ABSTRACT
ARSENIC is a computerized system providing assistance for telephone consultation in poison centers. Its main characteristic is to blend the document consultation process with the case-recording procedure. It has been used in the daily routine of our poison center since 1987. To evaluate this system, 2 weeks were randomly chosen. During one, ARSENIC was used by the telephone responders; during the other week, traditional paper documents and files were used. Document search times, coding times and quality of responders were recorded by a blinded observer and analysed in total and on the basis of the training of the telephone officer (medical student, resident or toxicologist). ARSENIC decreased the document search times (3.1 +/- 2.7 min vs 3.8 +/- 2.9 min; p less than 0.05) and did not increase coding time (2.1 +/- 1.2 min vs 2.2 +/- 1.4 min; NS). For each group of telephone responders, answer quality increased with ARSENIC. More important, the answer quality of less-trained officers using ARSENIC was similar to that of trained toxicologists without ARSENIC. The quality assurance given by ARSENIC was, for us, the most important argument for computer use at telephone desks.
Subject(s)
Hotlines , Poison Control Centers , Software , Program EvaluationABSTRACT
In massive arsenic poisoning, the use of hemodialysis and dimercaprol (BAL) therapy is still controversial. Hemodialysis is thought of value only for supportive care. BAL therapy has been criticized because of its delayed action, its own toxicity and its possible influence on arsenic clearance during hemodialysis. We studied arsenic kinetics during an acute suicidal intoxication (10 g of sodium arsenate). Treatment included gastric lavage, oral charcoal and supportive measures. Hemodialysis was performed immediately and repeated the next day. BAL therapy was prescribed only on the second day. Cardiovascular collapse, anuria and hepatic disturbance recovered in a few days and the patient could be discharged on the 15th day. Instantaneous serum arsenic hemodialysis clearance was 85 +/- 75 ml/min without previous BAL injection and 87.5 +/- 75 ml/min with a previous 250 mg BAL injection (difference not significant) indicating that BAL did not impede arsenic dialysis. The calculated total hemodialysis clearance of arsenic was higher than mean serum hemodialysis clearance indicating that erythrocyte bound arsenic is also eliminated during dialysis. We propose to consider early hemodialysis as an elimination measure in massive arsenic poisoning and to choose BAL as a chelator when dialysis is required.
