By G. Hector. Michigan Technological University.
Aetiology Iron poisoning is usually seen in childhood and results Tricyclic antidepressant overdose from accidental ingestion of iron-containing medica- Deﬁnition tions such as vitamin preparations mistaken for sweets buy rogaine 5 60 ml on-line. Patients may de- Incidence/prevalence velop nausea generic 60 ml rogaine 5 otc, vomiting buy rogaine 5 60 ml mastercard, abdominal pain and diarrhoea cheap rogaine 5 60 ml on line. Late signs in severe overdose include hypotension, coma, hy- Pathophysiology poglycaemia and hepatocellular necrosis. Tricyclic antidepressants have anticholinergic, alpha- adrenergic blocking, and adrenergic uptake inhibiting Investigations properties. They also have a quinidine like effect on the Aserum iron level (ideally at 4 hours after ingestion) is myocardium. Clinical features Araised neutrophil count and serum glucose suggests r Common features include hot, dry skin, dry mouth, toxicity. There may r In severe poisoning (unconscious or hypotension) be increased tone, increased deep tendon reﬂexes and intravenous ﬂuids and desferrioxamine (a chelating extensor plantar responses. If the patient is comatose, agent for iron) should be commenced immediately all reﬂexes may be absent. Lithium overdose r Confusion, agitation and visual hallucinations may Deﬁnition occur during recovery. Lithium poisoning usually results from chronic drug ac- cumulation, accidental or deliberate overdose of lithium Complications carbonate. Aetiology/pathophysiology Investigations Lithium has a narrow therapeutic index (the levels at Arterial blood gases to check both pH and bicarbonate which it becomes toxic are only marginally higher than levels. U&Es and urine output duce toxicity, as may concomitant use of nonsteroidal should be monitored. Management Clinical features r Patients should be stabilised with management of air- Thereisgoodcorrelationbetweensymptomsandplasma way, breathing and circulation as required. Intravenous lidocaine may be Investigations of beneﬁt in treatment of cardiac arrhythmias; how- Serum lithium levels should be measured if chronic toxi- ever, it may precipitate seizures. Refractory should be taken 6 hours post-ingestion and 6–12 hourly seizures require intubation, ventilation, paralysis and thereafter. Persisting hypotension may require intravenous ﬂu- ids, glucagon bolus and infusion (corrects myocardial depression) and in severe cases inotropes. Management In chronic accumulation, stopping lithium is often all Prognosis that is needed to alleviate symptoms; however, patients Tricyclic antidepressant overdose carries a high mor- may require other treatments for bipolar disorder. All patients should be surviving patients most cardiac complications resolve observed for a minimum of 24 hours post-ingestion. In refractory hypotension, inotropes may 532 Chapter 15: Overdose, poisoning and addiction be required. The mortality in chronic poisoning is 9%, but as high r In severe poisoning the treatment of choice is as 25% in acute overdose. Clinical symptoms may per- haemodialysis which is considered if there are any sist after the serum lithium levels have fallen and 10% of neurological features or if very high plasma levels are patients with chronic poisoning have long-term neuro- detected. This module focuses on drugs—powerful substances that can change both the way the brain functions and how the brain communicates with the body. Some drugs are helpful when used properly: they fall into the category of medicines. The purpose of today’s activity is for students to begin to understand how different drugs can affect the body. Learning Objectives • Students learn about different drugs and how they affect the body. Then they are invited to question whether they think these substances are helpful or harmful. Background When we refer to “drugs” during this module, we divide them into two categories: helpful medicines and harmful drugs. Medicines are helpful only when they are given at the right times in the right amounts by people who care about children—parents, doctors, dentists, and other caregivers. In this module, drugs classifed as medicines include the following: aspirin or Tylenol, antibiotics, fuoride, and immunizations. With medicines, however, it is extremely important to follow the dosage prescribed by the health care provider. Although caffeine itself isn’t a medicine, it is an ingredient found in some medications. Nicotine itself is not harmful in the doses found in cigarettes, but it does produce addiction. Using the fact sheets at the back of this guide, students work either in small groups or as a class to identify drugs from riddles. After children guess the name of the substance, ask them whether they think its effect is helpful or harmful. Questions like these will help students better understand whether it is appropriate to take certain substances and, if so, how much is acceptable. During the discussion portion of the module, you have the option of giving the students a second riddle, which explains how each drug affects the body. The trading cards reinforce the information in both riddles and are an effective way to convey complex, unfamiliar information. Some substances that are acceptable for adults are not acceptable for children because their bodies are smaller and they are still growing. For example, some people fnd that drinking a glass of wine with dinner is pleasurable, but drinking a whole bottle of wine could be dangerous. You could do it as a whole-class exercise, by dividing the class into two teams, or by dividing the class into groups of three students each. Ask students what drugs they are familiar with and what they know about each drug. Tell the students that they will be learning about the following drugs: aspirin/ Tylenol, fuoride, immunizations, antibiotics, alcohol, caffeine, nicotine, and illegal drugs. The reader will ask the questions identifed on the fact sheet; the responder will answer them; and the recorder will write down the responses on the recording sheet. If you decide to do the activity this way, make sure that each student has a chance to do each job. If you are going to do the activity as a class, you probably don’t have to make extra copies. Depending on your teaching approach, decide whether you are going to distribute them to the class. Try to have at least one other adult in the room while the children are doing this activity. Use the riddles on the handout “Learn More About Drugs” to give the students more information about each of these substances. Lead a discussion about the different drugs the students learned about and answer any questions they may have. One circle should say “Drugs That Help the Body,” and the other circle should say “Drugs That Hurt the Body.
