Description
As with any severely ill patient, the initial step is to stabilize the patient's respiration, circulation, and airway. By identifying the toxin, either by laboratory testing, toxidrome, or history, the doctors may be led in the appropriate direction. In situations where the precise poisoning agent is known, antidotes can be applied.
Summary Listen
- The presentation focuses on the initial management of poisoned patients in emergency departments, highlighting the increasing importance of clinical toxicology. Common challenges include vague patient histories due to altered mental states or lack of bystanders, and the prevalence of co-ingestions or multiple drug overdoses. The "toxidrome" approach, based on recognizing syndromes through history, vital signs, and targeted physical exams, aids in identifying unknown toxins.
- Key components of the initial assessment involve recording vital signs, and focusing on the central nervous system (mental state, pupils), skin, and bowel/bladder function. Recognizing common toxidromes such as opioid (CNS depression, miosis, respiratory depression), sympathomimetic (hypertension, tachycardia, agitation), anticholinergic (hyperthermia, dry skin, altered mental status), and cholinergic (SLUDGE symptoms, muscle weakness) assists in narrowing the diagnosis.
- Initial emergency department management prioritizes stabilizing the patient's ABCs (airway, breathing, circulation) before proceeding with decontamination. Decontamination methods include dermal and ocular irrigation, along with traditional techniques like gastric lavage, whole bowel irrigation, and activated charcoal, while being mindful of contraindications.
- Gastric lavage, once routine, is now more selectively applied, primarily within 2-3 hours of ingestion of a potentially lethal poison in a conscious patient. Contraindications include corrosive ingestion, convulsions, and esophageal varices. Activated charcoal remains a valuable tool for adsorbing various toxins but is less effective against alcohols, heavy metals, and acids.
- Enhanced elimination methods, like forced alkaline diuresis, can aid in removing certain toxins primarily excreted in urine, such as phenobarbital and salicylates. Hemodialysis and hemoperfusion are useful for specific toxins like paraquat and theophylline. Initial treatment also includes addressing specific complications like convulsions (diazepam), metabolic acidosis (sodium bicarbonate), and bronchoconstriction (beta-agonists).
- Antidotes play a crucial role in reversing the effects of specific poisons, with examples including N-acetylcysteine for acetaminophen, naloxone for opioids, and atropine for organophosphates. Proper documentation is emphasized due to the medical-legal implications often associated with toxicology cases.
Sample Certificate
About the Speakers
Dr. Nikhil Paul
Consultant Emergency Medicine,Kasturba Medical College Mangalore MAHE
Financial Disclosure
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