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Telling the living — part 2
CORRESPONDENCE
Telling the Living m Part 2 To the Editor." Being away from one's words for a few months often results in a clearer editorial vision. Four corrections will make my previous letter, "Sudden Death in the ED: Telling the Living" [April 1988;17:382], more informative. The last sentence in the fifth paragraph of the figure should read "This usually stops the initial reaction to your information." The second sentence in paragraph six in the figure should read "If major problems regarding quality of care exist, do not address them." In addition to answering questions and requesting the autopsy, the now legislated discussion regarding transplantation must be held with the family. It is important to return to the family after talking with the private physician and/or coroner. This second visit allows for another view of the group dynamics, gives time
Digisorb ® m Instrument,
Cocaine
ment code while still an experimental product at Amoco, where the manufacturing process was developed and patented. The name Digisorb ® is not the name of this drug, but it is the name of the analytical instrument used to measure the material's surface area.
Pat W Haragan President Gulf Bio-Systems, Inc Dallas
Crisis
To the Editor: Gay and Loper published a letter in which they described the successful treatment of a hypertensive cocaine user with labetalol. I The same report, with some changes in medical managem'ent, appeared again in "The Use of Labetalol in the Management of Cocaine Crisis" [March 1988;17:282-283]. In both papers there are serious omissions and misstatements of fact. The potentially dangerous ones are listed below. 1. "Seizure activity should be treated with diazepam 0.25 rng/kg IV bolus repeated every 15 minutes." There is some experimental evidence that high doses of diazepam can reverse the cardiovascular effects of massive overdose, ~ and it seems to work for seizures, but the dose suggested here, 70 mg/hr in a 70-kg man, is unlikely to find wide clinical application. The reference cited described a patient with cocaine overdose who received one 18-rag dose of diazepam. 3 The patient's weight w a s n ' t even stated in the paper, he received only one dose of the drug, and the authors never asserted that this sort of dosage
168/228
Glenn C Hamilton, MD Department of Emergency Medicine Wright State University Dayton, Ohio
Not a Drug
To the Editor." I alert you to an error in the article "Evaluation of Theophylline Overdoses and Toxicities" [February 1988;17: 135-144]. On page 142, the authors state,that "enhancing effective surface area of activated charcoal using the product PX-21 (Digisorb ~) improves the efficiency of reducing theophylline halfqifc." The product they are describing is SuperChar ® activated charcoal, manufactured by Gulf BioSystems, Dallas, Texas. It was described in earlier studies as PX-21 because this was its original product develop-
Managing
for additional questions regarding the patient to be asked, is usually the best time to complete paperwork regarding autopsy and transplantation, and gives the opportunity for you to express the condolences of the family physician and/or the coroner's decision regarding release of the patient. It is also the time to ask if they want to view the deceased. I found this second visit to be important to the family. It establishes a caring dialogue that can increase cooperation and decrease bewilderment at a time of tremendous stress.
regimen should be used. 2. " U n c o n t r o l l e d hypertension damages the vascular muscularis and intima, and may result in pulmonary and cerebral edema, hemorrhage, or infarct." This may be true, but it is totally unsupported by any tissue studies in cocaine users. Furthermore, the reference cited was a case report describing an IV user with pulmonary edema. 4 Far from being hypertensive, the patient was in shock and required pressor support! Had he been treated with beta blockers he no doubt would have died even sooner. Nowhere in their paper 4 did the authors ever suggest that pulmonary edema in their patient was due to hypertension. This same misstatement is contained in the Anesthesia and Analgesia paper. 3. "Accumulation of catecholamines disposes the myocardium to arrhythmias that may compromise cardiac output." The statement is obviously true, but why support'it by citing Benchimol? 5 His paper was about a co-
Annals of EmergencyMedicine
18:2 February1989
Telling the Living m Part 2 To the Editor." Being away from one's words for a few months often results in a clearer editorial vision. Four corrections will make my previous letter, "Sudden Death in the ED: Telling the Living" [April 1988;17:382], more informative. The last sentence in the fifth paragraph of the figure should read "This usually stops the initial reaction to your information." The second sentence in paragraph six in the figure should read "If major problems regarding quality of care exist, do not address them." In addition to answering questions and requesting the autopsy, the now legislated discussion regarding transplantation must be held with the family. It is important to return to the family after talking with the private physician and/or coroner. This second visit allows for another view of the group dynamics, gives time
Digisorb ® m Instrument,
Cocaine
ment code while still an experimental product at Amoco, where the manufacturing process was developed and patented. The name Digisorb ® is not the name of this drug, but it is the name of the analytical instrument used to measure the material's surface area.
Pat W Haragan President Gulf Bio-Systems, Inc Dallas
Crisis
To the Editor: Gay and Loper published a letter in which they described the successful treatment of a hypertensive cocaine user with labetalol. I The same report, with some changes in medical managem'ent, appeared again in "The Use of Labetalol in the Management of Cocaine Crisis" [March 1988;17:282-283]. In both papers there are serious omissions and misstatements of fact. The potentially dangerous ones are listed below. 1. "Seizure activity should be treated with diazepam 0.25 rng/kg IV bolus repeated every 15 minutes." There is some experimental evidence that high doses of diazepam can reverse the cardiovascular effects of massive overdose, ~ and it seems to work for seizures, but the dose suggested here, 70 mg/hr in a 70-kg man, is unlikely to find wide clinical application. The reference cited described a patient with cocaine overdose who received one 18-rag dose of diazepam. 3 The patient's weight w a s n ' t even stated in the paper, he received only one dose of the drug, and the authors never asserted that this sort of dosage
168/228
Glenn C Hamilton, MD Department of Emergency Medicine Wright State University Dayton, Ohio
Not a Drug
To the Editor." I alert you to an error in the article "Evaluation of Theophylline Overdoses and Toxicities" [February 1988;17: 135-144]. On page 142, the authors state,that "enhancing effective surface area of activated charcoal using the product PX-21 (Digisorb ~) improves the efficiency of reducing theophylline halfqifc." The product they are describing is SuperChar ® activated charcoal, manufactured by Gulf BioSystems, Dallas, Texas. It was described in earlier studies as PX-21 because this was its original product develop-
Managing
for additional questions regarding the patient to be asked, is usually the best time to complete paperwork regarding autopsy and transplantation, and gives the opportunity for you to express the condolences of the family physician and/or the coroner's decision regarding release of the patient. It is also the time to ask if they want to view the deceased. I found this second visit to be important to the family. It establishes a caring dialogue that can increase cooperation and decrease bewilderment at a time of tremendous stress.
regimen should be used. 2. " U n c o n t r o l l e d hypertension damages the vascular muscularis and intima, and may result in pulmonary and cerebral edema, hemorrhage, or infarct." This may be true, but it is totally unsupported by any tissue studies in cocaine users. Furthermore, the reference cited was a case report describing an IV user with pulmonary edema. 4 Far from being hypertensive, the patient was in shock and required pressor support! Had he been treated with beta blockers he no doubt would have died even sooner. Nowhere in their paper 4 did the authors ever suggest that pulmonary edema in their patient was due to hypertension. This same misstatement is contained in the Anesthesia and Analgesia paper. 3. "Accumulation of catecholamines disposes the myocardium to arrhythmias that may compromise cardiac output." The statement is obviously true, but why support'it by citing Benchimol? 5 His paper was about a co-
Annals of EmergencyMedicine
18:2 February1989