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Transfusion hepatitis: the blood label could make you liable
ABSTRACTS Peter Rosen, M D - - editor Director of the Division of Emergency Medicine, Denver General Hospital
Frank J. Baker, II, MD m a s s i s t a n t editor Associate Professor and Director, Department of Emergency Medicine, University of Chicago Hospitals and Clinics Intramuscular injection-site complications. G reenbiatt
t h a t blood products from paid donors are much more likely produce serum hepatitis t h a n t h a t from volunteer donor pro. ducts. The new federal regulations establish a standard o f care. The physicians could be subject to negligence suits from patients who develop hepatitis from paid donor transfusions when the physician h a s not documented on the chart t h e reason using purchased blood was necessary. A physician who must use paid donor products should protect himself b y justifying t h e i r use or by obtaining informed consent from the patient. (Editor's note: Hopefully, this will also have some effect in discouraging the use o f paid donor blood when volun. : teer donor blood products are available.)
DJ, Allen MD, JAMA 240:542-544, (Aug) 1978. Of 12,134 p a t i e n t s receiving intramuscular (IM) injections, 0.4% h a d clinically i m p o r t a n t injection-site complications. The 48 patients who h a d complications received at least one IM injection. All the reactions were a t t r i b u t a b l e to the local t r a u m a of the injection itself or the irritating properties of the drug. The reactions consisted of abscess formation, induration, erythema, hemorrhage, or persistent pain. The most common offender was cephalothin; 9 of 83 p a t i e n t s (10.8%) receiving c e p h a l o t h i n h a d local complications. O t h e r freq u e n t offenders were tetracycline, 2 of 25 (8%); paraldehyde, 2 of 75 (2.7%); colistimethate, 2 of 99 (2%), a n d digoxin, 4 of 389 (1%). Although clinically important, injection-site complications were uncommon in this series. Certain drugs, such as cephalothin a n d tetracycline, have a h i g h e r complication rate. Alternate routes for these drugs should be used where possible. (Editor's note: Unfortunately for the emergency physician, this study was carried out upon hospitalized patients. I n our emergency department we see problems after tetanus toxoid [a p a i n f u l arm 24 hours later due to local hyperimmune response] and procaine penicillin G [procaine reaction often mislabeled as penicillin allergy].)
Charles C. Johnston, MD
hepatitis, blood transfusion Terbutaline in asthmatic children: A dose-response study. Ardal B, Beaudry P, Eisen AH, J Pediatr 93:305-
307, (Aug) 1978. A double-blind study of response to oral terbutaline was conducted in 20 asthmatic children, aged from 5 to 14..Terbutaline has been little studied in p a t i e n t s younger than age 12 so t h a t optimum dosages and expected time courses have not been known. Using m a x i m u m mid-expiratory flow rate as criteria for evaluating bronchodilation, the authors found t h a t 50 pg/kg is an appropriate starting dose in children. The recommended adult dose is 75 Ijg/kg. The initial pediatric dose may, be increased to 100 pg/kg to achieve a more satisfactory response. Bronchodilation begins at an average: of one-half hour, peaks between two and three hours, and lasts up to six hours. The most p r o m i n e n t adverse effect was tremor, with t r a n s i e n t l y elevated blood glucose levels noted in several patients. (Editor's note: In the prepubescent child with mild to moderate asthma controlled on oral theophyllines, there is little advantage to starting terbutaline therapy. While currently not approved for use in this age group, it may prove to be o f u s e in asthmatic bronchospasm uncontrolled with the usual regimens.) David Aronow, MD
