Poison Center Planning for Mass Gatherings: The Georgia Poison Center Experience with the 1996 Centennial Olympic Games

Background: The host city for the Olympic Games needs to prepare for “the world” to visit. This article is the first published report describing the impact of an event such as the Olympics on poison center services. Planning and Actions: We evaluated our operations and identified potential new demands. Operational aspects reviewed included: staffing; communication with foreign language callers; knowledge of international drug products; telephone access; procedures for disaster response and recovery; poison treatment protocols; and handling of hazardous material releases. We collaborated with local, state, and federal planners to delineate the poison center role and to develop protocols for use in a poisoning, including a hazardous material's release at a densely populated site. We enhanced our capability to respond to unusual incidents by forming new alliances. Fortunately, no such events occurred; these plans were therefore not tested. Conclusions: The Georgia Poison Center developed and implemented new capabilities for the Centennial Olympic Games. Immediate access to poison center resources would have facilitated the care of poisoned patients at multiple hospitals if this had become necessary. Communities preparing for mass gatherings should capitalize on the common interests of poison centers, hazardous materials specialists, and public safety agencies. Preparations should emphasize the most likely events, while recognizing the possibility of the unexpected. Planning an integrated response allows the talents and resources of participating agencies to be maximally utilized.     

Hemodialysis and Extracorporeal Removal after Pediatric and Adolescent Poisoning Reported to a State Poison Center

Background

There is currently limited literature regarding the use of hemodialysis after acute pediatric and adolescent poisoning.

Objective

We sought to characterize the use of hemodialysis (HD) and other extracorporeal removal techniques (ECR) in the treatment of acutely poisoned children and adolescents reported to a state poison control system over a 10-year period.

Methods

After institutional review board approval, a state poison control system database was queried for all cases coded for hemodialysis and other ECR after pediatric and adolescent (0–19 years old) poisoning. We also analyzed National Poison System Data to determine national trends.

Results

Ninety patients were reviewed after exclusions for errors in coding or incomplete documentation. HD was the principle method of ECR employed. One case of hemoperfusion and hemofiltration was reported. HD was used, on average, nine times per year. ECR was used predominantly in adolescent patients (age ≥ to 12 years) (84 patients, 93%) for intentional ingestions (82 patients, 91%). Fifteen different toxins were encountered, with salicylates (29 patients) and ethylene glycol (23 patients) most commonly encountered. Ethylene glycol and methanol blood levels were not available before initiation of hemodialysis in all but one case.

Conclusions

All salicylate-poisoned patients who underwent HD demonstrated clinical findings indicative of toxicity even in the absence of elevated levels advocated by some as indication for HD. HD and other ECR are rarely used in the management of pediatric and adolescent poisoning.     

A Review of a Preventable Poison: Pediatric Lead Poisoning

PURPOSE: A review of lead poisoning in pediatric populations enables nurses to increase their knowledge base about lead poisoning and to further the work on the Healthy People 2010 goal of eliminating childhood lead poisoning as a public health issue in the United States. CONCLUSION: Nurses should be aware of and use the variety of primary, secondary, and tertiary prevention strategies that are available to address pediatric lead poisoning. PRACTICE IMPLICATIONS: Prevention, education, and evidence-based treatment plans can decrease the occurrence of pediatric lead poisoning.     

The Drug Information Center Movement: Some Correlations with Poison Control

Abstract

The safety, efficacy and pharmacokinetic parameters of 5?g of hydroxocobalamin given intravenously, alone or in combination with 12.5?g of sodium thiosulfate, were evaluated in healthy adult men who were heavy smokers. Sodium thiosulfate caused nausea, vomiting, and localized burning, muscle cramping, or twitching at the infusion site. Hydroxocobalamin was associated with a transient reddish discoloration of the skin, mucous membranes, and urine, and when administered alone produced mean elevations of 13.6% in systolic and 25.9% in diastolic blood pressure, with a concomitant 16.3% decrease in heart rate. No other clinically significant adverse effects were noted. Hydroxocobalamin alone decreased whole blood cyanide levels by 59% and increased urinary cyanide excretion. Pharmacokinetic parameters of hydroxocobalamin were best defined in the group who received both antidotes: t_1/2 (alpha), 0.52 h; t_1/2 (beta), 2.83 h; Vd (beta), 0.24 L/kg; and mean peak serum concentration 753 mcg/mL (560 μmol/L) at 0—50 minutes after completion of infusion. Hydroxocobalamin is safe when administered in a 5 gram intravenous dose, and effectively decreases the low whole blood cyanide levels found in heavy smokers.     

