Brenda Swanson-Biearman

Successful donation and transplantation of multiple organs from a victim of cyanide poisoning

AbstractDemand for viable human organs for transplantation continues to exceed the supply. To expand supply, the criteria for identification and management of suitable donors must continue to evolve. Poisoned patients are often excluded as potential organ donors due to perceived risks of transmittable agents and/or physiologically compromised organs. In this report, a patient succumbed after an intentional ingestion of cyanide and multiple Pharmaceuticals. Donor organ viability was determined by lack of significant injury beyond the central nervous system. Following standard procurement procedures, the heart, liver, corneas, 16 skin grafts and 16 bone grafts were deemed suitable and successfully transplanted. All organ recipients were doing well eight months post transplantation. The focus of procurement personnel should be on tissue injury and not on the mere presence of clinical effect of a toxic agent. With the paucity of organs available, poison centers need to be cognizant of this dilemma when faced ...

Delayed Life-Threatening Reaction to Anthrax Vaccine

Background: Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Due to the current world threat of unpredictable biological terrorism, the Department of Defense has mandated the systematic vaccination of all US military personnel against this warfare agent. Many may experience a mild flu-like illness and soreness at the injection site, but systemic reactions are rare. Case Report: We report a delayed and potentially serious life-threatening adverse reaction to anthrax vaccine. A previously healthy 34-year-old male was transported to the emergency department with dyspnea, diaphoresis, pallor, and urticarial wheals on his face, arms, and torso after the administration of the third dose of anthrax vaccine. All symptoms resolved after pharmacological intervention and the patient was discharged. Pharmaco-epidemiological data indicate that 30% of anthrax vaccine recipients experience mild local reactions. With large numbers of military personnel being vaccinated, emergency physicians may encounter more vaccine-related adverse reactions.

Nystagmus Secondary to Fomepizole Administration in a Pediatric Patient

Background: Fomepizole is an alcohol dehydrogenase inhibitor used to treat ethylene glycol poisoning in adults, with only one report describing the use of fomepizole in the pediatric population. We report a case of nystagmus associated with fomepizole treatment of a 6-year-old female who ingested ethylene glycol 15 hours prior to admission. Case Report: A previously healthy 6-year-old presented to the emergency department mottled, comatose, and with Kussmaul respirations. Initial arterial blood gases: pH 7.11, Po2 200, HCO3 2, base excess −29, and within 20 minutes her pH dropped to 7.03. The patient was responsive to pain only. Initially, crystalluria without fluorescence was observed in the emergency department; 2 hours after admission, the urine fluoresced under Woods light. Laboratory data were significant for increased anion and osmolar gaps. She was fluid-resuscitated, NaHCO3, thiamine, and pyridoxine were administered, and she was admitted to the pediatric intensive care unit. Within 4 hours of admission, a loading dose of fomepizole (15 mg/kg) was infused due to the severity of the patients clinical status. Hemodialysis was initiated but discontinued temporarily due to catheter thrombus formation. The initial (3-hour postadmission) ethylene glycol concentration was 13 mg/dL. She developed coarse vertical nystagmus within 2 hours of fomepizole infusion. The ethylene glycol concentration was 5 mg/dL 3 hours after hemodialysis which then was discontinued. No further fomepizole was administered and the child recovered uneventfully. Conclusion: There was no evidence of the more frequently cited adverse events, such as headache, nausea, and dizziness. Fomepizole has been incompletely evaluated in the pediatric population, and the nature and occurrence of adverse events have not been described adequately. The use of fomepizole appeared safe in this patient although she developed transient nystagmus.

A review of barriers to effective asthma management in Puerto Ricans: cultural, healthcare system and pharmacogenomic issues.

Abstract Background: Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes. Methods: Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed. Results: Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described. Conclusions: We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient–clinician rapport and, hence, asthma outcomes. Finally, given ethnically based differences in pharmacogenomics, clinical trials targeting the Puerto Rican population may help to better define optimal asthma medication regimens in this ethnic group.

Improving the Patient's Experience With a Multimodal Quiet-at-night Initiative

This project describes a multifaceted noise reduction program on 2 hospital units designed to ensure a quiet hospital environment, with the goal of improving the patient experience. The noise committee in an urban city hospital developed a plan to control noise including scripted leadership rounding, staff education, a nighttime sleep promotion cart, and visual aids to remind staff to be quiet. Postintervention improvement in patient satisfaction scores was noted.

Interprofessional Collaboration to Improve Sepsis Care and Survival Within a Tertiary Care Emergency Department

Problem: Sepsis is a leading cause of death in the United States; however, health care providers struggle with timely recognition, diagnosis, and treatment of patients. Both the Centers for Medicare and Medicaid Services and the National Quality Forum have identified this diagnosis as a priority. Presently, many patients with sepsis are identified late, resulting in significant morbidity and death. Methods: In this project, a collaborative, interprofessional approach was created for screening and early identification of ED patients with possible sepsis. The department has 38 beds with annual patient volumes of more than 40,000 visits. Education was provided about the symptoms and treatment of patients with sepsis. A screening and management algorithm tool was instituted that consisted of early identification triggers and how to intervene according to Surviving Sepsis Campaign recommendations. The tool allowed for assessment of the patient by the ED team; the team worked to determine if sepsis was present and the extent of the illness. Results: During the first 4 months after implementation, more than 240 patients were screened, assessed, and treated according to the algorithm. Project outcomes resulted in an increase in staff knowledge of sepsis, a decrease in length of stay by 3 hours, and a significant decrease in mortality when compared with the previous year’s coded data. Implications for Practice: This project demonstrates that sepsis education and team collaboration are an integral part of identifying and treating patients with sepsis. An interprofessional collaborative approach could be implemented in other institutions to combat the life‐threatening complications of sepsis.

Acute phenolphthalein ingestion in children A retrospective review

The Patient Management Exchange for this edition of the Journal features a research study on phenolphthalein ingestion done at the Pittsburgh Poison Center. The purpose of selecting this article was twofold. First, the material presented about the management of phenolphthalein ingestion in children is valuable information for health care practitioners working in ambulatory settings. Second, this work is an excellent illustration of how research can be incorporated into ones clinical practice. This study also demonstrates that research does not always involve a long and cumbersome process. Instead, research can evolve from the need of health care professionals to answer a simple question that is raised about a particular aspect of their patient practice.

Good Catch Campaign: Improving the Perioperative Culture of Safety

Although health care workers feel pressure to reduce adverse events in the perioperative department, a lack of education, communication, and leadership can prevent hospital personnel from reporting good catches. The purpose of this evidence-based quality improvement project was to improve the culture of safety in our perioperative department by implementing the Good Catch Campaign. An interprofessional team led staff member education after implementing a standardized electronic reporting system and debriefing process to occur after good catches. Staff members reported 391 good catches from all perioperative areas during the six-month postimplementation period. Staff members completed the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture before and six months after implementation; scores improved in five areas: communication openness, feedback and communication about error, frequency of event reporting, nonpunitive response to error, and organizational learning and continuous improvement. The campaign was a successful strategy for improving perioperative patient safety.