In message <[log in to unmask]>, Dr D G Williams <david-
[log in to unmask]> writes
>Further to the discussion on thyroxine overdose, while I have never been
>asked to deal with that, I have, over the years, had some fairly rum
>requests following junior medical staff telephoning a "poisons centre"
>(unspecified). The local poisons centre in Newcastle has now issued
>guidelines for the clinical management of common overdoses, including
>which laboratory investigations should be done in given cases including
>requests for assays (for drugs) which are simply not available. While
>this is laudable, we still find that these guidelines are not being
>followed, and we still recieve unusual requests following a telephone
>call to a "poisons centre".
>Am I alone in thinking that it is about time somebody took a good hard
>look at the quality and appropriateness of the advice offered? In my
>experience, the advice usually comes from somebody sitting in front of a
>database.
>
>David Williams
>
Further to the discussion about overdoses, when I was SR at the West
Midlands Poisons Unit, the staff reading out the information from the
(Edinburgh) database were the nursing staff on the Poisons Ward who had
a much more practical and hard-nosed attitude towards what was necessary
although they were trained to give out the information on the screen and
give limited practical advice. If necessary, there was always a medic.
on call for further advice on patient management. The situation may not
now be the same, but it might be worth finding out what the West
Midlands Unit (at City - old Dudley Road - Hospital, Birmingham) offer
in the way of advice. As far as analyses were concerned, the Toxicology
lab. at the Hospital would provide a very wide range of tests out of
hours - far wider than normally available, but although we made use of
the standard repertoire, the exotic tests were rarely requested out-of-
hours. There are very few situations in which tests cannot be delayed
until the next morning. As far as thyroxine is concerned, propanolol is
a fairly good treatment for symptoms.
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
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