Lewis R Goldfrank, M.D.

Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city
Wall, S P; Kaufman, B J; Gilbert, A J; Yushkov, Y; Goldstein, M; Rivera, J E; O'Hara, D; Lerner, H; Sabeta, M; Torres, M; Smith, C L; Hedrington, Z; Selck, F; Munjal, K G; Machado, M; Montella, S; Pressman, M; Teperman, L W; Dubler, N N; Goldfrank, L R
2011 Jul;11(7):1417-1426, American journal of transplantation
Evidence from Europe suggests establishing out-of-hospital, uncontrolled donation after circulatory determination of death (UDCDD) protocols has potential to substantially increase organ availability. The study objective was to derive an out-of-hospital UDCDD protocol that would be acceptable to New York City (NYC) residents. Participatory action research and the SEED-SCALE process for social change guided protocol development in NYC from July 2007 to September 2010. A coalition of government officials, subject experts and communities necessary to achieve support was formed. Authorized NY State and NYC government officials and their legal representatives collaboratively investigated how the program could be implemented under current law and regulations. Community stakeholders (secular and religious organizations) were engaged in town hall style meetings. Ethnographic data (meeting minutes, field notes, quantitative surveys) were collected and posted in a collaborative internet environment. Data were analyzed using an iterative coding scheme to discern themes, theoretical constructs and a summary narrative to guide protocol development. A clinically appropriate, ethically sound UDCDD protocol for out-of-hospital settings has been derived. This program is likely to be accepted by NYC residents since the protocol was derived through partnership with government officials, subject experts and community participants
— id: 136512, year: 2011, vol: 11, page: 1417, stat: Journal Article,

The Agent Profile: Sixteen Attributes as a Framework for Risk Determination and Response to Agents of Opportunity in Academic Medical Centers
Farmer, B. M.; Nelson, L. S.; Tunik, M. G.; Graham, M. E.; Bendzans, C.; McCrillis, A.; Portelli, I; Zhang, M.; Goldberg, J. D.; Goldfrank, L. R.
2010 MAR ;48(3):256-256, Clinical Toxicology (Philadelphia)
— id: 139127, year: 2010, vol: 48, page: 256, stat: Journal Article,

Developing a consensus framework and risk profile for agents of opportunity in academic medical centers: implications for public health preparedness
Farmer, Brenna M; Nelson, Lewis S; Graham, Margaret E; Bendzans, Carly; McCrillis, Aileen M; Portelli, Ian; Zhang, Meng; Goldberg, Judith; Rosenberg, Sheldon D; Goldfrank, Lewis R; Tunik, Michael
2010 Dec;4(4):318-325, Disaster medicine & public health preparedness
Agents of opportunity (AO) in academic medical centers (AMC) are defined as unregulated or lightly regulated substances used for medical research or patient care that can be used as 'dual purpose' substances by terrorists to inflict damage upon populations. Most of these agents are used routinely throughout AMC either during research or for general clinical practice. To date, the lack of careful regulations for AOs creates uncertain security conditions and increased malicious potential. Using a consensus-based approach, we collected information and opinions from staff working in an AMC and 4 AMC-affiliated hospitals concerning identification of AO, AO attributes, and AMC risk and preparedness, focusing on AO security and dissemination mechanisms and likely hospital response. The goal was to develop a risk profile and framework for AO in the institution. Agents of opportunity in 4 classes were identified and an AO profile was developed, comprising 16 attributes denoting information critical to preparedness for AO misuse. Agents of opportunity found in AMC present a unique and vital gap in public health preparedness. Findings of this project may provide a foundation for a discussion and consensus efforts to determine a nationally accepted risk profile framework for AO. This foundation may further lead to the implementation of appropriate regulatory policies to improve public health preparedness. Agents of opportunity modeling of dissemination properties should be developed to better predict AO risk
— id: 122674, year: 2010, vol: 4, page: 318, stat: Journal Article,

Derivation of the NYC UDCD Protocol for New York City
Gilbert, AJ; Wall, SP; Kaufman, BJ; Teperman, LW; Dubler, NN; Goldfrank, LR
2010 APR ;10(Suppl 4):367-367, American journal of transplantation
— id: 111531, year: 2010, vol: 10, page: 367, stat: Journal Article,

Agent of opportunity risk mitigation: people, engineering, and security efficacy
Graham, Margaret E; Tunik, Michael G; Farmer, Brenna M; Bendzans, Carly; McCrillis, Aileen M; Nelson, Lewis S; Portelli, Ian; Smith, Silas; Goldberg, Judith D; Zhang, Meng; Rosenberg, Sheldon D; Goldfrank, Lewis R
2010 Dec;4(4):291-299, Disaster medicine & public health preparedness
BACKGROUND: Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk. METHODS: Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes. RESULTS: We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to 'defeat' inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about 'open' front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls. CONCLUSIONS: We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered
— id: 116222, year: 2010, vol: 4, page: 291, stat: Journal Article,

Profiling the Risk to Academic Medical Centers by Agents of Opportunity
Smith, SW; Portelli, I; Farmer, BM; Nelson, LS; Rosenberg, S; Tunik, M; Bendzans, C; Graham, ME; Goldfrank, LR
2010 MAR ;48(3):259-260, Clinical Toxicology (Philadelphia)
— id: 111937, year: 2010, vol: 48, page: 259, stat: Journal Article,

Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events: Current Initiatives
Stroud, C; Altevogt, BM; Goldfrank, LR
2010 JUN ;4(2):174-177, Disaster medicine & public health preparedness
It is only possible to achieve a resilient community and an integrated, comprehensive, and resilient health system that can respond effectively to a public health emergency through active collaboration, coordination, and shared responsibility among a broad group of public and private stakeholders and the community itself. The Institute of Medicine established the Forum on Medical and Public Health Preparedness for Catastrophic Events in 2007 to provide a neutral venue for dialogue and collaboration among stakeholders in the preparedness field. In the Forum's first year, the members began to address topics such as medical countermeasures dispensing, crisis standards of care, and medical surge capacity. In the past 9 months, the Forum members have expanded their areas of interest in response to current events and national areas of focus. Current topics include individual, family, and community preparedness and resiliency; medical countermeasures from development through dispensing; and the response to the 2009 H1N1 influenza pandemic. Across all of the initiatives undertaken by the Forum, the common element is that they tackle problems, gaps, and future opportunities that can only be successfully addressed if multiple stakeholders work together. (Disaster Med Public Health Preparedness. 2010;4:174-177)
— id: 110155, year: 2010, vol: 4, page: 174, stat: Journal Article,

Derivation of the NYC Uncontrolled Donation after Cardiac Death Protocol for New York City
Wall, SP; Gilbert, AJ; Kaufman, BJ; Teperman, LW; Dubler, NN; Goldfrank, LR
2010 ;10(Suppl 1):44-45, American journal of transplantation
— id: 122679, year: 2010, vol: 10, page: 44, stat: Journal Article,

Racial variations in the incidence of severe alcohol withdrawal
Chan, Gar Ming; Hoffman, Robert S; Gold, Jeffrey A; Whiteman, Paula J; Goldfrank, Lewis R; Nelson, Lewis S
2009 Mar;5(1):8-14, Journal of medical toxicology
The use of race as a risk assessment tool and pharmacologic target has garnered recent attention and debate. It is currently unclear if a relationship between race and the development of severe alcohol withdrawal exists. We explored this potential relationship using several study groups. Methods: A simultaneous prospective enrollment of patients and retrospective chart review of severe alcohol withdrawal in two separate settings was performed comparing both the incidence of withdrawal and alcoholism based on race. These two study groups were then compared to an 'at risk' group of alcoholics and the general ED population to determine differences in the distribution of race. Results: Individuals of white race in both study groups were at increased odds [OR 1.93 (CI 1.11-3.39) and 2.19 (CI 1.41-3.40)] of having severe alcohol withdrawal when compared to non-White 'at risk' alcoholics. Blacks in both study groups however, appear to have lower odds [OR 0.23 (CI 0.11-0.47) and 0.11 (CI 0.05-0.23)] of having severe alcohol withdrawal when compared to non-Black 'at risk' alcoholics. Conclusions: Despite the controversial use of race in medical research and targeting therapies, there appears to be a difference in the odds of severe alcohol withdrawal based on race. The reasons for this finding are currently unclear
— id: 96163, year: 2009, vol: 5, page: 8, stat: Journal Article,

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care
Dart, RC; Borron, SW; Caravati, EM; Cobaugh, DJ; Curry, SC; Falk, JL; Goldfrank, L; Gorman, SE; Groft, S; Heard, K; Miller, K; Olson, KR; O'Malley, G; Seger, D; Seifert, SA; Sivilotti, MLA; Schaeffer, T; Tomassoni, AJ; Wise, R; Bogdan, GM; Alhelail, M; Buchanan, J; Hoppe, J; Lavonas, E; Mlynarchek, S; Phua, DH; Rhyee, S; Varney, S; Zosel, A
2009 SEP ;54(3):386-394, Annals of emergency medicine
Study objective: We developed recommendations for antidote stocking at hospitals that provide emergency care. Methods: An expert panel representing diverse perspectives (clinical pharmacology, clinical toxicology, critical care medicine, clinical pharmacy, emergency medicine, internal medicine, pediatrics, poison centers, pulmonary medicine, and hospital accreditation) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel. The panel used a formal iterative process to reach their recommendation for the quantity of an antidote that should be stocked and the acceptable period for delivery of each antidote. Results: The panel recommended consideration of 24 antidotes for stocking. The panel recommended that 12 of the antidotes be available for immediate administration on patient arrival. In most hospitals, this period requires that the antidote be stocked in the emergency department. Another 9 antidotes were recommended for availability within 1 hour of the decision to administer, allowing the antidote to be stocked in the hospital pharmacy if the hospital has a mechanism for prompt delivery of antidotes. The panel identified additional antidotes that should be stocked by the hospital but are not usually needed within the first hour of treatment. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine the need for antidote stocking in that hospital. Conclusion: The antidote expert recommendations provide a tool to be used in creating practices for appropriate and adequate antidote stocking in hospitals that provide emergency care. [Ann Emerg Med. 2009;54:386-394.]
— id: 102146, year: 2009, vol: 54, page: 386, stat: Journal Article,

Call Centers, Disaster Medicine, and Public Health Preparedness
Goldfrank, LR
2009 OCT ;3(1):136-137, Disaster medicine & public health preparedness
— id: 107398, year: 2009, vol: 3, page: 136, stat: Journal Article,

Success of organ donation after out-of-hospital cardiac death and the barriers to its acceptance
Kaufman, Bradley J; Wall, Stephen P; Gilbert, Alexander J; Dubler, Nancy N; Goldfrank, Lewis R
2009 ;13(5):189-189, Critical care
It is well documented that transplants save lives and improve quality of life for patients suffering from kidney, liver, and heart failure. Uncontrolled donation after cardiac death (UDCD) is an effective and ethical alternative to existing efforts towards increasing the available pool of organs. However, people who die from an out-of-hospital cardiac arrest are currently being denied the opportunity to be organ donors except in those few locations where out-of-hospital UDCD programs are active, such as in Paris, Madrid, and Barcelona. Societies have the medical and moral obligation to develop UDCD programs
— id: 122673, year: 2009, vol: 13, page: 189, stat: Journal Article,

Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks
Raven, Maria C; Billings, John C; Goldfrank, Lewis R; Manheimer, Eric D; Gourevitch, Marc N
2009 Mar;86(2):230-241, Journal of urban health
Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs
— id: 94377, year: 2009, vol: 86, page: 230, stat: Journal Article,

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers
Shine, Kenneth I; Rogers, Bonnie; Goldfrank, Lewis R
2009 Nov 5;361(19):1823-1825, New England journal of medicine
— id: 105166, year: 2009, vol: 361, page: 1823, stat: Journal Article,

A novel approach to multihazard modeling and simulation
Smith, Silas W; Portelli, Ian; Narzisi, Giuseppe; Nelson, Lewis S; Menges, Fabian; Rekow, E Dianne; Mincer, Joshua S; Mishra, Bhubaneswar; Goldfrank, Lewis R
2009 Jun;3(2):75-87, Disaster medicine & public health preparedness
OBJECTIVE: To develop and apply a novel modeling approach to support medical and public health disaster planning and response using a sarin release scenario in a metropolitan environment. METHODS: An agent-based disaster simulation model was developed incorporating the principles of dose response, surge response, and psychosocial characteristics superimposed on topographically accurate geographic information system architecture. The modeling scenarios involved passive and active releases of sarin in multiple transportation hubs in a metropolitan city. Parameters evaluated included emergency medical services, hospital surge capacity (including implementation of disaster plan), and behavioral and psychosocial characteristics of the victims. RESULTS: In passive sarin release scenarios of 5 to 15 L, mortality increased nonlinearly from 0.13% to 8.69%, reaching 55.4% with active dispersion, reflecting higher initial doses. Cumulative mortality rates from releases in 1 to 3 major transportation hubs similarly increased nonlinearly as a function of dose and systemic stress. The increase in mortality rate was most pronounced in the 80% to 100% emergency department occupancy range, analogous to the previously observed queuing phenomenon. Effective implementation of hospital disaster plans decreased mortality and injury severity. Decreasing ambulance response time and increasing available responding units reduced mortality among potentially salvageable patients. Adverse psychosocial characteristics (excess worry and low compliance) increased demands on health care resources. Transfer to alternative urban sites was possible. CONCLUSIONS: An agent-based modeling approach provides a mechanism to assess complex individual and systemwide effects in rare events
— id: 99323, year: 2009, vol: 3, page: 75, stat: Journal Article,

Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events: activities and goals
Stroud, Clare; Altevogt, Bruce M; Goldfrank, Lewis R
2009 Oct;3(3):183-185, Disaster medicine & public health preparedness
— id: 109507, year: 2009, vol: 3, page: 183, stat: Journal Article,

Translating the IOM's "boldest recommendation" into accepted practice
Wall, Stephen P; Dubler, Nancy N; Goldfrank, Lewis R
2009 Spring;20(1):23-26, Journal of clinical ethics
— id: 111645, year: 2009, vol: 20, page: 23, stat: Journal Article,

Overcoming legal obstacles involving the voluntary care of children who are separated from their legal guardians during a disaster
Foltin, George L; Lucky, Christian; Portelli, Ian; Goldfrank, Lewis R; Fertel, Baruch S; Lackey, Benjamin; Marr, Mollie; Dreyer, Benard P
2008 Jun;24(6):392-398, Pediatric emergency care
A large-scale disaster may separate children from their parents or guardians and may strand many children in the care of temporary caregivers, including physicians and nurses. In general, unless a physician or nurse is a member of a public sector emergency response program (a 'VHP'), parental consent is required for the treatment of minors outside of an emergency department unless the minor is suffering from an imminently life-threatening condition. Physicians or nurses who are not VHP's may be held liable (civilly, criminally and administratively) if they provide care without parental consent outside of an emergency room to a child who is not suffering from an imminently life-threatening condition. The existing rules regarding parental consent would, in many cases, limit (or at least discourage) the provision of optimal health care to children in a large-scale disaster by restricting care aimed to alleviate pain, the treatment of chronic conditions as well as the treatment of conditions, or potential conditions, that could worsen or develop in the absence of treatment.Additionally, 'Good Samaritan' laws that generally limit the liability of health care providers who voluntarily provide care in an emergency may not apply when care is provided in a crude or makeshift clinic or when care is not provided at the scene of the emergency. Thus, benevolent physicians and nurses who voluntarily provide care during a large-scale disaster unjustly risk liability. The prospect of such liability may substantially deter the provision of optimal medical care to children in a disaster. This article discusses the shortcomings of current laws and proposes revisions to existing state laws. These revisions would create reasonable and appropriate liability rules for physicians and nurses providing gratuitous care in emergencies and thus would create reasonable incentives for health care providers to deliver such care. ('Gratuitous care' is the legal term for care provided voluntarily and without expectation of payment.)
— id: 81576, year: 2008, vol: 24, page: 392, stat: Journal Article,

How safe should the work environment be? For the patient? For the health care worker?
Goldfrank, Lewis R
2008 Apr;34(3):235-235, Journal of emergency medicine
— id: 79552, year: 2008, vol: 34, page: 235, stat: Journal Article,

The Public Hospital in American Medical Education
Gourevitch, Marc N; Malaspina, Dolores; Weitzman, Michael; Goldfrank, Lewis R
2008 Sep;85(5):779-786, Journal of urban health
The importance of the public hospital system to medical education is often absent from the debate about its value. Best known as a core provider of services to the underserved, the safety net hospital system also plays a critical role in the education of future physicians. Particular strengths include its ability to imbue physicians in training with core professional values, to reveal through the enormous range of clinical experience provided many of the social forces shaping health, and to foster interest in and commitment to advancing population health. Faculty teaching in the public hospital system has unusual opportunities to reveal to learners the broader meanings of their diverse and rich experiences. Now, as an alarming array of pressures bearing down on the safety net system threaten its stability, the potential negative impact on medical education, were it to shrink or be forced to change its essential mission, must be considered. As advocates of the safety net system marshal forces to rationalize its funding and support, its tremendous contribution to the training of physicians and other health care professionals must be clearly set forth to ensure that support for the public hospital system's health is appropriately broad based
— id: 80970, year: 2008, vol: 85, page: 779, stat: Journal Article,

Methods and processes for the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial
Hertzberg, V; Ingall, T; O'Fallon, W; Asplund, K; Goldfrank, L; Louis, T; Christianson, T
2008 SEP ;5(4):308-315, Clinical trials
Background Treatment group imbalances in baseline stroke severity in the NINDS intravenous t-PA for acute stroke treatment trial led to controversy regarding the efficacy of tissue plasminogen activator (t-PA) in the treatment of acute ischemic stroke. Purpose Describe the steps used to independently re-evaluate this trial. Methods NIH appointed an independent multidisciplinary committee that gained access to the original data. We undertook analyses of t-PA efficacy accounting for this imbalance, as well as analyses to identify subgroups that experienced additional harm or benefit from t-PA. Analyses of time from stroke onset to treatment (OTT), blood pressure, and intracerebral hemorrhage are given as illustrations. Results Despite subgroup imbalances in baseline stroke severity, when t-PA was administered to acute ischemic stroke patients according to study protocol, there was a statistically significant and clinically important benefit of t-PA treatment resulting in a higher likelihood of having a favorable clinical outcome at 3 months. Moreover, we were unable to identify subgroups of patients between which t-PA treatment effect differed, albeit these analyses had low power. These data failed to support the NINDS investigators' conclusion that effect of t-PA therapy diminished with increasing values of OTT within the protocol-specified 3 h time limit. In addition, the blood pressure measurements were highly variable and inconsistently determined so as to be too unreliable for inclusion in analysis. Conclusion With new NIH requirements for data-sharing, the frequency of re-analysis of clinical trial data may increase substantially. This re-evaluation provides a blueprint for future re-evaluations of other trials. These best practices include re-analysis of the study data, after suitable replication, by an independent multidisciplinary committee, including a skilled statistical programmer analyst. Primary investigators should address significant errors determined in such re-analyses
— id: 86803, year: 2008, vol: 5, page: 308, stat: Journal Article,