John R. Mclnerney, MD injections, intramuscular Civilian gunshot wounds of the brain. Kirkpatrick JB, et al, J Neurosurg 49:185-198, (Aug) 1978. The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms commonly available to civilians ranged from a .22 caliber revolver to a .45 semi-automatic pistol. M e a s u r i n g misaile t r a c k s and c o m p u t i n g volume showed t h a t t h e relative low velocity missiles from these weapons do not create the devastation t h a t characterizes wounds from high-velocity military firearms. There is considerable variation in the size of the missile tracks t h a t cannot be directly related to caliber. Pressure m a r k s and contusions, impaction of bone chips, internal ricochet and cerebral edema occurred frequently. In every case the missile passed completely t h r o u g h the brain but in a large percentage of cases w a s r e t a i n e d by t h e s k u l l or soft t i s s u e s . T h e m e c h a n i s m of d e a t h m a y be acute pressure on the b r a i n stem from the passage of the missile through the brain. (Editor's note: O f significance is the variability of tissue damage produced by low velocity weapons such as pistols. Victims sometimes survive or can be maintained long enough to become organ donors.) Solomon Hockbaum, MD
asthma, terbutaline The bacterial pathogenesis of acute pelvic inflammatory disease. Cunningham FG, Hauth J, Gilstrap L, et al,
Obstet Gynecol 52:161-164, (Aug) 1978. To investigate w h e t h e r nongonococcal acute pelvic inflamm a t o r y d i s e a s e (PID) follows g o n o r r h e a l infgctions or whether it is a separate entity, peritoneal fluid was obtained by culdocentesis in 133 women with clinical signs of acute pelvic infection. Of these, 104 with bacteria identifiable in both culture and G r a m stain were included in the study. Fifty-six women h a d positive cervical culture for Neisseria gonorrhoeae. From the 56 with lower t r a c t gonorrhea, 22% grew only N gonorrhoeae from peritoneal fluid; 32% grew N gonorrhoeae and o t h e r o r g a n i s m s , 46% grew only non'gonococcal organisms. In the 4 8 w o m e n without cervical g o n o r r h e a , only nongonococcallbacteria were identified in
gunshot, brain Transfusion hepatitis: the blood label could make you liable. Spencer JD, Legal Aspects of Medical Practice
6:41-42, (Aug) 1978. Federal regulations now require t h a t all blood products be labeled e i t h e r "volunteer" or "paid donor." The rationale is
78/294
JACEP
8:7 (July) 1979
Frank J. Baker, II, MD m a s s i s t a n t editor Associate Professor and Director, Department of Emergency Medicine, University of Chicago Hospitals and Clinics Intramuscular injection-site complications. G reenbiatt
t h a t blood products from paid donors are much more likely produce serum hepatitis t h a n t h a t from volunteer donor pro. ducts. The new federal regulations establish a standard o f care. The physicians could be subject to negligence suits from patients who develop hepatitis from paid donor transfusions when the physician h a s not documented on the chart t h e reason using purchased blood was necessary. A physician who must use paid donor products should protect himself b y justifying t h e i r use or by obtaining informed consent from the patient. (Editor's note: Hopefully, this will also have some effect in discouraging the use o f paid donor blood when volun. : teer donor blood products are available.)
DJ, Allen MD, JAMA 240:542-544, (Aug) 1978. Of 12,134 p a t i e n t s receiving intramuscular (IM) injections, 0.4% h a d clinically i m p o r t a n t injection-site complications. The 48 patients who h a d complications received at least one IM injection. All the reactions were a t t r i b u t a b l e to the local t r a u m a of the injection itself or the irritating properties of the drug. The reactions consisted of abscess formation, induration, erythema, hemorrhage, or persistent pain. The most common offender was cephalothin; 9 of 83 p a t i e n t s (10.8%) receiving c e p h a l o t h i n h a d local complications. O t h e r freq u e n t offenders were tetracycline, 2 of 25 (8%); paraldehyde, 2 of 75 (2.7%); colistimethate, 2 of 99 (2%), a n d digoxin, 4 of 389 (1%). Although clinically important, injection-site complications were uncommon in this series. Certain drugs, such as cephalothin a n d tetracycline, have a h i g h e r complication rate. Alternate routes for these drugs should be used where possible. (Editor's note: Unfortunately for the emergency physician, this study was carried out upon hospitalized patients. I n our emergency department we see problems after tetanus toxoid [a p a i n f u l arm 24 hours later due to local hyperimmune response] and procaine penicillin G [procaine reaction often mislabeled as penicillin allergy].)
