Chemical Burns from Secondary Exposure to Paraquat Through Mishandling Urine of a Patient with Toxic Exposure

2021 ◽  
Author(s):  
H Denise Holley-Harrison ◽  
David Cunningham ◽  
Sai R Velamuri ◽  
William L Hickerson ◽  
David M Hill
Keyword(s):  
Registered Nurse ◽  
Burn Injury ◽  
Foley Catheter ◽  
Poison Control ◽  
Severe Toxicity ◽  
Accidental Ingestion ◽  
Skin Exposure ◽  
Secondary Exposure ◽  
Relative Safety ◽  
Initial Care

Abstract Paraquat is used throughout the world as an herbicide due to efficacy and relative safety with proper handling. Accidents and misuse still occur, leading to countries banning its use or employing extra safeguards and special handling certifications. Severe toxicity is primarily associated with ingestion, but skin exposure leads to corrosive injury to the dermis, occurs rapidly, and progresses for up to 24 hours. Prolonged skin exposure or the presence of open wounds can lead to systemic absorption. This is the first known report of burn injury and treatment due to secondary exposure to the urine of a patient who had accidental ingestion of paraquat. A 50-year-old Caucasian male presented to the emergency room after accidental ingestion of eight ounces of Gramoxone extra (Paraquat 30% concentration). During initial care of the patient, the bedside registered nurse was placing an indwelling foley catheter when her forearms were contaminated with urine, while wearing basic personal protective equipment (gloves). The registered nurse noticed bullae to bilateral forearms a short time after exposure to the urine. She presented to the burn center for evaluation and treatment. Poison Control was contacted but was unable to offer advise due to lack of supportive literature. The risk and effects of primary exposure to Paraquat is described throughout the literature and documented in MSDS, but data regarding risk and treatment of secondary exposure is lacking. This case will aid outreach efforts for prevention and treatment of burn injuries from secondary exposure to paraquat.

scholarly journals Catheter-Associated Urinary Tract Infections (CAUTIs) Reduction: A Multidisciplinary Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s154-s154
Author(s):  
Hanish Jain ◽  
Elizabeth Hartigan ◽  
Joseph Tschopp ◽  
Paul Suits ◽  
Kristopher Paolino
Keyword(s):  
Best Practice ◽  
Registered Nurse ◽  
Urine Analysis ◽  
Urine Culture ◽  
Care Center ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Culture Collection ◽  
Institutional Cost ◽  
Tract Infections

Background: CAUTIs remain one of the most common hospital-acquired infections (HAIs) accounting for prolonged hospital stay and increased healthcare costs. According to the NHSN, the standardized infection ratio (SIR) at our institution was 1.6 compared to national average of 0.84 in 2018. We highlight the interventions implemented in our institution to prevent CAUTIs. These interventions have shown a reduction in the rate of CAUTIs, the SIR, Foley catheter days, and institutional cost. Methods: In addition to standard CAUTI prevention practices, we hypothesized that we could decrease CAUTIs through the daily implementation of specific practices. We developed a comprehensive interdisciplinary team which included the staff or charge registered nurse (RN), the unit manager, an infection preventionist, an advanced practice registered nurse (APRN), a pharmacist with an antimicrobial focus, and a physician from the infectious disease department who would conduct daily rounds on different units in the institution for education and assessment of catheter indications. A detailed review and analysis of the urine culture orders for patients with a Foley catheter was performed. A nurse-driven Foley catheter removal protocol before urine culture collection was initiated. We implemented a Foley catheter bundle that has guidelines for Foley insertion, best practice competency, and urinary catheter best practice algorithm and advocated alternative use of male or female external catheter. We educated physicians about ordering a reflexive urine analysis test followed by urine culture instead of testing either individually after removal of a Foley catheter. Lastly, we performed a root-cause analysis on all reported CAUTIs. These policies were implemented in a 435-bed tertiary-care center in November 2018, and we present data from 1-year before and after the interventions. Results: At our institution, we had 71 CAUTIs, with an SIR of 1.6, a standardized utilization ratio (SUR) of 0.92, 27,621 Foley days, and institutional cost of $979,303 compared to 40 CAUTIs with an SIR of 1, an SUR of 0.88, 24,193 Foley days, and institutional cost $537,927 after implementing our interventions. Conclusions: CAUTIs can be reduced by implementing specific measures that include infection control team rounds, nurse-driven protocol, and the use of Foley catheter bundles. Measures should be undertaken to prioritize these practices as part of a protocol. We advocate further studies to evaluate these measures. Education programs for healthcare professionals concerning CAUTIs and its complications can be implemented to carry out the prevention methods efficiently.Funding: NoneDisclosures: None

