Care Of Poisoned Patients Research Articles

Opšti principi hitnog zbrinjavanja trovanja u ambulanti lekara opšte medicine - izazovi i prepreke

Introduction. Timely recognition of acute or chronic poisoning, as well as the pharmacodynamic mechanisms and pathophysiology of poisoning, is of the utmost importance in the general practice office. Objective. We aimed to find out the rate of awareness and education of primary healthcare physicians on necessary measures in the case of poisoning treatment. Method. Physicans working in general practice in the Republic of Serbia were sent an electronic questionnaire ''Urgent poisoning treatment in the general practice office''. The questionnaire had 13 questions referring to the physician's practical experience. Results. The rise of medication, product, and biological substance poisoning rate was registered at the primary healthcare level in the last five years and it went from 0,14 to 0,21. Poisoning with non-medical substances is on the steep decline, from 0,30 to 0,19 per 1000 inhabitants. We followed the experience of general physicians (GPs) from outpatient clinics, concerning the cases of acute and chronic poisoning, by examining the questionnaire which showed 71,43% of GPs met with this condition. Physicans were more likely to be met with accidental poisoning (41,07%), while (21,43%) were met with multiple intentional poisonings. A larger percentage of these cases (44,65%) were treated on-site. About the existence of the National Poisoning Control Center knew 53,57% of physicans and 58,93% were familiar with detoxication measures. Additional expertise in the area of poisoning is necessary in the opinion of 75% of physicians. Discussion. Poison intake, in different ways, into a body, may cause a patient's death if not recognized on time, at the initial encounter in the general physician's office. Conclusion. Awareness and education of the GPs in the outpatient clinics, as well as, readiness to learn additional skills proved to be an important factor in taking care of poisoned patients who call on their GPs first. Continuous education is a necessary measure for the improvement of healthcare quality in the treatment of acute and chronic poisoning.

A Narrative Review on Emergency Management of Poisoning

Poisoning cases are coming to the Emergency Department (ED) and cases are increasing day by day due to their easy and vast availability. Clinicians are frequently dealt with to manage critically ill poisoning patients. With the swing of prominence in managing poisoning from in-patient care to early decontamination and early stabilisation, ED physicians are playing a more dynamic role in the care of poisoned patients. The clinical effects encountered by them are dependent on numerous variables, such as the dose, the duration of exposure, the health history of the patient, to provide thorough supportive care, recognition of patients requiring treatment with a specific antidote, and to use the appropriate methods to restrict poison absorption or to increase its elimination, which is the foundation of management. If poisoning in the patient is documented early and appropriate compassionate care is commenced hastily, maximum of patients recover soon. This article is aimed to focus on the more specific issues of emergency management of the poisoned patient.

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care

We provide recommendations for stocking of antidotes used in emergency departments (EDs). An expert panel representing diverse perspectives (clinical pharmacology, medical toxicology, critical care medicine, hematology/oncology, hospital pharmacy, emergency medicine, emergency medical services, pediatric emergency medicine, pediatric critical care medicine, poison centers, hospital administration, and public health) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel. The panel used a formal iterative process to reach their recommendation for both the quantity of antidote that should be stocked and the acceptable timeframe for its delivery. The panel recommended consideration of 45 antidotes; 44 were recommended for stocking, of which 23 should be immediately available. In most hospitals, this timeframe requires that the antidote be stocked in a location that allows immediate availability. Another 14 antidotes were recommended for availability within 1 hour of the decision to administer, allowing the antidote to be stocked in the hospital pharmacy if the hospital has a mechanism for prompt delivery of antidotes. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine its specific need for antidote stocking. Antidote administration is an important part of emergency care. These expert recommendations provide a tool for hospitals that offer emergency care to provide appropriate care of poisoned patients.

Utilizing an Ingestible Biosensor to Assess Real-Time Medication Adherence.

Medication adherence monitoring has relied largely on indirect measures of pill ingestion including patient self-report, pharmacy refills, electronically triggered pill bottles, and pill counts. Our objective is to describe an ingestible biosensor system comprising a radio-frequency identification (RFID)-tagged gelatin capsule. Once the capsule dissolves in the stomach, the RFID tag activates to transmit a unique signal to a relay device which transmits a time-stamped message to a cloud-based server that functions as a direct measure of medication adherence. We describe a constellation of mobile technologies that provide real-time direct measures of medication adherence. Optimizing connectivity, relay design, and interactivity with users are important in obtaining maximal acceptability. Potential concerns including gut retention of metallic components of the ingestible biosensor and drug dissolution within a gelatin capsule should be considered. An ingestible biosensor incorporated into a medication management system has the potential to improve medication compliance with real-time monitoring of ingestion and prompt early behavioral intervention. Integration of ingestible biosensors for multiple disease states may provide toxicologists with salient data early in the care of poisoned patients in the future. Further research on device design and interventions to improve adherence is needed and will shape the evolving world of medication adherence.

Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

A B S T R A C T Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU) for poisoned patients in Imam Reza (p) hospital, Mashhad, Iran. Data was gathered by a researcherdesigned questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients. Please cite this paper as:

Clinical toxicology in Edinburgh, two centuries of progress

The Scottish Poisons Information Bureau was established in Edinburgh in September 1963 and shortly afterwards one of the wards of the city's Royal Infirmary was designated a Regional Poisoning Treatment Centre. Both units were soon to be brought under one roof. To mark this 50th anniversary, we review how they built upon a history dating from the early 19th century and highlight their influence on current clinical toxicological practice and the delivery of poisons information. While many centres worldwide seek to improve the care of poisoned patients, the contribution of Edinburgh over the past 50 years has been notable.

The major role of toxicology societies in global collaborations – a call to action

The major role of toxicology societies in global collaborations – a call to action

Inaccuracy of ECG Interpretations Reported to the Poison Center

The ECG is an essential tool in the care of poisoned patients. This study is designed to investigate the accuracy of ECG interpretation reported to a poison center. In this prospective study, all cases in which both an electronically faxed copy of the ECG and the caller's interpretation of the ECG were available were eligible for inclusion. ECG interpretation of callers was compared with that of a blinded electrophysiologist. In cases of disagreement, a Delphi panel of toxicologists decided whether the differences were clinically significant or would have changed recommendations. Two hundred cases were included, with complete agreement in 78. In 23 cases, the sole difference was nonspecific ST-T-wave changes, which were believed insignificant and classified as agreement for a total of 101. The Delphi panel reviewed the remaining 99. In 42 cases, the differences in ECG interpretations were thought to be clinically significant; 37 of these would have resulted in a change in management recommendations. Forty-five cases were thought not likely to be clinically significant and would not have resulted in a recommendation change. Twelve cases were thought not clinically significant but would still have resulted in a change in recommendations. Initial interpretation of the ECG reported by callers to the poison center is frequently inaccurate. In this study, the misinterpretation was clinically significant or would have resulted in a change in management recommendations in approximately one quarter of all calls.

Aspectos legales de la atención toxicológica

The care of poisoned patients in the sphere of the hospital emergency services is an increasingly frequent phenomenon. Any patient, whether or not they die, who is subjected to medical care in the course of a poisoning generates certain obligations from the medical-legal point of view. This paper reviews the most frequent causes of medical care in living patients, or in those who have died because of a poisoning, the legal obligations that care gives rise to, and the suitable form for approaching and resolving these.