ABSTRACT
Most patients on chronic maintenance lithium therapy become toxic at some point during their therapy. Lithium intoxication portends morbidity and mortality. The serum lithium concentration can be used as an adjunct to a physician's clinical acumen in diagnosing and managing the patient with lithium intoxication.
Subject(s)
Lithium/blood , Lithium/poisoning , Emergencies , Humans , Poisoning/diagnosisABSTRACT
STUDY OBJECTIVE: To demonstrate the usefulness of cranial computed tomography (CT) in the emergency department evaluation of HIV-infected patients and patients with risk factors for HIV infection who present with neurologic complaints. DESIGN: Retrospective review of imaging reports and medical records of patients who visited the ED from March 1991 through March 1992. SETTING: Urban university ED. PARTICIPANTS: Patients with HIV infection or risk factors for infection who underwent emergency cranial CT after presenting to the ED with headache, altered mental status, focal deficits, or other neurologic signs or symptoms. RESULTS: One hundred forty-six patients visited the ED 169 times. Of the 169 cranial CTs obtained, 85 (50%) were normal, 49 (29%) showed atrophy only, and 35 (21%) demonstrated focal lesions, with mass effect noted in ten (6%). Enhancing lesions were present in 13 scans. In 21 (12%) cases, CT revealed either an indication for admission, a contraindication to lumbar puncture, or both. In 25 instances, patients with lesions had nonfocal presentations and no papilledema. Two presentations--focal deficit and altered mental status--were each statistically significantly associated with lesions on CT. In seven patients with multiple ED visits, repeat CT showed new findings. Among patients who had risk factors but were of unknown HIV status, there was the same proportion of abnormal scans as in known HIV-infected patients. CONCLUSION: CT detected clinically significant neuropathology among our study patients. Because lesions and mass effect were associated with nonfocal as well as focal presentations, CT is indicated in every neurologically symptomatic patient with HIV infection or risk factors for infection. Because HIV-related diseases can progress rapidly, repeat CT is recommended even in patients with recent scans.
Subject(s)
Brain Diseases/diagnostic imaging , Brain/diagnostic imaging , HIV Infections/complications , Tomography, X-Ray Computed , Adult , Analysis of Variance , Brain Diseases/etiology , Emergency Medicine , Emergency Service, Hospital , Female , HIV Infections/diagnostic imaging , Humans , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed/statistics & numerical dataABSTRACT
The baseball bat, according to Baltimore City police crime statistics, is a commonly used weapon. To assess the severity of injuries inflicted by this modern-day club, we retrospectively reviewed 75 charts of patients treated at the University of Maryland Medical Systems Hospital for baseball bat injuries from January 1990 through July 1991. Multisystem trauma was documented, with craniocerebral injury being the most frequent and the most frequent cause of death. Of the victims struck on the head, 26% sustained an intracranial hemorrhage. In our series, the history of loss of consciousness and the Glasgow Coma Scale score failed to reliably identify the patients with serious injuries. Seventeen percent of our patients with intracranial hemorrhages had both a negative or uncertain history of loss of consciousness and a normal Glasgow Coma Scale score on arrival.
Subject(s)
Craniocerebral Trauma/etiology , Multiple Trauma/etiology , Violence , Wounds, Nonpenetrating/etiology , Adolescent , Adult , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Child , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/epidemiology , Female , Glasgow Coma Scale , Humans , Male , Maryland/epidemiology , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/epidemiology , Retrospective Studies , Unconsciousness/etiology , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/epidemiologyABSTRACT
In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.
