( : ) 18 2000 12 19 2001 06 18 2001 10 30 1
2
89 12 19 90 6 18 2.1 2.1.1 2.1.2 24 Denver Health Medical Center 2.1.3 Dr. Richard C Dart 5 minute toxicology consult 2000 6 2.1.4 2.2 Dr Richard C Dart 2.2.1 Associate Professor of Surgery and Medicine, University of Colorado Health Sciences Center 2.2.2 Director, Rocky Mountain Poison & Drug Center (city and county of Denver) 2.2.3 Chief, Section of Clinical Toxicology, Division of Clinical Pharmacology and Toxicology University of Colorado Health Sciences Center 2.2.4 Chief, Medical Toxicology Service Denver Health Medical Center 2.2.5 American Board of Emergency Medicine, Medical Toxicology Sub-Board, 1993-98 3
2.2.6 American Association of poison Control Centers, 1994-current 2.2.7 Advisory Board, American Pharmaceutical Association, Responsible Use of Nonprescription products, 1998-current 2.2.8 American College of Medical Toxicology, Board of Directors, 1993-96 3.1 3.1.1 3.1.2 ---- 3.1.3 Denver Health Medical Center --- Acetaminophen Aspirin Ethylene Glycol 3.1.4 ---- Denver Health Medical Center Aspirin Acetaminophen Denver Health Medical Center Li Aspirin Acetaminophen Aspirin Acetaminophen BUN Creatinine PH 4
3.2 3.2.1 Rocky mountain Poison and Drug Center 3.2.2 Denver Health Emergency Medicine M&M Conference 3.2.3 University Hospital Emergency Medicine M&M Conference 3.2.4 Rocky Mountain Poison and Drug Center 3.2.5 Clinical Pharmacy Conference 3.2.6 Rocky Mountain Poison & Drug Center Research Conference 4.1 4.1.1 4.1.2 4.1.3 Acetaminophen Acetaminophen Acetaminophen Acetaminophen 5
4.2 4.2.1 4.2.1.1 4.2.1.2 4.2.1.3 Cd As Pb Hg Fe 4.2.1.4 1. Heterocyclic Antidepressants 2. SSRI s and Serotonin Syndrome 3. Lithium 4. Barbiturates 5. Phenytoin 6. Opioids 7. Clonidine 8. Toxic alcohols Ethylene Glycol Methanol 9. Cocaine 10. Amphetamines 11. Hallucinogens 12. Salicylates 13. Acetaminophen 14. Iron 15. Hydrocarbons 16. Caustic ingestions 17. Organophosphates 18. Cyanide 19. Carbon Monoxide 20. CV medicine 4.2.1 ( ) 6
( 3 5 minute Toxicology Consult) 1. ashes, ballpoint pen ink, baby products, bubble bath, candles, clay, cosmetics, pencil lead, shampoos, shoe polish, soap, toothpaste, white glue, erasers, pet foods, etc. 2. antacids, calamine lotion, birth control pills (if single ingestion), zinc oxide, water-soluble vitamins (excluding iron), corticosteroid (if single ingestion), etc. Clincal Toxicology, 38(1), 21-28(2000) 523 Physostigmine Cyanide antidote Package Hydroxocobalamine DMPS Ca-EDTA Methylene Blue DMSA 5.1.1 20 ( ) Cal. Gluconate Ointment (HF) HF Cal.gluconate 7
5.1.2 Hydroxocobalamine 6.1 6.1.1 6.1.2 6.1.3 (24 ) 6.1.4 VGHKS89-118 933868 8
6.2 6.2.1 ( ) Nitrite Nitrate Methemoglobinemia Ascorbic acid 15-20 Ascorbic Acid Methylene Blue 6.2.2 ( ) Lithium Aspirin Salicylates Theophylline Acetaminophen Acetaminophen acetaminophen 24 1. : 24 Acetaminophen 4 ( 150mg/kg) 8 10 Rumack-Matthew nomogram 9
NAC 17 Acetaminophen 24 2. Acetaminophen 24 4 ( 90mg/kg) Rumack-Matthew Nomogram NAC AST ALT PT/INR Acetaminophen NAC NAC Acetaminophen 36 7.1 24 24 7.2 10
7.3 7.4 8.1 8.1.1 8.1.2 8.1.3 8.1.4 8.1.5 8.1.6 8.1.7 9.1 9.2 9.3 Denver Health Medical Center 11
1. Hsin-Chen Ong, Chen-Chang Yang, Jou-Fang Deng, Inadequate Stocking of Antidotes in Taiwan, Clinical Toxicology, 38(1), 21-28(2000). 2. Richard C. Dart, The 5 minute Toxicology Consult. 3.,,, The Practical Pharmacoeconomic Evaluation of Kaohsiung Veterans General Hospital VGHKS89-118 4. Steven Curry, Methemoglobinemia, Annals of Emergency Medicine, 11:4 April, 1982. 5. Edwin K. Kuffner, Management of Acetaminophen Toxicity in the Intensive Care Unit, Journal of Intensive Care Medicine, 14(4) July / August 1999. 6.,,,, (,, ) 14 p.322-326. 1. Poisoning & Drug overdose 3th eds, 1999, Kent R. Olson, Appleton & Lange, ISBN0838516149 2. Clinical management of Poisoning and Drug overdose 1983, Haddad Winchester, W.B.Saunders, ISBN0721623425 3. 5 minute Toxicology Consult, 2000, Richard C Dart, Lippincott Williams & Wilkins, ISBN0683302027 4. Disposition of Toxic Drug and Chemicals in man, Randall C Baselt, Chemical Toxicology Institute, ISBN0962652334 5. Drug in Pregnancy and Lactation, Gerald G. Briggs, Williams & Wilkins, ISBN08976112 6. Toxicology of metals, Louis W Chang, Lewis 7. Toxicology - The basic science of poisons, Casarett and Doull s, MacMillan, ISBN0023646500 8. The Pharmacological Basis of Therapeutics, MacMillan, Goodman & Gilmans, ISBN0023447109 9. Toxicologic Emergenices, Gold Frank s, Appleton & Lange, ISBN0838531466 10. Medical Toxicology, Ellenhorn s, Matthew J Ellenhorn, Williams & Wilkins, ISBN0683300318 12
Inadequate Stocking of Antidotes in Taiwan. 1. Snake antivenin for agkistrodon acutus 2. Snake antivenin for hemorrhage 3. Snake antivenin for neurotoxic 4. Physostigmine 5. Cal-EDTA 6. Cyanide antidote kit 7. Deferoxamine 8. Flumazenil 9. Pyridoxine 10. Naloxone 11. N-acetylcystein(NAC) 12. Diphenydramine 13. Cal.gluconate 14. Phytonadione 15. Atropine 16. Methylene Blue 17. BAL (DMSA, DMPS) 18. Botulism ( ) 19. Calcium Gluconate Ointment ( ) 20. Snake antivenin for Vipera Russel Formosensis ( ) 13