Recent advances in injury prevention.
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Biomedical subjects
Publications and source records attributed to J Greensher.
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After reviewing the data associated with injuries and deaths to adolescents participating in the activities described above, the question repeatedly arises: Why does our society continue to accept and promote this toll of injuries and deaths? While waiting for answers from researchers, physicians must continue an advocacy role for measures of protection known to reduce the morbidity and years of life lost among the adolescent age group.
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The problem of toy-related injuries is a complicated one. The authors detail specific hazards related to toys, playgrounds, skateboards, and baby walkers. Guidelines are provided for toy suitability for children of all ages.
There is controversy regarding the best maneuver to expel a completely obstructing foreign body from the upper airway of a patient. Further study and research are needed. However, we recommend that no change in the present recommendations be made until these studies are accomplished. We have attempted to outline the major aspects of the controversy and give the rationale for the present recommendations.
This article reports five patients who had taken a substantial medication overdose and presented in coma. Two had taken a salicylate overdose and three a phenobarbital overdose (one of these ingested a combination of phenobarbital and phenytoin). The cases were treated by our standard protocol of supportive therapy and alkaline diuresis plus repetitive oral doses of activated charcoal (gastrointestinal dialysis). All patients were alert and oriented within 24 hours. Toxicokinetic analysis of the blood levels is discussed. Gastrointestinal dialysis represents a relatively noninvasive method that may benefit certain intoxicated patients even after systemic absorption has occurred. The technique and recommendations for its use are discussed and described in detail.
Activated charcoal, commonly recommended for treatment of chemical ingestions, is the residue from destructive distillation of various organic materials treated to increase its adsorptive power. Since there are no known side effects, the dose should be sufficiently large for optimum adsorption. In the literature, the recommended doses range from 30 gm to 120 gm, or in a charcoal-drug ratio of 10:1. For maximum effect, activated charcoal should be administered within 30 minutes of ingestion. It can be given while its effectiveness for a particular toxic substance is verified.
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This analysis of thirteen cases of lower airway foreign body aspiration in children reveals a high incidence of aspiration into the left main bronchus, and an increased incidence in older children. Early indentification of nonradio opaque foreign bodies such as food and plastic toys is difficult in the absence of a positive history. Suggestions are offered for prevention, early detection, and treatment.
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