急性CO中毒349例患者的护理体会

CO与血液中的血红蛋白（hemoglobin．Hb）结合后形成碳氧血红蛋白,使氧气不能与Hb结合．血液携氧能力下降,直接造成组织缺氧。同时CO可通过阻断细胞线粒体呼吸链,造成细胞呼吸障碍。产生直接的细胞毒性。     

急性有机磷农药中毒抢救体会

目的:探讨急性有机磷类农药中毒(AOPP)的病理生理特点和治疗方案,提高AOPP的救护水平。方法:回顾性分析44例AOPP的诊治经过,调查了胃肠道清洗、规范使用阿托品和复能剂、动态检测胆碱酯酶、监护重要器官功能、辅助呼吸和血液透析治疗的价值。结果:胆碱酯酶的活性和中毒程度相关,44例患者中,治愈39例,死亡5例。结论:胃肠道清洗是可阻断有机磷继续进入体内,合理使用阿托品和复能剂以及严格掌握减量时机是关键步骤,辅助呼吸和血液透析是抢救重度中毒者的必要手段,动态检测胆碱酯酶的活性可减少IMS的死亡率。     

Poison exposures in young Israeli military personnel: a National Poison Center Data analysis

Context: To characterize poison exposures in young Israeli military personnel as reported to the national poison center.

Methods: Retrospective poison center chart review over a 14-year period. Cases included were Israeli soldiers aged 18–21 years, the compulsory military service age required by the Israeli law.

Results: 1770 records of poison exposures in young military personnel were identified. Most exposed individuals involved males (n?=?1268, 71.6%). Main routes of exposure were ingestion (n?=?854, 48.3%), inhalation (n?=?328, 18.6%) and ocular (n?=?211, 11.9%). Accidents or misuse (n?=?712, 40.2%) were the most frequently reported circumstances, followed by suicide attempts (370, 20.9%), and bites and stings (161, 9.1%). More than half of the cases involved chemicals (n?=?939, 53.1%); hydrocarbons, gases and corrosives were the main causative agents. Pharmaceuticals (mainly analgesics) were involved in 519 (29.3%) cases, venomous animals (mainly scorpions, centipedes, and snakes) in 79 (4.5%). Clinical manifestations were reported in 666 (37.6%) cases, mostly gastrointestinal, neurologic, and respiratory. The vast majority of cases (1634, 92.3%) were asymptomatic or mildly affected; no fatalities were recorded. In 831 (46.9%) cases the clinical toxicologist recommended referral to an emergency department; ambulatory observation was recommended in 563 (31.8%) cases, and hospitalization in 86 (4.9%).

Conclusions: Our data show that poison exposures among young soldiers involve mainly males, accidents, misuse and suicides, oral route and chemicals; most exposures were asymptomatic or with mild severity. Repeated evaluations of poison center data pertaining to military personnel is advised for identifying trends in poison exposure and characteristics in this particular population.     

Hydrogen Peroxide Exposure 325 Exposures Reported to a Regional Poison Control Center

Abstract

Isolated case reports have documented that hydrogen peroxide exposure can be associated with serious toxicity by various routes of exposure. The purpose of this study was to better delineate the epidemiology, medical outcome, and potential health hazards of hydrogen peroxide exposures to the general public. We performed a retrospective review of all exposures reported to a regional poison center over a 36 month period and found that of 95,052 exposures reported, 325 (.34%) were due to hydrogen peroxide. The pediatric population (< 18 years) accounted for 71 % of hydrogen peroxide exposures and ingestion was the most common route of exposure (83%). Nausea and vomiting were the most common symptoms secondary to ingestion. Ocular and dermal exposures to dilute solutions resulted in transient symptoms without permanent sequelae. While most exposures by all routes resulted in a benign outcome (no effect or minor effect), there was a trend toward more severe outcomes in those who ingested a concentration greater than 10% (p = 0.011).     

