tailieunhanh - Chapter 134. Botulism (Part 4)

Botulism: Treatment Patients should be hospitalized and monitored closely, both clinically and by spirometry, pulse oximetry, and measurement of arterial blood gases for incipient respiratory failure. Intubation and mechanical ventilation should be strongly considered when the vital capacity is | Chapter 134. Botulism Part 4 Botulism Treatment Patients should be hospitalized and monitored closely both clinically and by spirometry pulse oximetry and measurement of arterial blood gases for incipient respiratory failure. Intubation and mechanical ventilation should be strongly considered when the vital capacity is 30 of predicted especially when paralysis is progressing rapidly and hypoxemia with absolute or relative hypercarbia is documented Chap. 263 . Serial measurements of the maximal static inspiratory pressure may be useful in predicting respiratory failure. In food-borne illness equine antitoxin should be administered as soon as possible after specimens are obtained for laboratory analysis. Treatment should not await laboratory analyses which may take days. The previous trivalent antitoxin preparation types A B and E is no longer available. Instead a bivalent preparation containing toxin types A and B and an investigational monovalent type E preparation can be obtained. The bivalent preparation is administered routinely monovalent type E antitoxin is given in addition when exposure to type E toxin is suspected after seafood ingestion for example . In the United States antitoxin as well as help with clinical management and laboratory confirmation are available at any time from state health departments or from the Centers for Disease Control and Prevention CDC emergency number 770-488-7100 . A limited supply of an investigational heptavalent antitoxin types A through G is maintained by the . military for emergency use. After testing for hypersensitivity to horse serum antitoxin is given as recommended by the CDC repeated doses are not considered necessary. Anaphylaxis and serum sickness are risks inherent in use of the equine product and desensitization of allergic patients may be required. If there is no ileus cathartics and enemas may be used to purge the gut of toxin emetics or gastric lavage can also be used if the time since ingestion is brief .

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