General Approach to the Poisoned Patient

2020 ◽  
Author(s):  
Emily Gordon ◽  
Steven B Bird
Keyword(s):  
Suicide Attempts ◽  
The United States ◽  
Critically Ill Patient ◽  
Accidental Poisoning ◽  
Poison Control ◽  
Drug Abusers ◽  
Stepwise Approach ◽  
Work Related ◽  
Accidental Overdose ◽  
Digitalis Glycoside

Poisoning and ingestions constitute an increasing amount of morbidity and mortality nationwide. According to the American Association of Poison Control Centers (AAPCC), 2.2 million exposures were reported in 2013, and ingestions are currently the leading cause of injury-related death in the United States. Exposures include intentional overdose or suicide attempts, accidental overdose in drug abusers or children, and work-related injuries or acts of terrorism. According to the AAPCC, 50% of exposures are in children less than 5 years old and 80% of exposures are unintentional. When it comes to the unstable undifferentiated and possibly poisoned patient, one must take a stepwise approach similar to that for any critically ill patient, This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of poisoning. Figures show The Full Outline of Unresponsiveness (FOUR) scale, a patient with methemoglobinemia, a hand with scaling due to mercury poisoning, an electrocardiogram with examples of QT prolongation and QRS widening, and an electrocardiogram of bidirectional ventricular tachycardia, pathognomonic of digitalis glycoside poisoning. Tables list a stepwise approach to a potentially poisoned patient, a general approach to the poisoned patient,  heart rate, toxidromes, anticholinergic toxidrome, cholinergic toxidrome, Glasgow Coma Scale, toxins and associated odors, electrocardiogram findings, causes of anion-gap metabolic acidosis, and antidotes.  This review contains 5 highly rendered figures, 13 tables, and 23 references Key words: Poison ingestion, Accidental poisoning, Toxidrome, Accidental overdose

NEWS AND ANNOUNCEMENTS

PEDIATRICS ◽  
1959 ◽  
Vol 24 (4) ◽  
pp. 689-690
Keyword(s):  
Public Health ◽  
United States ◽  
Annual Meeting ◽  
American Association ◽  
The United States ◽  
Educational Programs ◽  
Morning Session ◽  
Accidental Poisoning ◽  
Poison Control ◽  
Poison Control Centers

The second annual meeting of The American Association of Poison Control Centers will be held on October 6, 1959 at The Palmer House, Chicago, Illinois. An all-day meeting is scheduled: The morning session will be devoted to business activities; during the afternoon, papers on research, clinical and public health aspects of poisoning will be presented and discussed. The Association was organized in October 1958 to promote the exchange of information among its members on various aspects of acute accidental poisoning. It also expects (1) to promote amid encourage investigation into methods for treating such cases of poisoning and (2) to develop educational programs for their prevention. Its members are, for the most part, connected is some capacity with poison control and information centers in the United States and Canada.

"SUICIDE" AS SEEN IN POISON CONTROL CENTERS

PEDIATRICS ◽  
1971 ◽  
Vol 48 (6) ◽  
pp. 914-922
Author(s):  
Matilda S. McIntire ◽  
Carol R. Angle
Keyword(s):  
Mental Health ◽  
United States ◽  
Behavior Problems ◽  
Suicide Attempts ◽  
The United States ◽  
Poison Control ◽  
Age Group ◽  
Abrupt Increase ◽  
Poison Control Centers ◽  
History Of

Of 1,103 cases of poisoning, ages 6 to 18, admitted to 50 poison control centers during 1 year, 13% were considered unintentional, 13% "trips," 26% suicide attempts, and 48% suicide gestures or affect reactions. The youngest age group, 6 to 10, is 63% male, 40% Negro, and about one-half give a history of precipitating stress or current or prior referral for behavior problems. The abrupt increase in self-poisoning in girls at age 12 peaks at age 16, while male paisonings continue to increase with age. An admittedly immature concept of death was retained by 16% of the 17 to 18-year-olds. In the five deaths (mortality 1: 220 hospitalized self-poisonings), lethality of intent was presumed low with death the result of a toxicologic mishap. The estimate of about 115,000 self-poisonings annually in the United States, ages 6 to 18, defines a mental health problem of the first magnitude, but open to epidemiologic analysis by relatively simple techniques.

