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to teaching

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research

psychiatry,

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Directory

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the

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future

is faculty

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they’re

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Medical

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its

graduated

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Business, new be

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And

L., Washington

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importance

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JUDE Grossberg

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at

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(AAGP).

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diagnosed

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in

Ccinc.er.

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Medical G.:

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54:836-837.

Education

hoped

psychiatry

cancer

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started

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meetings

6,000

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creatitis

strates

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calcifications,

pancreas

(figure

was

On

scopic

VOL

Patchy

Obstructive

Pathologic

gross

57,

shrunken,

from

MARCH

to

both

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Figure

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specimen

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the

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is

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not

the

be

Here’s

7

pancreatitis

mation

logical choledocholithiasis mal scanning able ultrasound alternating tion tive well radiologic lakes scan

to of and, surgical

References 3. 2. 4. 1,

Right

determine

Mulholtand alcoholic ot K, Lowes obstructive genesis Suda Howard obstructive

This

morphology.

pancreatitis

of

chronic

therefore,

eds. as

except

and

appearance

K, on

the

radiologic

JR., calcifications

Surgery:

of

T, procedure. upper

case Mogaki

pancreatitis

provides

ERCP.

pancreatitis.

the

pancreatitis.

Maiden

M.

why: pancreatitis.

RodeJ, workup pancreatic and

areas

involved,

Chronic

for

the

pancreas

scientific

M,

underscores

the

ERCP

pancreatitis,

C,

quadrant

Cyama Lees

the

and

from

most of

Smith The

or

pancreatitis.

British

valuable

best The approach

Surgery

to

chronic

W.R.,

principles

followed

stenosis

calcifications,

stricture.

American T,

in H,

include

CT duct

seems

and

Journal

nonobstructive

likely

to operative

Matsumoto

Russell

Wiebke

nonobstructive

1995;

obstructive

determine

scan ultrasound

tn:

thus,

and

distal

information

the

of

Journal

Greentield

118:727-735

R.C.G.,

to and obvious.

distal

E,

form

practice.

Surgery

by

ultrasound,

in

CT

Y.

Sherman

this

need

pancreatitis:

the

Histopathologic

ERCP approach.

our dilation of

to

Cotton

Gastroenterology of

1988; however,

scanning

Philadelphia: L,

pancreatectomy

optimal

the

the

disease

Muihotland patient

S,

to

chronic

for

However,

RB.

forms

75:1129-1133

Lehman

most stricture

about

pancreatitis.

special

and

rule

Obstructive

(the

a

ERCP,

and

We

complete Lippincott-

surgical

process.

M, was then

G,

distinguishes emphasis

likely

may

of

out

pancreatic

pancreatitis

immunohistochemical

“chain

Oldham

1990;

Madura

believe

pancreatitis

the

without

largely

pancreatitis:

and CT

cholelithiasis

85:271-276

show,

Raven. form

on

K,

J.

addition

is

approach.

Uniform

ductal

The

scanning of Zetenock

then

Surgicat

preoperative

that

the

1997:

unremark lakes”),

of

parenchy

a

unusual

obstruction

however,

need involved

obstruc

chain

CT

chronic

in

optimal

treatment

G,

890.

on

studies

of

cases

Lillemoe

dila

scan

causes

is

CT

CT for

or

as of and

on a

of

A.

foods,

lows: divided

discussion

male

admitted

for

months

who

3

hundred

frequency

8.9%;

this

incidence

following:

age

mortality

Observations

may

Hospital,

unified

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alcohol,

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forty-nine

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number

3.8

incidence

Cresoline”; in

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Another

of

4

from do

made

salicylates,

59

the

on

phenolphthalein

best

18

of

one

cases;

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private

period

years.

oil

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major

cases admitted

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poisons

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12

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months fourteen

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D.

VOL

C.

B.

to

eucalyptus

Of

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mustard

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57,

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convulsion,

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Honolulu

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434

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1998

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tion.

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69

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the

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62

treatment

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patients

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the

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69

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the

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JOURNAL,

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Complications

accident

57,

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found

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MARCH

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1.—Complications

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Of

1998

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Emergency

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&

52

common

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Ciba

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Percent

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discussion

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21.7

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19

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J.

as the hence, at systems.

is ments kerosene nia. other kerosene in direct 18.8%. ous Degenerative can Children’s when kerosene

been also

ing is

mention year-old 8.6%, occurred associated A Lead child

hazardous shape encephalopathy. Nelson’s standing half recover, Encephalitis tions case residual should toys. acute America General cases frequent was

controversial.

