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Show St mitr County fHonitor PAGE 3 II IIS Wall of Fame ' Forces until February 1946. In October 1947 I was called on a mission for the Church of Jesus Christ of Latter-Da- y Saints and labored in the States until New England 1949. September I then entered Brigham Young University, majoring in Economics and Agricultural and graduated with a Agronomy, in B.S. degree June 1954. 1 later received a Masters Degree in Agricultural Economics at Utah State Agricultural College, June 1955. Jean Marie McKell August 15, 1951, and we are the parents of three children: Mrs. Jilene Burger, Idaho Falls, Idaho, Mrs. Mary Jean Pangman, Bountiful, Utah, and a son, J. McKell Goodwin, Salt Lake City, Utah. Our family also includes David Burger, two and Edwin Pangman and four grandchildren, Criscell Burger, Chalise Burger, Jason Reed Pangman and Alicia Christine I married sons-in-la- Pangman. I labored thirty years as a statistician for the United States tfcA: tot was bom in Milford, June Utah, 24, 1924 and lived life in Milford Valley whole my until I entered the Military' in 1944. I was the oldest child of George Carlos Goodwin and Cuma Bond Goodwin. I have one younger brother, William Albert Goodwin. I was educated in the Milford Public School System. I well remember the first day of elementary school. When the bell rang we all entered the great hall on the east of the building. There standing in the center was the principal with a yard stick in his hand. If any one got out of line we could hear his voice the full length of the building. Upon leaving the sixth in grade 1936, we entered Junior High. It was in the High School of Agriculture, Department in Arizona, Phoenix, operating Austin Madison, Texas, Wisconsin, Washington D.C. and Salt Lake City, Utah. The last ten years was as assistant in charge of the Utah office. I retired in Goodwin building just to the south of the I Elementary School. Graduation day of junior high was a great day. We all entered the assembly room. The seniors marched up on the stage. The juniors moved into the place vacated by the seniors and the 10th grade into the juniors spot, then we moved into the freshman area. Whenever an was there assembly school the years, high throughout we always sate according to the class we were in. Our class graduated from Milford High School May 29, 1942. It was year of much uncertainty as our country was involved in World War II. L'. 'i;. '. " J?,44 Xwas inducted into the Military Service and served in Ground Support Units of the Fifth and Eighth Air 1985. performed as Director, Vice President, and President of Madison Chapter O.P.E.D.A.. I have also served as Director, President Elect, and President of Twin Peaks Chapter Sons of Utah Pioneers and as Area Vice President, National Society of Sons of Utah Pioneers. As an active member of the Church of Jesus Christ of Latter-Da- y Saints, I have served in various ward and stake positions, including Ward Clerk of the Phoenix First Ward, Bishopric and Bishop of the Austin Ward.High. Council of the San Antonio Stake, High Council of the Milwaukee Stake and ordinance worker in the Salt Lake Temple. I All Orange Coveralls $51.99 Adult Orange Jackets $19.99 Childrens Orange Jackets starting at $15.99 Childrens Orange Sweatshirts only $4.99 ll-- . Ill oT 1 I 560 North Main rjL 387-249- 6 & Nicotine Poisoning It's Not Just About Cigarettes Reproduced with permission from EMERGENCY MEDICAL SERVICES Magazine, Volume 26, Number 9, September 1997. Uncle Donnie was the By Kenneth L Phillips, PA-family prankster. He was the only person with the chi'tzpa to hire a male stripper to deliver a singing birthday greeting to his wife in the city's most conserv ative restaurant, and then start a food fight when the restaurant's management asked the stripper to leave. So no one was surprised when, at the family reunion, Uncle Donnie gave a piece of Aunt Mary's "chewing gum" to 4 year old Toby. Everyone laughed when Toby bit into the hard gum, and then wrinkled his nose in a cute expression of disapproval at the peppery taste. Toby was an expert at avoiding adults when be wanted to get his way. He waited very quietly until no one was paying attention to him, then he went to Aunt Mary's purse and withdrew the box of gum under his shirt, put the remaining sleeves back in die box and returned to box to the purse. Toby wandered around for a bit, making sure he was noticed, and then crawled under a picnic table. It was difficult to punch the beige pieces of gum through the blister wrap, but he managed. The strips were full, and his mouth w as small, so after stuffing several pieces of the hard bum into his mouth, he would swallow it It didn't taste very good anyway, but it was his now, and he was determined to get it all down. The taste of the gum had gone beyond hot, and his mouth was now tingling and numb. He could no longer feel his tongue and cheeks. When he heard someone say toasted marshmallow, he gulped own one last piece of bum and went to get his share of the sticky sweet treat. Toby became the life of the party. He giggled and talked a little too loudly with everyone. I lis an danced, mother scolded him and told him to stop showing off. His grandmother remarked, "You shouldn't give sugar to a child, it makes them hyperactive." After a while, Toby said, "My rummy feels sick," and crawled back under the picnic table to start his afternoon nap. Marcus had been a paramedic for nearly five years. En route to the call for an unconscious child at the municipal park, he mentally reviewed causes