Effect of Safety Packaging on Aspirin Ingestion by Children

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 687-693
Author(s):  
Alisone Clarke ◽  
William W. Walton
Keyword(s):  
Poison Control ◽  
Health Statistics ◽  
Accidental Ingestion ◽  
Poison Control Centers ◽  
Poison Prevention ◽  
Ingestion Level ◽  
Aspirin Ingestion

The effectiveness of child-resistant closures, required under the Poison Prevention Packaging Act of 1970, in reducing the incidence of accidental ingestion of aspirin and aspirin-containing products among children less than 5 years of age has been investigated. Data from Poison Control Centers and the National Center for Health Statistics were analyzed to determine the ingestion level before and two to three years after safety closures were required. Baby aspirin and nonbaby aspirin products were analyzed separately. For baby aspirin, it is estimated that safety packaging has reduced the incidence of ingestions 45% to 55%. For nonbaby aspirin products, the reduction has been 40% to 45%.

scholarly journals Characteristics of unintentional ingestion of oral non-steroidal anti-inflammatory drugs and analgesics in preschool children

2021 ◽  
Vol 72 (4) ◽  
pp. 299-304
Author(s):  
Željka Babić ◽  
Nikolina Benco Kordić ◽  
Arnes Rešić ◽  
Rajka Turk
Keyword(s):  
Preventive Measures ◽  
Real Life ◽  
Opioid Analgesics ◽  
Poison Control ◽  
Accidental Ingestion ◽  
Hospital Records ◽  
Control Centre ◽  
Poison Control Centre ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract We characterised accidental ingestion of non-steroidal anti-inflammatory drugs and non-opioid analgesics in children aged 0–5 years between 2009 and 2019 by analysing records of telephone consultations with the Croatian Poison Control Centre (CPCC) and cases treated at the Children’s Hospital Zagreb (CHZ). Among the total of 466 identified cases (411 from CPPCC records and 55 from CHS hospital records), the most frequently ingested drugs were ibuprofen (47 %), paracetamol (20 %), ketoprofen (15 %), and diclofenac (11 %). In 94 % of the cases unsupervised children ingested the drug left within their reach. The remaining 6 % were dosing errors by parents or caregivers and involved liquid formulations as a rule. Our findings can serve as real-life examples informing preventive measures.

Pomoc przedszpitalna u oparzonych

2020 ◽  
Vol 8 (4) ◽  
pp. 103-114
Author(s):  
Ryszard Mądry ◽  
Jerzy Strużyna ◽  
Tomasz Korzeniowski ◽  
Aleksandra Winiarska
Keyword(s):  
Burn Injury ◽  
Prehospital Care ◽  
Patient Treatment ◽  
Treatment Center ◽  
Hospital Treatment ◽  
Burn Treatment ◽  
Treatment Protocols ◽  
Severe Burns ◽  
Comprehensive Therapy ◽  
Initial Care

Advancements in burn treatment, in the last decades, resulted in a reduction of mortality among burn victims. Increased funding and the creation of regional burn treatment facilities focused on comprehensive therapy of severe burns resulted in improvement of treatment outcomes. Effective functioning and usage of resources in burn centers depends on the organization of prehospital care, proper segregation of patients, triage and prompt transfer to a place where highly specialized care is available. Initial care of a burn injury patient includes actions taken by witnesses of the event and by the emergency medical team during transfer to the emergency department. After evaluating and stabilizing the patient, a decision is made whether or not he should be treated at a specialized burn treatment center to which he may be transferred by land or by air. This paper presents burn patient treatment protocols at each of the following stages: at the burn scene, during transportation, initial hospital treatment and criteria for referring the patient to a burn treatment center.

Camphor Poisoning: Over-the-Counter Dangers

PEDIATRICS ◽  
1976 ◽  
Vol 57 (3) ◽  
pp. 428-431
Author(s):  
William J. Phelan
Keyword(s):  
Castor Oil ◽  
Medical Center ◽  
Case Reports ◽  
Poison Control ◽  
University Of Michigan ◽  
Accidental Ingestion ◽  
Self Medication ◽  
Over The Counter ◽  
The University ◽  
Michigan Medical

Intoxication from camphor has been reported frequently in the literature for decades, most cases involving the accidental ingestion of camphorated oil, mistaken for castor oil or other similar products. Over 20 years ago, Smith and Margolis1 collected 130 nonfatal and 18 fatal cases from literature dating back to 1833. Recent data from the National Clearinghouse for Poison Control Centers reveal an increasing proportion of ingestions of other over-the-counter camphor-containing preparations.2-3 Two cases with documented serum camphor levels have prompted this report and discussion of camphor's role in the self-medication over-the-counter armamentarium. CASE REPORTS Case 1 A 3-year-old girl was transferred to the University of Michigan Medical Center from a local emergency room.

