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