Needle-sharing among intravenous drug users in New Orleans.

We studied needle sharing among intravenous drug users in New Orleans, where needles are not controlled by prescription. Three hundred and eighty self-identified intravenous drug users were interviewed regarding needle-sharing practices, frequency of drug use, and drug(s) of choice. Overall, 65.8% admitted they regularly used needles which had been used by others. No significant differences in needle sharing were found by sex, race, frequency of injection, or drug of choice. A survey of pharmacies found that 85.5% have self-imposed restrictions on the sale of needles and syringes. Legal availability of injection equipment may not be equivalent to actual availability to the consumer.

Complications from i.v. therapy: results from field-started and emergency department-started i.v.'s compared.

Because the complications resulting from IV therapy started outside the hospital seem inordinately higher than those resulting from IV therapy started in the emergency department, we undertook a comparative two-month study of the complications resulting from both sources. We found the number and severity of complications from IV therapy started in the field significantly greater than complications from that started in the ED. The phlebitis rate in the prehospital group was 4.65 times that in the ED group (P less than .001). The percentage of patients with unexplained fever in the prehospital group was 5.58 times that in the ED group (P less than .01). Means for reducing the complications and areas for further research are suggested.

Ethylene glycol poisoning. The value of glycolic acid determinations for diagnosis and treatment.

Glycolic acid is the ethylene glycol (EG) metabolite that accumulates in the highest concentrations in the blood and may be the major contributing factor to the acute toxicity of EG. Serum and urine levels of glycolic acid have been found to correlate directly with clinical symptoms and mortality in poisoning cases, making it a valuable diagnostic tool. A high pressure liquid chromatographic (HPLC) method for quantitation of glycolic acid in serum was used in several cases of EG ingestion presented to the Louisiana Regional Poison Control Center. The data collected in this study support the value of glycolic acid determination for diagnosis and evaluation of patients poisoned by EG.

The incidence of myoglobinuria in patients with pneumatic trousers.

The possible association between the use of pneumatic trousers and myoglobinuria was investigated. One hundred and four victims of multiple trauma were entered into a study over a three-month period. Patients who suffered serious injuries to two or more organ systems qualified for entrance into the study. Patients who arrived at the emergency department with inflated pneumatic trousers served as the test population (n = 50), and patients who did not have pneumatic trousers served as the controls (n = 54). Urine specimens were obtained from all patients just before the completion of their treatment in the emergency department. No patients in the control group had myoglobinuria 0%), and only one patient in the test group had myoglobinuria 2%). The results were not statistically significant. Myoglobinuria is not an acute complication of the use of pneumatic trousers. The presence of pneumatic trousers on a multiple-trauma patient is not an indication for routine screening for myoglobinuria in the emergency department.

A general EMS curriculum for residency training.

The increasing emphasis on the emergency physician's role in the community led us to investigate the role of residency training programs in providing more than clinical competence to their graduates. Using guidelines provided by the American College of Emergency Physicians, the Joint Commission on Accreditation of Hospitals, the Department of Health, Education and Welfare, and program alumni, we set about to determine methods of enhancing the EMS and administrative aspects of the residency program at Charity Hospital. We describe the curriculum that was developed.