Emergency department use of flumazenil prior to poison center consultation.

We studied the frequency of use of flumazenil by emergency departments in our region and compared it to recommendations made by specialists in poison information at our poison control center. For a 5-mo period, we prospectively collected cases involving benzodiazepines or zolpidem. Data was documented only from calls from emergency departments. Emergency department personnel were asked the following: If given, the dose and frequency, contraindications, and adverse reactions. Each case was followed to completion. Flumazenil was not given in 55 cases. Of the remaining 14 cases in which it was given, 10 of the cases received flumazenil prior to poison control center consultation. We noted 1 case of dizziness. Ten cases given flumazenil had contraindications (eg ethanol abuse or possible seizurogenic coingestants). Despite possible contraindications, flumazenil was given 10/14 times (71%) prior to calling the poison control center. These results point to potential overuse of this antidote where contraindications or cautions are suspected in the overdosed patients. Our study suggests that when flumazenil use is contemplated by an emergency department physician, a poison control center consult may have a contrary recommendation.

Field test of the new fungal identification system in POISINDEX.

A new program, Fungal Identification System (FIS) was introduced in POISINDEX (PI) in 1991. We studied the accuracy of this program compared to the traditional method of consulting an expert mycologist and also the utility of FIS for the certified specialist in poison information (CSPI) and the emergency department personnel. Fifteen samples were obtained from a Chicago area forest preserve and immediately identified by a CSPI using FIS from PI of summer-fall 1991. The samples were then refrigerated overnight and identified the following morning by a PhD mycologist, using standard mycological identification techniques (SMIT). Another group of 18 mushrooms were collected in August 1992 from rural southwestern Michigan and identified by FIS and SMIT after refrigeration overnight. In 4 cases the mycologist used both SMIT and FIS to identify the mushrooms. Identification by FIS did not match SMIT in 27 of 31 samples (1 was discarded and 1 was identified by FIS but not identified by SMIT). In 2 of 4 cases where the mycologist used FIS, a different answer was obtained from that obtained by the CSPI; however, these were still incorrect identifications. Four types of problems using FIS have been identified which can lead to erroneous results; these are the use of multipart questions, emphasis on color over less variable characteristics, questions which do not account for variability in morphology, and problems which arise from the sequence of questions. These points need to be addressed before FIS can be used as a safe basis for clinical recommendations.

[Prognostic factors in dilated cardiomyopathy]. / Etude des facteurs pronostiques des cardiomyopathies dilatées.

Thirty-eight patients, 27 men and 11 women, mean age 49 +/- 12 yr, suffering from dilated cardiomyopathy were included in this prospective study of prognostic factors. Twenty-two subjects admitted heavy alcohol consumption (greater than 80 g/d, for at least 10 yr). The survival rates for 2, 5 and 7 yr were 87, 35 and less than 20%, respectively. Prognostic factors were evaluated in 34 (22 alcoholic and 12 non-alcoholic) patients: 10 improved or were cured, as determined clinically, radiologically and echocardiographically (group 1); 24 deteriorated, 13 of whom died (group 2). Statistically significant values for group 1 versus group 2 were: echocardiographic left ventricular (LV) end diastolic diameter (3.50 +/- 0.80 vs 4.02 +/- 0.5 cm/m2, p less than 0.026) and LV end systolic diameter (2.97 +/- 0.65 vs 3.43 +/- 0.53 cm/m2, p less than 0.02); hemodynamic LV systolic pressure (113.9 +/- 15 vs 101.82 +/- 17.36 mm Hg, p = 0.045); angiographic LV end diastolic volume (137.8 +/- 57.44 vs 177.85 +/- 55.45 ml/m2, p = 0.057), LV end systolic volume 93 +/- 53.5 s 139.28 +/- 48.99 ml/m2, p less than or equal to 0.036), ejection fraction 0.36 +/- 0.16 vs 0.22 +/- 0.7%, p less than or equal to 0.006) and velocity of fiber shortening (0.79 +/- 0.53 vs 0.36 +/- 0.3 circ/s, p = 0.036). Other electrical, radiological and hemodynamic parameters were not significant and alcohol consumption did not influence the prognosis. The severity of LV functional impairment appears to be the major determinant of a poor prognosis and reduced survival in idiopathic and alcoholic cardiomyopathies.