CJEM Articles: Jeffrey Brubacher
Displaying 1-3 of 3 results
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March
2004
6
2
Ioana Lupu, Jean Wilson, Jeffrey Brubacher, Mark Yarema, Ming Fang, Richard Simons, Riyad B. Abu-Laban, Roy A. Purssell, Sharon Kasic
Background: Alcohol is a frequent contributing factor to motor vehicle collision injuries. Our objective was to determine the proportion of intoxicated drivers hospitalized following motor vehicle crashes who were subsequently convicted of an impaired driving criminal code offence.
Methods: We reviewed British Columbia Trauma Registry records from Jan. 1, 1992, to Mar. 31, 2000, and identified drivers of motor vehicles who were hospitalized for treatment of crash-related injuries. Patient identifiers were then used to link with the Insurance Corporation of British Columbia's (ICBC) contraventions database and the ICBC Traffic Accident System collisions database.
Results: Of 6067 patients identified in the Trauma Registry, 4042 had not been administered a blood ethanol test, 209 had no driver's licence match in the relevant databases and 119 died, leaving 1697 eligible patients. Mean age was 34 years, and 79.6% were male. The average Injury Severity Score was 20, the average hospital stay was 14 days and, among ethanol-positive patients, the mean ethanol level was 34.0 mmol/L (156.4 mg/dL). In patients with levels >17.3 mmol/L, the police had listed ethanol as a contributing factor in 70.6% of cases. Despite this, only 11.0% were convicted of impaired driving and 8.4% of another criminal offence; 10.7% received a 24-hour roadside prohibition, 3.9% received a 90-day administrative driving prohibition and 25.0% were convicted of a contravention of the Motor Vehicle Act. Forty-one percent were not convicted of any offence at all.
Conclusions: Intoxicated drivers in British Columbia requiring hospitalization as a result of alcohol-related motor vehicle crashes are seldom convicted of impaired driving or other criminal code offences. -
January
2003
5
1
Gillian A. Willis, Jeffrey Brubacher, Peter J. Zed, Roy A. Purssell, Sean K. Gorman
Introduction: Previous studies have demonstrated that antidotes are insufficiently stocked in Canadian and US health care facilities. The purpose of this study was to determine the adequacy of antidote stocking in British Columbia hospitals based on the current guidelines.
Methods: A written survey was mailed to hospital pharmacy directors at all 93 acute care facilities in BC. Availability of 14 essential antidotes was classified as sufficient or insufficient based on the current guidelines. Facilities were stratified into small (<50 beds), medium (50-250 beds) or large (>250 beds); teaching or non-teaching; trauma or non-trauma, urban or rural, and isolated or non-isolated.
Results: Complete responses were received from 75 (81%) of 93 hospitals. No hospital had adequate stock of all 14 antidotes. Overall, the average number (± standard deviation) of antidotes adequately stocked was 4.2 ± 2.9 per hospital. Urban hospitals had adequate stocks of 6.5 ± 2.6 antidotes while rural centres had adequate stocks of 2.6 ± 1.8 (p < 0.001). Corresponding figures were 9.0 ± 1.8 for teaching hospitals vs. 3.7 ± 2.4 for non-teaching hospitals (p < 0.001), 8.9 ± 2.0 for trauma centres vs. 3.8 ± 2.5 non-trauma centres (p < 0.001), and 2.5 ± 2.1 for isolated hospitals vs. 4.6 ± 2.9 for non-isolated hospitals (p = 0.018). Small, medium, and large hospitals adequately stocked 2.3 ± 1.7, 5.7 ± 2.2, and 7.7 ± 3.0 antidotes, respectively (p < 0.001). The 4 antidotes most adequately stocked were sodium bicarbonate (77%), N-acetylcysteine (64%), ethanol (49%) and naloxone (47%). Digoxin immune Fab fragments, glucagon, pyridoxine and rattlesnake antivenin were poorly stocked with sufficient supplies of 5%, 7%, 7% and 13%, respectively.
Conclusion: BC hospitals do not have adequate antidote stocks. Provincial stocking guidelines and coordination of antidote purchasing and stocking are necessary to correct these deficiencies.
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January
2002
4
1
Jeffrey Brubacher, William R. Henderson
Poisoning is an uncommon but potentially fatal outcome of toxic alcohol ingestion. The toxic alcohols methanol, ethylene glycol and isopropyl alcohol are commonly found in household and commercial products. Because the toxic effects are caused by the metabolites of methanol and ethylene glycol rather than the agents themselves, there is often a substantial delay between ingestion and onset of clinical toxicity. Anion and osmolar gaps are often used for the diagnosis and exclusion of these sometimes subtle overdoses. The pitfalls of using these tests to rule out alcohol ingestion are reviewed. Ethanol infusion is the traditional therapy for such overdoses. In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed.
