Description
Intensive care management of toxicological emergencies involves a comprehensive approach to assessing, stabilizing, and treating patients who have been exposed to toxic substances. Promptly assess the patient's airway, breathing, and circulation to ensure their vital functions are stable. Provide supportive measures, including maintaining oxygenation and ventilation, establishing intravenous access, and monitoring vital signs. Continuously monitor the patient's vital signs, cardiac rhythm, oxygen saturation, and urine output to detect any changes or complications. Conduct a thorough toxicological screening to identify the specific toxin or toxins involved and guide further management. Administer specific antidotes if available and indicated based on the identified toxin. Ensure adequate oxygenation and ventilation through supplemental oxygen, non-invasive ventilation, or intubation and mechanical ventilation if necessary.
Résumé
- Toxicology is the study of poisons, defined as any substance (liquid, gas, or solid) that produces adverse biological effects on the body, leading to illness, injury, or death. A substance's toxicity depends on the dose and context. The initial management of poisoned patients follows the ABCs (Airway, Breathing, Circulation), along with decontamination to prevent further exposure.
- Diagnosis involves a parallel process of history taking, physical examination, and laboratory tests, including toxicology screens and blood gas analysis. History gathering includes asking about environmental factors, witness accounts, available medications, and past poisoning attempts. Examination includes identifying signs and symptoms like trauma, infection, or injection sites.
- The identification of the toxin relies on constellations of findings from clinical examination and lab results. Various toxidromes help classify the type of poison, such as narcotics/sedatives, anticholinergics, sympathomimetics, serotonergic agents, and opioids. Each toxidrome has specific symptoms, like altered mental status, vital sign changes, and pupillary responses.
- Specific treatments exist for certain poisonings, such as naloxone for opioid overdose. However, nonspecific therapies like activated charcoal and whole bowel irrigation are more commonly used. Acid or alkaline diuresis can enhance renal excretion in some cases. Dialysis may be considered in severe poisonings.
- Supportive care is the cornerstone of poison management, focusing on stabilizing the patient and maintaining vital organ functions. This includes managing airway, breathing, circulation, temperature, and blood pressure. Consulting with poison control centers is recommended for guidance.
Exemple de certificat
À propos des intervenants
Dr Munish Chauhan
Consultant principal, médecine de soins intensifs, Fortis Memorial Research Institute, Gurgaon
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