Acute Indoramin Poisoning: a Review of 55 Cases Reported to the Paris Poison Centre from 1986 to 2010

Authors report a retrospective study of all cases of indoramin-only poisoning notified to the Paris poison Centre from 1986 to 2010. Fifty five cases of indoramin self-poisoning were included: 40 adults and 15 children. The mean supposed ingested dose was about 701 mg ± 464 mg. ECG showed a prolonged QTc interval (equal to or greater than 0.50 s) in 30% of patients. The lowest observed dose for prolonged QTc was 625 mg. This series includes two cases of seizures occurring around two hours after ingestion of 900 and 2 250 mg of indoramin. A review of the literature showed cardiac disorders, with a delayed mechanism of action up until 18 hours after ingestion. Therefore, rapid medical resuscitation and prolonged cardiac monitoring for at least 24 hours after ingestion of 625 mg are recommended.     

血液灌流应用于急性中毒患者的抢救护理体会

目的探讨血液灌流（hemoperfusion,HP）治疗急性中毒的效果和护理方法。方法根据患者家属是否同意行HP治疗,将急性中毒患者随机分为两组,HP组在常规救治的基础上,尽早进行血液灌流术,同时给予相应的护理措施;非HP组进行常规救治和护理。结果HP组患者的意识清醒时间、平均住院时间、以及有机磷中毒患者的胆碱酯酶（ChE）恢复时间均明显缩短。结论对急性中毒患者进行HP并给予适当的护理,可以有效治疗急性中毒。     

Evaluation of the Effectiveness of a Poison Information Center

Abstract

The efficacy of gastric lavage as it is practiced in a major metropolitan hospital was evaluated. From a population of 76 patients with chemical evidence of sedative-hypnotic drugs in the blood, two or more therapeutic doses were recovered from 15.8% of the lavage samples, and 10 or more therapeutic doses were recovered from 6.6%. In a population consisting of patients with detectable quantities of drugs in the lavage sample, diazepam and amitripty-line are more adequately recovered than the sedative-hypnotic drugs. Very poor recoveries were obtained in patients lavaged more than 2?h after ingestion except in cases of amitriptyline overdose or massive sedative-hypnotic ingestion. The study indicates that inadequate criteria are employed in selecting patients most likely to benefit from lavage. Dose, time since ingestion, and symptomatology are discussed as criteria for selection of patients for lavage.     

Buprenorphine poisoning in children: a 10-year-experience of Marseille Poison Center

Buprenorphine is a µ-partial agonist and k-antagonist acting on central opioid receptors. Patented for analgesia in 1968, buprenorphine has been used as opioid substitutive therapy since the 1990s, as well as methadone. The aim was to document pediatric poisoning, to discover the severity, and to evaluate the treatment with naloxone. All pediatric poisonings reported to the poison control center Marseille (France)—from January 1, 2009 to December 31, 2018—were included. Analysis put value on gender, age, estimated quantity, symptoms and their delay, place of treatment, medical treatment, utilization of antidotes, severity of intoxications, and patients’ outcome. Fifty-four infant poisonings with buprenorphine were recorded, doses varied between 1 and 36 mg, and children showed mainly neurological (somnolence, miosis…) and gastroenteric (vomiting) effects. Pulmonary effects were described for four children. According to the poisoning severity score, 8 intoxications were classified as ‘no symptoms or signs’, 37 as minor poisonings, 3 as moderate, none as severe or fatal and 6 were unknown. Medical care was required for 46 children, and four of them were treated with naloxone. Buprenorphine poisoning can cause neurological, gastroenteric, and respiratory symptoms. Even licking a tablet leads to intoxication because of maximal tablet’s absorption while placing it under the tongue. Hospital admission is necessary even at small doses. Naloxone was efficient in the four described cases. Parents have to be aware of the poisoning risk with buprenorphine. Recently, commercialized instantly dissolving formulations could cause more severe intoxications.     

