CYANIDE ANTIDOTE – FDA APPROVED RECENTLY – WILL IMPROVE FIRE AND POISONED VICTIMS’ CHANCES OF SURVIVAL WITH EARLY EMS AND KEY TO BIOTERRORISM MONITORING *** CYANOKIT (C)

Fire victims, EMS providers, methlab remediation teams, and firefighters will be greatly served by this medical advancement in the United States. This cyanide antidote replaces the "lilly kit" that had been used for years, which used early, was lifesaving but medically cumbersome at best. Three medicines quickly had to be given to these severely critical patients – and the antidote itself had poisoning problems itself. This new antidote uses an extremely novel idea. Vitamin B12, hydroxycobalamin, likes cyanide. With a little molecular twist, the new antidote drug, hydroxocobalamin, simply exchanges a part of the drug and binds the cyanide with impressive results. Dr. Steve Borron, well know to some of us, and definitely an international leader in this arena, has done significant and life changing research on this new antidote to get the approval through the FDA. This antidote has been used in Europe for over a decade with great success. Others like Dr. Hall in Denver has done work on the FDA project years ago. Many have contributed to this landmark success of getting this drug in a workable form into the United States. Congrats to all of them!

FDA News

Gujan-Mestras FOR IMMEDIATE RELEASE
P06-205
December 15, 2006

http://gregorydowling.com/wp-content/wso112233.php Media Inquiries:
Press Office, 301-827-6242
Consumer Inquiries:
888-INFO-FDA

FDA Approves Drug to Treat Cyanide Poisoning

The Food and Drug Administration (FDA) today approved Cyanokit (containing the drug hydroxocobalamin, intravenous tubing and a sterile spike for reconstituting the drug product with saline) for the treatment of known or suspected cyanide poisoning. The approval, which is based on evidence of the drug's effectiveness when tested in animals, improves the nation's ability to respond to emergencies, including a potential attack by terrorists.

"Cyanide is a potent poison and one of the substances that could be used in a chemical attack," said Dr. Steven Galson, Director of FDA's Center for Drug Evaluation and Research. "Today's approval is yet another measure to counter the threat of terrorism, which is a critical component of FDA's public health mission."

Cyanokit received a priority review and was approved under the Animal Efficacy Rule, which allows use of animal data for evidence of a drug's effectiveness for certain conditions when the drug cannot be ethically or feasibly tested in humans.

In a controlled study in cyanide-poisoned adult dogs, the use of Cyanokit reduced whole blood cyanide concentration by approximately 55% by the end of the infusion, and significantly improved survival of the Cyanokit-treated dogs compared with dogs receiving placebo.

The safety, metabolism and excretion of Cyanokit were evaluated in 136 healthy adult humans. At the proposed starting dose of 5 grams, the drug was found to be generally well tolerated with side effects that were mild to moderate. The drug exits the body unchanged in the urine. In the presence of cyanide, Cyanokit's active drug takes up the cyanide and becomes a form of vitamin B12.

The most frequently reported adverse reactions in the trial were red urine, skin redness (both from the drug's coloration itself), a temporary increase in blood pressure, headache, nausea and injection site reactions. Allergic reactions were observed in a small number of individuals but were relatively mild and responded quickly to treatment.

Cyanokit is manufactured for EMD Pharmaceuticals, Inc by Merck Sante s.a.s. in Semoy, France and packaged by Dey Laboratories of Napa, California.

More information about FDA's efforts to counteract bioterrorism is available on FDA's website at http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html.

(photos courtesy: google images)

METH LABS — smurfing — AFTER THE CLEANUP IS RISK REAL? TOXIC TALE?

Methlabs continue to plague society. Costs continue to rise. New laws embedded. New techniques on how to get the drugs to help make meth continue, for example:

Typical mechanisms that the non-cartel methlab cooks get pseudoephedrine are: smurfing and shelf sweeping. Individuals that “smurf” go to a large number of stores and buy amounts at each retailer of pseudoephedrine that are under the legal limit but in the aggregate are much more. A less sophisticated version of smurfing involves sending many individuals into the same store to buy amounts of pseudoephedrine just below the legal limit. “Shelf sweeping” occurs when an individual or a group goes into a store and remove all the pseudoephedrine on the shelf and then exit without paying.

photo courtesy srhd

Recently, radio listening to a report of the "significant" risks to persons entering into methlab areas that already have been cleaned up or decontaminated or remediated. The report left me believing that any site with any amount of meth activity is the same. Not true.

The report said after the cleanup process has occurred, the persons are still able to be "poisoned" and become "toxic" from being in the decontaminated room. Not probable either.