The the

the

In

The

Because

Increased the flat

At

in

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of

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Kauikeolani

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x-ray only

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of observations

of

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the Poisoning

be

above

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The

is girl about

into was

effects paint

poisoning will that

Conference

followed after described.5

Textbook

annually. features

been from

study

among

educated

Hosptial,6 introduced et

rabbits incidence

with

lead infants have

to

release

amounts

of

Measures

et

exception.

pulmonary intracranial

admitted

out al.2,

instilled the with 400

changes

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experiments,

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peelings. one-third

eating

absorption

The

poisoning

or fever. are

of

that

shown

because

lungs

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of In and

made

Waring,4

different

these

abdomen Children’s

lumbar report that

convulsions and metabolic of

gastric by study

of of

Caustic

made

were similar not issue

the

to

kerosene

At

may

of the

on Pediatrics7

the of lead directly pneumothorax kerosene. directly

paint

because

in pneumonia

use A small

and

While

that being

a of the chapter

kerosene

changes

Blood are

Poisoning

pneumonia occurrence

pressure

was leukocytosis

they lead

the preventable recent is

careful on

lavage

develop

punctures in

into

lead-free

types

poisoning

another

and

that

to

about

alkali all

off

mortality

showed left

pulmonary

the

children disturbance.

children liver,

Hospital

completed.

into do

from unusual. those

into

into

mentioned this

of

the level the Reed may

no with

It clinical

complications on

of not

as resolved

it

history

an the

poisoning

were

the

was

and

is

pneumonia the

is from

blood wall study

kidneys, poisons at

the treatment the

lead

case

made

scattered

paint vomit. acute of

be permanent

caused

for

stated mode

et

may

stomach, in the on

and have is in

is

stomach. in

emphasized

cerebral

were

bones

mediastinal

pulmonary precipitated

changes instilled al.3

conference

over

poisoning lead

about unlike

lead kerosene

65%

of children.

revealed Duke

patients

The reported stream.5

that

Because

by in

in

onset the

have

of

Deichman that

encephalitic have

kill

lead by not

was

two lungs,

all

others.

a in during was

poisoning, developing

dense

drowsiness

responsibility case

of

was

of pulmonary period

25%.

direct Hospital5 over

approximately

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edema

neurologic

Rabbits house

x-rayed

of

can

been

into

said shown

weeks.

their

poisoning kerosene

0.8

of with

the poisoning

an

convulsions

observed Therefore, was

that HAWAII

in and

and

system.

at

in

shadows

in

500 occur

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the Leukocytosis

Of

to the

aspiration mg%.

the Mitchell incidence et

of

cases.

higher

fact interiors

adults,

are

intercurrent

subcutane many

that a

heart

be by

al.5, acute were The

manifesta routinely,

permanent those

children

2

ingestion MEDICAL the

pneumo in

stomach.

quiescent

St. occurred

changes

without months.

the

poison the sequels.

experi that

1947,

of

When

on

which is

Louis cases public

when

in

have of used have

than

brief

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who lead it out

a with

the

and

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the the

JOURNAL,

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of

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is

in

it

436

the handling

Summary poisoning Kauikeolani groups

literature. of and Conclusions common water have from to

2. References 3. 4. 6. 5. 1.

8. 7.

4.

2.

6. 3. 5.

A Fifty-nine 1. There The VOL

Kerosene There Other

This

There

2.

1. the

eucalyptus,

Arena, parents.

Lesser,

Waring, Pediat. Clinical Deichmann, Reed, Clinic Mitchell, Subcutaneous 1944.

Evacuation

Identify When Antagonist Antidoting

camphorated Symptomatic

in pulverized part. the study strychnine, the metals,

57, the

this

Many We child’s natural

color

Emergency

age

cases

on of study E.

J.M.:

tannic MARCH 23:352

Conference

LI.,

more

form were J.I.:

were

are,

S., acute AG.,

practicing The

Poisoning,

poisons

the

study

1-1/2

must

are of

Weens, Leikin,

of

Accidental W.

Pneumonia

They

the

and

poisoning

paint,

of of

Children’s different and

Emphysema (Sept.)

however,

nature curiosity pulverized probably

B,,

knack greatest

of

1998

acid common twice

3

221

the of

when

kerosene poisonings.

presented

charcoal

phenolphthalein,

the poison

S., Kitzmiller,

Nelson,

the

the

at deaths,

years,

H.S., complete,

never Conference

the treatment

milk

the

and

suggested

1943. residual

encountered oil.

in

and

Poisoning

Hospital

cases

cases

last in

of

St.

second McKey, physicians

poison

Kerman, available.

as

for

the Kerosene

W.E.:

complicating

the Louis

as

of

poisons

K.

is frequency

for

oil

does

will 1 many two

underestimate

charcoal

2

types and due

V.,

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Hospital

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at

year,

of poison

JO.: magnesia.

