Naloxone: intravenously, intramuscular, inhalatory and intranasal use in emergency cases

The use of naloxone in emergency medicine is primarily connected to the treatment of a syndrome known as overdose, which is cause by non-essential use of heroin and certain opioid agonists. The dose of naloxone required to be efficacious depends on the quantity of opioid assumed, its receptorial affinity and its kinetics: in propoxyphene and pentazocine intoxication, for instance, higher doses are require than those needed in the treatment of morphine or heroin overdose. Intravenous administration is the most efficacious and fast-acting method: however, in certain cases, and depending on aspects that are typical of overdose patient management (e.g. the difficulties connected to vein access, skin scarring, severe hypotension), alternative pathways may be used. These include intraand sub-lingual and intratracheale administration, inhalatory administration via nebulisation (possible in the presence of respiratory action only), and intramuscular and subcutaneaous administration (which are efficacious in the absence of hypoperfusion). However, the most promising means of administration would appear to be intranasal administration, thanks to the relative ease of access, lower risk of contact with bodily fluids and the excellent bioavailability and rapidity of the effect, which is similar to that achieved with intravenous administration

Plant poisoning: Increasing relevance, a problem of public health and education. North-Western Italy, Piedmont region

Indoor and outdoor plants are responsible for a rising number of accidental poisonings. Plant ingestions are among the top five causes of accidental poisonings in children younger than 5 years. Pets are also frequent victims of plant poisonings. Young children and pets will often chew and eat anything within reach, no matter how it tastes or if it is bitter. Eating a small amount of a plant may not always be a problem, but large or repeated doses may be extremely harmful. There is no easy test for knowing poisonous plants from those that are safe. Don't assume a plant is safe for humans just because animals or birds eat it without harm, and heating and cooking do not necessarily destroy the toxin in a mushroom or a plant. Regarding plant exposures and/or poisonings in Piedmont region, on average fifty cases per year were monitored by the Milan Poison Control Center at the Niguarda Hospital, Italy. This study was divided into provinces, ages and sex, place of exposures (home, school, at work); in addition some cases of group intoxication were monitored. Many plants cause nausea, vomiting, abdominal cramps and diarrhea. Some plants have substances that are very irritating to the tongue, mouth and skin. The expositions mainly regard houseplants, garden or vegetable-garden plants, but the most severe and dangerous expositions are due to wild plants