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Introduction: The identification of a causative toxin is one of the most important tasks in emergency medicine; it requires both rapidness and accuracy. In the Japan-shaking poisoning incidents taking place in 1998, such as curry (arsenous acid) poisoning in Wakayama, sodium azide poisoning in Niigata and cyanide poisoning in Nagano, the importance of a rapid and accurate analysis system for poisons was well recognized by Japanese people and goverment. Since then, the importance of toxin analysis (clinical analytical toxicology) on the spots of clinical treatments of poisoned patients (clinical toxicology) was also confirmed. . | I.8 Problems in toxin analysis in emergency medicine By Makoto Nihira Introduction The identification of a causative toxin is one of the most important tasks in emergency medicine it requires both rapidness and accuracy. In the Japan-shaking poisoning incidents taking place in 1998 such as curry arsenous acid poisoning in Wakayama sodium azide poisoning in Niigata and cyanide poisoning in Nagano the importance of a rapid and accurate analysis system for poisons was well recognized by Japanese people and goverment. Since then the importance of toxin analysis clinical analytical toxicology on the spots of clinical treatments of poisoned patients clinical toxicology was also confirmed. The Ministry of Health and Welfare of Japan decided to distribute an X-ray fluorescence spectrometer to be used for metal analysis together with an HPLC instrument with a photodiode array detector to be used for drug analysis to the 65 critical care medical centers the above two instruments plus some mass spectrometric instruments for the final identification and quantitation to the 8 advanced critical care medical centers. Such analytical instruments were introduced also to our Advanced Critical Care Medical Center of Nippon Medical School. Upon introduction of the state-of-the-art analytical instruments all staffs of both Department of Legal Medicine and Advanced Critical Care Medical Center discussed together on the selection of each type of instruments which had been proposed by various manufacturers for strengthening the toxin analysis system in emergency medicine at our College Hospital. At Nippon Medical School the Department of Legal Medicine and the Advanced Critical Care Medical Center have been cooperating for practical analysis and studies on new analytical methodologies of drugs and poisons in specimens sampled from poisoned patients for more than 20 years since 1980 1-8 . Screening tests are being made at bedside viz. inside the Advanced Critical Care Medical Center and .
