The endotracheal and intraosseous routes are alternatives to the intravenous route of access to t... more The endotracheal and intraosseous routes are alternatives to the intravenous route of access to the circulation during emergency resuscitation. Adrenaline, lignocaine and atropine are readily absorbed from the respiratory tract via an endotracheal tube. All drugs and resuscitative fluids can be infused into the tibial bone marrow using an intraosseous needle.
Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys ... more Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys (Macaca fascicularis), and the central movement of venom was delayed by first-aid treatment. This treatment consisted of the application of firm pressure over the site of injection and immobilization of the limb. It was found that quantities of venom as high as 2 mg were inactivated when the first-aid procedures were maintained for 24 hours. Over a six-hour period, 0.5 mg of venom could be inactivated. Since the amount of venom injected by the spider into a human victim is unlikely to exceed 0.2 mg, these findings have immediate application both to the first aid and to actual medical management of human victims.
The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored m... more The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored monkeys, and a number of new features were observed. Excessive catecholamine release was demonstrated and linked to the development of hypertension, arrhythmias, pulmonary oedema, hyperthermia, and metabolic acidosis. Acute intracranial hypertension was found, and may partly explain the central neurological manifestations. It is believed that a neurogenic basis for pulmonary oedema may sometimes exist. Survival after massive envenomation was achieved with the use of aggressive pharmacological denervation of the motor and autonomic nervous systems.
To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to... more To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to estimate the toxic dose and to recommend management strategies. Retrospective analysis of case histories of children admitted to the Royal Children's Hospital, Melbourne, between 1 January 1981 and 31 December 1992 with a diagnosis of eucalyptus oil poisoning. Demographic data, circumstances of ingestion, doses, clinical effects, management, complications and duration of hospital stay. 109 children (mean age, 23.5 months; range, 0.5-107) were admitted; clinical effects were observed in 59%. Thirty-one (28%) had depression of conscious state; 27 were drowsy, three were unconscious after ingesting known or estimated volumes of between 5 mL and 10 mL, and one was unconscious with hypoventilation after ingesting an estimated 75 mL. Vomiting occurred in 37%, ataxia in 15% and pulmonary disease in 11%. No treatment was given for 12%. Ipecac or oral activated charcoal was given for 21%, nasogastric charcoal for 57%, and gastric lavage without anaesthesia for 4% and under anaesthesia for 6%. All patients recovered. Hazardous treatment and overtreatment were common. For 105 children, mean hospital stay was 22 hours (range, 4-72 h) and for 13 patients mean intensive care unit stay was 18 hours (range, 4-29 h). In 27 patients who ingested known doses of eucalyptus oil, 10 had nil effects after a mean of 1.7 mL, 11 had minor poisoning after a mean of 2.0 mL, five had moderate poisoning after a mean of 2.5 mL and one had major poisoning after 7.5 mL (P = 0.0198). Ingestion of eucalyptus oil caused significant morbidity in infants and young children. Significant depression of conscious state should be anticipated after ingestion of 5 mL or more of 100% oil. Minor depression of consciousness may occur after 2-3 mL. Airway protection should precede gastric lavage.
The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neu... more The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic and metaphysical assertions that were either false, ad hoc, or confused. Epistemically, the project was not successful in explaining away remaining brain functions, complex reflexes as "spinal," the risk and lack of utility of the apnea test, the ignored and often present confounders of central endocrine dysfunction and high-cervical-spinal-cord injury, the limitations of ancillary tests, or the cases of reversibility of some findings of brain death/death by neurologic criteria. Metaphysically, the World Brain Death Project variously suggested different concepts of death that were not supported with argument. Concepts offered included simply restating the criterion of brain death/death by neurologic criteria; personhood, without recognizing it is a higher-brain concept; and emergent functions of the organism as a whole, without specifying what these might be, if not biologic anti-entropic integration that actually remains after brain death/death by neurologic criteria. The World Brain Death Project only offered confused metaphysical discussion, and gave no reason why the state they described as brain death/death by neurologic criteria should be considered death itself. The main epistemic and metaphysical problems with brain death/death by neurologic criteria remain untouched by the World Brain Death Project.