Charles C. Johnston, MD
hepatitis, blood transfusion Terbutaline in asthmatic children: A dose-response study. Ardal B, Beaudry P, Eisen AH, J Pediatr 93:305-
307, (Aug) 1978. A double-blind study of response to oral terbutaline was conducted in 20 asthmatic children, aged from 5 to 14..Terbutaline has been little studied in p a t i e n t s younger than age 12 so t h a t optimum dosages and expected time courses have not been known. Using m a x i m u m mid-expiratory flow rate as criteria for evaluating bronchodilation, the authors found t h a t 50 pg/kg is an appropriate starting dose in children. The recommended adult dose is 75 Ijg/kg. The initial pediatric dose may, be increased to 100 pg/kg to achieve a more satisfactory response. Bronchodilation begins at an average: of one-half hour, peaks between two and three hours, and lasts up to six hours. The most p r o m i n e n t adverse effect was tremor, with t r a n s i e n t l y elevated blood glucose levels noted in several patients. (Editor's note: In the prepubescent child with mild to moderate asthma controlled on oral theophyllines, there is little advantage to starting terbutaline therapy. While currently not approved for use in this age group, it may prove to be o f u s e in asthmatic bronchospasm uncontrolled with the usual regimens.) David Aronow, MD
John R. Mclnerney, MD injections, intramuscular Civilian gunshot wounds of the brain. Kirkpatrick JB, et al, J Neurosurg 49:185-198, (Aug) 1978. The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms commonly available to civilians ranged from a .22 caliber revolver to a .45 semi-automatic pistol. M e a s u r i n g misaile t r a c k s and c o m p u t i n g volume showed t h a t t h e relative low velocity missiles from these weapons do not create the devastation t h a t characterizes wounds from high-velocity military firearms. There is considerable variation in the size of the missile tracks t h a t cannot be directly related to caliber. Pressure m a r k s and contusions, impaction of bone chips, internal ricochet and cerebral edema occurred frequently. In every case the missile passed completely t h r o u g h the brain but in a large percentage of cases w a s r e t a i n e d by t h e s k u l l or soft t i s s u e s . T h e m e c h a n i s m of d e a t h m a y be acute pressure on the b r a i n stem from the passage of the missile through the brain. (Editor's note: O f significance is the variability of tissue damage produced by low velocity weapons such as pistols. Victims sometimes survive or can be maintained long enough to become organ donors.) Solomon Hockbaum, MD
asthma, terbutaline The bacterial pathogenesis of acute pelvic inflammatory disease. Cunningham FG, Hauth J, Gilstrap L, et al,
Obstet Gynecol 52:161-164, (Aug) 1978. To investigate w h e t h e r nongonococcal acute pelvic inflamm a t o r y d i s e a s e (PID) follows g o n o r r h e a l infgctions or whether it is a separate entity, peritoneal fluid was obtained by culdocentesis in 133 women with clinical signs of acute pelvic infection. Of these, 104 with bacteria identifiable in both culture and G r a m stain were included in the study. Fifty-six women h a d positive cervical culture for Neisseria gonorrhoeae. From the 56 with lower t r a c t gonorrhea, 22% grew only N gonorrhoeae from peritoneal fluid; 32% grew N gonorrhoeae and o t h e r o r g a n i s m s , 46% grew only non'gonococcal organisms. In the 4 8 w o m e n without cervical g o n o r r h e a , only nongonococcallbacteria were identified in
gunshot, brain Transfusion hepatitis: the blood label could make you liable. Spencer JD, Legal Aspects of Medical Practice
6:41-42, (Aug) 1978. Federal regulations now require t h a t all blood products be labeled e i t h e r "volunteer" or "paid donor." The rationale is
78/294
JACEP
8:7 (July) 1979