- Email: [email protected]
Expanded TOC
625
Oral Arsenic Trioxide Poisoning and Secondary Hazard From Gastric Content (Case Report) H Kinoshita, Y Hirose, T Tanaka, Y Yamazaki In a suicide attempt, a 54-year-old man ingested arsenic trioxide. Gastric lavage was performed, but most of the poison remained as a mass in his stomach. A total gastrectomy was also performed to avoid intestinal perforation and arsenic poisoning. After the operation, he developed ventricular fibrillation. At one point, his circulation recovered spontaneously, but he later died from refractory circulatory failure. Many medical staff members were exposed to fumes from the patient’s stomach. Some of the staff were diagnosed with corneal erosion or laryngitis. Because arsenic trioxide reacts with acid to produce arsine, the symptoms experienced by medical staff are directly attributable to arsine produced as a result of the reaction of arsenic trioxide with gastric acid. We highlight the need for the introduction of protective measures to safeguard medical staff from exposure to arsine gas during the treatment of patients poisoned from ingested arsenic trioxide.
DISASTER AND TERRORISM 628
Use of a Portable Forced Air System to Convert Existing Hospital Space Into a Mass Casualty Isolation Area (Concepts) RA Rosenbaum, JS Benyo, RE O’Connor, BA Passarello, DR Williams, BD Humphrey, RW Ross, JM Berry, JG Krebs We determine whether negative-pressure isolation for multiple patients with communicable diseases can be achieved quickly and effectively using general hospital space not previously dedicated to respiratory isolation. The physical therapy gymnasium was the area designated to test the ability to create a negativepressure isolation environment in a large space. Four high-efficiency particulate air filtered forced air machines were used to generate negative pressure.We measured the ability of the equipment to generate a negative air pressure relative to adjacent areas and determined the noise levels created during the use of different combinations of machines at various power settings. After drill activation and the request for equipment setup, 1 hour was required to convert the physical therapy gymnasium into an operational negative-pressure environment. The room pressure readings ‘‘high’’ power ranged from 1.5 to 13 Pa (0.006 to 0.052 inches of water), and noise levels ranged from 70 to 76 dB. Calculated air changes per hour using 1, 2, 3, or 4 units running simultaneously at ‘‘high’’ power were 4.1, 8.2, 12.3, and 16.4, respectively. Using 4 units at once running at ‘‘low’’ power setting yielded 8.2 air changes per hour and generated a room pressure reading of 8.0 Pa, or 0.032 inches of water.
635
An Evaluation of Portable High-Efficiency Particulate Air Filtration for Expedient Patient Isolation in Epidemic and Emergency Response (Concepts) K Mead, DL Johnson Extraordinary incidents resulting in airborne infectious disease outbreaks could produce patient isolation requirements that exceed most hospitals’ capacity. We investigated expedient methods to establish airborne infection isolation areas using a commercially available portable filtration unit and common hardware supplies. The study was conducted within a conventional, nonisolation hospital room, and researchers evaluated several airborne isolation configurations that did not require building ventilation or structural modifications. A portable high-efficiency particulate air filtration unit and fulllength plastic curtains established a “zone-within-zone” protective environment using local capture and directional airflows. The cost of constructing the expedient configurations was less than US$2,300 and required fewer than 3 person-hours to construct. The best-performing designs showed no measurable source migration out of the inner isolation zone and mean respirable particle counts up to 87% lower at the health care worker position(s) than those observed directly near the source patient location.
DECEMBER 2004
44:6
ANNALS OF EMERGENCY MEDICINE
1 3 A
INJURY PREVENTION 646
Previous Emergency Department Use Among Homicide Victims and Offenders: A Case-Control Study (Original Research) CS Crandall, PF Jost, LM Broidy, G Daday, DP Sklar We differentiate risk factors for future homicide victimization and offending, and we also measure emergency department (ED) use among homicide victims, offenders, and controls. Among the 124 victims and 138 offenders who used health care, most were men (80%) and averaged 27.7 years of age. Victims and offenders had similar health care use and were grouped for final analyses. Cases (victims and offenders) were more likely to have had an ED visit within 3 years of the homicide (85%) compared with controls (59%) (odds ratio [OR] 4.3; 95% confidence interval [CI] 3.0 to 6.2). Within previous ED visits, assault (OR 4.5; 95% CI 2.9 to 7.0), firearm injury (OR 13.6; 95% CI 4.9 to 37.7), and substance abuse (OR 3.7; 95% CI 2.2 to 6.0) were associated with future homicide. ED visits clustered closer to the homicide incident for cases (median days before the homicide 402 days; 95% CI 434 to 364) compared with controls (median 487 days; 95% CI 498 to 474).
656
Analysis of Crashes Involving 15-Passenger Vans (NHTSA Notes)
657
Commentary: Supersized Vans: A Supersized Problem (NHTSA Notes) MP McKay, F Vaca CHANGE OF SHIFT
660
The Loading Dock AL Moettus
662
Christmas Eve in the Department NM Anderson
664
IMAGES IN EMERGENCY MEDICINE
665
CORRESPONDENCE
Moonflower-Induced Anisocoria K Meng, DK Graetz
Whole Bowel Irrigation and the Capsule Summary M Tenenbein/ML Callaham/RC Dart
Effect of Whole Bowel Irrigation on Delayed-Release Acetaminophen and Gut Transit Time M Tenenbein
Holes in the Article on Whole Bowel Irrigation GM Chan, K Johnson, JE Rodriguez, LS Nelson/BT Ly, AB Schneir, RF Clark
Another Perspective on “Severe Hypercapnia Caused by Acute Heroin Overdose” SA McLaughlin, ME Richards/R Gupta, T Haydock
1 4 A
ANNALS OF EMERGENCY MEDICINE
44:6
DECEMBER 2004
Oral Arsenic Trioxide Poisoning and Secondary Hazard From Gastric Content (Case Report) H Kinoshita, Y Hirose, T Tanaka, Y Yamazaki In a suicide attempt, a 54-year-old man ingested arsenic trioxide. Gastric lavage was performed, but most of the poison remained as a mass in his stomach. A total gastrectomy was also performed to avoid intestinal perforation and arsenic poisoning. After the operation, he developed ventricular fibrillation. At one point, his circulation recovered spontaneously, but he later died from refractory circulatory failure. Many medical staff members were exposed to fumes from the patient’s stomach. Some of the staff were diagnosed with corneal erosion or laryngitis. Because arsenic trioxide reacts with acid to produce arsine, the symptoms experienced by medical staff are directly attributable to arsine produced as a result of the reaction of arsenic trioxide with gastric acid. We highlight the need for the introduction of protective measures to safeguard medical staff from exposure to arsine gas during the treatment of patients poisoned from ingested arsenic trioxide.