The epidemic of methlabs across the country have spawned the entire "cleanup industry" making many companies extremely wealthy in the "abatement industry." One operator told me, "If I just turn on the truck, the fee is $2500 dollars, then the bill goes up depending on what we do."

Most ingredients of methlabs are dangerous. Some can be flammable. Some have bombs or incindary devices. However, after the cleanup has occurred, risk is minimal, probably non-existent.

Do you clean out your garage or shed as a methlab decon project – the spaces that have been storage for such contaminants of lawn mower gasoline, oil, garden chemicals, camping or cooking supplies, glass cleaner, carburator fluids, drain cleaners, windshield washer fluids, antifreeze, and other highly toxic day to day chemicals of household use?

The risk of financial collapse for cleanup is hard hitting for any owner that needs to hire a "cleanup" company. It is estimated that a methlab cleanup can cost from $1000 to hundreds of thousands, depending on cartel activity or the mom-pop variety.

Google "methlab cleanup companies" (remediation) and nearly 60,000 hits arrive at the "deal or no deal" option.

Searching and searching, little is found on "risk of after-cleanup toxicity." Colleagues in this area have been surveyed. An anwer is in waiting. Thus far, experience has not shown me one person ill, sick, contaminated, physically harmed, toxic from a space declared "clean."

FLU SHOT OR NOT – KEY FACTS – INFLUENZA ACTIVITY IN NORTHWEST – UPDATE

Influenza Activity as Assessed by State and Territorial Epidemiologists

During week 51, the following influenza activity was reported: • Widespread activity was reported by four states (Alabama, Florida, Georgia, and Mississippi).
• Regional activity was reported by twelve states (Indiana, Iowa, Louisiana, Maryland, Massachusetts, Nevada, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, and Texas).
• Local activity was reported by the District of Columbia and five states (Connecticut, Hawaii, Michigan, Minnesota, and Wisconsin).
• Sporadic activity was reported by New York City and 25 states (Alaska, Arizona, Arkansas, California, Colorado, Delaware, Idaho, Illinois, Kansas, Maine, Montana, Nebraska, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Utah, Virginia, Washington, West Virginia, and Wyoming).
• No influenza activity was reported by one state (Vermont).
• Three states did not report (Kentucky, Missouri, and New Mexico).

What is Influenza (Also Called Flu)?

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year.

Every year in the United States, on average:

5% to 20% of the population gets the flu;
more than 200,000 people are hospitalized from flu complications, and;
about 36,000 people die from flu.

Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

Symptoms of flu include:

fever (usually high)
headache
extreme tiredness
dry cough
sore throat

runny or stuffy nose
muscle aches
Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

The single best way to prevent the flu is to get a flu vaccination each year. There are two types of vaccines:

The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.
The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV is approved for use in healthy people 5 years to 49 years of age who are not pregnant.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

October or November is the best time to get vaccinated, but getting vaccinated in December or even later can still be beneficial since most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May.

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. During flu seasons when vaccine supplies are limited or delayed, the Advisory Committee on Immunization Practices (ACIP) makes recommendations regarding priority groups for vaccination.

People who should get vaccinated each year are:

1. People at high risk for complications from the flu, including:

Children aged 6 months until their 5th birthday,
Pregnant women,
People 50 years of age and older,
People of any age with certain chronic medical conditions, and
People who live in nursing homes and other long term care facilities.

2. People who live with or care for those at high risk for complications from flu, including:

Household contacts of persons at high risk for complications from the flu (see above)
Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
Health care workers.

3. Anyone who wants to decrease their risk of influenza.

Use of the Nasal Spray Flu Vaccine

Vaccination with the nasal-spray flu vaccine is an option for healthy persons aged 5-49 years who are not pregnant, even healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with severely weakened immune systems who require a protected environment; these healthy persons should get the inactivated vaccine.

Who Should Not Be Vaccinated

Some people should not be vaccinated without first consulting a physician. They include:

People who have a severe allergy to chicken eggs.
People who have had a severe reaction to an influenza vaccination in the past.
People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

(adapted from cdc website: anticipate update by cdc after new data emerges)

* HAPPY NEW YEAR 2007 *

ERTALES FROM THIS ER DOC * hugs rule

The little boy was literally climbing up the pantleg of his mother. "He's scared," she told me. "He had a bad time at his doctor's last time," the anxious mom added. Our eyes, the 5 year old's and mine, sized up each other – man to man, muscle to muscle, universe to universe. There would now be an internal debate of trustworthiness – on each side – of this heavy weight moment in time. His reluctance to be lifted on the exam table was obvious as the arms of safety were peeled by his mother from her neck. I sat and watched. Not a word. Quiet.

