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Availability of Decontamination, Elimination Enhancement, And Stabilization Resources For The Management of Acute Toxic Exposures And Poisonings In Emergency Departments In Malaysia

Journal Title, Volume, Page: 
Internal and Emergency Medicine, 2011, Volume 6, Number 5, Pages 441-448
Year of Publication: 
2011
Authors: 
Rahmat Awang
WHO Collaborating Centre for Drug Information, Clinical Toxicology Program, National Poison Centre, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
Sulaiman I. Al-Sohaim
WHO Collaborating Centre for Drug Information, Clinical Toxicology Program, National Poison Centre, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
Sa’ed H. Zyoud
WHO Collaborating Centre for Drug Information, Clinical Toxicology Program, National Poison Centre, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
Halilol Rahman Mohamed Khan
Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
Sirajuddin Hashim
Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
Preferred Abstract (Original): 

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

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Evaluate The Impact of Hospital Types on The Availability of Antidotes For The Management of Acute Toxic Exposures And Poisonings In Malaysia

Journal Title, Volume, Page: 
Human & Experimental Toxicology; 2011 Apr 8. [Epub ahead of print]
Year of Publication: 
2011
Authors: 
Sulaiman I Al-Sohaim
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Rahmat Awang
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Sa'ed H Zyoud
Poison Control and Drug Information Center (PCDIC), An-Najah National University, Nablus, Occupied Palestinian Territory
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Sazaroni Md Rashid
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Sirajuddin Hashim
Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
Preferred Abstract (Original): 

The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes.
Objectives: The purpose of this study was to determine the availability of antidote stocking at hospitals, based on published guidelines for antidote stocking, and to evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia.
Methods: A questionnaire on the availability of antidotes was sent to all government accident and emergency departments in Malaysia. The list of commonly required antidotes and essential drugs was compiled from published guidelines. Collected data were analysed in SPSS version 16 using descriptive and comparative analysis.
Results: The response rate was 59.06%. None of the responding hospitals stocked all of the antidotes on the lists. In relation to hospital type, there was great variability in the availability of antidotes (there were significant differences between hospitals for 13 antidotes). The availabilities of most antidotes were far better in the General Hospitals and the District Hospitals with specialists compared to District Hospitals without specialists. Calcium gluconate, sodium bicarbonate, atropine sulphate, naloxone, flumazenil, vitamin K, and pyridoxine were available at all general hospitals. Atropine sulphate and naloxone were available at all district hospitals with specialists.
Conclusion: Most Malaysian government hospitals stocked some important antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Malaysian hospitals and the National Poison Centre at Universiti Sains Malaysia is also important.

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