Incidence, Distribution, and Determinants of Suicide by Self-Poisoning in two Egyptian Provinces

2021 ◽  
Vol 15 (12) ◽  
pp. 3571-3575
Author(s):  
Zeinab A. Kasemy ◽  
Safaa A. Amin ◽  
Asmaa F. Sharif ◽  
M. M. Fayed ◽  
D. E. Desouky ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Accidental Poisoning ◽  
Poison Control ◽  
Poison Control Center ◽  
Aluminum Phosphide ◽  
Continuous Increase ◽  
Control Center ◽  
Two Phases

Objectives: Suicide by self-poisoning is a serious public health problem that accounts for global morbidities and mortalities. This work aims to study the incidence, trend, and determinants of suicide by self-poisoning in two Egyptian provinces. Methods: The current study is a bi-designed two-phases observational study carried out in two Egyptian poison control centers including Menoufia Poison Control Center (MPCC) and Tanta Poison Control Center (TPCC). A total of 7,802 patients were enrolled. The first phase of the current study was conducted retrospectively to show the trend of suicide attempts over 2016, 2017, and 2018 when the cases diagnosed as suicide by self-poisoning were extracted from medical record. The second part was conducted prospectively (January 2019-Januaray 2020) among cases of suicide by self-poisoning and accidental poisoning. Results: The current study revealed that incidence of poisoning exposure no matter what its type represented 34.99/100,000 (CI95%: 33.84–36.20) distributed as 28.18/100,000 (CI95%: 27.14–29.26) for suicide by self-poisoning and 6.82/100,000 (6.32–7.36) for accidental poisoning. The suicide by self-poisoning death rate represented 2.08/100,000 (1.90–2.49). The suicide by self-poisoning was significantly associated with young age <25years, low socioeconomic status, being a student or not working. Conclusion: Suicide by self-poisoning shows a continuous increase across time raising a serious concern. Collaborative Efforts are required by to conduct health education and enforce legislation to overcome this serious condition. Keywords: Aluminum phosphide; Egypt; pesticides; self-poisoning; suicide

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽  
2020 ◽  
pp. 1-5
Author(s):  
Shannon Lange ◽  
Courtney Bagge ◽  
Charlotte Probst ◽  
Jürgen Rehm
Keyword(s):  
United States ◽  
Suicidal Ideation ◽  
Random Effects ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
The United States ◽  
Individual Level ◽  
The Past ◽  
Meta Analyses ◽  
Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

scholarly journals The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement

2021 ◽  
Vol 10 (16) ◽  
pp. 3454
Author(s):  
Joep G. J. Wijnand ◽  
Devin Zarkowsky ◽  
Bian Wu ◽  
Steven T. W. van Haelst ◽  
Evert-Jan P. A. Vonken ◽  
...  
Keyword(s):  
Staging System ◽  
The United States ◽  
Lessons Learned ◽  
Observer Agreement ◽  
Lesion Length ◽  
Solid Base ◽  
Stepwise Approach ◽  
Additional Tool ◽  
Atherosclerotic Lesions ◽  
Stenosis Severity

Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.

scholarly journals The Ugly Side of Colchicine

2021 ◽  
Vol 9 ◽  
pp. 232470962110297
Author(s):  
Justin Cozza ◽  
Tuong Vi Cassandra Do ◽  
Shyam Ganti ◽  
Jayaramakrishna Depa
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Activated Charcoal ◽  
The United States ◽  
Multiple Organ ◽  
Poison Control ◽  
Fab Fragments ◽  
Early Use ◽  
Potential Use ◽  
Electrolyte Abnormalities