of unconsciousness. He remembered it by PATIOEIS (poison, alcohol, trauma, infection, overdose, epilepsy, intracranial pressure, stroke and shock). But there was not enough information from the dispatcher to formulate a plan. As the rig entered the park, it sped past playing children and other folks having barbecues, then the crew saw a group of excited adults directing them to the scene. When they arrived, a tearful woman in her late 30s said "Please help us, he just won't wake up." no one could say for sure when Toby had started his nap, but it had been at least 30 to 45 minutes ago. Marcus quickly evaluated the scene, and then turned all of his attention to the child. Toby's chest was rising and falling effortlessly, and his lips were normal in color. OK, so much for airway and oxygenation: He took the child's small wrist in his hand and felt a normal pulse of about 96. There were no signs of trauma. The mother told Marcus that the child had no allergies, was in good health and had not taken any medications since his last ear infection about six months ago. She said she gives him children's vitamins, but she is careful to keep the bottle out of reach. She said he had never been unconscious before. Marcus carefully looked all over the boy's small body. Toby seemed pale, and his skin felt unnaturally cool tor such a warm day. The skin was moist with sweat. There were no bruises, no signs of bites or stings and the limbs seemed straight and undamaged. He noticed an occasional involuntary twitch in the legs and arms. He supported the neck and head with one hand as he rolled the boy's small body and looked at the back Nothing! As he rolled the limp head and neck back be noticed that the child was tearing and that his face was wet and sticky from a mixture of marshmallows and drooling. He could not detect an odor from the nose or mouth. He looked at the pupils, but couldn't decided if they were constricted or just reacting to the bright sunlight He shielded the little face with his hands for a few seconds, and then quickly opened the eyes. The pupils reamined fixed and constricted. The mnemonic SLUDGE came to mind. Marcus had first learned those symptoms in basic medical training in the Army. Salivation, Lacrimation, Urination, Diaphoresis, Gastrointestinal Upset and Emesis; they were symptoms of nerve agent poisoning. He also knew that pinpoint pupils and bradycardia (slowed pulse) went along with the other finding. His training had since taught him these were overdose symptoms of any cholinergic drug. Marcus looked around the area, but there was nothing in the vicinity to suggest the presence of an organophosphate insecticide. As he continued his exam of the little boy, he asked if they had been using an insecticide, eating mushrooms, or if anyone had left any medication in the child's reach. Several people spoke at once and said they had not. Uncle Donnie muttered something about wasting time and getting the kid to a doctor. As Marcus continued his secondary survey, he palpated the pelvis and noticed something in Toby's pockets. He reached inside and pulled out two blister packs with 1 2 empty slots in one and eight in the other. Behind him he heard Aunt Mary say "Those arc my Nicorettes!" So that was it. Nicotine poisoning! He had been expecting something like this to happen ever since Nicorette and other tools like it became available over the counter, but this was his first case. Nicotine poisoning would explain the cholinergic symptoms as well. He knew the poison was rapidly absorbed, especially in children. He remembered reading on the poisindex that 40 to 60 mg of nicotine was potentially lethal to an adult. At 2 mg per piece of gum, it didn't take a rocket scientist to determine that the child had taken a serious overdose. At least these pieces were beige in color - he knew the yellow pieces were 4 mg each. He had read that one ingested cigarette, three cigarette butts or one cigar butt was potentially toxic to an adult. One transdermal nicotine patch contains as much as 52.5 milligrams of nicotine. He had shuddered when he thought of what would happen to a baby or a pet who chewed on a discarded patch. He snapped back to the reality of the situation and told everyone to look for the gum, hoping Toby had spit it out When none could be found, he knew the gum was in the stop-smoki- CD-RO- i Milford True Value Hardware A OCTOBER 16, 1997 F Enterprises stomach, and it w as continuing to slow hy leech poison in to the little body in his arms. Race Against Time Marcus got the child and mother into the rig and called his base at University Hospital. At the emergency department, a nurse who had seen it all by now calmly recorded the vital signs and said "stand by." In a moment, another woman's voice came ovedr the speaker. Marcus recognized it as Dr. Ruth Frank, one of the finest emergency medicine residents he had ever met Besides, she had worked as an EMT before beginning medical school and was "street smart." "Start an IV line, nasal 02, put the kid on a monitor, and watch respirations," she said. "Pull over and intubate if you need to. In the meantime, put him in a left lateral decubitus position. Most of the time in severe nicotine poisoning, death will occur because of respiratory failure. Normally we wouldn't try to make the child vomit because the poison is so rapidly abosrbed. Since he still has it in his stomach, and Isn't fully alert, we'll have to lavage him" die physician asked Marcus if Toby had a gag reflex. Marcus opened the boy's mouth and inserted a tongue blade to the back of the tongue. Toby