vietnam poison control center

1 Vietnam Poison Control Center An introduction 2 Vietnam in brief  A developing country approximately 330,900Km 2 .  Population over 80 million, with 80% farmers.  Vietnam: an agricultural country.  Blooming of economy from 1991.  Developing tourism.  Health care system: 61 provinces with only PCC placed in Ha Noi (Bach Mai university hospital).  Other poisoned patients → EMs & ICUs at local hospitals. 3 Toxicologic epidemiology general condition  Increasing risks of toxical industrial chemicals, agricultural chemicals, imported drugs, venomous animals, alcohol, drugs abuse, food poisonings.  Over 25 years since the last war, warfare toxic agents: dioxin, CS 1996 1997 1998 1999 2000 Poisoned patients 9524 10372 8110 8339 8916 Deaths 273 335 305 252 244 % Mortality 2.86% 3.23% 3.76 % 3.02% 2.74% Survey in 48 local hospitals 4 Toxicologic epidemiology general condition 24.81% 17.76% 17.67% 12.16% 8.12% 4.77% 2.64% 1.47% 10.60% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% Pesticides Sedative- drugs Food poisoning Rodenticides Venemous animal Opiates alcohol Chemical Other reasons  1 st :pesticides (OPs, carbamat, organochloride, trifluoroacetamide, Zn phosphide, thallium; new insecticides-nereistoxin , herbicide)  2 nd :sedatives and drugs abuse or overdose, opiates and alcohol  3 rd :venomous animals and plants: snakebite, puffer fish, bee stings, toad venom, poisonous plants, mushroom 5 Toxicologic Epidemiology  reported cases.(%of total) Numeralmortality (Mortality, expressedin%of reported) 1.Pesticides 24.81% 6.61% 2.Sedative-drugs 17.76% 0.86% 3.Foodpoisonings 17.67% 0.24% 4.Rodenticides 12.16% 3.5% 5.Venomousanimal 8.12% 3.42% 6.Opiates 4.77% 5.12% 7.Alcohol 2.64% 0.28% 8.Chemicals   1.47% 6.17% 9.Othercauses 10.6% 7.48% Total 100% 3.26% Survey in 48 local hospitals 6 Toxicology epidemiology Pesticide poisoning  Annual importing ~ 30.000 tons of raw materials and pesticides ~120 millions USD  743 types of permitted commercial insecticides, formulated of 171different activated elements  organophosphate in the North and Paraquat in the South.  Illegally Imported rodenticides: exessive use, suicide, dangerous misuse in children (7% of acute poisoning) 7 poison control center Bach Mai Hospital Establishment and development:  1998, Department of clinical toxicology, separated from the emergency and intensive care department.  17/9/2003: National poison control center. 8 Personels  Number of patient bed: 20  Administration board: Director :Prof. Nguyen Thi Du, Vice directors: MD. Pham Due, MD. Nguyen Kim Son.  Staffs: 8 doctors: 3 PhD, 3 masters, 1 pharmacologist,1 pharmacist, 1 bachalor of informatics, 21 nurses.  9 Member units: Clinical  Management of acute and chronic poisoning patients.  Management of prehospital poisoning emergency.  Research, development of new preventive and curative measures.  Education and training. 10 Member units: Laboratory   Toxicology analysis.  Study and development of antidotes.  Training of laboratory staffs in the field of toxicology [...]... atropine in the treatment of acute organophosphate poisoning 2 Nereistoxin poisoning 3 Clinical manifestation and treatment of acute chinese rodenicide poisoning 4 Treatment of snakebite (Naja Kaouthia) with antivenom 5 Combination of charcoal and sorbitol in the treatment of acute poisoning 6 Improvement of gastric lavage technique in the treatment of acute poisoning.  7 Correlation between plasma drug... 122 170 17 Toxicology laboratory 18 Achievements: Researches 38 studies at various levels: All studies are clinical - State level: Study in to proposed network of poison control in Vietnam and the management measures of mass and acute poisonings in argriculture, industrial activities and dailly life - Ministry level: + Development of preparation method for the antidote B.Mai-ANTIPOIS + Investigation...Member units: Poison information office       Collection, processing and reporting of data and information Consultation of poisoning Link to and exchange of information with other PCCs, related organizations Organization of conferences and workshops 11 Achievements Clinical unit: the most developed one Annual number of poisoned patients addmitted 12 Achievements Clinical unit: the poisoned-related... 12 Achievements Clinical unit: the poisoned-related death (%) 13 Achievements: Clinical unit Reasons for poisoning (The year 2004) Homicide Misuse Suicide Accident Total 7 0,38% 14 0,76% 445 24,12% 1380 74,76% 1846 14 Achievements Clinical unit: causes of poisoning (2004) Causes No of patients Food poisoning 659 Sedative/hypnotics 327 Drugs of abuse 258 Venoms 228 Pesticide 125 Other medications 87 Household... poisoning.  7 Correlation between plasma drug level and clinical features in phenobarbital poisoning 8 Clinical and laboratory features and treatment of alcohol withdrawal syndrome And many other studies 20 Achievements: - Publication: + Emergency treatment of Poisoning, + Guideline on Rapid Diagnosis and Management of Acute Poisoning, + Handbook of emergency treatment, Emergency and Intensive Care Medicine... causes 12 15 Achievements: Clinical Characteristics of poisoning   Causes are diverse, complicated and dangerous Special agents: + Pesticide: organophosphate, carbamate, organochloride, trifluoroacetate, tetramine (possibly), nereistoxin, cyanoacetamide and many new chemicals + Metals: Pb, Hg, As, Thallium, + Toxic gases: CO, Chlorine, + Food poisoning: complicated, not only by microbial agents +...                    Published researches and books - 22                  Published researches and books 23               Published researches and books 24 Remaining difficulties Clinical: - Despite of large number of poisoned patients NO clinical toxicologist has been trained - Lack of important antidotes - Lack of information on toxicology  Information: -Not yet funded, lack of appropriate equipment -No communication... labs (require modern methods) -Lack of experience seen in all labs involved in toxicology analysis 26 -Lack of overseas training courses  Commercial products of insecticide insecticide 27 28 Pictures of poisoned patients 29 30 31 32 33 34 Snakebite (Bungarus candidus) 35 Snakebite (cobra) 36 . 1 Vietnam Poison Control Center An introduction 2 Vietnam in brief  A developing country approximately 330,900Km 2 .  Population over 80 million, with 80% farmers.  Vietnam: an. rodenticides: exessive use, suicide, dangerous misuse in children (7% of acute poisoning) 7 poison control center Bach Mai Hospital Establishment and development:  1998, Department of clinical. are clinical. - State level: Study in to proposed network of poison control in Vietnam and the management measures of mass and acute poisonings in argriculture, industrial activities and dailly