of serum glucose was directly associated with the clinical severity of the overdose. Serum glucose concentrations may be a useful prognostic indicator of morbidity or mortality. A larger study confirming this finding would support the early initiation of aggressive therapy (e.g. hyperinsulinemic euglycemic therapy) based on the determination of the serum glucose level.
263 264 265 266
Abstract Withdrawn Abstract Withdrawn Abstract Withdrawn Inhalation of Methanol-Containing Products: A Significant Source of Possible Toxicity
Givens ML, Kalbfleisch K, Bryson S/Madigan Army Medical Center, Tacoma, WA
Study Objectives: Methanol poisoning by ingestion of various commercially available products is well represented in current emergency medicine literature. Much less described, however, is poisoning via intentional inhalation of methanolcontaining products such as carburetor cleaner. This study intends to explore the exposure routes and treatment patterns of methanol cases reported to Texas Poison Centers. Methods: All cases of methanol exposures from January 2003 to May 2005 were collected from the Texas Poison Center Network database “Toxicall.” Inclusion criteria were 1) methanol as primary exposure, 2) documented route of exposure. Exclusion criteria were unknown, dermal, and eye exposures. Data was extracted from documented calls to Texas Poison Centers and analyzed using descriptive statistics. Results: A total of 203 cases were collected from 6 regional Poison Centers. Eight unknown exposures, 5 dermal, and 22 eye exposures were excluded. Eighty seven of the remaining cases were inhalational and 81 were methanol ingestions. Carburetor cleaner was responsible for nearly all the inhalational cases (97%) while ingestions involved mostly windshield washer fluid (48%) and carburetor cleaner (25%). The mean age of the ingestion group was 19 (range ⬍ 1 to 70 years, with 12 patients under the age of 6), while the mean age of the inhalation group was 28 (range 2-62 years with one patient under the age of 6). Seventy-six percent of the inhalational exposures were intentional while most of the ingestions were accidental (60%) and suicidal (22%). An anion gap was documented in 36% of the inhalational cases and in 12% of the ingestions. Dialysis was documented more frequently in the inhalational group (10%) than in the ingestion group (6%) along with more frequent use of 4-methylpyrazole in the inhalational group (24%) versus those ingesting methanol (20%). Six patients in the inhalational group suffered visual loss and 2 in the ingestion group. Fifty-one percent of the inhalational group were admitted compared to 38% of the ingestion group. Conclusion: We propose that the results obtained from our review show inhalational exposure involving methanol (ie, “huffing”) represents a significant source of toxicity in the studied population. This is in contrast to previous literature that proposed inhalational toxicity was rare and aggressive treatment usually not necessary in cases of inhalation of methanol containing carburetor cleaners. Although awareness of toxicity from methanol ingestion has been highlighted for years in emergency medicine literature, this is one of the few studies looking at inhalational exposures. Emergency physicians need to be cognizant of the potential for toxicity in cases of inhalational abuse of methanol containing products.
Volume , . : October