We report a rare case of a 32-year-old male who ingested 32.4 to 54 mg of colchicine and presented after 44 hours. He developed progressive multiple organ failure with shock, acute kidney failure, troponemia, pancytopenia, absolute neutropenia, disseminated intravascular coagulation, acute liver failure, rhabdomyolysis, and lactic acidosis. He also developed electrolyte abnormalities and refractory hypoglycemia. Initial treatment consisted of activated charcoal, fluids, and broad-spectrum antibiotics with supportive treatment of mechanical ventilation, hemodialysis, vasopressors, N-acetylcysteine, colony-stimulating factors, and blood products. Literature shows potential benefit of colchicine-specific Fab fragments for acute toxicity with limited studies and is not currently available in the United States. Further research for N-acetylcysteine protocol for acute liver failure in colchicine toxicity and potential use of colchicine-specific Fab fragments is needed. Our case demonstrates the importance of early use of activated charcoal for ingestion overdose with the incorporation of poison control into multidisciplinary team for coordinated patient care.

The MacArthur Maze Fire and Roadway Collapse: A “Worst Case Scenario” for Spent Nuclear Fuel Transportation?

2012 ◽  
Author(s):  
Christopher S. Bajwa ◽  
Earl P. Easton ◽  
Harold Adkins ◽  
Judith Cuta ◽  
Nicholas Klymyshyn ◽  
...  
Keyword(s):  
Nuclear Fuel ◽  
Spent Nuclear Fuel ◽  
Steel Structure ◽  
Nuclear Regulatory Commission ◽  
The United States ◽  
Severe Accident ◽  
Case Scenario ◽  
Worst Case ◽  
Work Related ◽  
Regulatory Commission

In 2007, a severe transportation accident occurred near Oakland, California, at the interchange known as the “MacArthur Maze.” The accident involved a double tanker truck of gasoline overturning and bursting into flames. The subsequent fire reduced the strength of the supporting steel structure of an overhead interstate roadway causing the collapse of portions of that overpass onto the lower roadway in less than 20 minutes. The US Nuclear Regulatory Commission has analyzed what might have happened had a spent nuclear fuel transportation package been involved in this accident, to determine if there are any potential regulatory implications of this accident to the safe transport of spent nuclear fuel in the United States. This paper provides a summary of this effort, presents preliminary results and conclusions, and discusses future work related to the NRC’s analysis of the consequences of this type of severe accident.

Recurrent Adolescent Suicidal Behavior

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 605-608
Author(s):  
Matilda S. McIntire ◽  
Carol R. Angle ◽  
Richard L. Wikoff ◽  
Marilyn L. Schlicht
Keyword(s):  
Adolescent Suicide ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Poison Control ◽  
Age Group ◽  
Emergency Room Visits ◽  
Suicidal Risk ◽  
Destructive Behavior ◽  
The Third ◽  
Completed Suicide

Suicide is the third leading cause of death among people in the age group 15 to 25 years.1 Self-destructive behavior in children and adolescents is a continuum that ranges from drug intoxications to gestures of low lethality to suicide attempts with high lethality of intent. In our survey of 1,100 self-poisonings in people aged 6 to 18 who were seen at poison control centers we found an incidence of 220 self-poisonings for every fatality.2 This is higher but comparable to other estimates of 50 to 150 suicide gestures for every reported death from suicide in the adolescent.3-6 Suicide attempts may account for 12% of all emergency room visits.7 This represents a public health problem of the first magnitude. It is ironically tragic that many of the adolescent suicide deaths are unintentioned-the victim did not really intend to die. In our collaborative poison study, for example, none of the six deaths could be called intended. The adolescents were not victims of suicide but of pharmacologic roulette. The single best correlate of suicidal risk appears to be lethality of intent. A diagnosis of suicide attempt, as contrasted to a gesture, implies both a lethality of intent coupled with a mature concept of death as an irreversible state. Lethality is defined by Shneidman8 as the probability of an individual's killing himself in the immediate future. In classifying all deaths as intentioned, subintentioned, and unintentioned as contrasted to the traditional classifications of natural, accidental, suicidal, and homicidal he has used the dimension of lethality to cut across the terms attempted, threatened, and completed suicide.

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