LMPG: Recommendations for the Use of Laboratory Tests to Support the Impaired and Overdosed Patient from the Emergency Department
 (Draft Guidelines)

Table of Contents - Word Document Format

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     Committee
     Preamble with Introduction and Needs Assessment

Part I
Recommendations for Drug Testing to Support Emergency Department Toxicology
     A. Immunoassays
     B. Tier I Toxicology Testing
     C. Assay Turnaround Times for Tier I Tests
     D. Tier II Testing
     E. Broad Spectrum Testing
     F. Selectivity of Testing
     G. Drug Panels by "Toxidromes"
     H. Gastric Samples
     I. "Universal" Acetaminophen Screening

Part II
Recommendations on Analytical and Reporting Issues for Drugs of Abuse Testing
     A. Listing of Cross-Reacting Substances on Immunoassays
     B. Immunoassay Cutoffs
     C. Inadequate Spectrum of Benzodiazepine Detection
     D. Opiate vs. Opioid Detection by Immunoassay
     E. Amphetamines vs. Sympathomimetic Drug Class
     F. Confirmation of Positive Immunoassays
     G. "Chain-of-Custody" for Clinical Immunoassay Specimens

Part III
Recommendations for Analyses of Ethyl Alcohol and Other Toxic Alcohols
     A. Need for a Breath Alcohol QA/QC Program
     B. Selection and Validations of Breath Alcohol Devices
     C. Reporting Units for Ethyl Alcohol
     D. Assays for Methanol and Ethylene Glycol
     E. Osmolality Measurements for Toxic Alcohol Surveillance
     F. Isopropyl Alcohol and Propylene Glycol Intoxication

Part IV
Recommendations on Laboratory Assays for Other Toxicants as Causes of Poisonings
     A. Cyanide and Hydrogen Sulfide
     B. Anticoagulants
     C. Lead Poisoning
     D. Testing for Iron Toxicity
     E. Arsenic and Mercury
     G. Broad spectrum trace element screening
     H. Pesticides
     I. Inhalants
     J. Methemoglobinemia
     K. Regional Toxicology Centers

References, Tables and Figures