Why meperidine should not make a comeback in treating patients with sickle cell disease
Howland, Mary Ann; Goldfrank, Lewis R
2008 Feb;51(2):203-205, Annals of emergency medicine
— id: 75775, year: 2008, vol: 51, page: 203, stat: Journal Article,

Thermal extremes in the work environment
Delaney, Kathleen A; Goldfrank, Lewis R.
Environmental and occupational medicine Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins, 2007,
— id: 5373, year: 2007, vol: , page: ?, stat: Chapter,

Organization-based incident management: developing a disaster volunteer role on a university campus
Fulmer, Terry; Portelli, Ian; Foltin, George L; Zimmerman, Rae; Chachkes, Esther; Goldfrank, Lewis R
2007 Jul-Sep;5(3):74-81, Disaster management & response : DMR
BACKGROUND: Catastrophic events are an ongoing part of life, affecting society both locally and globally. Recruitment, development, and retention of volunteers who offer their knowledge and skills in the event of a disaster are essential to ensuring a functional workforce during catastrophes. These opportunities also address the inherent need for individuals to feel necessary and useful in times of crisis. Universities are a particularly important setting for voluntary action, given that they are based in communities and have access to resources and capabilities to bring to bear on an emergency situation. METHODS: The purpose of the study was to discern how one large private organization might participate and respond in the case of a large scale disaster. Using a 2-phase random sample survey, 337 unique respondents (5.7%) out of a sample of 6000 replied to the survey. RESULTS: These data indicate that volunteers in a private organization are willing to assist in disasters and have skills that can be useful in disaster mitigation. DISCUSSION: Much is to be learned related to the deployment of volunteers during disaster. These findings suggest that volunteers can and will help and that disaster preparedness drills are a logical next step for university-based volunteers
— id: 74002, year: 2007, vol: 5, page: 74, stat: Journal Article,

Terrorism preparedness
Goldfrank, Lewis; Greller, Howard
Environmental and occupational medicine Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins, 2007,
— id: 5367, year: 2007, vol: , page: ?, stat: Chapter,

Rewarming rates in urban patients with hypothermia: prediction of underlying infection
Delaney, Kathleen A; Vassallo, Susi U; Larkin, Gregory L; Goldfrank, Lewis R
2006 Sep;13(9):913-921, Academic emergency medicine
BACKGROUND: In the urban setting, hypothermia is commonly associated with illness or intoxication, with death often secondary to infection. OBJECTIVES: To evaluate factors that affect the rewarming rate (RWR) and the ability of the RWR and other clinical markers to predict the presence or absence of underlying infection in an adult urban population. METHODS: This was a prospective observational study of hypothermic patient visits to a large emergency department. Serial temperatures were obtained during rewarming to construct rewarming curves. Rewarming modalities selected by emergency physicians were correlated with admission temperatures. Univariate associates of RWR and infection were assessed. RESULTS: The authors identified 96 patient visits. The median temperature was 89.5 degrees F (31.9 degrees C; range, 73.0 degrees F to 95.0 degrees F [22.8 degrees C to 35.0 degrees C]). Thirteen patients had temperatures of < 80.0 degrees F (26.0 degrees C). Seven died within 14 hours of presentation; six, of infection. No patient experienced ventricular fibrillation. Potential candidate predictors of infection from a multivariate analysis were a RWR of < 1.80 degrees F (1.0 degrees C) per hour and a serum albumin of < 2.7 g/dL. Rapid rewarming was associated with the absence of infection and a temperature below 86.0 degrees F (30.0 degrees C). In patients without significant underlying illness, rewarming rates appeared to be independent of the modality of rewarming. CONCLUSIONS: Rewarming rates reflect intrinsic capacity for thermogenesis. Increased RWRs were associated with the absence of infection. The achievement of normothermia did not prevent death in infected patients. Initiation of invasive rewarming in urban patients with hypothermia who have not had hypothermic cardiac arrest may be unwarranted. Management of this population should emphasize support, detection, and treatment of underlying illness
— id: 74008, year: 2006, vol: 13, page: 913, stat: Journal Article,

Initial evaluation of the patient : vital signs and toxic syndromes
Flomenbaum NE; Goldfrank LR; Hoffman RS; Howland MA; Lewin NA; Nelson LS
Goldfrank's toxicologic emergencies New York : McGraw-Hill Medical, 2006,
— id: 4542, year: 2006, vol: , page: 37, stat: Chapter,

Principles of managing the poisoned or overdosed patient
Flomenbaum NE; Goldfrank LR; Hoffman RS; Howland MA; Lewin NA; Nelson LS
Goldfrank's toxicologic emergencies New York : McGraw-Hill Medical, 2006,
— id: 4541, year: 2006, vol: , page: 42, stat: Chapter,

The interface: ethical decision making, medical toxicology, and emergency medicine
Kreismann, Erica; Gang, Maureen; Goldfrank, Lewis R
2006 Aug;24(3):769-784, Emergency medicine clinics of North America
The overwhelming social and economic costs of alcohol, tobacco, and other substances of abuse are discussed, as are some of the important public health interventions appropriate for emergency physicians. This article addresses the complexity of ethical decision making when toxicologic emergencies occur in emergency medicine. The management strategies for patients with apparent intoxication are addressed with regard to decision-making capacity. The balance between confidentiality and support for an individual patient and responsibility of the physician to society is discussed. The relative importance of HIPAA is compared with an individual physician's code of ethics
— id: 68408, year: 2006, vol: 24, page: 769, stat: Journal Article,

NINDS Reanalysis Committee's reanalysis of the NINDS trial - Response
Ingall, TJ; O'Fallon, WM; Asplund, K; Goldfrank, LR; Hertzberg, VS; Louis, TA; Christianson, TJH
2005 FEB ;36(2):230-231, Stroke
— id: 48247, year: 2005, vol: 36, page: 230, stat: Journal Article,

NINDS Stroke Trial data reanalysis leaves issues unresolved - Response
Ingall, TJ; O'Fallon, WM; Christianson, TJH; Asplund, K; Goldfrank, LR; Hertzberg, VS; Louis, TA
2005 MAR ;36(3):529-530, Stroke
— id: 49013, year: 2005, vol: 36, page: 529, stat: Journal Article,

Herbal medication use by patients presenting to the emergency department
Kwon, NS; Waxman, M; Moore, EC; Lewin, J; Mary, AH; Hoffman, RS; Nelson, LS; Chiang, WK; Goldfrank, LR
2005 SEP ;46(3):S77-S78, Annals of emergency medicine
— id: 58904, year: 2005, vol: 46, page: S77, stat: Journal Article,

Jewelry confusion : the importance of a site visits following toxin-induced injury in the workplace
Bouchard NC; Schmidt Jp; Goldfrank LS; Nelson LS
2004 ;42:809-809, Journal of toxicology. Clinical toxicology
— id: 70363, year: 2004, vol: 42, page: 809, stat: Journal Article,

Forward
Goldfrank LR
Clinical procedures in emergency medicine Philadelphia : Saunders, 2004,
— id: 3293, year: 2004, vol: , page: ?, stat: Chapter,

Ecgonine methyl ester protects against cocaine lethality in mice
Hoffman, Robert S; Kaplan, Joseph L; Hung, Oliver L; Goldfrank, Lewis R
2004 ;42(4):349-354, Journal of toxicology. Clinical toxicology
BACKGROUND: Plasma cholinesterase (PChE) metabolizes cocaine to ecgonine methyl ester (EME). Limited data demonstrate that EME is a mild vasodilator. Exogenous PChE protects against cocaine-induced seizures and lethality. It is unclear whether this protective effect results from enhanced degradation of cocaine, the loss of active metabolites (benzoylecgonine, norcocaine), or the production of a beneficial metabolite (EME). This study was designed to further investigate the pharmacologic effects of EME. METHODS: All experiments used female ICR Swiss albino mice weighing 20-30 grams. Mice were acclimated to 12 h alternating light-dark cycles and given food and water ad libitum. Using a randomized, blinded protocol, 80 mice were then pretreated with either IP EME (50 mg/kg) in a 0.9% sodium chloride solution or an equal volume of 0.9% sodium chloride solution as control. Five minutes later, all animals received 126 mg/kg of cocaine IP and were observed for seizures and death. Fatality was compared using a Fisher's exact test, and the time to seizures and death were compared using a Mann-Whitney U statistic. RESULTS: Pretreatment with EME increased survival following cocaine (9/40 vs. 2/40, for EME vs. control, respectively, p<0.05). The median times to seizure and death for both groups were 2.0 vs. 1.5 min (p>0.05), and 4.5 vs. 4.6 min (p>0.05) (EME vs. control for seizures and death, respectively). CONCLUSION: In this animal model, EME is protective against cocaine lethality. This effect is consistent with the previously described vasodilatory effects of EME. Further studies are indicated to determine whether the increase in EME produced by exogenous PChE administration contributes to the benefits that occur when PChE is given to cocaine-poisoned animals
— id: 46109, year: 2004, vol: 42, page: 349, stat: Journal Article,

Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial
Ingall, TJ; O'Fallon, WM; Asplund, K; Goldfrank, LR; Hertzberg, VS; Louis, TA; Christianson, TJH
2004 OCT ;35(10):2418-2424, Stroke
Background and Purpose - Following publication of concerns about the results of the National Institute of Neurological Disorders and Stroke (NINDS) intravenous tissue plasminogen activator (t-PA) in acute stroke treatment trial, NINDS commissioned an independent committee 'to address whether there is concern that eligible stroke patients may not benefit from t-PA given according to the protocol used in the trials and, whether the subgroup imbalance ( in baseline stroke severity) invalidates the entire trial.' Methods - The original NINDS trial data were reanalyzed to assess the t-PA treatment effect, the effect of the baseline imbalance in stroke severity between the treatment groups on the t-PA treatment effect, and whether subgroups of patients did not benefit from receiving t-PA. Results - A clinically important and statistically significant benefit of t-PA therapy was identified despite subgroup imbalances in baseline stroke severity and an increased incidence of symptomatic intracerebral hemorrhage in t-PA treated patients. The adjusted t-PA to placebo odds ratio ( OR) of a favorable outcome was 2.1 (95% CI, 1.5 to 2.9). Although these exploratory analyses found no statistical evidence that the t-PA treatment effect differed among patient subgroups, the study was not powered to detect subgroup treatment differences. Conclusions - These findings support the use of t-PA to treat patients with acute ischemic stroke within 3 hours of onset under the NINDS t-PA trial protocol. Health professionals should work collaboratively to develop guidelines to ensure appropriate use of t-PA in acute ischemic stroke patients
— id: 46495, year: 2004, vol: 35, page: 2418, stat: Journal Article,

The Homeless patient
Rao RB; Goldfrank LR
Emergency medicine : a comprehensive study guide New York : McGraw-Hill, 2004,
— id: 3322, year: 2004, vol: , page: 2014, stat: Chapter,

Emergency doctor
Ziegler, E; Goldfrank LR
New York : Perennial, 2004,
— id: 786, year: 2004, vol: , page: , stat: ,

Preparing for the psychological consequences of terrorism : a public health strategy
Butler AS; Panzer AM; Goldfrank LR; Institute of Medicine (US). Committee on Responding to the Psychological Consequences of Terrorism Board on Neuroscience and Behavioral Health
Washington DC : National Academies Press, 2003,
— id: 792, year: 2003, vol: , page: , stat: ,

Terrorism in America
Goldfrank LR
2003 ;25:4-4, Emergency medicine news
— id: 44412, year: 2003, vol: 25, page: 4, stat: Journal Article,

Personal and literary experiences in the development of an emergency physician
Goldfrank, Lewis R
2003 Jan;24(1):73-84, Journal of emergency medicine
The development of Emergency Medicine in the United States has evolved in diverse manners, depending particularly on the societal needs and academic support available in each city and institution. Significant personal and literary experiences are described with regard to the author's role in the development of Emergency Medicine at Bellevue Hospital Center and the New York City Poison Center in New York City. Critical quotations of literary and philosophic importance for the author are utilized to demonstrate the importance of literature in the development of a philosophy of life, a residency program in Emergency Medicine, a residency program in Medical Toxicology and an academic Department of Emergency Medicine. Critical societal events during the last quarter of the 20(th) century are related to this personal formative literature and the development of Emergency Medicine
— id: 44357, year: 2003, vol: 24, page: 73, stat: Journal Article,

Emergency physicians' perspectives on smallpox vaccination
Kwon, Nancy; Raven, Maria C; Chiang, William K; Moran, Gregory J; Jui, Jon; Carter, Richard A; Goldfrank, Lewis
2003 Jun;10(6):599-605, Academic emergency medicine
OBJECTIVE: To evaluate emergency physician (EP) attitudes toward smallpox vaccination, the treatment of patients with suspected smallpox, and the threat of a bioterrorist attack. METHODS: This was a prospective study utilizing a standardized survey instrument that was distributed on November 16, 2002, and collected by February 1, 2003. EPs from a sample of 50 accredited emergency medicine programs were surveyed regarding their perspectives on smallpox vaccination. RESULTS: A total of 989 surveys were collected from 42 emergency medicine programs. Of the respondents, 43.4% would currently volunteer for smallpox vaccination. EPs previously vaccinated against smallpox were 1.46 times more likely to volunteer for vaccination (95% CI = 1.14 to 1.93). EPs who believed they were at risk for complications were less than half as likely to volunteer for vaccination. EPs who perceived a significant risk of a bioterrorist attack were 2.7 times more likely to volunteer for the vaccine compared with those who thought the risk was minimal (95% CI = 2.06 to 3.47). Of the respondents, 34.4% believed the risks of the vaccination outweighed the benefits, 33% did not, and 32.6% were unsure. CONCLUSIONS: Currently, fewer than half of EPs surveyed would volunteer for smallpox vaccination. Factors associated with a willingness to be vaccinated include previous smallpox vaccination and the perceived threat of a bioterrorist attack. The variation in EP attitudes toward smallpox vaccination may be due to uncertain risk-to-benefit ratio. The opinions and actions of EPs may be influential on current and future government policy and public opinion
— id: 42079, year: 2003, vol: 10, page: 599, stat: Journal Article,

Principles of managing the patient with an unknown overdose
Goldfrank LR; Flomenbaum NE; Lewin NA
Goldfrank's toxicologic emergencies New York : McGraw-Hill Medical, 2002,
— id: 4532, year: 2002, vol: , page: 37, stat: Chapter,

Vital signs and toxic syndromes
Goldfrank LR; Flomenbaum NE; Lewin NA
Goldfrank's toxicologic emergencies New York : McGraw-Hill Medical, 2002,
— id: 4540, year: 2002, vol: , page: 255, stat: Chapter,

Goldfrank's toxicologic emergencies
Goldfrank, Lewis R.
New York : McGraw-Hill, Medical Pub. Division, c2002,
— id: 734, year: 2002, vol: , page: , stat: ,

Behavioral risk factor and preventive health care practice survey of immigrants in the emergency department
Jacobs, David H; Tovar, Juan M; Hung, Oliver L; Kim, Mimi; Ye, Philip; Chiang, William K; Goldfrank, Lewis R
2002 Jun;9(6):599-608, Academic emergency medicine
OBJECTIVE: To compare the demographic profiles, behavioral risk factors, and preventive health care practices of adult immigrant and non-immigrant patients while considering the effects of various socioeconomic variables. METHODS: This was a prospective survey administered at a large urban emergency department in New York City. Study subjects were adult immigrant patients presenting in an eight-week period in 1998. One non-immigrant control patient was recruited concurrently with every two immigrant patients. Differences between immigrants and non-immigrants were evaluated using the chi-square test. Multivariate logistic regression models were used to adjust for confounding variables. RESULTS: Eight hundred sixty-nine immigrant patients from 80 countries and 354 non-immigrant patients completed surveys. Immigrants were more likely not to have reached high school (28.9% vs 8.5%; p < 0.001), to have annual family incomes less than $20,000 (73.8% vs 64.5%; p < 0.01), and to have no health coverage (51.7% vs 30.8%; p < 0.001). Immigrant women were more likely never to have had a Papanicolaou test (16.1% vs 1.4%; OR 11.24, 95% CI = 2.70 to 46.8) and never to have performed a self-breast examination (20.8% vs 7.5%; OR 2.03, 95% CI = 1.29 to 3.20). Immigrants were more likely not to use condoms (63.4% vs 42.8%; OR 1.61, 95% CI = 1.20 to 2.15) and never to have visited a dentist (21.2% vs 7.8; OR 2.54, 95% CI = 1.60 to 4.04). Immigrants were more likely never to have received a purified protein derivative (PPD) skin test (30.3% vs 9.1%; OR 3.85, 95% CI = 2.56 to 5.80) and never to have received a tetanus immunization (48.1% vs 13.5%; OR 3.09, 95% CI = 2.17 to 4.42). These differences were independent of age, gender, marital status, employment, education, income, and health insurance status. When analyzing the immigrant group alone, region of origin, length of time in the United States, and English ability were significant independent predictors of higher-risk behavioral profiles and poor preventive health care practices. CONCLUSIONS: Differences exist between the socioeconomic profiles, behavioral risk profiles, and preventive health care practices of immigrant and non-immigrant patients presenting to a large inner-city municipal emergency department. Different populations within a heterogeneous group of immigrants have distinct health risks and public health needs
— id: 42081, year: 2002, vol: 9, page: 599, stat: Journal Article,

Preparing for terrorism : tools for evaluation the Metropolitan Medical Response System program
Manning EJ; Goldfrank LR; Institute of Medicine (US). Committee on Evaluation of the Metropolitan Medical Response Program
Washington DC : National Academy Press, 2002,
— id: 790, year: 2002, vol: , page: , stat: ,

Social bias and injustice in the current health care system
Manoach, Seth M; Goldfrank, Lewis R
2002 Mar;9(3):241-247, Academic emergency medicine
This paper reflects upon historical and modern events and challenges emergency physicians to affirm a genuine commitment to social justice. Such an affirmation does not allow the physician to rest in the belief that the system is inherently just. Rather, it challenges the practitioner to recognize the widespread and inherent injustices that are present. It is probable that significant strides have been made toward protecting the rights and dignity of our patients. Even so, much remains to be done. Poor and minority patients are still less than optimally treated, and increasing marketplace competitiveness may jeopardize some of the recent gains in caring for the uninsured. Future generations may look upon some of the current discriminatory practices of our professional lifetimes with the condemnation that we hold for past abuses
— id: 44358, year: 2002, vol: 9, page: 241, stat: Journal Article,

