Chemical decontamination.
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Decontamination↗
Biomedical subjects
M J McMullen
Publications and source records attributed to M J McMullen.
Repetitive doses of activated charcoal in the treatment of poisoning.
Activated charcoal has found a renewed role in the management of overdosed patients. Routinely administered to reduce the gastrointestinal (GI) absorption of many drugs, growing evidence indicates that repeated doses of charcoal also may enhance drug elimination. Some drugs are excreted into the bile or gastric fluids (phencyclidine, digoxin) and are reabsorbed. Other drugs (theophylline, phenobarbital) can diffuse from the plasma into the lumen of the GI tract. Activated charcoal is administered at regular intervals to sequester these toxins in the GI tract, eventually causing their excretion in feces. This article reviews the evidence for the safety and efficacy of repetitive charcoal therapy. While supportive management remains the mainstay of therapy in poisoned patients, activated charcoal is inexpensive, effective, simple to administer, and may obviate the need for more invasive methods of toxin removal.
Acute Disease↗
Toxic smoke inhalation: cyanide poisoning in fire victims.
The most common cause of death in fires is the inhalation of noxious gases rather than thermal injury. Hydrogen cyanide gas, the most toxic product of combustion, seldom is recognized as a significant hazard in smoke inhalation. During the first four months of 1986, toxic amounts of cyanide were found in four of the six fatalities from house fires in Akron, Ohio. These cases illustrate the increasing frequency of cyanide poisoning in household fires. Sources of cyanide toxicity include the increased use of synthetic polymers in building materials and furnishings. Prompt recognition of and therapy for cyanide intoxication may reduce the morbidity and number of delayed deaths in fire victims. The key point in the diagnosis of cyanide poisoning is a high index of suspicion. The clinical presentation of cyanide intoxication, its diagnosis, and subsequent treatment are discussed. Finally, a prehospital protocol for treating smoke-inhalation victims who may have been exposed to cyanide gas is suggested.
Aged↗
Short-term follow-up of emergency department patients in a medical center environment.
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Aftercare↗
The geriatric obstacle course: a training session designed to help prehospital personnel recognize geriatric stereotypes and misconceptions.
A significant proportion of ambulance transports to the Emergency Department involve elderly patients, and this use of EMS services by the elderly is expected to increase. Emergency medical technicians (EMTs) may have preconceived notions about the behavior they observe in this group of patients, who tend to be difficult to assess. To provide EMTs with the perspective from which their elderly patients view the situations in which they find themselves, we developed and implemented training scenarios in which the EMTs were required to play the role of the geriatric patient. The EMTs' evaluations of the sessions were enthusiastically positive and indicated that the course did enable them to reevaluate their attitudes toward elderly patients. It is our conviction that this type of sensitivity training is an easily implemented and highly valuable method of augmenting the facts and algorithms taught to these prehospital care providers.
Activities of Daily Living↗
Core temperature monitoring of firefighters during hazardous materials training sessions.
OBJECTIVE: To determine core temperature (Tc) elevations in hazardous materials (HazMat) technicians wearing level-A fully encapsulated, chemically resistive suits (FECRSs) during training scenarios. DESIGN: Cross-sectional, observational feasibility study with Institutional Review Board approval. SETTING: HazMat training scenarios held during the summer of 1994. Weather conditions included both rainy and sunny days, with a mean ambient temperature of 75.8 degrees F (24.3 degrees C) (range 69-83 degrees F [20.6-28.3 degrees C). PARTICIPANTS: Nine male firefighters participating in training scenarios in the Midwestern United States. INTERVENTIONS: Each volunteer swallowed a capsule containing a Tc sensor developed by the National Aeronautics and Space Administration. The capsule continuously monitored Tc and stored data in an ambulatory recorder worn under the level-A FECRS during training. RESULTS: Mean age of the volunteers was 34 years, mean weight was 92.6 kg, and average baseline Tc was 36.7 degrees C (97.1 degrees F) (range 35.3-38.2 degrees C [95.5-100 degrees F]). Time in the FECRS averaged 25.4 minutes (range 14-35 minutes). All subjects demonstrated increased Tc while in the suit; the mean Tc increase was 0.8 degree C (1.4 degrees F) (range 0.2-1.3 degrees C [0.4-2.3 degrees F]). The Tc continued to increase during wet decontamination procedures and after suit removal. Mean heat storage values (delta Tcx LBMx 3.47 kJ) were calculated, and found to be moderately elevated to 3.6 kJ/kg (range 2.1-4.6 kJ/kg). CONCLUSION: These observations support the validity and significance of implementing prophylactic measures for firefighters using protective clothing. Simple protective measures include enforced time limitations, hydration, and efforts to minimize heat buildup by avoiding both direct sunlight and unnecessary time encapsulated in the suit.
Adult↗
Continuous core temperature monitoring of search and rescue divers during extreme conditions.
OBJECTIVES: To study the feasibility of continuously monitoring core temperatures of search and rescue divers, to compare core temperature gradients occurring during warm and cold diving events, and to identify conditions under which divers are subjected to extreme temperatures. METHODS: Between June 1994 and March 1995, emergency medical technicians (EMTs) from two midwestern dive teams volunteered to ingest an encapsulated temperature sensor developed for the National Aeronautics and Space Administration. The capsule monitored continuous core temperatures and transmitted the data to a recorder worn under the divers' dry suits. RESULTS: Twenty male EMTs, mean age 34 years and mean body weight 184 pounds, were monitored during training. Nine dives were ice dives, with ice thickness averaging 9 inches, and mean ambient temperatures of 33 degrees F. Eleven dives were warm-water dives; average water temperature was 70 degrees F and mean ambient temperature was 74 degrees F. The average time spent in the dry suit was 95 minutes, and the mean total bottom time was 15 minutes. The ice divers showed a mean increase in core temperature of 1.0 degrees C, while the warm-water divers showed a mean increase of 1.2 degrees C. Divers experiencing the most extreme fluctuations were those in the role of safety diver, regardless of the season. Divers reported more subjective discomfort during ice dives than during warm-water dives. CONCLUSIONS: Continuous monitoring of body temperature during the duration of dive operations is possible, but labor-intensive. Safety measures to protect divers from extreme core temperature fluctuations should focus on the safety diver as well as the active diver.
Adult↗