HAWAII MEDICAL JOURNAL March 1998 Volume 57, No. 3 ISSN: 0017-8594 Ii CA4 Special Issue on Clinical Toxicology I Center - Part I 1856 and the Hawaii Poison Great misconceptions about information technology • It costs a fortune to get hooked up • It still takes forever to check patient eligibility • HIVISA will never accept it The truth? HMSA investments in state-of-the-art information technology is second to none. We designed the Hawaii Healthcare Information Network to help doctors get important information—like patient eligibility—quickhj. That means a more efficient office for you and better service for your patients. Best of all, if you’re an HMSA participating provider, we’ll hook you up free. To find out how HHIN can help i/our practice call HHIN at 948-6446. HNLSA Blue Cross Blue Shield of Hawaii Choices for a Healthier Hawaii ZL,WZV.hiflSa.COlfl HAWAII MEDICAL Contents JOURNAL (USPS 237-640) Editorial Norntan Goldstein MD 425 Guest Editor 425 Published monthly by the John Racine PhD, R,VandAlson S. Inaba MD Hawaii Medical Association Incorporated in 1856 under the Monarchy President’s Message 1360 South Beretania, Second Floor Leottard Howard MD 426 Honolulu, Hawaii 96814 Phone (808) 536-7702. Fax (808) 528-2376 Military Medicine MAJ Robert E. Johnson MD 427 Editors Editor: Norman Goldstein MD Medical School Hotline News Editor: Henry N. Yokoyama MD Junji Takeshira MD and Iqbal Ahmed MD 429 Contributing Editor: Russell T. Stodd MD Harry L Arnold Case Report of the Month: CT Demonstration of a Pancreatic Duct Stricture and Obstructive Pancreatitis with ERCP and Intraoperative Correlation Editorial Board Jeffrey M. Nelson MD, Dean E. Baird MD and Jeffrey P. Kavolius MD 431 Vincent S. Aoki MD, Benjamin W. Berg MD, John Breinich, Satoru Izutsu PhD, with Special Reference to Kerosene Poisoning James Lumeng MD, Douglas G. Massey MD, Accidental Poisoning in Children 433 Myron E. Shirasu MD, Frank L. Tabrah MD, Reprinted for.’n HMJ Nov/Dec 195] by L.T. Chun MD Alfred D. Morris MD Who Calls the Hawaii Poison Center Debbie Ahina RN, BSN 437 Journal Staff Kendro Managing Editor: Becky Hawaii Poison Center Forty Years of Saving Lives and Health Costs Editorial Assistant: Carol Uyeda Willow S. Morton MSW 440 Child Officers Clinical Pearls in Pediatric Toxicology: A Systematic Approach to the Poisoned 445 President: Leonard R. Howard MD Alison S. Inaba MD President-Elect: Patricia L. Chinn MD Secretary: Roger T. Kimura MD The Hawaii Poison Center: What’s it Worth to You? MD Treasurer: Charles R. Kelley John F. Racine PhD and RN and Bruce S. Behnke MHA 451 Past President: John S. Spangler MD Selected Information Sources on Poisoning Toxicology 455 County Presidents Christine Sato RRA, MLIS Hawaii: Timothy Oldfather MD Honolulu: Cynthia Goto MD Council Highlights Maui: Jon Betwee MD Roger Kimura MD 457 West Hawaii: Au Bairos MD Kauai: Thatcher Magoun MD News and Notes 459 Henry Y. Yokovama MD Advertising Representative 461 Roth Communications Classified Notices 960 Prospect Street, Suite II Honolulu, Hawaii 96822 Weathervane 462 Phone (808) 545-4061 Russell T, Stodd MD Fax (808) 545-4094 The Journal cannot be held responsible for opinions expressed in papers, discussion, communications or advertisements. The ad vertising policy of the Hawaii Medical Journal is governed by the rules of the Council on Drugs of the American Medical Cover art and descriptive text by Dietrich Varez, Volcano, Hawaii. The right is reserved to reject material submitted for Association. All rights reserved by the artist. editorial or advertising columns, The Hasvaii Medical Journal (USPS 237640) is published monthly by the Hawaii Medical Maile Association (ISSN 0017-8594), 1360 South Ileretania Street, Second Floor, Honolulu, Hawaii 96814. Postmaster: Send address changes to the Hawaii Medical Maile is the fragrant leafy vine much used for ceremony and purification. Journal, 1360 South Beretania Street, Second Floor. Honolulu, Maile also has substantial mythological and legendary importance. Hawaii 96814. Periodical postage paid at Honolulu, Hawaii. Nonmember subscriptions are $25. Copyright t998 by the Hawaii Medical Association. Printed in the U.S. HAWAII MEDICAL JOURNAL, VOL 57. MARCH 1998 423 You are invited to attend... Join us in the quest — Friday Noon Conference — Luncheon Hepatitis C: 1998 for continued Willis C. Maddrey, MD March 6, 1998, 12:30 - 1:30 p.m. Doctors Dining Room Learning Objectives medical excellence. At the conclusion, participants will be able to: • Understand the natural history of chronic hepatitis C viral infection and factors which influence the course in an individual patient. • Recognize the range of clinical disorders associated with hepatitis C. • Develop a comprehensive program for the long term manage ment of patients with chronic hepatitis C. We would like to acknowledge the Educational Grant Schering Oncology Biotech. — Friday Noon Conference — Luncheon Mixed Anxiety and Depression Peter L. Forster, MD March 13, 1998, 12:30 - 1:30 p.m. Doctors Dining Room Learning Objectives At the conclusion, participants will be able to: • Understand relationship of anxiety and depression. • Learn how to assess patients and initiate effective treatment. • Effectively discuss anxiety and depression with patients. We would like to acknowledge the Educational Grant Bristol-Myers Squibb. — Friday Noon Conference — Luncheon Evaluation, Diagnosis and Treatment of Impotence for the Primary Care Physician Join your Straub colleagues as we strive for March 20, 1998, 12:30 - 1:30 p.m. continuing medical excellence. Doctors Dining Room Learning Objectives At the conclusion, participants will be able to: Straub Clinic & Hospital, Inc. is accredited by • Provide the primary care physician with an anatomic and the Hawaii Medical Association to sponsor physiologic over view of normal erectile function and erectile dysfunction (ED). continuing medical education for physicians. • Discuss the causes of organic impotence. • Discuss the diagnosis, evacuation and treatment options of the Straub designates this educational activity erectile dysfunction patient. for a maximum of one credit hour in We would like to acknowledge the Educational Grant Osbon - IMAGYN. Category 1 of the Physician’s Recognition — Friday Noon Conference — Award of the American Medical Association. Hospice Case Studies Each physician should claim only those Elizabeth Nelson, RN, MPH & Kathy Ha/lock, LSW March 27, 1998, 12:30 - 1:30 p.m. hours of credit that he/she actually spent in Doctors Dining Room the educational activity. Learning Objectives At the conclusion, participants will be able to: • Describe the hospice philosophy and admission criteria as well as services offered. • Understand the referral process. • Describe the difference between hospice home care and Stmub residential hospice care. W7aen it really matters Please call Fran Smith at 522-4471 for more information. Visit Straubs homepage at http//wwwstraubhealth,com Editorials Guest Editors March Special Issue Clinical Toxicology and the Hawaii Poison Center Norman Goldstein MD Editor John F Racine, PhD, RN and Alson S. Inaba MD Guest Editors This Special Issue honors the Hawaii Poison Center—helping physicians, nurses and the general public for 40 years. We appreciate the opportunity to commemorate the 40th ann iver Last year the Center received more than 12,000 calls for help and sary ofthe Hawaii Poison Center (HPC) with this special issue ofthe information. One in five calls came from health professionals. Hawaii Medical Journal on Clinical Toxicology and the Hawaii Guest editors John Racine, PhD, RN is an Assistant Professor in Poison Center. Poisoning is a serious health problem, with which University of Hawaii—Manoa School of Nursing and Chair of the clinicians are probably familiar, particularly if they have family, Education Research Committee of the Hawaii Poison Center and internal medicine, or pediatric practices. Usually classified as an Alson S. Inaba, MD Associate Professor ofPediatrics in the John A. injury, poisoning is the third leading cause of unintentional deaths Burns School of Medicine and Medical Director of the Hawaii in the United States.’ The call volume of the HPC, almost 12,000 Poison Center, have provided a very special Special Issue. calls in 1996-1997, indicates that it is also an issue in our State. As This issue belongs in every pediatric, family practice, and internal an analysis of these calls in this issue has shown, clinicians also seek medical practice office as well as every emergency room in the the expertise and information from the specialized databases of the State! It is an extremely valuable source of practical information on Center, comprising 13 percent of all callers. For an inside look at clinical toxicology and the operations of the Poison Control Center. operations and some of the specific queries received by the Center, Mahalo to John Racine, Al Inaba, and Debbie Ahina, manager of another article in the Journal provides a sense of the resources the Hawaii Poison Center for a superb Special Edition. available for health professionals and the protocols followed for A limited number of extra copies are available at the Journal victims. office. Call 536-7702, ext. 2239 for more information. In this issue, several features are provided for the continuing education of clinicians. First of all, a systematic approach to assess ment of the poisoned child, the most likely victim, is presented. Secondly, there are questions to challenge current clinical knowl edge of toxicology, accompanied by their answers. Third, since acute poisoning usually presents in panic, clinical techniques for crisis intervention and emergency counseling are reviewed in a case study. Finally, selected references from the print and electronic databases of the Hawaii Medical Library are recommended for further investigation into clinical toxicology. It is very appropriate for the Journal to dedicate a special issue to this topic on the 40th anniversary of the Hawaii Poison Center. The Journal had published a study by Dr L. T. Chun in 1951, reprinted ALOHA in this issue, which called attention to kerosene poisoning among LABORATORIES, INC.