LMPG: Laboratory Support for Emergency Toxicology
(Draft Guidelines)

Table of Contents


Part I
Recommendations for Drug Testing to Support Emergency Department Toxicology
     A. Immunoassays
     B. Tiered Testing
     C. Broad Spectrum Testing
     D. Selectivity of Testing
     E. Drug Panels by "Toxidromes"
     F. "Universal" Acetaminophen Screening

Part II
Recommendations on Analytical and Reporting Issues for Drugs of Abuse Testing
     A. Listing of Cross-Reacting Substances in 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 Breath Alcohol Analysis
     A. Need for a QA/QC Program
     B. Selection and Validation

Part IV
Recommendations for Testing of Serum Ethyl Alcohol and Other Volatiles
     A. Reporting Units for Ethyl Alcohol
     B. Assays for Methanol and Ethylene Glycol
     C. Osmolality Measurements
     D. Isopropyl Alcohol

Part V
Recommendations of Laboratory Assays for Substance Abuse and Exposure
     A. Cyanide and Hydrogen Sulfide
     B. Anticoagulants
     C. Lead Poisoning
     D. Other Heavy Metals
     E. Pesticides
     F. Inhalants
     G. Regional Toxicology Centers