scholarly journals Severe thermal injury of larynx in a child following accidental ingestion of hot tea

2019 ◽  
Vol 6 (6) ◽  
pp. 2730
Author(s):  
Bendangienla Jamir ◽  
Senthil Kumar S. P. ◽  
Md Nawed Azam ◽  
Arun Kumar ◽  
Pupun Patnayak
Keyword(s):  
Thermal Injury ◽  
Burn Injury ◽  
Pediatric Population ◽  
Warning Signs ◽  
Radiographic Examination ◽  
Laryngeal Edema ◽  
Upper Respiratory Tract ◽  
Accidental Ingestion ◽  
Upper Gi Endoscopy ◽  
Flat Lesions

Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications. Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.

Medical Risks of Marijuana

2017 ◽  
Author(s):  
Keyword(s):  
Synthetic Cannabinoids ◽  
Accidental Ingestion ◽  
Secondary Exposure ◽  
Recreational Use ◽  
Medical Risks

In recent years, exposure to marijuana and other cannabinoids has become an increasing challenge. Legalization of marijuana for both medical and recreational use has already happened in some states, and more states are considering this. What is the risk of use or secondary exposure, including accidental ingestion, to marijuana or synthetic cannabinoids? https://shop.aap.org/pediatric-collections-medical-risks-of-marijuana-paperback/

Toxicity of traditional and soluble film automatic dishwashing tablets

2019 ◽  
Vol 39 (4) ◽  
pp. 433-439
Author(s):  
R Day ◽  
SM Bradberry ◽  
EA Sandilands ◽  
SHL Thomas ◽  
JP Thompson ◽  
...  
Keyword(s):  
Information Service ◽  
Severe Toxicity ◽  
Blurred Vision ◽  
Corneal Abrasion ◽  
Skin Exposure ◽  
Eye Pain ◽  
Automatic Dishwashing ◽  
Poisoning Severity Score ◽  
The Uk ◽  
Poisons Information

Introduction: Detergents used in automatic dishwashing machines are of two main types: traditional tablets that require removal from an external wrapper and newer soluble film tablets. Objective: To determine the toxicity of automatic dishwashing tablets. Methods: Telephone enquiries to the UK National Poisons Information Service were analysed for the period January 2008 to June 2019. Results: Ingestion: Ingestion was involved in 798 traditional tablet exposures and 725 soluble film exposures. Clinical features (Poisoning Severity Score ≥ 1) developed in 22.2% of patients ingesting traditional tablets and in 28.8% ingesting soluble film tablets; moderate or severe toxicity was rare (<0.5% for both traditional and soluble film tablets). Children (≤5 years) significantly ( p < 0.0001) more often developed features following ingestion of soluble film ( n = 193, 28.2%) than traditional tablets ( n = 134, 19.1%). In contrast, adults more often developed features following ingestion of traditional than soluble film tablets, although this difference was not statistically significant. Eye exposure: The eye was involved in only 26 of 1539 exposures; 17 of 26 exposures resulted in ocular features. The most commonly reported features were conjunctivitis, eye pain and blurred vision, although one patient sustained a corneal abrasion and developed loss of vision. Skin exposure: Thirty-four of 1539 exposures involved the skin but only 3 developed dermal features which were minor. Conclusions: Children (≤5 years) significantly more often developed features following ingestion of soluble film than traditional tablets, although the likelihood of a child developing features was relatively low (<30%) and features that did develop were almost always mild. In contrast, adults more often developed features following the ingestion of traditional than soluble film tablets. Overall, the eye was involved in only 1.7% of exposures and only one patient sustained a corneal abrasion.

Foley Catheter and Esophageal Foreign Bodies

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 791-791
Author(s):  
James E. Arnold ◽  
Diana Radkowski
Keyword(s):  
Success Rate ◽  
Cost Reduction ◽  
Foreign Bodies ◽  
Foley Catheter ◽  
Esophageal Disease ◽  
Fluoroscopic Guidance ◽  
Relative Safety ◽  
History Of ◽  
Esophageal Foreign Bodies ◽  
Clear Presentation

Dr Schunk and colleagues1 have provided a very clear presentation of their use of the Foley catheter with fluoroscopic guidance for removal of esophageal foreign bodies in children. They cite their high success rate and relative safety and infer that this is the procedure of choice based primarily on cost reduction. They properly point out that fluoroscopic-guided catheter extraction should be applied only to blunt foreign bodies that have been lodged for 3 days or less, and there should be no history of esophageal disease.

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