Problems in pediatric drug therapy
Pagliaro LA; Pagliaro AM; Goldfrank LR; Pediatric Advisory Committee
Washington DC : American Pharmaceutical Assoc, 2002,
— id: 797, year: 2002, vol: , page: , stat: ,

The epidemiology of the homeless population and its impact on an urban emergency department
D'Amore J; Hung O; Chiang W; Goldfrank L
2001 Nov;8(11):1051-1055, Academic emergency medicine
OBJECTIVES: To characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness. METHODS: A prospective, case-control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non-homeless controls over an eight-week period during summer 1999. Research assistants administered a 50-item questionnaire and were trained in assessing dentition and triceps skin-fold thickness. Inclusion criteria: all homeless adults who consented to participate. Homelessness was defined as being present for any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless:control rate. Exclusion criteria: critically ill, injured, or incapacitated patients, or patients <21 years of age. Univariate analysis with appropriate statistical tests was used. The Mantel-Haenszel test was used to adjust for population differences. RESULTS: Two hundred fifty-two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients, and all p-values were <0.01. Odds ratios (ORs) with 95% confidence intervals (95% CIs) are given where appropriate: mean age (+/-SD) = 42 +/- 10 vs 48 +/- 13; male gender 95% vs 54% (OR = 17; 95% CI = 8 to 37); history of (hx) tuberculosis 49% vs 15% (OR = 2.5; 95% CI = 1.2 to 3); hx HIV infection 35% vs 13% (OR = 3.8; 95% CI = 1.8 to 8); hx penetrating trauma 62% vs 16% (OR = 8.62; 95% CI = 4.4 to 17.1); hx depression 70% vs 15% (OR = 13.4; 95% CI = 6.7 to 27); hx schizophrenia 27% vs 7% (OR = 5.1; 95% CI = 2.0 to 14); hx alcoholism 81% vs 15% (OR = 24; 95% CI = 12 to 49); significant tooth loss (>3) 43% vs 18% (OR = 3.3; 95% CI = 1.8 to 6.4); percentage of body fat 16.5% vs 19.7%; hx social isolation (no weekly social contacts) 81% vs 11% (OR = 33.3; 95% CI = 14 to 100); mean number of ED visits/year 6.0 vs 1.6. CONCLUSIONS: In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization
— id: 26583, year: 2001, vol: 8, page: 1051, stat: Journal Article,

Lessons from the Wall of Prayers
Goldfrank LR; Rao R
2001 ;23(11):?-?, Emergency medicine news
— id: 44415, year: 2001, vol: 23, page: ?, stat: Journal Article,

Tools for evaluation the Metropolitan Medical Response System program : phase I report
Manning EJ; Goldfrank LR; Institute of Medicine (US). Committee on Evaluation of the Metropolitan Medical Response Program
Washington DC : National Academy Press, 2001,
— id: 791, year: 2001, vol: , page: , stat: ,

Access to harm reduction education among injection drugusers in an urban emergency department
Stone MB; Rao RB; Goldfrank LR
2001 ;38:S107-S107, Annals of emergency medicine
— id: 44437, year: 2001, vol: 38, page: S107, stat: Journal Article,

Domestic abuse in the emergency department: can a risk profile be defined?
Zachary MJ; Mulvihill MN; Burton WB; Goldfrank LR
2001 Aug;8(8):796-803, Academic emergency medicine
OBJECTIVES: The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse. METHODS: This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as 'recent' (within the preceding 12 months) or 'lifetime' (recent or past). This included emotional, physical, and sexual abuse. RESULTS: Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and <25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7). CONCLUSIONS: Clinical presentations and demographic characteristics of women presenting to the ED may not be sensitive or predictive indicators of domestic abuse. In the absence of typical clinical or demographic findings, asking all women in the ED about domestic abuse remains a necessary priority
— id: 26714, year: 2001, vol: 8, page: 796, stat: Journal Article,

Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States
Dart RC; Goldfrank LR; Chyka PA; Lotzer D; Woolf AD; McNally J; Snodgrass WR; Olson KR; Scharman E; Geller RJ; Spyker D; Kraft M; Lipsy R
2000 Aug;36(2):126-132, Annals of emergency medicine
STUDY OBJECTIVE: To develop guidelines for the stocking of antidotes at hospitals that accept emergency admissions using combined evidence-based and consensus methods. METHODS: Study participants were 12 medical care providers from disciplines that are affected by insufficient stocking of emergency antidotes (clinical pharmacology, critical care, clinical pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed care pharmacy, clinical toxicology, pediatrics, poison control centers, pulmonary medicine, regulatory medicine). Selection of individuals for the study panel was based on evidence of previous antidote research or perspective regarding the purchase and use of antidotes. The literature regarding each antidote was systematically amassed using pre-1966 literature files, current MEDLINE searches, the reference lists of major medical textbooks, and citations solicited from the consensus panel. Articles relevant to 4 defined core questions were included. These articles formed the basis of an evidence-based analysis performed by the principal investigator. After literature analysis, a literature summary and proposed guidelines for antidote stocking were submitted to the panel. Consensus was formed by electronic iterative presentation of alternatives to each panel member using a modified Delphi method. All panel members participated in 5 rounds of guideline analysis of 20 antidotes. RESULTS: Of the 20 antidotes, 16 antidotes were ultimately recommended for stocking (N -acetylcysteine, atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol, fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine, sodium bicarbonate), 2 were not recommended for stocking (black widow antivenin, ethylenediamine tetraacetic acid), and consensus could not be reached for 2 antidotes (flumazenil, physostigmine). CONCLUSION: These guidelines provide a tool to be used in revising or creating policies and procedures with regard to the stocking of antidotes in hospitals that accept emergency patients
— id: 44359, year: 2000, vol: 36, page: 126, stat: Journal Article,

Management of the multiply injured or intoxicated patient
Delaney KA; Goldfrank LR
Head injury New York : McGraw-Hill, 2000,
— id: 3297, year: 2000, vol: , page: 41, stat: Chapter,

The Medical Toxicology Fellowship
Goldfrank LR
2000 ;38:643-644, Journal of toxicology. Clinical toxicology
— id: 44436, year: 2000, vol: 38, page: 643, stat: Journal Article,

The next century : mission impossible with universal health care
Goldfrank LR
2000 ;22(1):?-?, Emergency medicine news
— id: 44414, year: 2000, vol: 22, page: ?, stat: Journal Article,

Racially and ethnically selective oligoanalgesia: is this racism?
Goldfrank LR; Knopp RK
2000 Jan;35(1):79-82, Annals of emergency medicine
— id: 44361, year: 2000, vol: 35, page: 79, stat: Journal Article,

The utility of an alcohol oxidase reaction test to expedite the detection of toxic alcohol exposures
Hack JB; Chiang WK; Howland MA; Patel H; Goldfrank LR
2000 Mar;7(3):294-297, Academic emergency medicine
— id: 42084, year: 2000, vol: 7, page: 294, stat: Journal Article,

Evaluation of the physician's ability to recognize the presence or absence of anemia, fever, and jaundice
Hung OL; Kwon NS; Cole AE; Dacpano GR; Wu T; Chiang WK; Goldfrank LR
2000 Feb;7(2):146-156, Academic emergency medicine
OBJECTIVE: The evaluation of the patient through a comprehensive history and physical examination is considered the cornerstone of medical diagnosis, but many studies suggest that physicians have inadequate physical examination skills. It is unknown whether these skills are reliable and whether they can be adequately acquired through training. The objective of this study was to evaluate the ability of the clinician to detect the presence and discriminate the extent of clinical anemia, fever, and jaundice in an ED or hospitalized patient. METHODS: This was a prospective observational study of a convenience sample of patients presenting to the ED or admitted to the hospital who had a rectal temperature measurement within 30 minutes prior to the observation, serum hematocrit measurement on the day of observation, or serum bilirubin measurement one day prior to the day of observation. Observers' (emergency medicine attending physicians', resident physicians', and rotating medical students') estimated serum hematocrit, rectal temperature, and serum bilirubin values were obtained after each observation. Sensitivity, specificity, positive predictive value, negative predictive value, and mean absolute difference between actual and estimated values were calculated for each observer. RESULTS: The physicians detected the presence or absence of anemia, fever, and jaundice in patients with sensitivities and specificities of approximately 70%. Their predictions varied from the measured value on average by 6.0 +/- 4.6% for serum hematocrit, 1.3 + 1.1 degrees F for rectal temperature, and 3.4 +/- 5.3 mg/dL for serum bilirubin. Observer accuracy decreased when evaluating patients with high and low measured values. CONCLUSIONS: The ability to correctly perform and interpret the physical examination appears to be independent of the observer level of training, patient ethnicity, or patient gender. The examination for pallor, warmth, and jaundice is unreliable in predicting the corresponding laboratory or electronic measurement. Certain anemic, febrile, or jaundiced patients may not be reliably detected solely by a focused physical examination
— id: 11820, year: 2000, vol: 7, page: 146, stat: Journal Article,

Poisoning
Nelson LS; Goldfrank LR
Melmon and Morrelli's clinical pharmacology New York : McGraw-Hill, 2000,
— id: 3305, year: 2000, vol: , page: 1091, stat: Chapter,

Poisoning
Nelson LS; Goldfrank LR
Melmon and Morrelli's clinical pharmacology: basic principles in therapeutics New York : McGraw-Hill, 2000,
— id: 4129, year: 2000, vol: , page: ?, stat: Chapter,

The Homeless patient
Rao RB; Goldfrank LR
Emergency medicine : a comprehensive study guide New York : McGraw-Hill, 2000,
— id: 3321, year: 2000, vol: , page: 2014, stat: Chapter,

Alcoholism in the emergency department: an epidemiologic study
Whiteman PJ; Hoffman RS; Goldfrank LR
2000 Jan;7(1):14-20, Academic emergency medicine
OBJECTIVE: To describe the epidemiology of alcoholism in ED patients. METHODS: Over a two-month period, every adult patient brought by ambulance to the ED of a large municipal hospital was prospectively enrolled by questionnaire. Data collected included demographics, previous ED use, triage complaint-related diagnoses, hospital admission rates, and ethanol levels (if determined). The CAGE alcoholism questions were administered to all patients by trained assistants. The only exclusion criterion was the inability to communicate while in the ED. A chi-square analysis was used to compare categorical variables. RESULTS: A total of 2,658 patients were enrolled in the study; 226 were unable to respond to the CAGE questions. Five hundred eighty-eight of the remaining 2,432 patients (24%) were defined as being alcoholic by an affirmative response to at least two of the CAGE questions. All four questions were answered affirmatively by 17% of the total patients. Alcoholic patients were more likely to be male (88% vs 60%), unemployed (87% vs 71%), undomiciled (46% vs 20%), polysubstance users (52% vs 25%), and tobacco users (77% vs 41%), and to have had an ED visit in the previous six months (51% vs 35%) (p < 0.001 for all tests). Ethanol levels ranged from zero to 573 mg/dL. Whereas no positive response to a single CAGE question was predictive of a final diagnosis of alcoholism, a blood ethanol level more than 300 mg/dL predicted an affirmative response to at least two CAGE questions in 97% of cases. CONCLUSIONS: Alcoholism should be presumed to be present in a substantial number of patients who present to urban EDs by ambulance
— id: 44360, year: 2000, vol: 7, page: 14, stat: Journal Article,

Emergency center categorization standards
Goldfrank L; Henneman PL; Ling LJ; Prescott JE; Rosen C; Sama A
1999 Jun;6(6):638-655, Academic emergency medicine
The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations 'should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day.' By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM
— id: 56451, year: 1999, vol: 6, page: 638, stat: Journal Article,

David R. Boyd lecture in trauma care and emergency medical systems: "The surgical complications of toxins."
Goldfrank LR
1999 Nov-Dec;17(6):1055-1064, Journal of emergency medicine
Toxins have had major roles in our societies for thousands of years. Interactions between surgeons, both generalists and subspecialists, and those caring for poisoned patients have been extensive throughout history. The advancement of the science of toxicology, the development of regional poison control centers, the development of emergency medicine, and the development of the subspecialty of medical toxicology have led to more appropriate and creative interactions between medical toxicologists, emergency physicians, and surgeons. This article will review the diverse interfaces between the medical toxicologist and the surgeon
— id: 39447, year: 1999, vol: 17, page: 1055, stat: Journal Article,

The leadership of emergency medicine
Goldfrank LR
1999 ;6:1193-1194, Academic emergency medicine
— id: 44434, year: 1999, vol: 6, page: 1193, stat: Journal Article,

Erratum: (Journal of Toxicology - Clinical Toxicology (1999) 36:7)
Goldfrank LR; Flomenbaum NE; Lewin NA; Weiman RS; Howland MA; Hoffman RS
1999 ;37(2):309-309, Journal of toxicology. Clinical toxicology
— id: 44405, year: 1999, vol: 37, page: 309, stat: Journal Article,

Comparative efficacy of thallium adsorption by activated charcoal, prussian blue, and sodium polystyrene sulfonate
Hoffman RS; Stringer JA; Feinberg RS; Goldfrank LR
1999 ;37(7):833-837, Journal of toxicology. Clinical toxicology
BACKGROUND: Although Prussian blue is considered the antidote of choice for thallium poisoning, the lack of a Food and Drug Administration-approved pharmaceutical formulation has led to the search for other adsorbents. Activated charcoal has been demonstrated to adsorb thallium in vitro, and the similarity between thallium and potassium has led some authors to consider the use of sodium polystyrene sulfonate as a potential adsorbent. This experiment was designed to compare the relative thallium binding efficacy of these agents in a standard isotherm model. METHODS: A standard aqueous solution of thallium acetate buffered to pH 7.0 was agitated at 25 degrees C with activated charcoal, Prussian blue, or sodium polystyrene sulfonate at adsorbent:thallium ratios ranging from 1.5:1 to 100:1. In order to further simulate physiologic conditions, all trials were repeated in a solution containing 4 mmol/L potassium phosphate. After thorough agitation, the mixtures were allowed to settle and were centrifuged and filtered through a 0.22-micron filter. Supernatant thallium concentrations were measured by atomic absorption spectrophotometry. Langmuir isotherms were used to calculate the maximal adsorptive capacity of each adsorbent, using linear regression with Pearson's correlation coefficients (r). Maximal adsorptive capacities were compared statistically with a p < 0.05 considered significant. RESULTS: The maximal adsorptive capacities defined as milligrams of thallium per gram of adsorbent (shown with linear regression p and r values) were as follows: activated charcoal, 59.7 mg/g (p = 0.005, r = 0.995); Prussian blue, 72.7 mg/g (p = 0.004, r = 0.996); and sodium polystyrene sulfonate, 713 mg/g (p = 0.049, r = 0.951). All three values were statistically different from each other. At a physiologic potassium concentration, the maximal adsorptive capacities for activated charcoal and Prussian blue were essentially unchanged (58.3 mg/g and 69.8 mg/g, respectively, p > 0.05 for each vs trials without potassium), while the maximal adsorptive capacity for sodium polystyrene sulfonate fell to 39.1 mg/g (p = 0.003, r = 0.997, p = 0.005 vs sodium polystyrene sulfonate without potassium). CONCLUSIONS: This in vitro study confirms the utility of Prussian blue and activated charcoal as thallium adsorbents. Although sodium polystyrene sulfonate demonstrates exceptional in vitro adsorption of thallium, its greater affinity for potassium probably renders it clinically ineffective
— id: 11870, year: 1999, vol: 37, page: 833, stat: Journal Article,

Occupational exposures to blood among emergency medicine residents
Lee CH; Carter WA; Chiang WK; Williams CM; Asimos AW; Goldfrank LR
1999 Oct;6(10):1036-1043, Academic emergency medicine
OBJECTIVES: To investigate the epidemiologic characteristics of potentially infectious occupational exposures to blood among emergency medicine (EM) residents. METHODS: A SAEM-sponsored multiple-choice survey was administered anonymously to all EM residents participating in the 1998 American Board of Emergency Medicine in-service examination. Survey questions included resident demographics, use of universal precautions, frequency and types of exposures to blood, and exposure reporting. Residents who experienced at least one exposure were then asked to complete an additional set of questions referring only to their latest exposure. Mean values were calculated for each variable and differences between groups were compared by chi-square analysis. RESULTS: Three thousand one hundred sixty-two surveys were distributed to the resident participants, and 2,985 surveys (94.4%) were returned. Of the participants, 56.1% reported at least one exposure to blood during their EM training. The frequency of this self-reported exposure increased with advancing EM level of training (43% EM-1, 58% EM-2, 64% EM-3, 76% EM-4, p<0.001). Of these residents, 36.6% always followed universal precautions, 54% frequently, and 9.4% sometimes, rarely, or never. Those individuals who 'always' followed universal precautions reported significantly fewer exposures than those who did not (p<0.005). The latest exposures were most commonly caused by a solid needle or sharp object (39.4%), by a hollow-bore needle (30.6%), or by eye splashes (17.2%). Of these exposures, 71.7% occurred in the ED setting, and only 46.7% of these exposures were reported to health care providers. CONCLUSION: Emergency medicine residents are frequently exposed to blood, most commonly due to puncture injuries by sharp objects. The rate of exposure reporting is low, which may compromise appropriate postexposure counseling and prophylaxis
— id: 6222, year: 1999, vol: 6, page: 1036, stat: Journal Article,

Cocaine
Palmer ME; Goldfrank LR
Oxford textbook of critical care Oxford : Oxford Univ. Press, 1999,
— id: 3304, year: 1999, vol: , page: 642, stat: Chapter,

The difficult patient
Simon JR; Dwyer J; Goldfrank LR
1999 May;17(2):353-70, x, Emergency medicine clinics of North America
The term difficult patient refers to a group of patients with whom a physician may have trouble forming a normal therapeutic relationship. The care of these patients can present many ethical dilemmas, ranging from issues of patient autonomy to questions of appropriate use of resources, which the emergency physician must be prepared to handle. Encounters with these patients also challenge physicians to explore and cultivate many of the character traits and virtues necessary to being a humane, caring, and ethical practitioner
— id: 11974, year: 1999, vol: 17, page: 353, stat: Journal Article,