Ethylene Glycol Poisoning: Resolution of Cranial Nerve Deficit

Ethylene glycol poisoning is a major contributor to the development of idiopathic metabolic acidosis, which may lead to renal failure. Ethylene glycol poisoning should be among suspected differentials when assessing a seemingly intoxicated patient with hypocalcemia, anion gap acidosis, and nontoxic blood alcohol levels. Glycol intoxication may lead to delayed neurologic manifestations, which may lead to an inaccurate diagnosis. No clear clinical guidelines exist to recommend treatment for this late effect. This is a case of the complete resolution of facial nerve deficit secondary to glycol poisoning after the completion of a steroid therapy course on an inpatient psychiatric unit.     

急性重度有机磷农药中毒56例救治体会

患者不管是否已经简易洗胃或服毒超过 6小时 ,均给立即、反复、彻底洗胃 ,然后用 2 0 %甘露醇 80～ 12 0ml导泻 ;同时立即静注阿托品 10～ 30mg ,每 5～ 15分钟 1次 ,不得中断 ,直至阿托品化 ;解磷定 1.0 g静注后 ,以每小时 0 .35 g速度静滴维持 2～ 4天 ;一旦出现呼吸肌麻痹 (RMP) ,行紧急气管插管或切开 ,机械正压通气 ,并给氯磷定方案治疗。阿托品化后较长时间减量维持以防反跳。结果本组阿托品总量为 5 62～ 2 876mg ,治愈 41例 (73.2 % ) ,死亡 15例 (2 6.8% ) ,治疗期间有 9例发生RMP ,经抢救 8例治愈 ,1例死亡。急性重度有机磷农药中毒病情危急 ,抢救难度大 ,临床医生要有高度的责任性和极端负责的精神 ,积极采取正确有效的方法 ,以降低死亡率     

经纤维支气管镜肺灌洗治疗急性氨气中毒4例体会

1999年 8月我院急诊科收治了 12名急性氨气中毒的患者 ,其中 6例因有明显的呼吸困难 ,口唇轻度或中度发绀 ,肺内闻及湿性罗音 ,动脉血气分析示低氧血症而收入呼吸科治疗。病情较重的 4例经纤维支气管镜肺泡灌洗 (ＢＡＬ)治疗收到了较好的疗效。报告如下 :1　一般情况和方法4例患者均为女性 ,3例 18岁 ,1例 4 2岁。既往身体健康 ,无心肺疾病史。入院时呼吸 :2 2～ 2 8次 /ｍｉｎ ,Ｘ线检查表现为双肺纹理增粗 ,2例伴有片状浸润性阴影。肺部听诊两肺呼吸音粗糙 ,可闻及干湿性罗音。动脉血气分析 :氧分压 (ＰａＯ2 ) 80 .6ｍｍＨｇ ,氧饱和度 (…     

腹腔镜下经肛提肌外腹会阴联合直肠癌切除术的单中心经验

  目的  探索腹腔镜下完成经肛提肌外腹会阴联合直肠癌切除(extralevator abdominoperineal excision, ELAPE)手术的可行性。  方法  回顾性分析本院2012年6月至2013年8月实施的12例腹腔镜下ELAPE手术的围手术期特点, 手术过程中侧方完全切除肛提肌组, 后方切除其在尾骨的附着点, 前方根据肿瘤分期和位置决定是否行周围脏器的扩大切除。术中不更换体位, 会阴切口缝合皮下和皮肤, 缝闭盆底腹膜。从手术时间、术中出血、淋巴结获取数目、术后并发症等方面判断手术的可行性。  结果  患者平均年龄(65.2±12.5)岁, 体重指数21.6±3.1;肿瘤下缘距肛缘(3.3±0.7)cm; 手术时间(176.1±27.5)min, 术中出血(49.6±38.2)ml; 淋巴结获取数目(18.3±7.8)枚, 所有肠管断端及侧切缘均阴性; 2例发生尿潴留, 9例患者会阴切口达到甲级愈合。  结论  据手术短期效果, 术中不更换体位, 根据个体情况选择性行周围脏器的扩大切除, 在腹腔镜下完成ELAPE手术是可行的。