DISASTER AND TERRORISM 628
Use of a Portable Forced Air System to Convert Existing Hospital Space Into a Mass Casualty Isolation Area (Concepts) RA Rosenbaum, JS Benyo, RE O’Connor, BA Passarello, DR Williams, BD Humphrey, RW Ross, JM Berry, JG Krebs We determine whether negative-pressure isolation for multiple patients with communicable diseases can be achieved quickly and effectively using general hospital space not previously dedicated to respiratory isolation. The physical therapy gymnasium was the area designated to test the ability to create a negativepressure isolation environment in a large space. Four high-efficiency particulate air filtered forced air machines were used to generate negative pressure.We measured the ability of the equipment to generate a negative air pressure relative to adjacent areas and determined the noise levels created during the use of different combinations of machines at various power settings. After drill activation and the request for equipment setup, 1 hour was required to convert the physical therapy gymnasium into an operational negative-pressure environment. The room pressure readings ‘‘high’’ power ranged from 1.5 to 13 Pa (0.006 to 0.052 inches of water), and noise levels ranged from 70 to 76 dB. Calculated air changes per hour using 1, 2, 3, or 4 units running simultaneously at ‘‘high’’ power were 4.1, 8.2, 12.3, and 16.4, respectively. Using 4 units at once running at ‘‘low’’ power setting yielded 8.2 air changes per hour and generated a room pressure reading of 8.0 Pa, or 0.032 inches of water.
635
An Evaluation of Portable High-Efficiency Particulate Air Filtration for Expedient Patient Isolation in Epidemic and Emergency Response (Concepts) K Mead, DL Johnson Extraordinary incidents resulting in airborne infectious disease outbreaks could produce patient isolation requirements that exceed most hospitals’ capacity. We investigated expedient methods to establish airborne infection isolation areas using a commercially available portable filtration unit and common hardware supplies. The study was conducted within a conventional, nonisolation hospital room, and researchers evaluated several airborne isolation configurations that did not require building ventilation or structural modifications. A portable high-efficiency particulate air filtration unit and fulllength plastic curtains established a “zone-within-zone” protective environment using local capture and directional airflows. The cost of constructing the expedient configurations was less than US$2,300 and required fewer than 3 person-hours to construct. The best-performing designs showed no measurable source migration out of the inner isolation zone and mean respirable particle counts up to 87% lower at the health care worker position(s) than those observed directly near the source patient location.
DECEMBER 2004
44:6
ANNALS OF EMERGENCY MEDICINE
1 3 A
INJURY PREVENTION 646
Previous Emergency Department Use Among Homicide Victims and Offenders: A Case-Control Study (Original Research) CS Crandall, PF Jost, LM Broidy, G Daday, DP Sklar We differentiate risk factors for future homicide victimization and offending, and we also measure emergency department (ED) use among homicide victims, offenders, and controls. Among the 124 victims and 138 offenders who used health care, most were men (80%) and averaged 27.7 years of age. Victims and offenders had similar health care use and were grouped for final analyses. Cases (victims and offenders) were more likely to have had an ED visit within 3 years of the homicide (85%) compared with controls (59%) (odds ratio [OR] 4.3; 95% confidence interval [CI] 3.0 to 6.2). Within previous ED visits, assault (OR 4.5; 95% CI 2.9 to 7.0), firearm injury (OR 13.6; 95% CI 4.9 to 37.7), and substance abuse (OR 3.7; 95% CI 2.2 to 6.0) were associated with future homicide. ED visits clustered closer to the homicide incident for cases (median days before the homicide 402 days; 95% CI 434 to 364) compared with controls (median 487 days; 95% CI 498 to 474).
656
Analysis of Crashes Involving 15-Passenger Vans (NHTSA Notes)
657
Commentary: Supersized Vans: A Supersized Problem (NHTSA Notes) MP McKay, F Vaca CHANGE OF SHIFT
660
The Loading Dock AL Moettus
662
Christmas Eve in the Department NM Anderson
664
IMAGES IN EMERGENCY MEDICINE
665
CORRESPONDENCE
Moonflower-Induced Anisocoria K Meng, DK Graetz
Whole Bowel Irrigation and the Capsule Summary M Tenenbein/ML Callaham/RC Dart
Effect of Whole Bowel Irrigation on Delayed-Release Acetaminophen and Gut Transit Time M Tenenbein
Holes in the Article on Whole Bowel Irrigation GM Chan, K Johnson, JE Rodriguez, LS Nelson/BT Ly, AB Schneir, RF Clark
Another Perspective on “Severe Hypercapnia Caused by Acute Heroin Overdose” SA McLaughlin, ME Richards/R Gupta, T Haydock
1 4 A
ANNALS OF EMERGENCY MEDICINE
44:6
DECEMBER 2004