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© Borgis - Postępy Nauk Medycznych 9/2010, s. 758
Comment
Acute poisoning with exogenous substance independently from the intention of victim is the state potential danger to the lives. For the smooth conduct it is necessary to early diagnosis on the basis of clinical symptoms and the clinical examination. Results of laboratory tests and auxiliary toxicological significance, in particular, that in the case to implement rescue procedures (decontamination, helping eliminate, give references) important is the time, which expired since exposure.
The full assessment of the degree of exposure of the patient is difficult. The reliability facts obtained from poisoning victims intended is uncertain. If not patient may or do not want to provide information, question needs to be addressed to the family and friends or persons providing first aid. Valuable is gaining empty vials or containers with taken substance inside. Important for the proper diagnosis and treatment are information of the name, the quantities, the time it measure and by its adoption, the subjective and objective symptoms, which appeared after his you of the quantity and type constantly medicines taken by the patient, abuse of a previous cases medicines, on the associated been injuries, as to the possible pregnancy.
The health system in which a patient with the prevailing showing symptoms of the one organ was transported by road to the chambers entertainment various branches were causing that many poisoning incidents was not properly diagnosed. Setting up Emergency Departments, in which diagnosed are patients is from many organs, causes, that the patient receives, in the early phase disease, the wider diagnosis and by the faster aiming proper identification and implementing an effective treatment.
Multi-departmental hospital rescue branches have become so often place diagnosis and hospital patients with stringent poisoning in particular in the absence of any branches toxicology in the area. It is a natural consequence accidental poisoning and increasing the number targeted, especially among young people mainly from the environment big. Now the term toxicity is not confined to the relationship has traditionally been identified as "poisons” but is based on biological effects of the substance at the molecular level, depending on its concentration, the dose and/or exposure time. In this approach compounds commonly used and considered potentially non-toxic may pose a threat to health and even life.
The problem is issued without prescription pharmaceuticals group, which is available in each store. Among them there is an acetaminophen, which adopted the doses toxic causes severe organ liver requiring high specialized medical treatment in toxicological centers using albumin dialysis in the system MARS. Available without prescription some No steroidal anti-inflammatory agents adopted in toxic dose may cause symptoms life-threatening inter alias in the form of metabolic, coma, acute renal failure, disorders or liver damage freezing. With due to the significant fixation of the medicinal product with plasma proteins hemodialysis unfortunately is ineffective. It is difficult not to mention toxic spirit, which poisoning is in most cases fatal. The reason for that, alongside the mechanism of action toxins, is also too long period of time elapsed from exposure to obtain medical assistance and often unknown interview. Only a significant degree metabolic acidosis moves to seek in this direction.
11 Years of operation Emergency Departments in Poland may authorize the summary achievements of the units in the diagnosis and treatment acute poisoning. These developments are not to overestimate in centers, in which as mentioned above, there is no branches toxicological and the quantity incidence in cases necessitates the design and implementation of clinical practice their own algorithms diagnostic-medicinal products. Thus the proposal cycle papers concerning types of poisons and their effect in the form of acute poisoning, diagnosis and treatment of poisoned victims in hospital branches rescue, possible problems, in particular on the part of the respiratory tract. In further parts have been discussed most frequently encountered poisoning plant protection products, fungi, acute cyanide poisoning, finally, the effect of smarts and attempts to suicide. Last work is an analysis deaths of patients requiring intensive therapy at hospital Emergency Department USK in Bialystok during the period 3 years.
Presented work, although referred to as review, are synthesis our knowledge of the toxicology and experience acquired in the diagnosis and treatment poisoning in hospital Emergency Department. Białystok and Podlaskie Voivodeship has its own particular characteristics. We have here much poisoning by plant protection products, mushrooms and relatively much suicide and effects of the action of smarts. Practically there is no day we concept does not face problems with the toxicology. Deprived support centre toxicological solved these problems to good effect and very rarely site sick to specialized centers. This concerns the poison unknown substances, of a hard and extremely unusual course. A small volume put us at the disposal of "Progress in Medicine” number does not allow us to more comprehensive discussion topics included, this is particularly ever more frequent poisoning incidents and suicide in children and young people.
Prof. dr hab. Jerzy Robert Ładny
Kierownik Zakładu Medycyny Ratunkowej i Katastrof UM w Białymstoku
Konsultant wojewódzki w dziedzinie medycyny ratunkowej woj. podlaskiego
Postępy Nauk Medycznych 9/2010
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