Textbook

parts, in

Children’s of

exploring

poison

in

Wintherup, of

HO.: when

Duke

from

Children,

neutralize

further

will

Poisoning, important caustic

accidental

most

to should

not

the

Pulmonary

accidental

detail

eucalyptus.

of

as

boys

of

Kerosene

Hospital,

Kerosene

3

one

were

in tannic

and

strong

of the

is

may

indicated.

possible.

give

precipitate poison into following

years,

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in

barbiturates, common, Pediatrics,

Ciba

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alkali

AmJ.

each stomach

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information

The

be

and the

with

the

Manifestations

be

J.

Intoxication, encountered.

acids. Clinical

Poisoning’,

a trouble,

acid

Hawaiian girls tea,

Pediat.

points

2

“Mediasfinal stomach

Johansmann,

reviewed.

given the complete a

poisoning

Med. and

unknown cases

are:

poisoning years, first

of

poison.

ed,4, 5

a

and

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year

1

32:207 Sd.

the emergency

admitted. by

alkaloids, 18

and

give

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part,

arsenic

Phila.,

in

Am.

J.

will

this

of

the

185:325

followmg and lavage

Pediat.

the

month following:

Emphysema,

pine when

followed

69

J.

period

R.:

(Feb)

universal

poisoning should

Islands.

Vol.3,

W.B. picture

magnesium

Dis.

magnesium

through study

discussion

absorb

years.

are form

Ann.

cases

we

38:646 admitted

(Mar.)

Child.

1948.

compounds,

Ingestion

oil,

or

possible. Saunders

No.3,

glucosides

tnt.

preventable.

recognize to

emetic

is

of

measures

emphasizes:

Pneumothorax,

79:623 Med.

be

1933.

of

salicylates, (May) of

phenol

In by antidote presented.

burnt

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April.May

his

kerosene,

of

kerosene

admitted obtained

Co., the

21:803

order

oxide Kerosene,

the

oxide

(Apr.)

1951.

mouth.

except of

to

toast, 1945.

most

age and and (Nov.) 1951.

the

1950. the

of:

oil

his

in

in

and to

1

J.

HaleiwalWaialua)

Kaneohe,

32%.

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combined decline the dropped improved benefits 87 volume. plight Critical beyond 1978, costs poison keep in multiple hospitals.3 and services

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JOURNAL.

444

VOL ‘ ‘ ‘ ‘‘ ‘‘ ‘

G1AT

57,

Don’t

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JOURNAL.

1996

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Pediatric

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blood The

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in Hawaii emergency when gency victims gastrointestinal used department. who would compared controlled option Under may likely 1.8% calls plain gastric rationale would patient) would throughout starting evacuated already

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the Currently Activate Gastric Cathartics Syrup Based Whole

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32

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32

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JOURNAL,

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448

centers effectively Because gastric administration toxicity. activated “universal may wide Even “CHEMICaL ingested the be be charcoal coal tration phor containing in (ie; there by undergo to used gastrointestinal tricyclic more from trointestinal charcoal. the administered fact mixed monitored.

Table

VOL

Because

effective Activated

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Multiple Cathartic

Whole

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5.—CHEMICaL

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24 cases

toxins Cyanide Hydrocarbons is Caustics Camphor Iron Metals Ethanol Lithium Potassium

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a

is • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 4. Other 3.

2. 1. requires

References:

in

tube teenagers

recommended

the

has

overdoses. decontamination

charcoal.

from

The volumes Tobias acetaminophen drug Thompson charcoal Tenenbein Tenenbein drug Tenenbein Tenenbein Terrenbein Tenenbein poisoning. Ann of Shannon Smith Olson Rogers 1986:33:261. Olson Olson Med poisoned Metigian Lewander Kulig Ann Ann Kulig 1989:5:262. Krenzelok Krenzelok Komberg Kilham 1985:4:446. Goldfrank, Mad; concurrently. Haddad Freedman Pediair; Fartey water Dymowski Davis DC; Blyson Barkin induced Auerbach lions Amitai and Albertson the tnaba tnaba Hawaii

Surveillance children 1996 overdose. Emerg

overdose. the Emerg Emerg

Toxicol; stomach. Taylor

K, activated

major until K: poisoned SW, KR, 1991:20:648. KR: JD, KR: of GR, and TA: GC, Y,

RM: the H: Bar-Or for useful Gastric PD: AS: AS: Annual drugs LM: M, 1986:109:719. KS, with

patient. Poison advantage AM, Gregory Pentel AE, M: WJ, Mitchell Mad M, Is EP, M, M: Poisoning Ling M: Hospital TE, Santa M: EP: electrolyte GE, PS, Severe LR: JJ,

acute Mad; approximately Matyunas Mad; Mad; & Fish Comprehensive Toxicologic ‘CHEMICaL

“Wait-What’s of gut Multiple

The the 1987:2:52.

