Veterinary and human toxicology
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Comparative Study
Ipecac-induced emesis and gastric lavage are equally unpleasant.
It has been widely held that gastric lavage is more unpleasant than ipecac-induced emesis. In fact, patients are occasionally threatened with large rubber tubes in order to persuade them to drink ipecac. To confirm that this assumption exists, we asked 41 emergency physicians and nurses who had never personally undergone either procedure to estimate the discomfort of each using a 10 cm unsegmented visual analog scale. ⋯ Among these who had actually experienced both, there was no significant difference between the mean scores for lavage (4.09) and emesis (4.62) (P greater than 0.5, paired t-test). The mean score difference (lavage minus emesis) for the "naive" group was significantly greater than for the experimental group (1.52 vs -.53, P less than .001, unpaired t-test). Among normal volunteers, ipecac-induced emesis and gastric lavage are equally unpleasant gastric emptying procedures.
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Myonecrosis is an unusual sequelae to carbon monoxide poisoning with only 16 cases having been reported in the English-language literature. At the University of Illinois Hospital, we encountered a 25-year-old fire academy student who presented to our Emergency Department with a carboxyhemoglobin level of 16% following a training exercise in a smoke-filled room. The patient was not wearing a self-contained breathing apparatus and his duration of exposure was 7-8 min, by which time he had blacked out for about 1 min. ⋯ No oliguria was noted and the CPK fell to 893 five days later. This is the only case in the English-language literature who developed myonecrosis from carbon monoxide, despite hyperbaric oxygen treatment. We believe that this case demonstrates that hyperbaric oxygen cannot prevent the development of myonecrosis induced by carbon monoxide.
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1.25 g acepromazine maleate was consumed by a young woman in an unsuccessful suicide attempt. The drug is used extensively as an anesthetic premedication in veterinary practice. The woman had worked as a lay veterinary assistant. The clinical signs of toxicity were in part consistent with phenothiazine over-dosage in the human and were inconsistent with signs usually observed in animals.
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The use of OHB12 in the prophylaxis of CN intoxication resulting from SNP infusions is well documented in the literature. However, data is lacking to support its use as an antidote once signs and symptoms have developed. Because of the efficacy of oxygen therapy combined with supportive therapy and nitrite/sodium thiosulfate administration, the use of OHB12 as an antidote cannot be recommended at this time. Further studies are needed to determine efficacy, dosing, mode of administration and comparative trials to other antidotes.