A prospective evaluation of the electrocardiographic manifestations of hypothermia
Vassallo SU; Delaney KA; Hoffman RS; Slater W; Goldfrank LR
1999 Nov;6(11):1121-1126, Academic emergency medicine
OBJECTIVE: To determine the effects of body temperature, ethanol use, electrolyte status, and acid-base status on the electrocardiograms (ECGs) of hypothermic patients. METHODS: Prospective, two-year, observational study of patients presenting to an urban ED with temperature < or =95 degrees F (< or =35 degrees C). All patients had at least one ECG obtained. Electrocardiograms were interpreted by a cardiologist blinded to the patient's temperature. J-point elevations known as Osborn waves were defined as present if they were at least 1 mm in height in two consecutive complexes. RESULTS: 100 ECGs were obtained in 43 patients. Presenting temperatures ranged between 74 degrees F and 95 degrees F (23.3 degrees C-35 degrees C). Initial rhythms included normal sinus (n = 34), atrial fibrillation (n = 8), and junctional (n = 1). Osborn waves were present in 37 of 43 initial ECGs. Of the six initial ECGs that did not have Osborn waves present, all were obtained in patients whose temperatures were > or =90 degrees F > or =32.2 degrees C). For the entire group, the Osborn wave was significantly larger as temperature decreased (p = 0.0001, r = -0.441). The correlation between temperature and size of the Osborn wave was strongest in six patients with four or more ECGs (range r = -0.644 to r = -0.956, p = 0.001). No correlation could be demonstrated between the height of the Osborn waves and the serum electrolytes, including sodium, chloride, potassium, bicarbonate, BUN, creatinine, glucose, anion gap, and blood ethanol levels. CONCLUSIONS: The presence and size of the Osborn waves in hypothermic patients appear to be a function of temperature. The magnitude of the Osborn waves is inversely correlated with the temperature
— id: 56484, year: 1999, vol: 6, page: 1121, stat: Journal Article,

The effects of nutrition on plasma cholinesterase activity and cocaine toxicity in mice
Cahill-Morasco R; Hoffman RS; Goldfrank LR
1998 ;36(7):667-672, Journal of toxicology. Clinical toxicology
BACKGROUND: Low plasma cholinesterase activity is associated with severe cocaine toxicity in human subjects and animal experiments. Exogenously enhanced plasma cholinesterase activity is protective against cocaine toxicity in animals. Cocaine users tend to have lower plasma cholinesterase activity than controls. Yet, when cocaine users are allowed to use cocaine in controlled settings without dietary restriction, their plasma cholinesterase activity increases. This study evaluates the influence of diet on plasma cholinesterase activity and cocaine toxicity. METHODS: Forty-five Swiss albino mice were maintained on a high (30%) protein diet for 3 weeks. They were then randomized into equal groups and given either the high protein diet, an isocaloric low protein diet, or a protein and calorie deficient diet which consisted of reduced intake of the high protein diet. Body weights and plasma cholinesterase activities were measured after a 21-day study period. All animals then received a fixed dose of intraperitoneal cocaine and were observed for seizures and death. RESULTS: Body weights and plasma cholinesterase activities of the high protein animals remained stable. Weights for the low protein and reduced intake animals fell by 5% and 15%, respectively (p < 0.05 for both vs baseline). Similarly, plasma cholinesterase activities for the low protein and reduced intake animals fell by 4% and 10%, respectively (p = 0.06 for low protein and < 0.05 for reduced intake vs baseline). Cocaine caused seizures in 67% of the high protein animals as compared to 93% and 100% of the low protein and reduced intake animals, respectively (p < 0.05 for high protein vs reduced intake). None of the high protein animals died as compared to 20% and 100% of the low protein and reduced intake animals, respectively (p < 0.05 for high protein vs reduced intake). CONCLUSION: Protein and calorie malnutrition is associated with a reduction in plasma cholinesterase activity and enhanced cocaine toxicity in mice. Further study is needed to determine if dietary factors are partially responsible for variations in plasma cholinesterase activity and cocaine susceptibility in humans
— id: 44362, year: 1998, vol: 36, page: 667, stat: Journal Article,

Feasibility and pharmacokinetics of carbamazepine oral loading doses
Cohen H; Howland MA; Luciano DJ; Rubin RN; Kutt H; Hoffman RS; Leung LK; Devinsky O; Goldfrank LR
1998 Jun 1;55(11):1134-1140, American journal of health-system pharmacy. AJHP
The pharmacokinetics and adverse effects of an oral loading dose of carbamazepine administered in tablet or suspension form were studied. Patients on a hospital epilepsy unit who were to receive carbamazepine as a discharge medication were randomly assigned to receive either an oral 8-mg/kg loading dose of the tablet formulation or the same dose of the suspension on an empty stomach. Blood samples were drawn before and at intervals up to 12 hours after the loading dose. Adverse effects were evaluated subjectively and objectively. Total and free serum carbamazepine and carbamazepine-10, 11-epoxide (CBZE) concentrations were determined by high-performance liquid chromatography. Six adult patients were enrolled in and completed the study. All the patients achieved therapeutic total carbamazepine levels; the suspension group did so within two hours and the tablet group within five hours. Maximum serum carbamazepine concentrations ranged from 7.10 to 9.92 mg/L, area under the concentration-versus-time curve from 54.85 to 82.23 micrograms.hr/L, and terminal elimination half-life from 14.05 to 15.71 hours. Adverse effects were mild, few, and short-lived; none of the patients developed gastrointestinal toxicity. Adverse effects were not associated with total or free carbamazepine and CBZE concentrations or with total or free CBZE:carbamazepine ratios. An oral loading dose of carbamazepine 8 mg/kg achieved therapeutic levels within two hours when given as a suspension and within five hours when given as tablets and was well tolerated in all patients
— id: 57121, year: 1998, vol: 55, page: 1134, stat: Journal Article,

Managing the patient with an unknown overdose
Flomenbaum N; Goldfrank L; Lewin N
Goldfrank's toxicologic emergencies Stamford CT : Appleton & Lange, 1998,
— id: 4521, year: 1998, vol: , page: 515, stat: Chapter,

Principles of managing the poisoned or overdosed patient: an overview
Goldfrank L; Flomenbaum N; Lewin N
Goldfrank's toxicologic emergencies Stamford CT : Appleton & Lange, 1998,
— id: 4518, year: 1998, vol: , page: 32, stat: Chapter,

Vital signs and toxic syndromes
Goldfrank L; Flomenbaum N; Lewin N
Goldfrank's toxicologic emergencies Stamford CT : Appleton & Lange, 1998,
— id: 4519, year: 1998, vol: , page: 277, stat: Chapter,

Phencyclidine
Goldfrank L; Lewin N
Goldfrank's toxicologic emergencies Stamford CT : Appleton & Lange, 1998,
— id: 4527, year: 1998, vol: , page: 1105, stat: Chapter,

Goldfrank's toxicologic emergencies
Goldfrank LR
Stamford CT : Appleton & Lange, 1998,
— id: 793, year: 1998, vol: , page: , stat: ,

1998 Matthew Ellenhorn Award Lecture - Medical toxicology: past, present, and future
Goldfrank LR
1998 ;1:22-22, Internet journal of medical toxicology
— id: 44438, year: 1998, vol: 1, page: 22, stat: Journal Article,

Forward
Goldfrank LR
Clinical procedures in emergency medicine Philadelphia : Saunders, 1998,
— id: 3292, year: 1998, vol: , page: ?, stat: Chapter,

Goldfrank's toxicologic emergencies
Goldfrank LR; Flomenbaum NE; Lewin NA; Weisman RS; Howland MA; Hoffman RS
Stamford, CT : Appleton & Lange., 1998,
— id: 1133, year: 1998, vol: , page: , stat: ,

A milestone for emergency medicine in Europe
Goldfrank LR; Warnod V
1998 ;20(12):?-?, Emergency medicine news
— id: 44413, year: 1998, vol: 20, page: ?, stat: Journal Article,

Emergency department initiatives to improve the public health
Gordon JA; Goldfrank LR; Andrulis DP; D'Alessandri RM; Kellermann AL
1998 Sep;5(9):935-937, Academic emergency medicine
— id: 44364, year: 1998, vol: 5, page: 935, stat: Journal Article,

How dangerous is the unintentional use of the word accident in our literature?
Hung OL; Hoffman RS; Goldfrank LR
1998 ;36(1-2):1-2, Journal of toxicology. Clinical toxicology
— id: 44366, year: 1998, vol: 36, page: 1, stat: Journal Article,

Cocaine related chest pain
Lee CC; Goldfrank LR
1998 ;4:35-40, Journal of Korean American Medical Association (JKAMA)
— id: 44431, year: 1998, vol: 4, page: 35, stat: Journal Article,

Rear seat belt accessibility and occupant seat belt use in New York City taxicabs
Manoach SM; Bruno GR; Grasso-Knight G; Goldfrank LR
1998 Dec;88(12):1878-1878, American journal of public health. AJPH
— id: 44363, year: 1998, vol: 88, page: 1878, stat: Journal Article,

Fixed-dose combination therapy: panacea or poison?
Rao RB; Goldfrank LR
1998 Apr;24(4):283-285, Intensive care medicine
— id: 44365, year: 1998, vol: 24, page: 283, stat: Journal Article,

How to treat the poisoned patient
Erickson TB; Goldfrank LR; Kulig K
1997 ;90:90-113, Patient care
— id: 44433, year: 1997, vol: 90, page: 90, stat: Journal Article,

A perspective on the IPCS methanol and ethylene glycol document
Goldfrank LR
1997 ;35:145-146, Journal of toxicology. Clinical toxicology
— id: 44429, year: 1997, vol: 35, page: 145, stat: Journal Article,

Flumazenil: a pharmacologic antidote with limited medical toxicology utility, or ... an antidote in search of an overdose
Goldfrank LR
1997 Oct;4(10):935-936, Academic emergency medicine
— id: 44368, year: 1997, vol: 4, page: 935, stat: Journal Article,

Forward
Goldfrank LR
Occupational, industrial, and environmental toxicology St. Louis : Mosby, 1997,
— id: 3303, year: 1997, vol: , page: ?, stat: Chapter,

Forward
Goldfrank LR
Safety and health in agriculture, forestry, and fisheries Rockville MD : Government Industries, 1997,
— id: 3320, year: 1997, vol: , page: ?, stat: Chapter,

The public hospital
Goldfrank LR
1997 ;4:703-718, Fordham urban law journal
— id: 44430, year: 1997, vol: 4, page: 703, stat: Journal Article,

The state of academic emergency medicine: 1996 SAEM Presidential Address
Goldfrank LR
1997 Jan;4(1):1-3, Academic emergency medicine
— id: 44371, year: 1997, vol: 4, page: 1, stat: Journal Article,

The troubled road to universal health care
Goldfrank LR
1997 Dec;30(6):737-738, Annals of emergency medicine
In our country the increasing commercialization of medicine is taking control of our medical school faculties, hospitals, and education. There is an overemphasis on health care efficiency, with a dramatic decrease in the commitment to research, an increase in the cost of medical education and resultant staggering student debt, an increasing number of medically uninsured, and an ever-widening gap between the best that American medicine can offer and that which the indigent receive
— id: 44367, year: 1997, vol: 30, page: 737, stat: Journal Article,

Voices from the ED. Emergency medicine: guarantor of public health
Goldfrank LR
1997 ;10(11):65-6,68, JAAPA : official journal of the American Academy of Physician Assistants
— id: 58186, year: 1997, vol: 10, page: 65, stat: Journal Article,

Le toxicomane au service d'urgence = Substance abuser in the emergency department
Goldfrank LR; Hoffman RS; Warnod V
1997 ;6(2):99-109, Reanimation urgences
— id: 44407, year: 1997, vol: 6, page: 99, stat: Journal Article,

Food-borne neurotoxins
Hamilton RJ; Goldfrank LR
Cuurent diagnosis [S.l.] : W.B. Saunders, 1997,
— id: 3326, year: 1997, vol: , page: 901, stat: Chapter,

Poison center data and the Pollyanna phenomenon
Hamilton RJ; Goldfrank LR
1997 ;35(1):21-23, Journal of toxicology. Clinical toxicology
— id: 44372, year: 1997, vol: 35, page: 21, stat: Journal Article,

Herbal preparation use among urban emergency department patients
Hung OL; Shih RD; Chiang WK; Nelson LS; Hoffman RS; Goldfrank LR
1997 Mar;4(3):209-213, Academic emergency medicine
OBJECTIVE: To determine the prevalence of herbal preparation use among patients presenting to an urban teaching hospital ED. METHODS: A prospective anonymous survey on herbal preparation use was performed. Consecutive, acutely ill or injured adult (> or = 18 years old) ED patients were offered the survey over a 1-month period. The survey also asked for information related to patient age, ethnicity, gender, employment, education, cigarette smoking history, ethanol consumption, use of illicit drugs, chief complaint, and HIV status. RESULTS: Of 2,473 eligible subjects, 623 (25%) participated. The overall reported prevalence of herbal preparation use among the participants was 21.7%. Women were more likely to use herbal preparations than men (28.5% vs 17.2%, p = 0.013). Prevalence rates in different ethnic populations were: whites, 18.2%; Hispanics, 13.9%; blacks, 26.4%; and Asians, 36.8%. Asians had a significantly higher use rate than the other ethnic groups (p = 0.039). Neither HIV positivity, educational level, employment status, nor age was significantly associated with herbal preparation use. The most commonly reported herbal preparations were goldenseal tea, garlic, and ginger. Several of the herbal preparations reported as used by patients in this study have been associated with severe systemic toxicity in the medical literature. CONCLUSION: Although the survey response rate was low, the prevalence of herbal preparation use among acutely ill or injured patients presenting to this urban ED remains significant. A directed history toward specific herbal preparation use may provide relevant pharmacologic information and uncover cases of herbal-preparation-induced toxicity
— id: 12373, year: 1997, vol: 4, page: 209, stat: Journal Article,

SAEM Kennedy Lecture - Infinite needs, finite resources: The new world of health care
Lamm RD; Goldfrank LR; Lowenstein SR
1997 ;4(6):593-603, Academic emergency medicine
— id: 44406, year: 1997, vol: 4, page: 593, stat: Journal Article,

Effects of Prussian blue and N-acetylcysteine on thallium toxicity in mice
Meggs WJ; Cahill-Morasco R; Shih RD; Goldfrank LR; Hoffman RS
1997 ;35(2):163-166, Journal of toxicology. Clinical toxicology
BACKGROUND: Thallium poisoning is now rare but still occurs as a result of homicide attempts. Prussian blue's efficacy in the treatment of experimental thallium poisoning has been demonstrated in animal models, and its use in humans is supported by anecdotal data. Since thallium binds sulfhydryl groups, the use of N-acetylcysteine is also considered as a potential antidote. STUDY OBJECTIVE: To compare the efficacy of Prussian blue and N-acetylcysteine in a murine model of thallium poisoning. METHODS: Female Swiss albino mice with free access to food and water were used. Two study doses of thallium, given as a subcutaneous injection of thallium acetate dissolved in sterile water, were chosen: 70 mg/kg (LD90) and 85 mg/kg (> LD100). A randomized, placebo controlled study was conducted with survival at 120 h chosen as the outcome measure. Four treatment groups were studied: control, Prussian blue, N-acetylcysteine, and the combination of Prussian blue and N-acetylcysteine. Prussian blue was dissolved in water and given by oral gavage at a dose of 50 mg/kg. N-acetylcysteine was diluted in normal saline and given as intraperitoneal injections of 200 mg/kg. Sterile water by gavage and normal saline by peritoneal injection were given as control treatments whenever an active agent was not given. Survival was recorded over a 120 h study period and compared at 120 h by a Fisher's exact test. RESULTS: At 120 h following subcutaneous injection of thallium 70 mg/kg, only 10% of the control animals survived. Treatment with N-acetylcysteine or Prussian blue increased survival to 35% (p = 0.13) and 50% (p = 0.014), respectively. The addition of N-acetylcysteine to Prussian blue offered no benefit over Prussian blue therapy alone. CONCLUSIONS: Prussian blue was found to decrease mortality from thallium poisoning at a dose equal to the LD90 in this model, but not a dose greater than the LD100. No role for N-acetylcysteine in the treatment of thallium poisoning was demonstrated by this study
— id: 44370, year: 1997, vol: 35, page: 163, stat: Journal Article,

Recurrent pyogenic cholangitis
Rella JG; Shamamian P; Chiang W; Goldfrank LR
1997 Dec;4(12):1173-1176, Academic emergency medicine
— id: 34663, year: 1997, vol: 4, page: 1173, stat: Journal Article,

Antidotal efficacy of glutamate and aspartate for colchicine toxicity
Wang RY; Morasco R; Henry GC; Hoffman RS; Goldfrank LR
1997 Aug;39(4):207-210, Veternary & human toxicology
Glutamic and aspartic acids were evaluated for their antidotal efficacy in colchicine toxicity. Female adult inbred mice were treated with ip doses of either 1000 mg glutamic acid (GA) or aspartic acid (AA)/kg bw by various treatment schedules relative to the administration of an ip LD5n of 7.8 mg colchicine/kg bw. Mice were observed for survival and changes in body weight. Pretreatment with AA increased survival by 42% (p = 0.01). Concurrent AA treatment improved survival non-significantly (p = 0.07). With post-exposure AA therapy, however, mortality was increased (p = 0.005). No significant beneficial effects of GA occurred. Early AA therapy improves survival in colchicine poisoned mice, but as delay in treatment is increased, AA efficacy is lost
— id: 44369, year: 1997, vol: 39, page: 207, stat: Journal Article,

Research directions in emergency medicine
Aghababian RV; Barsan WG; Bickell WH; Biros MH; Brown CG; Cairns CB; Callaham ML; Carden DL; Cordell WH; Dart RC; Dronen SH; Garrison HG; Goldfrank LR; Hedges JR; Kelen GD; Kellermann AL; Lewis LM; Lewis RG; Ling LJ; Marx JA; McCabe JB; Sanders AB; Schriger DL; Sklar DP
1996 Nov;14(7):681-683, American journal of emergency medicine
The goal of emergency medicine is to improve health while preventing and treating disease and illness in patients seeking emergency medical care. Improvements in emergency medical care and the delivery of this care can be achieved through credible and meaningful research efforts. Improved delivery of emergency medical care through research requires careful planning and the wise use of limited resources. To achieve this goal, emergency medicine must provide appropriate training of young investigators and attract support for their work. Promotion of multidisciplinary research teams will help the specialty fulfill its goals. The result will be the improvement of emergency medical care which will benefit not only the patients emergency physicians serve but also, ultimately, the nation's health
— id: 44373, year: 1996, vol: 14, page: 681, stat: Journal Article,

Prisoners' health
Baruch JM; Goldfrank LR
Case studies in emergency medicine and the health of the public Sudbury MA : Jones & Bartlett, 1996,
— id: 3319, year: 1996, vol: , page: 200, stat: Chapter,

Food and water-borne illnesses
Brubacher J; Goldfrank LR
Case studies in emergency medicine and the health of the public Boston : Jones & Bartlett, 1996,
— id: 3302, year: 1996, vol: , page: 208, stat: Chapter,

Amphetamine overdose
Goldfrank LR
Medicine for the practicing physician Stamford CT : Appleton & Lange, 1996,
— id: 3312, year: 1996, vol: , page: 1748, stat: Chapter,

