Incident reporting administrative functions

A central collection area should be established where all reports are collected. This is normally an administrative function even thongh, in some organizations, a safety coordinator is allocated the responsibility of administrating the collection, analysis, and submission of near miss incident reports. Both formal and informal incident reports should be colleeted and tabulated on a simple spreadsheet. 

There have been several reports of hepatotoxicity of iodipamide, variously characterized by epigastric pain, nausea and vomiting, jaundice, pyrexia, and tenderness over the liver, with abnormal liver function tests. Biopsy has shown centrilobular necrosis (154). The incidence of abnormal liver function tests may be as high as 18% after a dose of 40 ml, and the quantity given should be as small as possible. Prior administration of glucocorticoids or sulfonylureas impairs hepatic excretion of ioglycamide. Both iodoxamate and iotroxate can affect liver function tests in a small series of cases, the degree of intrahepatic cholestasis appeared to be relatively more marked after iodoxamate than after iotroxate (SED-12, 1168) (155). 

Patients with renal impairment should not receive metformin. Other contraindications include hepatic disease, a past history of lactic acidosis, cardiac failure requiring pharmacological therapy, or chronic hypoxic lung disease. The drug also should be discontinued temporarily prior to the administration of intravenous contrast media and prior to any surgical procedure. The drug should not be readministered any sooner than 48 hours after such procedures, and should be withheld until renal function is determined to be normal. These conditions all predispose to increased lactate production and hence to the potentially fatal complication of lactic acidosis. The reported incidence of lactic acidosis during metformin treatment is less than 0.1 cases per 1000 patient-years, and the mortality risk is even lower. 

It remains to be established whether the increased incidence of rash in patients receiving concurrent allopurinol and ampicillin should be ascribed to allopurinol or to hyperuricemia. Hypersensitivity reactions have been reported in patients with compromised renal function, especially those who are receiving a combination of allopurinol and a thiazide diuretic. The concomitant administration of allopurinol and theophylline leads to increased accumulation of an active metabolite of theophylline, l-methybcanthine the concentration of theophylline in plasma also may be increased (see Chapter 27). 

Supporting this view is a report from the Tokyo subway terrorist incident of 1995. One hospital received two casualties who were apneic with no heartbeat. With vigorous resuscitation, cardiac activity was established in both. One resumed spontaneous respiration and walked out of the hospital several days later, and the other did not start breathing spontaneously and died days later. These anecdotes suggest that when circumstances permit, resuscitation should be attempted. In a contaminated area where resources, including personnel, are limited, the use of ventilatory support and closed chest cardiac compression must be balanced against other factors (see above), but the immediate administration of diazepam and additional atropine requires little effort and can be very rewarding in the casualty who still has apparent cardiopulmonary function. Cyanide... 

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