When submitting dead fish for post mortem examination they should be wrapped in moist paper to prevent them drying out and then refrigerated but not frozen rogaine 5 60 ml generic. Fish decay very quickly but a fish refrigerated soon after death may be held for up to twelve hours before examination and sample fixation discount 60 ml rogaine 5. Keeping samples frozen Dry ice (solid carbon dioxide) or in some circumstances liquid nitrogen can be used to ship frozen specimens order rogaine 5 60 ml without prescription. The gaseous carbon dioxide given off by dry ice can also damage some disease agents and this must be considered before using it for tissue transport order rogaine 5 60 ml. As the volume of both dry ice and liquid nitrogen expand as they change to gas, specialist containers that allow for this expansion are needed for their transportation. Note: Shipment of formalin, dry ice, liquid nitrogen and alcohol is regulated in many countries and must be cleared with a carrier before shipping. Samples preserved in formalin, other chemical fixative or alcohol can be transported without chilling. Shipping It is important to pack any space within packages with a substance such as newspaper which will prevent movement of containers, act as a shock absorber and may also soak up any potential leakages. Packaging and labelling Packaging and labelling of specimens must conform to the regulations of the country from which the package is sent and also those of the country in which it will be received (if it is being sent to a laboratory in another country). It is important to mark the outside of the package with the required labelling regarding the type of specimen being transferred and where necessary the method of cooling (e. Advice from national authorities about permit requirements must be sought prior to collection and transportation of samples. Carriers Samples should be shipped where possible by carriers that can guarantee 24-hour delivery to the diagnostic laboratory. Where possible arrange for collection of sample packages from the point of origin to avoid delays. When shipping arrangements have been made, contact the diagnostic laboratory to provide them with further details including estimated time of arrival and any shipping reference numbers. Chapter 3, Field manual of wildlife diseases: general field procedures and diseases of birds. Detailed field observations during the course of an outbreak and information about events preceding it, may provide valuable data on which to base a diagnosis and corrective actions. It is important for the information gatherer to keep an open mind about the potential cause of the problem. Some information which may seem irrelevant in the field may become very important when piecing together the events leading up to an outbreak. A thorough chronology of events is key to diagnosis and disease control operations, and is almost impossible to obtain some time after the outbreak has occurred. A key concept is that of explaining to the diagnostician how the affected individuals relate to the whole population at risk. As an example, 100% of the dead animals may be adult males but the population present (i. How to record data It is important to record as much relevant information as possible as soon as events unfold. Photographs and video footage can quickly convey specific information such as land use, landscape, environmental conditions, gross lesions and the appearance of clinical signs in sick animals. Sources of information may include local people, landowners and agencies working in the area preceding or during an outbreak. Information should be passed to the diagnosticians as soon as possible, updating them as appropriate. Which data to collect Checklist 3-3 provides a summary of the information to collect at a suspected outbreak. A broad range of data should be collected at a suspected outbreak, including: Population(s) at risk i. A broad range of affected host species may suggest a storm, other sudden environmental event or toxic/poisoning incident, whereas a narrow host range, with other species present and at risk yet unaffected, may indicate a specific infectious agent. The proportion of animals affected in the population provides information about the nature and seriousness of the problem. Statements such as ‘100 dead birds were found’ are meaningless without an indication of what proportion of the population this constitutes. Ensure that demographic data collected from affected animals are related to that of the wider population present. For example, if all the animals were juveniles yet this was the population present and at risk at the time, then this needs to be explicit to the diagnostician. Species affected It is important to note as much detail as possible regarding the species affected. An understanding of the ecology of the affected species will help to determine why some species might have been affected and others not. As an example, some species may have avoided exposure to an infectious source or poisoning event through differences in feeding behaviour. Age Where possible assess the age of the population at risk and the age of those individuals affected. Other diseases affect all ages although those that are older or younger may be more susceptible due to other stresses. Diseases may also affect age groups differentially due to behavioural differences in feeding habits, for example. Sex Where possible assess the sex ratio of the population at risk and the sex of those animals affected. There may be inherent physiological or behavioural reasons for sex-related differences in susceptibility to disease. Number sick/dead The number of sick individuals compared with the number of deaths can help to determine the nature of the disease and the length of time it takes to become fatal. Make an assessment of the number of sick or dead animals which may have been lost to predators and scavengers or that may have decomposed. Clinical signs As much detail as possible should be recorded about clinical signs observed in sick individuals, including changes in behaviour, physical features or temperament. Photographs and video footage can be extremely helpful in recording this information. Estimation of time of disease onset Establishing a timeline of events in an outbreak is crucial. When estimating the time of onset of a disease incident, aspects to be considered include: The earliest date when people would have been on site to observe individual animals showing signs of illness or mortalities. The number and type of scavengers should be assessed to determine how long carcases are likely to remain in view. Air, water and soil temperatures will affect rates of decomposition and should be taken into account when estimating how long individuals have been dead. Any change in coat or plumage (including stage of moult) between live and dead individuals as this can help pinpoint how long ago an individual died. Size of any dead young compared with known growth rates (and size of living young) to help assess how long ago the individual died. Type of habitat/area and land use Identify the habitat type, including soil and vegetation present.