Sorry, am I missing something?
Whereabouts is this list of antidotes?

James

James McFetrich
SpR Emergency Medicine
Northern Deanery
 
[log in to unmask]
 

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 14 March 2007 20:19
To: [log in to unmask]
Subject: Re: Antidotes

There is duplication of benzatropine and procyclidine for dystonic reactions
- and diazepam is listed as well but not for dystonia for which it is
perfectly suited (well, I personally haven't used diazepam for 15 years and
diazemuls for 5; midazolam and lorazepam are much more suitable) so that's
two can be ditched. 

Three agents are listed for cyanide poisoning. Why? Hydroxycobalamin is the
best current treatment, although to be perfectly honest if the patient has
reached an ED they will probably survive whatever.

Methylene blue is a Victorian antidote for methaemoglobinaemia - ascorbic
acid reduces the ferric ion instantly and doesn't turn the patient a
disconcerting greenish colour but pink.

Fomepizole and absolute alcohol are both listed for methyl alcohol
poisoning.

For what it is worth, Anexate is misspelt.

Bicarbonate is listed at an unnecessarily high concentration - 8.4% should
not be used clinically any more.

Hypertension is not a poisoning. Convulsions (more Victoriana) and agitation
are not poisonings.

Methionine (which is oral) and NAC are both listed for paracetamol
poisoning; as vomiting is a common feature of severe paracetamol poisoning
it is not wise to use tablets for treatment. Just list one.

The dose of glucagon listed has never worked for me for beta blocker
poisoning - there is a desperate need for a presentation of 20mg. I like
Steve Barden's definition of the minimum dose of glucagon as 1mg more than
your hospital holds.

If Vit K is mentioned so should FFP and F7a be.

Pralidoxime is listed as to be available within the hour but is stated to be
only held centrally.

There is not enough background to explain choices; look at the flumezanil
entry as this simply lists it as something not to be used!

And so on.

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Coats Tim - Professor of
Emergency Medicine
Sent: 14 March 2007 09:25
To: [log in to unmask]
Subject: Antidotes


 
Rowley,
Have started a new thread for this.
I was interested that you didn't like the antidote list, which I must say
that I thought was OK. This is an interesting area - what in particular
would you change? Regards, Tim.


-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 13 March 2007 23:48
To: [log in to unmask]
Subject: Re: Fitness to Drive leaflets

This thread stimulates me to think about advice sheets. We all have advice
leaflets/cards of various sorts but there is no standardisation of this. As
we even have a national standard list of antidotes (out of date and
duplicative, but never mind)I would have thought CEM ought to have a
standard set of advice boilerplates for local adaptation with phone numbers,
URLs etc. We are particularly proud of our head injury ones written with the
neurosurgeons, but we have just realised we don't have one for people sent
home after a procedure involving sedation, for example.

/Rowley./

> *From:* Vic <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Tue, 13 Mar 2007 07:54:48 -0000
> 
> I agree, but what happens if a patient with a retinal haemorrhage in
> his left eye drives over a twin baby buggy that Essex girl has pushed 
> in to the road. He will claim medical condition as an excuse and 
> doctor should have told him. "Doctor did tell you not to drive" says 
> prosecution, "but the doctor knew I had to get the car home".
> 
> It happened when I was a student, the doctor took a long time to get
> over the fact he hadn't made it very, very clear.
> 
> Vic
> 
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
> Sent: 13 March 2007 01:08
> To: [log in to unmask]
> Subject: Re: Fitness to Drive leaflets
> 
> Good points Vic, but I think a custodial sentence would be unlikely in

> this sort of scenario.
> 
> AF
> 
> ----- Original Message -----
> From: "Vic" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, March 12, 2007 4:11 PM
> Subject: Re: Fitness to Drive leaflets
> 
> 
> There are no patient leaflets as such, but look at
> http://www.dvla.gov.uk/medical/ataglance.aspx which gives you an Adobe

> .pdf file that you can print the appropriate pages from. Are you
> getting your staff to record that they have told the person they are 
> not fit to drive and to warn them that because they have been told 
> they are not fit to drive they are driving without insurance or a 
> licence, and therefore could be imprisoned if they have an accident 
> whilst ignoring your advice?
> 
> 
> 
> Vic Calland
> 
> 
> 
> -----Original Message-----
> From: Accident and Emergency Academic List 
> [mailto:[log in to unmask]] On Behalf Of Bell, Simon
> Sent: 12 March 2007 11:57
> To: [log in to unmask]
> Subject: Fitness to Drive leaflets
> 
> 
> 
> Dear list
> Not wanting to re-invent the wheel, does anyone have a patient
> leaflets on
> fitness to drive after certain medical diagnoses eg fits, TIA, Stroke,
> un-explained collapse etc.
> 
> I want such a leaflet to give out to those patients we discharge. I 
> would be most grateful if anyone feels they could share. Please email 
> me off the list [log in to unmask]
> Many thanks
> Simon
> 


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