OBJECTIVES:This exploratory study compared the screening ability of a newly introduced radiation detection portal with a traditional Geiger counter for detection of radiation contamination in the setting of a mass casualty training exercise.METHODS:Following a pretrial evaluation of interobserver reliability for Geiger counter use, 30 volunteers were randomly assigned to don gowns containing three disks, each of which was either a sham resembling the radioactive samples or an actual cesium-137 sample; each subject participated a minimum of four times with different gowns each time. Each subject underwent standard radioactivity screening with the Geiger counter and the portal.RESULTS:Interobserver reliability was excellent between the two Geiger counter screeners in the pretrial exercise, correctly identifying 101 of 102 sham and radioactive samples (κ = 0.98; 95% confidence interval [CI] = 0.94 to 1.00). For radioactively labeled subjects across all bodily locations, the portal (43/61, or 70.5%; 95% CI = 58.1% to 80.5%) was less sensitive than the Geiger counter screening (61/61, or 100%; 95% CI = 92.9% to 100%), which resulted in a portal false-negative rate of 29.5%. For radiation detection in the posterior thorax, the portal radiation screening (4/19, or 21.1%; 95% CI = 8% to 43.9%) was less accurate than the Geiger counter (19/19, or 100%; 95% CI 80.2% to 100%). In contrast, there were no major differences between the portal and the Geiger counter for radiation detection at the left shoulder, right shoulder, or sham (nonradiation) detection. There were no false-positive detections of the sham-labeled subjects for either device, yielding a specificity of 100% for both screening modalities.CONCLUSIONS:Geiger counter screening was more sensitive than, and equally specific to, radiation detection portal screening in detecting radioactively labeled subjects during a radiation mass casualty drill.

Crack cocaine is not only being smoked, but it is also being dissolved and injected by some drug users ( 1 Lankenau S.E. Clatts M. Goldsamt L. Welle D. Crack cocaine injection practices and HIV risk: findings from New York and Bridgeport. J Drug Issues. 2004; 34: 319-322 Crossref PubMed Scopus (14) Google Scholar ). In its non-ionized form, crack cocaine is not readily dissolved for intravenous use. The addition of weak acids (lemon juice, lime juice, vinegar, and ascorbic acid) to the crack cocaine increases its solubility and allows for injection ( 2 Levine R.R. Walsh C.T. Schwartz R.D. Pharmacology: drug actions and reactions. 5th edn. Parthenon Publishing Group, London1996 Google Scholar ). We describe a case of infection and abscess formation in a woman after skin popping with crack cocaine and lemon juice.

An 86-year-old woman presented to our emergency department obtunded and intubated after she was found comatose below a second-story window. Family members found bottles of eszopiclone (Lunesta) and amitriptyline/perphenazine. The patient intentionally overdosed and then jumped from the window, sustaining multiple orthopedic injuries. She was hypothermic with a Glasgow Coma Scale of 3T on arrival. She underwent standard resuscitation measures but remained comatose for 48 hours despite the absence of neurologic trauma or sedative medications. Her mental status gradually improved and she was extubated 72 hours after admission without further neurologic sequelae. She admitted ingesting 30 three-milligram tablets of eszopiclone (30 times standard dosing) before jumping from the window. Her pharmacy confirmed filling prescriptions for 30 tablets of eszopiclone the day before admission. We suspect eszopiclone, a new nonbenzodiazepine sedative, as the cause of this patient's prolonged obtundation. We believe this represents the largest reported overdose of eszopiclone.