Cocaine overdose
Goldfrank LR
Medicine for the practicing physician Stamford CT : Appleton & Lange, 1996,
— id: 3316, year: 1996, vol: , page: 1752, stat: Chapter,

Humanism in patient-physician relationships: the best for patients - the best for physicians
Goldfrank LR
1996 Feb;8(2):?-?, SAEM newsletter
— id: 44424, year: 1996, vol: 8, page: ?, stat: Journal Article,

I am optimistic
Goldfrank LR
1996 April;8(4):?-?, SAEM newsletter
— id: 44426, year: 1996, vol: 8, page: ?, stat: Journal Article,

Leadership: implementing SAEM's vision & mission with a passion
Goldfrank LR
1996 March;8(3):?-?, SAEM newsletter
— id: 44425, year: 1996, vol: 8, page: ?, stat: Journal Article,

Preserving integrity in education and research
Goldfrank LR
1996 Jan;8(1):?-?, SAEM newsletter
— id: 44423, year: 1996, vol: 8, page: ?, stat: Journal Article,

Striving to maintain competence: 1996 SAEM President's comments on the annual meeting
Goldfrank, LR
1996 MAY ;3(5):389-390, Academic emergency medicine
— id: 52976, year: 1996, vol: 3, page: 389, stat: Journal Article,

Administration of purified human plasma cholinesterase protects against cocaine toxicity in mice
Hoffman RS; Morasco R; Goldfrank LR
1996 ;34(3):259-266, Journal of toxicology. Clinical toxicology
BACKGROUND: Cocaine is metabolized in part by plasma cholinesterase to form ecgonine methyl ester. Decreased plasma cholinesterase activity is associated with enhanced cocaine toxicity in both humans and animals. This study was designed to determine whether the administration of exogenous plasma cholinesterase is protective against cocaine toxicity. METHODS: Using a blinded protocol, female Swiss albino mice were randomized to receive an intraperitoneal injection of either 13.7 mg/kg of purified human plasma cholinesterase dissolved in phosphate buffered saline, or an equal volume of phosphate buffered saline as a control. One hour later, all animals received an intraperitoneal injection of either 100 or 125 mg/kg of cocaine, and the incidence of seizures and death was recorded. In a similar fashion, another group of animals was randomized to receive a human plasma cholinesterase dose of either 13.7 or 27.4 mg/kg, followed by 150 mg/kg of cocaine. RESULTS: Administration of 13.7 mg/kg of human plasma cholinesterase increased plasma cholinesterase activity by a mean of 63 +/- 13 fold, with a Tmax of 90 minutes and a Vd of 85 +/- 13 mL/kg. Cocaine's effects on seizures and death were attenuated by human plasma cholinesterase. A cocaine dose of 150 mg/kg represents an ED100 for seizures and an LD100. At this dose, lethality was reduced to 30% (p < 0.001) and seizures were reduced to 40% (p < 0.001) by administration of 27.4 mg/kg of human plasma cholinesterase. CONCLUSIONS: Pretreatment with purified human plasma cholinesterase protects mice against the convulsive and lethal effects of cocaine
— id: 44375, year: 1996, vol: 34, page: 259, stat: Journal Article,

Relationship between cocaine metabolism, symptoms and treatment in overdose
Hoffman RS; Newton E; Goldfrank LR
1996 ;34:582-582, Journal of toxicology. Clinical toxicology
— id: 44432, year: 1996, vol: 34, page: 582, stat: Journal Article,

Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers
Medicis JJ; Stork CM; Howland MA; Hoffman RS; Goldfrank LR
1996 ;34(3):289-295, Journal of toxicology. Clinical toxicology
BACKGROUND: Many authors currently recommend infusing the adult dose (1 g) of pralidoxime over a 15-30 minute period. When administered in this manner, computer simulations predict that plasma pralidoxime concentrations will fall below 4 mg/L as early as one and one half hours after administration. The objective of this study was to assess whether a loading dose followed by a continuous infusion would maintain therapeutic levels longer than the traditional short infusion regimen of pralidoxime if the same total dose was administered. METHODS: Utilizing a randomized, crossover design, healthy volunteers were administered either 16 mg/kg of pralidoxime intravenous over 30 minutes or 4 mg/kg of pralidoxime intravenous over 15 minutes followed by 3.2 mg/kg/h for 3.75 h (for a total dose of 16 mg/kg). Pralidoxime levels were obtained at 0, 10, 20, 30, 60, 120, 180, 240, 300, and 390 minutes and patients were observed for vital sign changes and adverse effects. RESULTS: Seven subjects completed both arms of the study. One subject's data were excluded from pharmacokinetic analysis due to aberrant plasma pralidoxime analysis. The loading dose followed by the continuous infusion maintained therapeutic levels for 257.3 +/- 50.5 minutes whereas the short infusion maintained therapeutic levels for 118.1 +/- 52.1 (p < 0.001). Adverse effects were encountered during the short infusion regimen which did not occur during the continuous infusion. Dizziness or blurred vision occurred in all subjects during the short infusion regimen. Additionally, statistically significant increases in diastolic blood pressure occurred during the short infusion regimen. CONCLUSIONS: The results of this study indicate that a loading dose followed by a continuous infusion of pralidoxime maintains therapeutic concentrations for a longer period of time than the currently recommended short infusion regimen in healthy volunteers
— id: 44374, year: 1996, vol: 34, page: 289, stat: Journal Article,

Assessment of visual acuity in the supine position
Rees SM; Goldfrank LR
1996 Nov;3(11):1053-1055, Academic emergency medicine
OBJECTIVE: To determine whether a modified Snellen eye chart could be used to accurately assess visual acuity (VA) in the supine position. METHOD: This was a prospective study involving ED staff volunteers comparing VA on a standard Snellen eye chart with VA on a size-reduced ceiling-mounted modified Snellen eye chart. RESULTS: Fifty-six volunteers participated. VA ranged from 20/10 to 20/200 on both of the charts, but 87% of the volunteers had VA of 20/50 or better. The VA results for the 2 charts were highly correlated; right eye r = 0.931 and left eye r = 0.953. Weighted ks showed substantial agreement for both eyes; kappa = 0.63 and 0.79 for the right and left eyes, respectively. In only 4 of 112 paired measurements did the VA recorded with the ceiling chart differ by > 1 line from that recorded on the Snellen chart. CONCLUSION: There is an excellent correlation between VAs determined in the erect and the supine positions using the standard Snellen eye chart and the modified ceiling-mounted version. Substantial agreement exists between readings using the 2 charts. Although additional testing is warranted in an ophthalmologically diverse patient population, use of this chart for the assessment of VA in the supine ED patient may allow for earlier VA evaluation
— id: 39431, year: 1996, vol: 3, page: 1053, stat: Journal Article,

Pharmacokinetics of extended relief vs regular release Tylenol in simulated human overdose
Stork CM; Rees S; Howland MA; Kaplan L; Goldfrank L; Hoffman RS
1996 ;34(2):157-162, Journal of toxicology. Clinical toxicology
BACKGROUND: The purpose of this trial was to compare the pharmacokinetics of the two available acetaminophen dosage forms in simulated human overdose. METHODS: Ten healthy volunteers received acetaminophen, 75 mg/kg orally, either as the regular release or extended relief formulation in a random, crossover fashion. Blood samples were analyzed using a TDx assay and a best fit correlation of data points was determined by PCNONLIN. RESULTS: The area under the curves for extended relief acetaminophen and regular release acetaminophen were 426 mg h/L and 432 mg h/L, respectively (p = 0.768). The mean half times for extended relief acetaminophen and regular release acetaminophen were 4.02 h and 2.56 h, respectively (p < 0.001). The mean maximum serum acetaminophen concentrations were 62.6 mg/L (414.4 mmol/L:) and 94.3 mg/L (624.3 mmol/L) for extended relief acetaminophen and regular release acetaminophen, respectively (p < 0.001) and the mean time to maximum serum acetaminophen concentrations were 0.87 h and 0.75 h for extended relief acetaminophen and regular release acetaminophen, respectively (p = 0.508). CONCLUSIONS: Although the formulations appear to have equal bioavailability, their half-lives and peak concentrations were significantly different. Further study is required to determine whether these differences affect the assessment and management of poisoned patients
— id: 56893, year: 1996, vol: 34, page: 157, stat: Journal Article,

Antiallergic drugs and antihistamines
Weisman RS; Goldfrank LR
Human toxicology Amsterdam : Elsevier, 1996,
— id: 3318, year: 1996, vol: , page: ?, stat: Chapter,

Disagreement on "optimal" treatment
Baruch JM; Goldfrank LR
Ethics in emergency medicine Tucson AZ : Galen Press, 1995,
— id: 3301, year: 1995, vol: , page: 245, stat: Chapter,

Initial management of the poisoned paitent or overdosed patient
DeRoos F; Goldfrank LR
Current topics in intensive care no. 2 Philadelphia : Saunders, 1995,
— id: 3325, year: 1995, vol: , page: 82, stat: Chapter,

Emergency diagnositic testing
Floemenbaum N; Goldfrank LR; Jacobson S
St. Louis : Mosby, 1995,
— id: 788, year: 1995, vol: , page: , stat: ,

Diagnostic testing in the emergency department
Flomenbaum N; Goldfrank L; Jacobson S
Emergency diagnostic testing St. Louis MO : Mosby, 1995,
— id: 4548, year: 1995, vol: , page: 1, stat: Chapter,

A long range focus for our future
Goldfrank LR
1995 Dec;7(10):?-?, SAEM newsletter
— id: 44422, year: 1995, vol: 7, page: ?, stat: Journal Article,

Emergency medicine
Goldfrank LR
1995 Jun 7;273(21):1673-1674, JAMA
A survey determined that Medicaid recipients had limited access to outpatient care other than the care received at emergency departments. Recent advances in our understanding of trauma call into question how fluid resuscitation should be performed in the field
— id: 44376, year: 1995, vol: 273, page: 1673, stat: Journal Article,

Emergency medicine and health care reform
Goldfrank LR
1995 ;26:659-659, Annals of emergency medicine
— id: 44428, year: 1995, vol: 26, page: 659, stat: Journal Article,

Health care reform or a return to social darwinism?
Goldfrank LR
1995 May;25(5):692-694, Annals of emergency medicine
— id: 44377, year: 1995, vol: 25, page: 692, stat: Journal Article,

Presenidential address
Goldfrank LR
1995 June;7(4):?-?, SAEM newsletter
— id: 44416, year: 1995, vol: 7, page: ?, stat: Journal Article,

Realization of the Emancipation Proclmation
Goldfrank LR
1995 Sept;7(7):?-?, SAEM newsletter
— id: 44419, year: 1995, vol: 7, page: ?, stat: Journal Article,

The advancement of emergency medicine research
Goldfrank LR
1995 Nov;7(9):?-?, SAEM newsletter
— id: 44421, year: 1995, vol: 7, page: ?, stat: Journal Article,

The public hospital - the crucible of learning and social safety net
Goldfrank LR
1995 Oct;7(8):?-?, SAEM newsletter
— id: 44420, year: 1995, vol: 7, page: ?, stat: Journal Article,

Was it humor? Were you proud?
Goldfrank LR
1995 August;7(6):?-?, SAEM newsletter
— id: 44418, year: 1995, vol: 7, page: ?, stat: Journal Article,

Why do so many fine students study emergency medicine?
Goldfrank LR
1995 July;7(5):?-?, SAEM newsletter
— id: 44417, year: 1995, vol: 7, page: ?, stat: Journal Article,

Individuals who swallow crack cocaine do not develop significant toxic reactions
Haynes S; Stork CM; Hoffman RS; Goldfrank L
1995 Jul-Aug;13(4):537-538, Journal of emergency medicine
— id: 64547, year: 1995, vol: 13, page: 537, stat: Journal Article,

The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'
Hoffman RS; Goldfrank LR
1995 Aug 16;274(7):562-569, JAMA
OBJECTIVE--In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making. DATA SOURCES--Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil. STUDY SELECTION--Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects. DATA EXTRACTION AND SYNTHESIS--Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome. CONCLUSION--Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose
— id: 7905, year: 1995, vol: 274, page: 562, stat: Journal Article,

Anticholinergic poisoning associated with an herbal tea-New York city, 1994
Meggs WJ; Weisman R; Hoffman RS; Shih R; Weimer SM; Fill SM; Deannuntis GJ; Goldfrank LR; Hsu CK; Sabo S; Leo P; Shastry D; Rubin K; Constantine I; Somwaru S; Munshi A
1995 ;.273(15):1166-1167, JAMA
— id: 44408, year: 1995, vol: .273, page: 1166, stat: Journal Article,

Anticholinergic poisoning associated with an herbal tea -- New York City 1994
Meggs WR; Weisman RS; Hoffman RS; Shih R; Weimer SM; Fill S; Deannuntis GJ; Goldfrank LR
1995 ;44:1-2, MMWR
— id: 44427, year: 1995, vol: 44, page: 1, stat: Journal Article,

Substance abuse and trauma
Perrone J; Goldfrank LR
1995 ;1:509-513, Current opinion in critical care
— id: 44435, year: 1995, vol: 1, page: 509, stat: Journal Article,

Tuberculosis in the HIV-infected patient
Waxman S; Gang M; Goldfrank L
1995 Feb;13(1):179-198, Emergency medicine clinics of North America
After decades of decline, tuberculosis has emerged as a global health challenge. In the setting of HIV immunocompromise, TB occurs frequently, early, and often atypically. New infections can take an accelerated course. The usual tests for diagnosing Mycobacterium tuberculosis infection are less sensitive when CD4+ counts are low. Increased prevalence of treatment failure, drug-resistant strains, and nosocomial transmission of multidrug-resistant TB are discussed as are new diagnostic tests that will accelerate the time to diagnosis and allow better epidemiologic tracking. Early recognition, isolation, appropriate therapy, and environmental controls that will protect staff and patients from the risk of exposure are also described
— id: 6770, year: 1995, vol: 13, page: 179, stat: Journal Article,

A public health approach to emergency medicine: preparing for the twenty-first century
Bernstein E; Goldfrank LR; Kellerman AL; Hargarten SW; Jui J; Fish SS; Herbert BH; Flores C; Caravati ME; Krishel S; et al.
1994 May-Jun;1(3):277-286, Academic emergency medicine
This paper focuses on the implications of an inadequate public health/preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM
— id: 30807, year: 1994, vol: 1, page: 277, stat: Journal Article,

General management of the poisoned or overdosed patient
Flomenbaum N; Goldfrank L; Weisman R; Howland MA; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1994,
— id: 4508, year: 1994, vol: , page: 25, stat: Chapter,

Role of emergency medicine residency programs in determining emergency medicine career choice among medical students
Gallagher EJ; Goldfrank LR; Anderson GV Jr; Barsan WG; Levy RC; Sanders AB; Strange GR; Trott AT
1994 May;23(5):1062-1067, Annals of emergency medicine
STUDY OBJECTIVE: To characterize the role of emergency medicine residency programs in determining emergency medicine career choice among medical students. DESIGN: Observational, cross-sectional, descriptive study. Information on student career choice was obtained through a targeted query of the National Resident Matching Program data base, simultaneously stratified by specialty and school, and adjusted for class size. PARTICIPANTS: All accredited emergency medicine residency programs and four-year allopathic medical schools. RESULTS: Fifty-two schools (42%) had a closely affiliated emergency medicine residency program, ie, one based primarily at the institution's main teaching hospital(s). This configuration was associated with a 70% increase in the median proportion of students choosing emergency medicine as a career when compared to the 73 schools with no closely affiliated emergency medicine residency (5.1% vs 3.0%, P < .0001). When institutions were stratified by overall commitment to emergency medicine, the median proportion of students choosing emergency medicine as a career was 2.9% for institutions with a minimal commitment to emergency medicine (neither an academic department of emergency medicine nor a closely affiliated emergency medicine residency), 4.1% for institutions with a moderate commitment to emergency medicine (either a department of emergency medicine or an emergency medicine residency, but not both), and 5.7% for institutions with a substantial commitment to emergency medicine (a department of emergency medicine and an emergency medicine residency) (P < .0001). When institutional commitment to emergency medicine was examined in a simple multivariate model, only the presence of an emergency medicine residency was associated independently with student career choice (P < .001). CONCLUSION: An emergency medicine residency program that is closely affiliated with a medical school is strongly and independently associated with a quantitatively and statistically significant increase in the proportion of students from that school who choose a career in emergency medicine. These data support the proposition that, if emergency medicine is to meet national manpower shortage needs by attracting students to the specialty, it must establish residency programs within the primary teaching hospital(s) of medical schools. Such a configuration does not currently exist in the majority of schools
— id: 44378, year: 1994, vol: 23, page: 1062, stat: Journal Article,

Medical toxicology training and certification
Goldfrank LR
1994 Mar-Apr;1(2):124-126, Academic emergency medicine
— id: 44381, year: 1994, vol: 1, page: 124, stat: Journal Article,

The effects of lidocaine pretreatment on cocaine neurotoxicity and lethality in mice
Heit J; Hoffman RS; Goldfrank LR
1994 Sep-Oct;1(5):438-442, Academic emergency medicine
OBJECTIVE: To evaluate the effects of an antiarrhythmic dose of lidocaine on cocaine-induced ataxia, seizures, and death in mice. METHODS: A randomized, controlled, blinded investigation was conducted using 220 female Swiss albino mice. Groups of 20 animals received intraperitoneal (IP) administration of either 31.6 mg/kg of lidocaine hydrochloride in 0.9% NaCl (ten animals) or an equal volume of 0.9% NaCl solution (ten animals). After 5 minutes, all the animals received IP cocaine in incremental doses ranging from 40 to 110 mg/kg. The animals were observed for ataxia, seizures, and death. The animals pretreated with lidocaine were compared with the control animals for the number of adverse effects from cocaine at each dose tested. RESULTS: Lidocaine significantly increased the overall incidences of cocaine-induced ataxia (p = 0.02) and seizures (p < 0.001). However, pretreatment with lidocaine offered protection against cocaine lethality (p < 0.0001). CONCLUSION: In this preexposure model, lidocaine protects mice against cocaine-induced lethality. These effects seem to be independent of convulsive activity. Further study is required to determine the safety and efficacy of lidocaine for the management of cocaine-induced arrhythmias
— id: 12912, year: 1994, vol: 1, page: 438, stat: Journal Article,

Cocaine
Lewin N; Goldfrank L; Hoffman R
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1994,
— id: 4515, year: 1994, vol: , page: 847, stat: Chapter,

Phencyclidine
Lewin N; Goldfrank L; Osborn H
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1994,
— id: 4516, year: 1994, vol: , page: 875, stat: Chapter,

Thallium poisoning from maliciously contaminated food
Meggs WJ; Hoffman RS; Shih RD; Weisman RS; Goldfrank LR
1994 ;32(6):723-730, Journal of toxicology. Clinical toxicology
Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative diagnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy
— id: 44382, year: 1994, vol: 32, page: 723, stat: Journal Article,

