Management of nerve agent (NA) poisoning requires recognition of the syndrome and availability of the antidote. It is important to remember that besides the classic “SLUDGE” and “Killer B’s,” there is also the nicotinic syndrome which can cloud the clinical presentation. Add the “weekdays” mnemonic for nicotinic effects to your list of symptoms in NA toxicity.
Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).
Hydrocodone/acetaminophen street drugs actually contained huge doses of fentanyl and caused numerous deaths. This type of overdose required unusually large doses and prolonged drips of naloxone for reversal.
Short Attention Span Summary
Detergent packets are dangerous when kids munch them. And the number of exposures is increasing. I would like to advocate for making the pods less eye appealing to kids. If it was packed to look like a piece of broccoli, exposures would stop overnight. In all seriousness, they look like candy - that's a problem.
Pediatrics. 2016 May;137(5). pii: e20154529. doi: 10.1542/peds.2015-4529.
1Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; School of Medicine, University of Washington, Seattle, Washington;
2Central Ohio Poison Center, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.
3Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio;
4Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and Child Injury Prevention Alliance, Columbus, Ohio firstname.lastname@example.org.
This study analyzes and compares pediatric exposures to packet and nonpacket forms of laundry and dishwasher detergents in the United States.
Data from the National Poison Data System involving exposures to laundry and dishwasher detergents among children younger than 6 years old from 2013 through 2014 were analyzed.
There were 62 254 children younger than 6 years old exposed to laundry and dishwasher detergents from 2013 to 2014. The number of exposures to detergent increased over the study period, but the increase was greatest for laundry detergent packets (17.0%) and dishwasher detergent packets (14.0%). Eighty-five percent of children were exposed through ingestion. The odds of clinical effects (3.9-8.2), hospitalization (4.8-23.5), intubation (6.9-71.3), and serious medical outcomes (8.4-22.6) were significantly higher for laundry detergent packet exposures than for other types of detergent. There were 117 children who required intubation, and 104 of these were exposed to laundry detergent packets. There were 2 deaths, and both were associated with laundry detergent packets.
This national study demonstrates that pediatric laundry detergent packet exposures are more severe than laundry detergent nonpacket and dishwasher detergent (packet and nonpacket) exposures. Pediatric exposures to laundry detergent packets increased by 17% during the study period nationally and should be closely monitored to assess the effectiveness of the newly adopted voluntary safety standard; this standard should be strengthened if the number of exposures does not demonstrate a substantial decrease.
Copyright © 2016 by the American Academy of Pediatrics.
PMID: 27244825 [PubMed - in process]