Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial.
Crotalidae Polyvalent Immune Fab (Ovine) has been the only antivenom commercially available in the US since 2007 for treatment of Crotalinae envenomation. Late coagulopathy can occur or recur after clearance of Fab antivenom, often after hospital discharge, lasting in some cases more than 2 weeks. There have been serious, even fatal, bleeding complications associated with recurrence phenomena. Frequent follow-up is required, and additional intervention or hospitalization is often necessary. F(ab')2 immunoglobulin derivatives have longer plasma half life than do Fab. We hypothesized that F(ab')2 antivenom would be superior to Fab in the prevention of late coagulopathy following treatment of patients with Crotalinae envenomation. ⋯ In this study, management of coagulopathic Crotalinae envenomation with longer-half-life F(ab')2 antivenom, with or without maintenance dosing, reduced the risk of subacute coagulopathy and bleeding following treatment of envenomation.
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Clin Toxicol (Phila) · Jan 2015
Randomized Controlled TrialThe efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial.
Hydrocarbons, especially kerosene (paraffin), are the most common agents causing childhood poisoning in low and middle income countries (LMICs). Aspiration of kerosene causes an inflammatory sterile chemical pneumonitis, which may increase susceptibility to secondary lower respiratory tract bacterial infection. This study aimed to assess the efficacy of prophylactic antibiotics in the management of kerosene-associated pneumonitis in children and to identify risk factors associated with severity or outcome. ⋯ Prophylactic antibiotics do not improve the outcome in children with mild respiratory illness after kerosene ingestion.
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Clin Toxicol (Phila) · Jun 2014
Randomized Controlled TrialIs oxygen required before atropine administration in organophosphorus or carbamate pesticide poisoning? - A cohort study.
Early and adequate atropine administration in organophosphorus (OP) or carbamate insecticide poisoning improves outcome. However, some authors advise that oxygen must be given before atropine due to the risk of inducing ventricular dysrhythmias in hypoxic patients. Because oxygen is frequently unavailable in district hospitals of rural Asia, where the majority of patients with insecticide poisoning present, this guidance has significant implications for patient care. The published evidence for this advice is weak. We therefore performed a patient cohort analysis to look for early cardiac deaths in patients poisoned by anticholinesterase pesticides. ⋯ We found no evidence of a high number of early deaths in an observational study of 1957 patients routinely given atropine before oxygen that might support guidance that oxygen must be given before atropine. The published literature indicates that early and rapid administration of atropine during resuscitation is life-saving. Therefore, whether oxygen is available or not, early atropinisation of OP- and carbamate-poisoned patients should be performed.
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Clin Toxicol (Phila) · Jan 2014
Randomized Controlled TrialA randomized controlled trial of a video module to increase U.S. poison center use by low-income parents.
U.S. poison centers decrease medical visits by providing telephone advice for home management of potential poisonings, but are underutilized by low-income African-American and Latino parents, and those with limited English proficiency, due to lack of knowledge and misconceptions about poison centers. ⋯ This video module, when presented by a community organization's instructors, was highly effective in improving knowledge, behavior, and behavioral intention concerning use of poison centers within a low-income, language-diverse population.
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Clin Toxicol (Phila) · Jul 2010
Randomized Controlled TrialDoes wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?
Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration. ⋯ The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.