Special considerations in gastrointestinal decontamination
Perrone J; Hoffman RS; Goldfrank LR
1994 May;12(2):285-299, Emergency medicine clinics of North America
Many considerations factor into selecting the most appropriate method of gastrointestinal decontamination used in the poisoned patient. A thorough knowledge of the indications and efficacy as well as contraindications and complications of each modality is critical to the clinician's assessment. This article examines the current utility of syrup of ipecac-induced emesis, orogastric lavage, activated charcoal, cathartics, and whole bowel irrigation. In addition, the role of multiple dose activated charcoal and the controversial issue of the N-acetylcysteine and activated charcoal interaction are discussed
— id: 44380, year: 1994, vol: 12, page: 285, stat: Journal Article,

Concepts and controversies of bronchodilator overdose
Stork CM; Howland MA; Goldfrank LR
1994 May;12(2):415-436, Emergency medicine clinics of North America
Beta-adrenergic agonists and theophylline are both capable of producing tremor, agitation, tachycardia, metabolic acidosis, hypokalemia, hyperglycemia, cardiac arrhythmias, and seizures. However, theophylline preparations, especially in the sustained-release formulations, are associated with a much higher incidence of morbidity and mortality secondary to status epilepticus and cardiovascular collapse. Overdoses of sustained-release preparations place patients at exceedingly high risk. This article describes the differentiation of the patient with acute and chronic theophylline overdoses and the implications for management of both clinical states
— id: 44379, year: 1994, vol: 12, page: 415, stat: Journal Article,

The homeless patient
Waxman SP; Goldfrank LR
Emergency care of the compromised patient Philadelphia : Lippincott, 1994,
— id: 3300, year: 1994, vol: , page: 731, stat: Chapter,

Initial management of the multiply injured or intoxicated patient
Delaney KA; Goldfrank LR
Head injury Baltimore : Williams & Wilkins, 1993,
— id: 3296, year: 1993, vol: , page: 43, stat: Chapter,

Data, epidemiology, and the future strength of emergency medicine
Goldfrank LR
1993 Dec;22(12):1859-1860, Annals of emergency medicine
— id: 44383, year: 1993, vol: 22, page: 1859, stat: Journal Article,

Tetracaine protects against cocaine lethality in mice
Grant SA; Hoffman RS; Goldfrank LR
1993 Dec;22(12):1799-1803, Annals of emergency medicine
STUDY HYPOTHESIS: Tetracaine will enhance cocaine toxicity. STUDY POPULATION: Two hundred forty female Swiss albino mice weighing 27 to 45 g. METHODS: Intraperitoneal injections of tetracaine and cocaine were given to groups of ten mice each in a controlled, blinded fashion. Either tetracaine or an equal volume of normal saline was given five minutes before one of six incremental doses of cocaine, ranging from 60 to 110 mg/kg. The experiment was repeated twice using two different doses of tetracaine: either an LD10 (40 mg/kg determined from preliminary studies), or one-twentieth of the dose of cocaine (which approximates the ratio used in tetracaine, epinephrine, and cocaine). Lethality was recorded at 24 hours. Lethality between groups was compared with a Wilcoxon sign-rank test. RESULTS: Tetracaine reduced cocaine lethality at all doses. This reduction in lethality was statistically significant at both tetracaine doses (P < .05). CONCLUSION: In the mouse, pretreatment with tetracaine significantly decreases cocaine lethality
— id: 44385, year: 1993, vol: 22, page: 1799, stat: Journal Article,

Poisioning and overdose
Henry GC; Goldfrank LR
Shock and reuscitation New York : McGraw-Hill Health Professionals, 1993,
— id: 3298, year: 1993, vol: , page: 527, stat: Chapter,

Osmol gaps revisited: normal values and limitations
Hoffman RS; Smilkstein MJ; Howland MA; Goldfrank LR
1993 ;31(1):81-93, Journal of toxicology. Clinical toxicology
A study was designed to define the osmol gap in patients whose serum ethanol concentrations are known, to reevaluate several accepted equations for calculating osmolarity, and to apply the results to the theoretical clinical scenario of a toxic alcohol ingestion. The design for the study used consecutive, prospective enrollment of all patients presenting to a large inner city hospital who clinically required determination of their serum ethanol and electrolytes. Three hundred and twenty one consecutive adult patients were enrolled in the study, sixteen were excluded from the final analysis. A stepwise multiple linear regression analysis was performed to determine the best coefficients for sodium, blood urea nitrogen, and ethanol from the data set. Osmolarity was then calculated using these coefficients and traditional models. The osmol gap (measured osmolality minus calculated osmolarity [2*Na + BUN/2.8 + Glu/18 + Etoh/4.6]) was -2 +/- 6 mOsm. Although different equations produced different osmol gaps (ranging from -5 to + 15 mOsm) the standard deviations and correlation coefficients were similar. Large variations exist in the range of osmol gaps. Absolute values are very dependent on the equations used to calculate osmolarity. Because of the larger range of values, small osmol gaps should not be used to eliminate the possibility of toxic alcohol ingestion
— id: 44386, year: 1993, vol: 31, page: 81, stat: Journal Article,

An in vitro evaluation of cocaine hydrochloride adsorption by activated charcoal and desorption upon addition of polyethylene glycol electrolyte lavage solution
Makosiej FJ; Hoffman RS; Howland MA; Goldfrank LR
1993 ;31(3):381-395, Journal of toxicology. Clinical toxicology
Cocaine body-packers and body-stuffers have become a common medical problem. Significant morbidity and mortality result when cocaine is absorbed from the gastrointestinal tract due to cocaine package compromise. The clinical prevention of gastrointestinal absorption of cocaine includes oral activated charcoal and/or whole bowel irrigation with polyethylene glycol--electrolyte lavage solution. This in vitro study investigates the maximal adsorptive capacity of activated charcoal for cocaine at varying activated charcoal:cocaine ratios, at pH 1.2 and pH 7.0, and the effect of polyethylene glycol--electrolyte lavage solution upon this binding. The percent adsorption of cocaine to activated charcoal was significantly better at pH 7.0 for all ratios of activated charcoal:cocaine tested and the maximal adsorptive capacity was 29% greater at pH 7.0 (273 micrograms/mg) than at pH 1.2 (212 micrograms/mg) (p < 0.05). Addition of polyethylene glycol--electrolyte lavage solution to the cocaine-activated charcoal slurry caused significant desorption of cocaine from activated charcoal at all pHs and ratios tested (except the 1:1 ratio at pH 7.0) and was most pronounced at pH 1.2. The addition of polyethylene glycol--electrolyte lavage solution to activated charcoal prior to adding cocaine solution further decreased the adsorption of cocaine to activated charcoal. This difference was significant at both pHs and all ratios tested except the 1:1 ratio at pH 1.2. The maximal adsorptive capacity of activated charcoal for cocaine at pH 1.2 was reduced 75% by pretreatment with polyethylene glycol--electrolyte lavage solution from 212 to 54.2 micrograms/mg, while at pH 7.0 the maximal adsorptive capacity was reduced by 11%, from 273 to 243 micrograms/mg. Polyethylene glycol--electrolyte lavage solution significantly reduces the adsorption of cocaine to activated charcoal particularly if the two are combined at a low pH prior to the addition of cocaine. The in vitro effects suggest that activated charcoal mixed in water should be administered first, followed by the polyethylene glycol--electrolyte lavage solution
— id: 44387, year: 1993, vol: 31, page: 381, stat: Journal Article,

Prevalence of sorbitol in multiple-dose activated charcoal regimens in emergency departments
Wax PM; Wang RY; Hoffman RS; Mercurio M; Howland MA; Goldfrank LR
1993 Dec;22(12):1807-1812, Annals of emergency medicine
STUDY OBJECTIVES: To determine the availability and use of premixed activated charcoal in sorbitol preparations during multiple-dose activated charcoal therapy in the emergency department. DESIGN AND SETTING: A prospective telephone survey of all 911 receiving hospitals within the catchment area of one poison center. TYPE OF PARTICIPANTS: Hospital pharmacy supervisors and ED charge nurses. INTERVENTION: Hospital pharmacy supervisors were surveyed about the available preparations of activated charcoal on their hospital's formulary, and ED charge nurses in these same hospitals were surveyed about the prevalence of sorbitol use in multiple-dose activated charcoal regimens. MEASUREMENTS AND MAIN RESULTS: Eleven hospitals (16%) stocked only activated charcoal in sorbitol preparations. Twenty-one hospitals (31%) had both activated charcoal in sorbitol preparations and activated charcoal without sorbitol preparations, and 35 hospitals (52%) had only activated charcoal without sorbitol preparations. Repeat dosing of sorbitol during multiple-dose activated charcoal therapy occurred in 33 of 67 (49%) of the EDs surveyed. CONCLUSION: Sorbitol dosing is often repeated with activated charcoal during multiple-dose activated charcoal therapy in the ED because of the ready availability (and sometimes exclusive availability) of premixed activated charcoal in sorbitol preparations
— id: 44384, year: 1993, vol: 22, page: 1807, stat: Journal Article,

Hot and cold environments
Delaney KA; Goldfrank LR
Environmental and occupational medicine Boston : Little-Brown, 1992,
— id: 3295, year: 1992, vol: , page: 1153, stat: Chapter,

Update in medical toxicology
Fine JS; Goldfrank LR
1992 Oct;39(5):1031-1051, Pediatric clinics of North America
This article examines some current issues in toxicologic care. First there is a review of the scope of pediatric poisonings and some aspects of initial management. Then there is a discussion of the decision-making process required to properly use gastric decontamination in the management of poisonings. Each of the common methods available--emesis, gastric lavage, activated charcoal, catharsis, and whole bowel irrigation--is discussed. Finally, several new and old antidotes are reviewed, namely naloxone, glucagon, bicarbonate, dimercaptosuccinic acid, digoxin-specific fab fragments, and flumazenil
— id: 44389, year: 1992, vol: 39, page: 1031, stat: Journal Article,

Toxicological evaluation and management by clinical presentation
Flomenbaum N; Goldfrank LR; Roberts JR
Principles and practice of emergency medicine Philadelphia : Lea & Febiger, 1992,
— id: 3317, year: 1992, vol: , page: 2951, stat: Chapter,

Effect of nitric oxide on mitogenesis and proliferation of cerebellar glial cells
Garg UC; Devi L; Turndorf H; Goldfrank LR; Bansinath M
1992 Oct 2;592(1-2):208-212, Brain research
In the brain, nitric oxide (NO) has been identified as a messenger molecule and a mediator of excitatory amino acid-induced neurotoxicity. In this study, the effects of NO on serum-induced mitogenesis and cell proliferation of the cerebellar glial cells were assessed. NO-generating agent, S-nitroso-N-acetylpenicillamine (SNAP) increased intracellular cyclic guanosine monophosphate (cGMP) levels. Furthermore, 2 chemically dissimilar NO-generating agents, SNAP and sodium nitroprusside (SNP) inhibited serum-induced thymidine incorporation and cell proliferation. The antimitogenic effect of NO was mimicked by 8-bromo-cGMP and blocked by hemoglobin, a known inhibitor of NO. The effect of NO was not cytotoxic, since the cells were not stained with Trypan blue and did not show increased release of lactate dehydrogenase in the culture supernatants. However, NO-treated cells showed decreased conversion of tetrazolium to blue formazan suggesting that NO inhibited mitochondrial activity in the glial cells. These results demonstrate that NO inhibits serum-induced mitogenesis and cell proliferation of cultured rat cerebellar glial cells
— id: 13398, year: 1992, vol: 592, page: 208, stat: Journal Article,

Amphetamine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworth-Heinemann, 1992,
— id: 3311, year: 1992, vol: , page: 1748, stat: Chapter,

Cocaine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworth-Heinemann, 1992,
— id: 3315, year: 1992, vol: , page: 1752, stat: Chapter,

Medical toxicology
Goldfrank LR
1992 Jul 15;268(3):375-376, JAMA
— id: 44390, year: 1992, vol: 268, page: 375, stat: Journal Article,

The cardiovascular effects of cocaine - Update 1992
Goldfrank LR; Hoffman RS
1992 ;(123):70-109, National Institute on Drug Abuse: Research Monograph Series
— id: 44409, year: 1992, vol: , page: 70, stat: Journal Article,

Association between life-threatening cocaine toxicity and plasma cholinesterase activity
Hoffman RS; Henry GC; Howland MA; Weisman RS; Weil L; Goldfrank LR
1992 Mar;21(3):247-253, Annals of emergency medicine
STUDY OBJECTIVE: To determine whether plasma cholinesterase (pseudocholinesterase) activity is a marker for severe cocaine toxicity. DESIGN: A prevalence study in a cohort of cocaine users. SETTING: A large urban emergency department. PARTICIPANTS: During a three-month period in 1989, 187 patients who presented to the ED on 191 consecutive occasions with signs and symptoms consistent with cocaine intoxication were prospectively enrolled in the study protocol. METHODS AND MEASUREMENTS: All patients had plasma cholinesterase activity determined by the electrometric method. The patients who were cocaine positive were stratified into one of two groups: life-threatening toxicity (LT) and non-life-threatening toxicity (NLT), based on a predetermined set of criteria. Cocaine-negative patients served as controls for the LT group if criteria were otherwise met. RESULTS: Mean (+/- SD) plasma cholinesterase activities for the LT, NLT, and control groups were 682 +/- 277, 904 +/- 279, and 1,058 +/- 385 Michel units/L, respectively. All three groups were significantly different from each other (P less than .05 by analysis of variance). CONCLUSION: The data suggest that decreased plasma cholinesterase activity is associated with increased risk of life-threatening cocaine toxicity
— id: 44392, year: 1992, vol: 21, page: 247, stat: Journal Article,

Decreased plasma cholinesterase activity enhances cocaine toxicity in mice
Hoffman RS; Henry GC; Wax PM; Weisman RS; Howland MA; Goldfrank LR
1992 Nov;263(2):698-702, Journal of pharmacology & experimental therapeutics
The illicit use of cocaine continues in epidemic proportions. Despite the incidence of life-threatening complications from cocaine use, little is known of the individual determinants of cocaine toxicity. In vitro analysis demonstrating that cocaine is poorly metabolized by the serum of patients with low plasma cholinesterase (PCh) activity (succinylcholine sensitivity) led to the hypothesis that altered PCh activity might modulate cocaine toxicity. An in vivo mouse model was created to test this theory. Mice were pretreated s.c. with either parathion [a mixed plasma and red blood cell cholinesterase (RBCCh) inhibitor], tetraisopropyl pyrophosphoramide (a selective PCh inhibitor) or placebo, and cholinesterase activity was determined at 24 hr. Incremental doses of i.p. cocaine were administered in a controlled and blinded fashion, and lethality was observed. Ten mg/kg s.c. parathion produced a mean suppression of 68 +/- 9 and 61 +/- 8% of PCh and RBCCh activity, respectively. One mg/kg s.c. tetraisopropyl pyrophosphoramide produced a mean suppression of 78 +/- 3 and 9 +/- 8% of PCh and RBCCh activity, respectively. Each pretreatment produced a statistically significant increase in cocaine lethality throughout the dose-response curve. Our results suggest that PCh activity is an important determinant of cocaine toxicity. This effect appears to be independent of either RBCCh activity or manifestations of organophosphate intoxication
— id: 44388, year: 1992, vol: 263, page: 698, stat: Journal Article,

An ethical foundation for health care: An emergency medicine perspective
Knopp RK; Goldfrank LR; Derse AR; Sanders AB; Schmidt TB; Sklar DP; Iserson KV; Adams JG; Kalbfleisch ND; Keim SM
1992 ;21(11):1381-1387, Annals of emergency medicine
What is health and health care? Health is a state of physical and mental well-being that facilitates the achievement of individual and societal goals. Good health over a lifetime is the comparative absence of pain and suffering, illness and disease, each of which could prevent people from pursuing their goals. Health care includes those services that provide adequate nutrition and shelter; sanitary, safe, unpolluted living and working conditions; personal medical services; and nonmedical personal and support services. The medical community can best address the area of personal medical services, which includes interventions to prevent disease, minimize morbidity from existing diseases, diagnose and cure illness, relieve pain and suffering, and provide education for the continued promotion of health. Society must also provide health care services such as adequate nutrition, shelter, and education about health care issues, including prevention that could result in reduced expenditures for curative services. 2. Is health care an ethical or legal right? At this time, there is no legal right to universal health care in the United States, although there is a patchwork of limited legislated rights to health care benefits for some citizens. Ethically, there is a right to health care; however, it is a limited right best expressed as a societal obligation to provide care rather than an open-ended individual right to receive any and all health care resources on demand. In restructuring our health care system, our society must identify the values that will serve as the foundation for our health care system. A health care system that stresses societal rather than individual priorities is essential. 3. What is 'equitable access' to health care? A just health care plan must provide equitable access to appropriate preventive, emergency and primary care, curative care with societally defined limits, and long-term care that includes convalescent care, care for the dying, and the relief of pain and suffering. 4. What are the limits to a society's obligation to provide health care? Society should provide all Americans with a basic level of health care that includes affordable services defined by society as essential. Extremely expensive services such as organ transplantation would be provided only if sufficient funding is available after basic health care services have been provided. Rationing is a reality in our health care system. Health expenditure priorities must be explicit and guided by the ethical principle of distributive justice and equity. Efforts must be made to eliminate costs that do not contribute directly to patient care or quality assurance, such as excessive administrative costs including those associated with current insurance systems, unproven medical procedures, unrealistic malpractice insurance premiums, physician self-referrals, and fraudulent billing practices. An equitable allocation of societal resources would not permit such a large share of the resources earmarked for health care to be diverted in this manner. The individual physician can and should participate as an advocate in efforts to improve our health care system. For physicians to become involved in decisions about the just distribution of health resources, they must be free of incentives for personal enrichment from these same health resources. Specific actions that individual physicians can take include direct personal communication with political representatives, speaking out on systemic or individual injustices on the broader health care issues defined in this article, and recognizing the value of personal efforts in improving individual patient care and societal responsibility for patient care
— id: 44410, year: 1992, vol: 21, page: 1381, stat: Journal Article,

