Mortality after emergency department intubation.

INTRODUCTION: The purpose of this study is to identify the rate of emergency department (ED) intubation and the mortality associated with ED intubation. METHODS: We conducted a retrospective chart review of all patients intubated in the ED between 1 January 2004 and 31 December 2004 at an urban level one trauma centre with approximately 50,000 ED visits annually. All ED intubations were identified and reviewed. Two investigators reviewed all charts and collected the following data: age, sex, and final disposition from hospital as well as reason for intubation. The main outcome measure was survival to hospital discharge. RESULTS: One hundred sixty-three intubations were reviewed. Of the total 163 patients, 44 (27.0%) died prior to discharge from the hospital, 42 (25.8.%) patients were discharged to a skilled nursing facility (e.g. nursing home, rehabilitation and extended care facility) and 71 (43.6%) patients were discharged home. Dividing our cohort into trauma and non-trauma subgroups, 38/126 (30.2%) of the non-trauma patients and 6/37 (16.2.%) of the trauma patients died. The mean age for all patients in our study group was 61.5 years, with trauma patients being younger than the non-trauma subgroup. The mean age for trauma patients was 50.1 while non-trauma patients had a mean age of 64.8. CONCLUSIONS: The mortality after an ED intubation in our study population was relatively high. Further studies need to confirm these findings and help identify predictors of mortality.

Correlation between in vitro and in vivo models of proconvulsive activity with the carbapenem antibiotics, biapenem, imipenem/cilastatin and meropenem.

The present study evaluated the proconvulsant liability of biapenem, a novel carbapenem antibiotic, in in vitro and in vivo experiments, in comparison with the carbapenems, imipenem/cilastatin and meropenem. Imipenem/cilastatin is a carbapenem antibiotic with known proconvulsive liability in man and in animal experiments. In in vivo studies imipenem/cilastatin, at doses of 400/400 mg/kg i.v., significantly lowered the convulsive threshold of pentylenetetrazol (PTZ) in mice and shifted the dose-response curve of PTZ. The effects of biapenem (400 mg/kg i.v.) and another reference carbapenem, meropenem (400 mg/kg i.v.), in the mouse PTZ model were not significantly different from control. In in vitro experiments the carbapenems were tested for their ability to inhibit [3H]muscimol (1.3 mM) binding to rat brain homogenates at concentrations of 1-10 mM. Similar to in vivo results, when compared to imipenem/cilastatin, biapenem and meropenem did not inhibit [3H]muscimol binding to the GABAA receptor complex in brain homogenates while imipenem/cilastatin exhibited significant inhibition (IC50 = 4.6 mM). These results further confirm the correlation between in vitro GABAA binding and in vivo PTZ convulsive testing with carbapenem antibiotics, and suggest that biapenem possesses a low proconvulsive liability.

Assessment of the possible role of iron and copper in cisplatin-induced nephrotoxicity in the rat.

Nephrotoxic lesions induced by cisplatin in rats are characterized by acute tubular necrosis in the outer stripe of the medulla. The purpose of this study was to examine the potential role of changes in metal binding proteins, and iron and copper content in urine and renal tissue in cisplatin-induced nephrotoxicity. Cisplatin was administered intravenously to groups of 20 rats at single doses of 0, 1, 2.5, and 5 mg/kg and rats were sacrificed at 1, 2, 3 and 6 days after treatment. Increased serum BUN and creatinine were observed at a dose of 5 mg/kg cisplatin on day 2 through day 6. Increased urinary copper excretion coincided with necrosis and increased BUN and creatinine on day 3 in the high-dose group. Evidence of renal injury was apparent histologically as karyomegaly at all dose levels as early as 48 hours after injection of cisplatin, prior to increases in urinary copper levels. No change in the distribution of metal binding proteins (transferrin, ferritin, ceruloplasmin, and metallothionein) evaluated by immunohistochemical staining, was seen. Based upon these results, it is unlikely that changes in metal excretion play a primary role in cisplatin-induced nephrotoxicity however, changes in nuclear function indicated by karyomegaly may be involved in early renal injury.

Theophylline assay on Kodak Ektachem DTSC--performance and interference by structurally-related compounds and salicylate.

Theophylline was measured with a Kodak Ektachem DTSC using its property of uncompetitive inhibition of alkaline phosphatase. Within- and between-batch reproducibility was satisfactory. Agreement with consensus mean values on quality assessment samples was good as was agreement on patients' samples with a high performance liquid chromatography reference method and an automated fluorescence polarisation immunoassay. At therapeutic theophylline concentrations, no interference was seen with caffeine, theobromine, 1,7-dimethylxanthine, 1,3-dimethyluric acid or 3-propylxanthine. 3-methylxanthine (a theophylline metabolite) gave a positive bias but the concentrations of this metabolite found in serum are such that the clinical significance of this finding is questionable. Salicylate at concentrations which might be found during therapy for paediatric rheumatoid arthritis also gave a positive bias.

Quality control in the simultaneous assay of anticonvulsants using an automated gas chromatographic system with a nitrogen detector.

An automated gas-liquid chromatographic technique for the routine determination of phenobarbitone, primidone and phenytoin using a nitrogen-detector is described. The high selectivity of the detector for nitrogen-containing compounds allows a direct extraction procedure and the use of a phenytoin analogue as an internal standard obviates the need for accurate aliquot measurement after extraction. The anticonvulsants are chromatographed as methyl derivatives produced by on-column methylation with trimethylphenyl ammonium hydroxide following automatic liquid injection. Quality control data from an internal quality control scheme is presented and the performance of the laboratory in an inter-laboratory control scheme is reported and discussed.

Detection of methaqualone and its metabolites in urine.

A method is described for the detection of methaqualone and its metabolites in the presence of large doses of other drugs.