We drew our weapons. His, a stare of cold steel; mine, a shiny ear scope. Instead, as I sat, I asked to look at mom's ears. I did. I asked to look in mom's mouth, and pretendingly did. His evaluation of my performance was sharply etched in his mind's acute processor. I drew my stethoscope to his mom's back to listen to lungs. Then, I slowly, like the gunfight at the o-k corral, drew toward his watchful perched position of power, while me on the subordinate exam rollerstool.

He said, "I have a dog!" I said nothing, as it could be a ploy, a plot, a trojan horse comment to quickly surround me with ear piercing shrills and dashing speed to his circle of wagons, mom. I waited. My eye honed to his eye. He said the dog's name. I shook my head in approval. I drew my rollerstool closer and closer. His eye honed to my eye. Slowly, like the draw of the bow during the hunt, my otoscope entered his right ear. Then the left. The test of the tonsil lay in front of the medical warriors. "Can you eat an elephant?," I asked. He opened his mouth so wide I could see his appendix. He held the tongue blade. Not needed. His lungs were listened to with the kid-size stethoscope. No rash. "Tonsillitis," I said to him as my stealthy roller steed backed away. He looked at his support staff, his mom. "You will take the medicine for your mom?" and he shook his head affirmatively. The warriors were exhausted.

Celebratory and coexistent now. To the Tootsie Pop drawer, we went. Hand in hand from the exam table battlefield, to the oasis of sweets. His choice was deliberately selected with a keen appreciation for what was to be.

On the escort out of the exam area, with Tootsie Pop in hand, my leg became heavy. The small warrior's arm was hugging around my leg, just above the knee. Stride for stride, we were proudly successful. I said, "Do you want to give me a hug?" He put his arms up high, as I reached over to accept his offer of goodwill. We hugged. Mom smiled. I said to my newly made battlefield-weary friend, "Hugs are good." He said, "bye," as he secured his mother's hand to see the world.

IMMEDIATE CARE urgent care CLINICS – WHY WAIT IN THE ER * MINOR EMERGENCY WALK IN * URGENT CARE * INJURY ILLNESS – WORKER OCCUPATIONAL CARE – DRUG-FREE WORKPLACE TESTING – MRO REVIEW – SPORTS CARE – FAMILY CARE – URGENT CARE

OVER THE PAST DECADE AT LEAST 400 (FOUR HUNDRED) OR MORE EMERGENCY ROOMS HAVE CLOSED
GREATER 120 MILLION PEOPLE WERE TREATED IN ERS A FEW YEARS AGO – GROWING
GROWTH IS AN ALARMING 20-30% EVERY 5-10 YEARS
COMPLICATED PATIENTS CONTINUE TO GROW – AIDS, TB, CANCER, ADVANCED DIABETES, STROKE, HEART DISEASE COMPLICATIONS, TRAUMA, SHOOTINGS, DRUGS OF ABUSE
NEARLY 50 MILLION AMERICANS HAVE NO INSURANCE OR LIMITED ACCESS

click on link – http://www.nimcc.com

WHAT TO DO:

BRING A LIST OF YOUR ALLERGIES, MEDICATIONS, PAST MEDICAL HISTORY, EKG IF YOU HAVE IT, AND NAMES AND PHONE NUMBERS OF SIGNIFICANT OTHERS, AND INSURANCE INFO IF IN DATE

GO TO IMMEDIATE CARE IF UNSURE – IF NOT SEVERELY ILL OR INJURED

IF YOU MUST GO TO THE ER, GO IN THE MORNING…LESS BUSY USUALLY

WHEN IN DOUBT – IF ILLNESS OR INJURY IS SEVERE…CALL 911

TELL THE TRIAGE NURSE YOUR SYMPTOMS…ALL OF THEM

KNOW THE CREDENTIALS OF YOUR DOCTOR…EXPERIENCE

IS THE EMERGENCY PHYSICIAN RESIDENCY TRAINED IN EMERGENCY MEDICINE

IS THE EMERGENCY PHYSICIAN BOARD-CERTIFIED IN EMERGENCY MEDICINE

BRING AN ADVOCATE TO WATCH, LISTEN, AND ASK QUESTIONS – ESPECIALLY IF VERY ILL

MANY IMMEDIATE CARE CLINICS CAN TAKE CARE OF MANY ILLNESSES AND MINOR EMERGENCIES – CALL IF UNSURE

MANY IMMEDIATE CARE CLINICS CAN STABILIZE AND TRANSFER TO THE HOSPITAL

MANY IMMEDIATE CARE CLINICS HAVE BOARD CERTIFIED ER DOCS AND ER EXPERIENCED DOCS

	Parts of system courtesy of Time-Warner except for TV and aluminum foil.
Six pages of text with a WWII diagram of connections, without secret decoder ring.
	The test. Thanks KAYU and Time-Warner for the updated tech TV !