Bretylium tosylate and electrically induced cardiac arrhythmias during hypothermia in dogs
Orts A; Alcaraz C; Delaney KA; Goldfrank LR; Turndorf H; Puig MM
1992 Jul;10(4):311-316, American journal of emergency medicine
The effect of bretylium tosylate on plasma catecholamines and on electrically induced arrhythmias was evaluated in anesthetized hypothermic dogs. Bretylium at a dose of 7.5 mg/kg was administered prior to cooling from 37 degrees C to 27 degrees C. During cooling, the ventricular arrhythmia threshold (VAT) in control animals decreased from 10.1 +/- 1.9 to 4.4 +/- 1.3 impulses, while the VAT in bretylium-treated animals increased from 9.8 +/- 2.9 to 23.2 +/- 2.7 impulses. Catecholamine levels increased during cooling in all animals. In control animals, the epinephrine/norepinephrine ratio was unchanged, but in animals treated with bretylium tosylate, the ratio increased more than 10-fold (from 0.48 +/- 0.1 to 5.49 +/- 0.32 at 29.9 degrees C). The demonstrated increase in catecholamine levels during hypothermia suggests that the protection offered by bretylium tosylate against cardiac arrhythmias is not explained by modification of catecholamine levels, and is more likely due to an alteration of the electrophysiologic properties of cardiac tissues
— id: 13528, year: 1992, vol: 10, page: 311, stat: Journal Article,

Blood cyanide concentrations after smoke inhalation
Strickland A; Wang RY; Hoffman RS; Goldfrank LR
1992 May 14;326(20):1362-1362, New England journal of medicine
— id: 44391, year: 1992, vol: 326, page: 1362, stat: Journal Article,

Rapid quantitative determination of blood alcohol concentration in the emergency department using an electrochemical method [see comments]
Wax PM; Hoffman RS; Goldfrank LR
1992 Mar;21(3):254-259, Annals of emergency medicine
STUDY OBJECTIVE: To determine the reliability of a recently developed electrochemical meter to rapidly (within 60 seconds) measure blood alcohol concentration (BAC) in the emergency department. DESIGN: A prospective study comparing the meter data with that of immunoassay and gas chromatography criterion standards undertaken during a ten-week period. SETTING: Adult ED of a municipal hospital. PARTICIPANTS: Three hundred eighty-three consecutive patients with altered mental status or suspected alcohol intoxication. INTERVENTIONS: Each patient underwent routine phlebotomy, and blood samples were obtained for meter and immunoassay BAC determinations. The first 60% of patients also underwent gas chromatography BAC determination. RESULTS: Two hundred nineteen patients (60%) had BAC detectable by both meter and immunoassay. BAC measurement by the meter correlated strongly with immunoassay and gas chromatography determinations (Pearson's correlation coefficient, r = .94; P less than .00000001 for both correlations). CONCLUSION: The electrochemical meter provides a rapid and reliable BAC measurement in the ED
— id: 13682, year: 1992, vol: 21, page: 254, stat: Journal Article,

Buprenorphine : an opioid mixed agonist-antagonist as possible antidote for acute cocaine toxicity
Bansinath M; Shukla VK; Goldfrank LR; Turndorf H
Drug addiction and AIDS New York : Springer Verlag, 1991,
— id: 3448, year: 1991, vol: , page: 330, stat: Chapter,

COCAINE-INDUCED RELEASE OF LACTATE-DEHYDROGENASE IS ATTENUATED BY BUPRENORPHINE PRETREATMENT
BANSINATH, M; SHUKLA, VK; GOLDFRANK, LR; TURNDORF, H; PUIG, MM
1991 MAR 19 ;5(6):A1563-A1563, FASEB journal
— id: 51651, year: 1991, vol: 5, page: A1563, stat: Journal Article,

Alcohols and glycols
Ford M; Goldfrank LR
Intensive care medicine Boston : Little-Brown, 1991,
— id: 3299, year: 1991, vol: , page: 1160, stat: Chapter,

Forward
Goldfrank LR
Clinical procedures in emergency medicine Philadelphia : Saunders, 1991,
— id: 3291, year: 1991, vol: , page: ?, stat: Chapter,

The cardiovascular effects of cocaine
Goldfrank LR; Hoffman RS
1991 Feb;20(2):165-175, Annals of emergency medicine
Cocaine use and abuse continue to overwhelm urban economic, social, and health care systems. Patients frequently present to the emergency department with life-threatening manifestations of cocaine use, including trauma, acquired immune deficiency syndrome, psychomotor agitation, and cardiovascular collapse. Adequate treatment of the cocaine-intoxicated patient requires a critical understanding of the risk-to-benefit ratios for pharmacologic, toxicologic, and surgical or obstetric interventions. The pharmacologic and physiologic bases for the vascular manifestations of cocaine toxicity and experimental evidence for treatment strategies are reviewed
— id: 44393, year: 1991, vol: 20, page: 165, stat: Journal Article,

Theophylline desorption from activated charcoal caused by whole bowel irrigation solution
Hoffman RS; Chiang WK; Howland MA; Weisman RS; Goldfrank LR
1991 ;29(2):191-201, Journal of toxicology. Clinical toxicology
Whole bowel irrigation with polyethylene glycol electrolyte lavage solution has been recommended as an adjunct to traditional overdose management. Although combined activated charcoal and whole bowel irrigation could enhance the efficacy of both modalities, this improvement remains largely speculative. An in vitro experiment was designed to determine whether polyethylene glycol electrolyte lavage solution alters the adsorption of theophylline to activated charcoal. Theophylline was agitated with activated charcoal in either water or polyethylene glycol electrolyte lavage solution, at each of three activated charcoal:theophylline ratios; 1:1, 3:1, and 10:1. The concentration in the supernatant was determined by high pressure liquid chromatography, and the maximal adsorptive capacity of activated charcoal for theophylline was calculated from the Langmuir equation. The percent of theophylline adsorbed by activated charcoal in water was 16 +/- 4%, 67 +/- 5%, and 97 +/- 3% for the 1:1, 3:1, and 10:1 ratios, respectively. This was decreased to 17 +/- 5%, 37 +/- 3%, and 62 +/- 2% when polyethylene glycol electrolyte lavage solution was added. A statistical difference (p less than 0.05) occurred at the 3:1 and 10:1 activated charcoal:theophylline ratios. Similarly the maximal adsorptive capacity was decreased 23% from 264 mg/g to 203 mg/g when polyethylene glycol electrolyte lavage solution was added to activated charcoal prior to theophylline. Polyethylene glycol electrolyte lavage solution significantly decreases adsorption of theophylline to activated charcoal in vitro. In vivo studies are required to confirm these findings. If activated charcoal is to be used clinically for theophylline toxicity, the authors suggest the possibility of larger quantities of activated charcoal, and administering activated charcoal in a slurry of water before the initiation of whole bowel irrigation
— id: 42088, year: 1991, vol: 29, page: 191, stat: Journal Article,

Critical care toxicology
Hoffman RS; Goldfrank LR
New York : Churchill Livingstone, 1991,
— id: 796, year: 1991, vol: , page: , stat: ,

Morphine-ethanol interaction on body temperature
Orts A; Alcaraz C; Goldfrank L; Turndorf H; Puig MM
1991 ;22(1):111-116, General pharmacology
1. The interaction between ethanol and morphine on core temperature was investigated in Swiss Webster mice. 2. Morphine (2.5-30 mg/kg) and ethanol (0.5-3.0 mg/g) administered individually resulted in a dose dependent decrease in body temperature. 3. When both drugs were injected simultaneously, body temperature decreased less than it would be expected to if the effects were additive. 4. Naloxone antagonized the hypothermic effect of morphine, but the hypothermic effect of ethanol and that of the combination of morphine plus ethanol was only reversed with high doses of naloxone (10 mg/kg). 5. Individual morphine and ethanol plasma levels were not significantly altered by their concomitant administration. 6. Binding of tritiated naloxone to opiate receptors in mouse brain membrane preparations was unchanged by pretreatment with ethanol (0.5 and 2 mg/g). 7. The interaction between morphine and ethanol was found to be less than additive and not related to pharmacokinetic changes of either drug
— id: 14241, year: 1991, vol: 22, page: 111, stat: Journal Article,

Time dependent cocaine-induced increase in plasma LDH activity decreased by buprenorphine pretreatment
Shukla VK; Bansinath M; Goldfrank LR; Turndorf H
1991 ;75:A626-A626, Anesthesiology
— id: 47361, year: 1991, vol: 75, page: A626, stat: Journal Article,

Antagonism of acute cocaine toxicity by buprenorphine
Shukla VK; Goldfrank LR; Turndorf H; Bansinath M
1991 ;49(25):1887-1893, Life sciences
The effect of buprenorphine pretreatment on the acute cocaine toxicity was assessed in male Swiss Webster mice. Buprenorphine pretreatment (0.15 or 0.30 mg/kg ip, 30 mins before) significantly attenuated the lethal effects of cocaine (60-140 mg/kg ip). The dose of cocaine which resulted in 50% mortality (LD50) in saline pretreated group was 100.61 mg/kg while the LD50 of cocaine in buprenorphine (0.15 and 0.3 mg/kg) pretreated groups were 113.57 and 118.16 mg/kg respectively. There was no significant change in the ratio of brain/plasma levels of cocaine in buprenorphine pretreated group when compared to the ratio from saline treated controls. Furthermore, neither naloxone (10 mg/kg ip, 15 mins before) nor naltrexone (3 mg/kg ip, 15 mins before) pretreatment affected the LD50 of cocaine. When tested 0.5, 1, 2, 4, 8 and 24 hrs after cocaine administration, sublethal dose of cocaine (80 mg/kg ip) injection resulted in significant increase in the plasma lactate dehydrogenase (LDH) levels. Buprenorphine pretreatment significantly attenuated cocaine-induced release of LDH. These results suggest that buprenorphine could be of potential advantage over naloxone in the management of cocaine and heroin ('speed ball') toxicity and in studies on the pharmacotherapy of cocaine-induced toxicity, LDH levels may be used as a biochemical marker to assess the protective effects of drugs
— id: 14224, year: 1991, vol: 49, page: 1887, stat: Journal Article,

Cocaine and the agitated patient
Wang RY; Goldfrank LR
1991 ;7(3):112-115, Care of the Critically Ill
The patient who presents with an agitated delirium, poses a clinical dilemma in the critical care setting. The aetiologies for this presentation are numerous and includes cocaine intoxication. Life threatening complications from the agitation can be effectively limited when the patient is adequately sedated with benzodiazepines and hyperpyrexia is controlled. This strategy is nonspecific for many of the aetiologies, of greatest therapeutic benefit for patients with sedative-hypnotic withdrawal and cocaine intoxication, and places no patient at increased risk
— id: 44411, year: 1991, vol: 7, page: 112, stat: Journal Article,

Toxicokinetics : applying pharmcokinetic principles to the poisoned
Weisman RS; Smith C; Goldfrank LR
Critical care toxicology New York : Churchill Livingstone, 1991,
— id: 3324, year: 1991, vol: , page: 1, stat: Chapter,

POISON CENTER NUMBERS
WEISMAN, RS; GOLDFRANK, L
1991 DEC ;29(4):553-557, Journal of toxicology. Clinical toxicology
— id: 52130, year: 1991, vol: 29, page: 553, stat: Journal Article,

The medical complications of drug abuse
Chiang W; Goldfrank L
1990 Jan 15;152(2):83-88, Medical journal of Australia
There is a vast array of abused drugs, and only a few of the more commonly used substances have been discussed. Patients with drug abuse frequently present with atypical syndromes and diseases. These individuals usually have less social, medical and economic support, making them more susceptible to the diseases that are associated with poverty, such as tuberculosis, and the complications of diseases such as hypertension, congestive heart disease and diabetes that require long-term care. Our strategy in the evaluation of these patients should consider all these aspects of medicine. A meticulous assessment and comprehensive care are necessary to render quality care for these complicated human and toxicological problems
— id: 42093, year: 1990, vol: 152, page: 83, stat: Journal Article,

Substance withdrawal
Chiang WK; Goldfrank LR
1990 Aug;8(3):613-631, Emergency medicine clinics of North America
As long as drug use and abuse persist in our society, a significant number of patients with various types of drug withdrawal will present to Emergency Departments. It is imperative that we recognize the signs and symptoms of drug withdrawal and render the appropriate treatments. Although it may be easy to recognize 'skid row' alcoholics, a drug abuser with track marks on his (or her) arms or with a perforated nasal septum, the executive alcoholic, the elderly patient on chronic diazepam therapy, or the 'blue collar' worker using cocaine may be more common and more elusive. Because most drug abusers use and can be dependent on multiple drugs, detoxification may need to proceed with one drug or one class of drugs at a time. Although our discussion has concentrated on the acute presentation and treatment of these symptoms for the emergency physician, we recognize that the acute treatment of withdrawal symptoms is only a small but vital part of withdrawal treatment. These patients will require chronic treatment, including social and psychologic counseling. As emergency physicians, by performing our jobs of recognition, stabilization, and counseling, we will fulfill the first critical link in the treatment of these patients
— id: 42089, year: 1990, vol: 8, page: 613, stat: Journal Article,

Metabolic aspects of hyperthermia
Delaney KA; Goldfrank LR
The metabolic and molecular basis of acquired disease London : Balliere Tindall, 1990,
— id: 3323, year: 1990, vol: , page: 381, stat: Chapter,

Goldfrank's toxicologic emergencies
Flomenbaum, Neal E.; Lewin, Neal A.; Howland, Mary Ann.; Goldfrank, Lewis R
Norwalk, Conn. : Appleton & Lange, c1990,
— id: 258, year: 1990, vol: , page: , stat: ,

Opioids and designer drugs
Ford M; Hoffman RS; Goldfrank LR
1990 Aug;8(3):495-511, Emergency medicine clinics of North America
Despite the increasing use of other illicit drugs, opioid abuse, overdose, and the ensuing medical complications continue to pose management challenges for the emergency physician. Heroin use is increasing as abusers of cocaine seek a drug to prolong cocaine's effects while blunting the postcocaine depression. Clandestine chemists have created newer, more powerful compounds--designer drugs--whose potencies are many-fold that of the presently available opioids. Aggressive airway support and use of naloxone enable the emergency physician to salvage many of these patients, leaving the many medical complications of parenteral and inhalational use as the greatest management challenge
— id: 44395, year: 1990, vol: 8, page: 495, stat: Journal Article,

Antipsychotic agents
Goldfrank L; Bresnitz E; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4498, year: 1990, vol: , page: 413, stat: Chapter,

Methanol, ethylene glycol, and isopropanol
Goldfrank L; Flomenbaum N; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4499, year: 1990, vol: , page: 481, stat: Chapter,

Substance withdrawal
Goldfrank L; Flomenbaum N; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4502, year: 1990, vol: , page: 535, stat: Chapter,

Vital signs and toxic syndromes
Goldfrank L; Flomenbaum R; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4491, year: 1990, vol: , page: 65, stat: Chapter,

Cyclic antidepressants
Goldfrank L; Lewin N; Flomenbaum N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4497, year: 1990, vol: , page: 401, stat: Chapter,

Diets
Goldfrank L; Lewin N; Howland MA
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4492, year: 1990, vol: , page: 295, stat: Chapter,

Carbon monoxide
Goldfrank L; Lewin N; Kristein R
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4506, year: 1990, vol: , page: 751, stat: Chapter,

Phencyclidine
Goldfrank L; Lewin N; Osborn H
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4501, year: 1990, vol: , page: 517, stat: Chapter,

Goldfrank's toxicologic emergencies
Goldfrank LR
Norwalk CT : Appleton & Lange, 1990,
— id: 795, year: 1990, vol: , page: , stat: ,

Prospective evaluation of "crack-vial" ingestions
Hoffman RS; Chiang WK; Weisman RS; Goldfrank LR
1990 Apr;32(2):164-167, Veternary & human toxicology
The 'crack' (cocaine alkaloid) epidemic has resulted in an increasing number of hospitalizations of 'crack-vial body-stuffers,' or patients who ingest 'crack-vials' in an attempt to avoid prosecution. Management strategies for this type of ingestion are lacking because of the paucity of data. This report discusses the demographics and symptomatology of 23 patients with 'crack-vial' ingestions, as well as the value of abdominal radiographs and the utility of varied strategies for decontamination in this patient population
— id: 42090, year: 1990, vol: 32, page: 164, stat: Journal Article,

The impact of drug abuse and addiction on society
Hoffman RS; Goldfrank LR
1990 Aug;8(3):467-480, Emergency medicine clinics of North America
Over 28 million Americans have admitted to abusing a substance in the last year alone, at a direct purchase price of over 79 billion dollars. Substance abuse and addiction have grave consequences on our existing social systems, effecting crime rates, hospitalizations, child abuse, and child neglect, and are rapidly consuming limited public funds. The intravenous drug abuser represents the fastest growing vector of HIV virus. This report focuses on the social and economic implications of substance abuse and addiction and discusses the merits and limitations of several popular solutions to the problem
— id: 44396, year: 1990, vol: 8, page: 467, stat: Journal Article,

Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem
Hoffman RS; Smilkstein MJ; Goldfrank LR
1990 Nov;8(6):523-527, American journal of emergency medicine
Gastrointestinal drug smuggling is a common problem in many major cities. Though the majority of cases never require medical attention, the 'body-packer' frequently presents with life-threatening symptoms of intoxication, including seizures and cardiorespiratory collapse, as well as mechanical obstruction from the ingested drug packets. The risk to asymptomatic smugglers may vary with packaging materials, and remains unknown. Lack of controlled studies, and variations in packaging materials and clinical outcomes have prevented formulation of a consistent management strategy. Current recommendations for asymptomatic body-packers vary from immediate surgical removal, to use of laxatives, to observation. The authors present the first reported case of an asymptomatic cocaine body-packer treated with whole bowel irrigation with polyethylene glycol electrolyte lavage solution. This strategy was safe, well tolerated, resulted in the rapid elimination of drug packets from the gastrointestinal tract, and facilitated assessment by contrast radiography. The potential benefits and limitations for the use of whole bowel irrigation in this difficult problem are discussed
— id: 44394, year: 1990, vol: 8, page: 523, stat: Journal Article,

Arthropods
Lewin N; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4507, year: 1990, vol: , page: 801, stat: Chapter,

Digitalis
Lewin N; Goldfrank L; Howland MA
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4494, year: 1990, vol: , page: 359, stat: Chapter,

Caffeine
Lewin N; Goldfrank L; Melinek M
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4505, year: 1990, vol: , page: 607, stat: Chapter,

Antiarrhythmic agents
Lewin N; Goldfrank L; Osborn H
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4496, year: 1990, vol: , page: , stat: Chapter,

Cocaine
Lewin N; Goldfrank L; Weisman R
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4500, year: 1990, vol: , page: 499, stat: Chapter,

Ergotamines
Lewin N; Goldfrank L; Weisman R
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4493, year: 1990, vol: , page: 313, stat: Chapter,

Herbal preparations
Lewin N; Howland MA; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4504, year: 1990, vol: , page: 587, stat: Chapter,

BRETYLIUM TOSYLATE AND ELECTRICALLY INDUCED CARDIAC-ARRHYTHMIAS DURING HYPOTHERMIA IN DOGS
Orts, A; Alcaraz, C; Goldfrank, L; Delaney, K; Turndorf, H; Puig, MM
1990 Feb;47(2):195-195, Clinical pharmacology & therapeutics
— id: 32008, year: 1990, vol: 47, page: 195, stat: Journal Article,