gagged quickly. I Ie gently shook the child and loudly called his name. The child stirred, but did not open his eyes. "Yes, he does," Marcus replied. "Then, if he will tolerate it give him sips of activated charcoal maybe we can slow some of the absorption," Dr. Frank said. "Go ahead and transport; we'll be waiting." While preparing for the ambulance to arrive. Dr. Frank told the nurse to set up a room for lavage, and w alked down the hall to find Dr. Edwards, the professor of clinical medicine. This was Dr. Frank's first serious nicotine poisoning, and she didn't want to leave anything to chance. "Tell me everything you know about nicotine poisoning." Dr. Edwards said. Frank's response: "It is an alkaloid used in insecticides and medicines. The old time docs used tobacco enemas to cure intestinal parasites. It causes CNS stimulation followed by bradycardia, hypotension, atrial and ventricular arrhythmias, seizures and coma. Atrial arrhythmias are most common, and I remember reading about at least one death from V tach. Treatment is aimed at maintaining the respirations and blook pressure. Atropine can be used for asystole, bradycardia and the cholinergic sumptoms. Diazepam or lorazepam can be used for seizures." "Very good," Dr. Edwards exclaimed. "But you have seen one other nicotine overdose. Remember the 42 year old civil engineer who had noticed tachycardia and an increase in secretions to the point of drooling? By the time his wife drove him in, he was in atrial fib. He was anxious, sweating, hypertensive and complained of chest discomfort. We were handling him as an MI. The nursing aide who hooked up the monitor became suspicious when she saw five Nicoderm patches on the chest and abdomen. The patient was still smoking two packs of cigarettes per day. He had an expensive lesson in the proper way to quit smoking. And he isn't alone, I remember hearing on the news that nicotine overdoses were up by 500 in the Denver area. With the gum and the patch now being sold over the counter, I think we are going to see a lot more cases like this." Dr. Edwards continued: "Remember, the nicotine in Nicorette is released by chewing. The nicotine is readily absorbed through the buccal mucosa but is poorly absorbed in the acid pH of the stomach. Most of the nicotine will remain in die resinous gum. Only about 15 of the nicotine will be absorbed from the gum withour chewing. Even if we chew a 2 mg piece thoroughly we can only extract about 1 .4 mg from the piece. So one piece with a loading dose of 1 .4 mg and a dozen pieces at 0.3 mg each would come out to 3.6 mg yet to be absorbed This boy's symptoms indicate he must have chewed several pieces rather well. Since we get peak plasma levels in about 15 to 30 minutes, I think you may be seeing the worst of it right now. "The objective is to get the remaining gum out of his body as soon as possible. You have two routes. One is a surgical opening through the abdominal wall, and the other is to speed the transit of the gum through the intestines. 1 recommend we use the latter. Protect the airway because most kids will spontaneously regurgitate much of the nicotine anyway. You already know how to manage any cardiac dysrhythmias that might occur. I think you've pretty much got this under control. I'll stop by later to check on him." Upon arrival at the emergency department, Toby's pressures were down, his pulse rate was dropping and irregular, and his pupils were dilating. His blood sugar was OK at about 140 and he had no response to naloxone. Dr. Frank slipped an endotracheal tube in place, and chckccd its position with a stethoscope. As she turned her attention to checking the IV line Marcus had placed, Dr. Frank said the ED team: "Hook up a monitor and let's get a CBC tytes, to see if we can see that gum." gasses, UA and an "Do you want nicotine levels?" a lab tech asked. "No," Dr. Frank said, "They just aren't helpful." the nurse hung the saline for lavage. The 32 French stomach tube went in smoothly and the saline began to run. It was slow going because the sticky gum kept blocking the tube. "Let's keep an I&O record of the lavage fluids. It wouldn't take a lot to upset the electrolytes in a little tyke like this. Mix a slurry of charcoal, and set out a bottle of mag sulfate. We'll need both of those. Call the pediatric resident and tell him he has an admission goin to ICU," Dr. Frank ordered. "I think we have him in time. It all depends on how much nicotine is still being absorbed. As long as we can keep him out of seizures and cardiac arrhythmias, he should pull through. It will be quite a while before we know." X-r- And They Lived Happily... About three weeks later, Marcus was reviewing run sheets. He had not forgotten Toby and wondered how he was doing. He looked up the phone nyumber and with some reluctance, dialed the number. Toby's mother answered the phone. She was delighted to hear from Marcus. "I never did thank you for all you have done for us," she said. Marcus was relieved to hear her cheerfulness because it told him Toby had done well. "Wait a minute," she said, "there is someone who wants to talk to you." a shy little voice said "Hello. My mommy tells me you gave me a ride in an ambulance, but I was asleep. Can you give me another ride now that I'm awake?" Kenneth L Phillips, PA-is a physician assistant in the Ambulatory Services Division at Evans Army Community Hospital in Ft. Carson, CO, and an EMS editorial advisory board member. Special Thank to Stephen Brooks, Mmersville Emergency Service, for tracking down this article and securing permission for reprint |