Cohen are Cohen Woodard Whole Ann Whole

ipecac. GI Francis, Dolgin Whole

Keller Because Robins Lacoulure Human Arch Dertet intoxication, Uehara charcoal following

System. advantages D, Gastrointestinal Toxicologic Toxicol; patient? Osterloh

U, Pasfernak Unlike lavage

emptying is PR,

Report iso-osmotic Center SS, 1991:20:536. Ana Amer 1985:14:562. drug emergency Cantrill AA,

1985:14:1152. rectal

Emerg given hypematremic DF, Halstenson management

references: tract

Intern 25 5, bowel

bowel Kelley R, S, The doses & Love)oy RW, J: CA, Ann

bowel for JB, absorption NJ: McGuigan overdose. Toxicol; Deshpande 1996. DT: and Sitar Drug Stewart JEmerg Sitar M, 1988: Pediatric in Mad accidental Annual emergencies. J, of SV, CamP.

PG:

method cc/kg/hour Morawski Prescott Med; Foulke the Gastrointestinal S, all Emerg

Mad; the of

Hedges Braun the irrigation Common of irrigation MT: Emergencies Pedi

acute

effluent WBI

the

that 1-2 OS: irrigation Overdose. Review Krenzelok

DS: two washed at activatedcharcoal: Toxicol; FM:

management of Office weight?’ 3:77.

treatment being CE: 1987:6:215. at: Physical RP: transit air 1987:16:164. Report

American Med;1990:8:479. limitations Efficacy 1987:147:905. GE,

or of of Ann Whole ingestions: MA,

dehydration Med; Emerg liters/hour 0, poisoning Cathartics Management LF:

JK:

this 4-6 overdose Emerg Whole-bowel JR,

Gastrointestinal SG, are severe

secretion. fluids management in in for

at iso-osmotic

household

are WBI at et 1986:1:247. up? Emerg

Changes as of PediatrAnn; Ondansetron Toxicology times iron Contemp 1986:15:692. EP: al: al: et 1996.1997. toxic etal: Norwalk; al: bowel assessment

ot

able is Med24(4(;1992:3:191.

of hours (5th

a not (editorial)

decontamination al: Supedotity choice

Efficacy advantage Care; acute Ipecac-induced poisoning. of Association

poisoning. GoLytely A ipecac-induced

gastrointestinal

clear. (up (editorial). Charcoal and Development of ingestion. in

Mad; include

Prospective clinical Edition). to poisoning. after Gastro; irrigation children.

cathartics to in of poisonings.

Timetorreappraisal?Ann effectively 1992: Pedlair; laxatives: irrigation toxic

Appleton eliminate cardiorespiratory

of for

acutely of

of

to to use 1987:16:838.

of eliminate 1990:19:629. transit Am to acute and

trial The Emergency of

gastric

for either Pediatr

J alone ipecac 1980:78:991. ingestions. prevent Norwalk;

J achieve

8:345. of 500 J activated as Pediatr J of Emerg differential Pediafr; Pediatr

using solutions 1994:11:134 Toxicol-CIin

an it’s poisoned Emerg evaluation used as limes of pediatric & emesis Do a emesis,

for

Poison significant recommended

decontamination and Pedlair versus

activated WBI a decontamination Lange, emptying: a

Clin cc/hour). they lavage emesis acute syrup

treatment

ability solution with 111:142, Mad; Appleton of

Ann; and Clinicians

charcoal toxins Mad; 1987:80:364. Ann and

cathartics NAmer;

toxins adsorbed still CoLytely. function patients diagnosis Control poisonings.

orogastnc a ipecac Emerg 1990. poisoning. activated of of solution 1989:7:403. Toxicol;

1987:16:900. charcoal-sorbitol has

following clear Emerg reduction 1990:8:560. have

ipecac gastric Gastric gastric

for that 1967. & Emerg

HAWAII to alone and (3rd Care;

1980: dunng from without Lange, Centers a combined

acute

via

iron become

of that procedure

associatedwith

eliminate Typically Mad; 1985:23:177. procedure lavage, place and

charcoal. rectal emptying charcoal. lavage N-acetylcysteine the PodiatrClin Pediatr Edition). compared of

Mad; are 1987:3:261.

27:603. a

gastric rate

lithium MEDICAL activated lavage,

plasma by poisoned gastric 1994.

1989:18:56. the

in

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nasogastric

Adults and Toxic and 1991:20:529. management versus with suspension.

Emerg

currently activated

Washington, Clln effluent. after after

Ann for in

lavage

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concentra lithium

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patient. toxins minimal Pharm; JOURNAL. Emerg emesis acute

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VIDEO!

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