The endotracheal and intraosseous routes are alternatives to the intravenous route of access to t... more The endotracheal and intraosseous routes are alternatives to the intravenous route of access to the circulation during emergency resuscitation. Adrenaline, lignocaine and atropine are readily absorbed from the respiratory tract via an endotracheal tube. All drugs and resuscitative fluids can be infused into the tibial bone marrow using an intraosseous needle.
Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys ... more Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys (Macaca fascicularis), and the central movement of venom was delayed by first-aid treatment. This treatment consisted of the application of firm pressure over the site of injection and immobilization of the limb. It was found that quantities of venom as high as 2 mg were inactivated when the first-aid procedures were maintained for 24 hours. Over a six-hour period, 0.5 mg of venom could be inactivated. Since the amount of venom injected by the spider into a human victim is unlikely to exceed 0.2 mg, these findings have immediate application both to the first aid and to actual medical management of human victims.
The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored m... more The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored monkeys, and a number of new features were observed. Excessive catecholamine release was demonstrated and linked to the development of hypertension, arrhythmias, pulmonary oedema, hyperthermia, and metabolic acidosis. Acute intracranial hypertension was found, and may partly explain the central neurological manifestations. It is believed that a neurogenic basis for pulmonary oedema may sometimes exist. Survival after massive envenomation was achieved with the use of aggressive pharmacological denervation of the motor and autonomic nervous systems.
To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to... more To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to estimate the toxic dose and to recommend management strategies. Retrospective analysis of case histories of children admitted to the Royal Children's Hospital, Melbourne, between 1 January 1981 and 31 December 1992 with a diagnosis of eucalyptus oil poisoning. Demographic data, circumstances of ingestion, doses, clinical effects, management, complications and duration of hospital stay. 109 children (mean age, 23.5 months; range, 0.5-107) were admitted; clinical effects were observed in 59%. Thirty-one (28%) had depression of conscious state; 27 were drowsy, three were unconscious after ingesting known or estimated volumes of between 5 mL and 10 mL, and one was unconscious with hypoventilation after ingesting an estimated 75 mL. Vomiting occurred in 37%, ataxia in 15% and pulmonary disease in 11%. No treatment was given for 12%. Ipecac or oral activated charcoal was given for 21%, nasogastric charcoal for 57%, and gastric lavage without anaesthesia for 4% and under anaesthesia for 6%. All patients recovered. Hazardous treatment and overtreatment were common. For 105 children, mean hospital stay was 22 hours (range, 4-72 h) and for 13 patients mean intensive care unit stay was 18 hours (range, 4-29 h). In 27 patients who ingested known doses of eucalyptus oil, 10 had nil effects after a mean of 1.7 mL, 11 had minor poisoning after a mean of 2.0 mL, five had moderate poisoning after a mean of 2.5 mL and one had major poisoning after 7.5 mL (P = 0.0198). Ingestion of eucalyptus oil caused significant morbidity in infants and young children. Significant depression of conscious state should be anticipated after ingestion of 5 mL or more of 100% oil. Minor depression of consciousness may occur after 2-3 mL. Airway protection should precede gastric lavage.
The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neu... more The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic and metaphysical assertions that were either false, ad hoc, or confused. Epistemically, the project was not successful in explaining away remaining brain functions, complex reflexes as "spinal," the risk and lack of utility of the apnea test, the ignored and often present confounders of central endocrine dysfunction and high-cervical-spinal-cord injury, the limitations of ancillary tests, or the cases of reversibility of some findings of brain death/death by neurologic criteria. Metaphysically, the World Brain Death Project variously suggested different concepts of death that were not supported with argument. Concepts offered included simply restating the criterion of brain death/death by neurologic criteria; personhood, without recognizing it is a higher-brain concept; and emergent functions of the organism as a whole, without specifying what these might be, if not biologic anti-entropic integration that actually remains after brain death/death by neurologic criteria. The World Brain Death Project only offered confused metaphysical discussion, and gave no reason why the state they described as brain death/death by neurologic criteria should be considered death itself. The main epistemic and metaphysical problems with brain death/death by neurologic criteria remain untouched by the World Brain Death Project.
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