Cardiopulmonary arrest following an infusion of calcium 2-amino ethanol phosphate
Sauter D; Goldfrank L; Charash BD
1990 Nov-Dec;8(6):717-720, Journal of emergency medicine
The intravenous infusion of calcium 2-amino ethanol phosphate was coincidental with cardiopulmonary arrest in a 53-year-old woman with a history of multiple sclerosis. Resuscitation was followed by massive hemolysis, renal failure, adult respiratory distress syndrome, shock liver, and disseminated intravascular coagulation. This agent, in use by at least one practitioner in West Germany for the treatment of inflammatory and autoimmune disorders is not FDA approved for use in the United States, nor is clinical investigation underway. It is currently thought to be in use by about 200 practitioners throughout this country as treatment for multiple sclerosis. It is apparently obtained in West Germany and brought illegally into the United States. This is the first known report of an adverse drug reaction associated with the use of this product
— id: 30181, year: 1990, vol: 8, page: 717, stat: Journal Article,

Buprenorphine decreases lethal effects of cocaine
Shukla VK; Goldfrank L; Turndorf H; Puig MM; Bansinath M
1990 ;32:126-126, Pharmacologist
— id: 47308, year: 1990, vol: 32, page: 126, stat: Journal Article,

Fish and marine animals
Weisman R; Goldfrank L; Lewin N
Goldfrank's toxicologic emergencies Norwalk CT : Appleton & Lange, 1990,
— id: 4503, year: 1990, vol: , page: 555, stat: Chapter,

Assessment of acid-base disturbances in hypothermia and their physiologic consequences
Delaney KA; Howland MA; Vassallo S; Goldfrank LR
1989 Jan;18(1):72-82, Annals of emergency medicine
— id: 10803, year: 1989, vol: 18, page: 72, stat: Journal Article,

Ethanol-associated metabolic disorders
Hoffman RS; Goldfrank LR
1989 Nov;7(4):943-961, Emergency medicine clinics of North America
The ingestion of alcohol, both intermittently and habitually, results in significant patient morbidity and mortality and stresses an already compromised socioeconomic system. Ethanol can interact with normal metabolic pathways to produce a variety of life-threatening abnormalities, particularly in those with underlying poor nutritional status, as is found in many alcohol users. Once identified, the metabolic derangements associated with alcohol use generally respond well to therapeutic interventions. The recurrence rate, however, is extremely high. Any attempt at long-term solutions must involve extensive rehabilitative services. Current research is directed largely toward improving survival from alcohol-related illnesses such as cirrhosis and cardiac disease. We must focus our efforts on the social implications of alcoholism, providing medical support, counseling, and rehabilitation to affected persons. Since alcohol-related problems present most frequently to the Emergency Department, it is appropriate that the emergency physician take the first step in attacking this disease, a step that may be as simple as a referral for detoxification or social services support
— id: 44398, year: 1989, vol: 7, page: 943, stat: Journal Article,

Comparison of titratable acid/alkaline reserve and pH in potentially caustic household products
Hoffman RS; Howland MA; Kamerow HN; Goldfrank LR
1989 ;27(4-5):241-246, Journal of toxicology. Clinical toxicology
Exposure to caustic agents is a common problem, affecting thousands of individuals annually. Despite this incidence, the factors responsible for the production of injury remain poorly defined. Although extremes of pH seem to correlate well with the production of esophageal lesions, pH alone fails to explain the damage resulting from exposure to agents with near neutral pH, such as soldering flux containing zinc chloride. We determined titratable acid/alkaline reserve (TAR) in 38 potentially caustic household agents. A subset of these products was evaluated in an in-vitro canine esophageal model to determine whether TAR correlated with esophageal injury. The results indicate that for the products evaluated TAR correlated better than pH with the production of caustic esophageal injury
— id: 44399, year: 1989, vol: 27, page: 241, stat: Journal Article,

Substance abuse education in residency training programs in emergency medicine. NIAAA Task Force of the American College of Emergency Physicians
Taliaferro EH; Rund DA; Brown CG; Goldfrank LR; Jorden RC; Ling LJ; Gallery ME
1989 Dec;18(12):1344-1347, Annals of emergency medicine
The emergency department is the focal point for many social ills, not the least of which is substance abuse. We conducted a study to determine to what degree substance abuse education is taught in emergency medicine residency training programs. A set of educational objectives was developed by a task force composed of representatives of the American College of Emergency Physicians, the Society of Teachers of Emergency Medicine, and the University Association for Emergency Medicine. A questionnaire then was sent to the directors of all emergency medicine residency programs accredited by the Accreditation Council for Graduate Medical Education to determine the degree to which those objectives are covered in residency training. A 62% response rate was achieved. The data revealed that such topics as narcotic prescription law, patterns of risk, and issues pertaining to substance abuse by physicians were covered by fewer than half of the programs responding. Respondents were generally satisfied with the adequacy of training of residents and faculty in the area of substance abuse; however, they were dissatisfied with the adequacy of available training materials. Recommendations for changes in graduate curriculum as well as avenues for further research are provided
— id: 44397, year: 1989, vol: 18, page: 1344, stat: Journal Article,

Amphetamine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworths, 1988,
— id: 3310, year: 1988, vol: , page: 1748, stat: Chapter,

Cocaine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworths, 1988,
— id: 3314, year: 1988, vol: , page: 1752, stat: Chapter,

Evaluation of coagulation factor abnormalities in long-acting anticoagulant overdose
Hoffman RS; Smilkstein MJ; Goldfrank LR
1988 ;26(3-4):233-248, Journal of toxicology. Clinical toxicology
Newer Rodenticides of the long-acting anticoagulant or 'superwarfarin' class are gaining popularity. Since few cases of severe, prolonged anticoagulation after ingestion have been reported, the course of toxicity is not precisely understood. In this case of an intentional ingestion of brodifacoum, a longitudinal analysis of specific coagulation factor derangements was carried out in an attempt to guide a future treatment strategy for this type of toxicity. Results of this analysis demonstrated a profound decrease in levels of factors II, VII, IX, and X, lasting at least 43 days post ingestion. Treatment with subcutaneous vitamin K1 in doses up to 100 milligrams per day was without complication and was effective in reversing the coagulopathy produced by brodifacoum
— id: 44400, year: 1988, vol: 26, page: 233, stat: Journal Article,

Poisoning
Flomenbaum N; Goldfrank L; Cohen L
Textbook of general medicine and primary care Boston MA : Little-Brown, 1987,
— id: 3294, year: 1987, vol: , page: 397, stat: Chapter,

Management of the cocaine-intoxicated patient
Silverstein, W; Lewin, N A; Goldfrank, L
1987 Feb;16(2):234-235, Annals of emergency medicine
— id: 73679, year: 1987, vol: 16, page: 234, stat: Journal Article,

Emergency doctor
Ziegler, E; Goldfrank LR
New York : Harper & Row, 1987,
— id: 787, year: 1987, vol: , page: , stat: ,

Goldfrank's toxicologic emergencies
Goldfrank LR
Norwalk CT : Appleton-Century-Crofts, 1986,
— id: 794, year: 1986, vol: , page: , stat: ,

THE NEWER FORMS OF ABANDONMENT
Goldfrank, LR
1986 May 15;18(9):3-?, Emergency medicine
— id: 31059, year: 1986, vol: 18, page: 3, stat: Journal Article,

OF DRUG-ABUSE, AIDS, AND HOSPITALS
Goldfrank, LR; Schrager, LK
1986 Aug 15;18(14):2-?, Emergency medicine
— id: 31018, year: 1986, vol: 18, page: 2, stat: Journal Article,

Nonavailability of poison antidotes
Howland, M A; Weisman, R; Sauter, D; Goldfrank, L
1986 Apr 3;314(14):927-928, New England journal of medicine
— id: 112800, year: 1986, vol: 314, page: 927, stat: Journal Article,

Arthropods
Lewin N; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton-Centry-Crofts, 1986,
— id: 4487, year: 1986, vol: , page: 754, stat: Chapter,

Cocaine
Lewin N; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton-Centry-Crofts, 1986,
— id: 4488, year: 1986, vol: , page: 477, stat: Chapter,

Ergotamine
Lewin N; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton-Centry-Crofts, 1986,
— id: 4490, year: 1986, vol: , page: 287, stat: Chapter,

Herbal preparations
Lewin N; Goldfrank L
Goldfrank's toxicologic emergencies Norwalk CT : Appleton-Centry-Crofts, 1986,
— id: 4489, year: 1986, vol: , page: 560, stat: Chapter,

ESOPHAGEAL TEAR FOLLOWING FORCEFUL REMOVAL OF AN IMPACTED ORAL-GASTRIC LAVAGE TUBE
WALD, P; STERN, J; WEINER, B; GOLDFRANK, L
1986 JAN ;15(1):80-82, Annals of emergency medicine
— id: 51225, year: 1986, vol: 15, page: 80, stat: Journal Article,

Forward
Goldfrank LR
Clinical procedures in emergency medicine Philadelphia : Saunders, 1985,
— id: 3308, year: 1985, vol: , page: ?, stat: Chapter,

Packaging requirements for investigational agents
Goldfrank LR; Weisman RS; Howland MA; Raia JJ
1985 Feb;42(2):273, 276-, American journal of hospital pharmacy
— id: 44401, year: 1985, vol: 42, page: 273, 276, stat: Journal Article,

CYANIDE INTOXICATION
Wald, P; Goldfrank, L
1985 ;254(20):2889-2889, JAMA
— id: 30713, year: 1985, vol: 254, page: 2889, stat: Journal Article,

Serum lidocaine concentrations following subcutaneous administration
Barone JA; Weisman R; Mangione RA; Goldfrank LR
1984 May-Jun;3(3):281-284, Clinical pharmacy
Serum lidocaine concentrations were determined following subcutaneous administration for local anesthesia in the management of lacerations in the emergency room setting. Thirty patients received doses of lidocaine hydrochloride 1% solution ranging from 10 to 300 mg. Venous blood samples were drawn 15, 30, 45, and 60 minutes after lidocaine administration. Serum lidocaine determinations were made using an immunoassay system and verified by gas chromatography. There was no evidence of lidocaine absorption from the subcutaneous injection sites. There were no detectable concentrations of lidocaine in any of the patient blood samples. The absorption characteristics of subcutaneously administered lidocaine appear to be altered in traumatized tissue
— id: 44402, year: 1984, vol: 3, page: 281, stat: Journal Article,

Diagnostic testing in the emergency department
Flomenbaum, Neal.; Goldfrank, Lewis R.; Traister, Michael
Rockville, Md. : Aspen Systems Corp., 1984,
— id: 6, year: 1984, vol: , page: , stat: ,

Newer antidotes and controversies in antidotal therapy
Goldfrank L; Cohen L; Flomenbaum N; Howland MA; Kulbert A; Lewin N; Weisman R
1984 ;:223-266, Emergency medicine
— id: 73684, year: 1984, vol: , page: 223, stat: Journal Article,

Who has bugs?
Kulberg, A; Goldfrank, L
1984 Jan;73(1):117-117, Pediatrics
— id: 121041, year: 1984, vol: 73, page: 117, stat: Journal Article,

New York City's Poison Control Center: a systematic approach to a complex problem
Bernstein, J; Goldfrank, L; Howland, M A; Weisman, R
1983 Aug;12(8):37-43, Urban Health
A pooling of public and private resources has created a regional poison control system which provides information and education to the medical and lay communities of metropolitan New York City. An overview of the poisoning problem on a national scale is followed by a description of the operations by the Center, and a special volunteer effort
— id: 112802, year: 1983, vol: 12, page: 37, stat: Journal Article,

Clinical aspects of drug intoxication: opioids and opiates
Goldfrank L; Bresnitz E; Weisman R
1983 Mar;12(2):114-122, Heart & lung
— id: 63343, year: 1983, vol: 12, page: 114, stat: Journal Article,

Toxicologic emergencies : dangerous dieting
Goldfrank L; Lewin N
1983 ;19:76-76, Hospital physician
— id: 73697, year: 1983, vol: 19, page: 76, stat: Journal Article,

Amphetamine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworths, 1983,
— id: 3309, year: 1983, vol: , page: 1748, stat: Chapter,

Cocaine overdose
Goldfrank LR
Medicine for the practicing physician Boston : Butterworths, 1983,
— id: 3313, year: 1983, vol: , page: 1752, stat: Chapter,

Diagnostic procedures
Goldfrank LR; Floemenbaum N
Gaithersburg MD : Aspen Systems Corp, 1983,
— id: 785, year: 1983, vol: , page: , stat: ,

THE MINOR ANALGESIC OVERDOSE - SALICYLATES AND ACETAMINOPHEN
GOLDFRANK, L; WEISMAN, R
1983 ;12(3):215-222, Heart & lung
— id: 40532, year: 1983, vol: 12, page: 215, stat: Journal Article,

Toxicologic emergencies : a comprehensive handbook in problem solving
Flomenbaum, Neal E.; Lewin, Neal A.; Weisman, Richard S.; Goldfrank, Lewis R
New York, N.Y. : Appleton-Century-Crofts, 1982,
— id: 137, year: 1982, vol: , page: , stat: ,

Agitation and hypertermia
Goldfrank L; Flomenbaum N; Lewin N
1982 ;18:50-50, Hospital physician
— id: 73693, year: 1982, vol: 18, page: 50, stat: Journal Article,

Alcohol substitutes "Liquid Time Bomb"
Goldfrank L; Flomenbaum N; Lewin N
1982 ;18:36-60, Hospital physician
— id: 73691, year: 1982, vol: 18, page: 36, stat: Journal Article,

Withdrawal
Goldfrank L; Flomenbaum N; Lewin N
1982 ;18:12-36, Hospital physician
— id: 73690, year: 1982, vol: 18, page: 12, stat: Journal Article,

Carbon monoxide
Goldfrank L; Lewin N
Toxicologic emergencies : a comprehensive handbook in problem solving New York : Appleton-Century-Crofts, 1982,
— id: 4486, year: 1982, vol: , page: 223, stat: Chapter,

Cocaine
Goldfrank L; Lewin N
Toxicologic emergencies : a comprehensive handbook in problem solving New York : Appleton-Century-Crofts, 1982,
— id: 4485, year: 1982, vol: , page: 179, stat: Chapter,

Ergotism "The worst headache"
Goldfrank L; Lewin N
1982 ;:99-118, Physicians Assistant. Health Practitioner
— id: 73682, year: 1982, vol: , page: 99, stat: Journal Article,

Herbal medicine
Goldfrank L; Lewin N
1982 ;18:64-64, Hospital physician
— id: 73694, year: 1982, vol: 18, page: 64, stat: Journal Article,

Phencyclidine
Goldfrank L; Lewin N
1982 ;18:62-62, Hospital physician
— id: 73692, year: 1982, vol: 18, page: 62, stat: Journal Article,

Toxicologic emergencies : non-seasonal heatstroke
Goldfrank L; Lewin N
1982 ;18:50-50, Hospital physician
— id: 73696, year: 1982, vol: 18, page: 50, stat: Journal Article,

Toxicologic emergencies dusted (PCP)
Goldfrank L; Lewin N
1982 ;18:62-62, Hospital physician
— id: 73695, year: 1982, vol: 18, page: 62, stat: Journal Article,

Anticholinergic poisoning
Goldfrank, L; Flomenbaum, N; Lewin, N; Weisman, R; Howland, M A; Kaul, B
1982 Mar;19(1):17-25, Journal of toxicology. Clinical toxicology
Since the fall of 1979 numerous patients have been brought to emergency departments in New York City after being poisoned with an alcoholic beverage. On admission to the emergency services, they were noted to manifest significant anticholinergic toxicity. An analysis of the case histories, clinical presentations and laboratory data suggests that scopolamine eyedrops were deliberately used to poison these patients
— id: 112805, year: 1982, vol: 19, page: 17, stat: Journal Article,

The pernicious panacea: herbal medicine
Goldfrank, L; Lewin, N; Flomenbaum, N; Howland, M A
1982 Oct;18(10):64-9, 73, Hospital physician
— id: 112804, year: 1982, vol: 18, page: 64, stat: Journal Article,

BACTERIAL FOOD POISONING - WHAT TO DO IF PREVENTION FAILS
Goldfrank, L; Weisman, R
1982 ;72(3):171-17?, Postgraduate medicine
— id: 30307, year: 1982, vol: 72, page: 171, stat: Journal Article,

Cafeine
Goldfrank L; Lewin N
1981 ;17:42-59, Hospital physician
— id: 73689, year: 1981, vol: 17, page: 42, stat: Journal Article,

Carbon monoxide : "The Red Alert"
Goldfrank L; Lewin N
1981 ;:48-62, Hospital physician
— id: 73685, year: 1981, vol: , page: 48, stat: Journal Article,

Ergotism "The Worst Headache"
Goldfrank L; Lewin N
1981 ;17:74-97, Hospital physician
— id: 73688, year: 1981, vol: 17, page: 74, stat: Journal Article,

Fish poisoning : the red snapper
Goldfrank L; Lewin N
1981 ;17:36-54, Hospital physician
— id: 73687, year: 1981, vol: 17, page: 36, stat: Journal Article,

Toxicologic emergencies : cocaine
Goldfrank L; Lewin N; Weisman R
1981 ;17:26-26, Hospital physician
— id: 73686, year: 1981, vol: 17, page: 26, stat: Journal Article,

A model for revitalization of a poison center
Goldfrank, L; Howland, M A; Weisman, R; Di Marco, A
1981 ;23(Suppl 1):24-25, Veternary & human toxicology
— id: 112806, year: 1981, vol: 23, page: 24, stat: Journal Article,

Toxicologic emergencies : a handbook in problem solving
Goldfrank LR; Kirstein R
New York : Appleton-Century-Crofts, 1978,
— id: 789, year: 1978, vol: , page: , stat: ,

Linking emergency room and ambulatory service: North Central Bronx Hospital
Goldfrank LR; San Augustin M; Dash S; Samms T
1978 Jul-Aug;7(6):12-4, 25, Urban Health
— id: 44403, year: 1978, vol: 7, page: 12, stat: Journal Article,

Methadone overdoses in a New York City hospital
Persky VW; Goldfrank LR
1976 Feb;5(2):111-113, JACEP
Charts of the 81 methadone overdose patients admitted to Morrisania City Hospital from the Emergency Department during the eight month period between June, 1973 and January, 1974 were reviewed. There were 87 overdose cases in the 81 patients. All were treated successfully with naloxone hydrochloride administered intravenously. Four patients had pulmonary edema. In more than half, liver and muscle function studies showed abnormalities. Ninety percent (79) of the overdoses were associated with a combination of methadone and other non-opiate drugs, including alcohol
— id: 44404, year: 1976, vol: 5, page: 111, stat: Journal Article,