Emergency medicine clinics of North America
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Toxins such as pharmaceuticals, herbals, foods, and supplements may lead to hepatic damage. This damage may range from nonspecific symptoms in the setting of liver test abnormalities to acute hepatic failure. The majority of severe cases of toxin-induced hepatic injury are caused by acetaminophen and ethanol. ⋯ Patients whose hepatic dysfunction progresses to acute liver failure may benefit from transfer to a transplant service for further management. Currently, the mainstay in management for most exposures is discontinuing the offending agent. This manuscript will review the incidence, pathophysiology, diagnosis and management of the different forms of toxin-induced hepatic injury and exam in-depth the most common hepatic toxins.
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Although the spectrum of information related to diagnosis and management of radiation injuries and illnesses is vast and as radiation contamination incidents are rare, most emergency practitioners have had little to no practical experience with such cases. Exposures to ionizing radiation and internal contamination with radioactive materials can cause significant tissue damage and conditions. Emergency practitioners unaware of ionizing radiation as the cause of a condition may miss the diagnosis of radiation-induced injury or illness. This article reviews the pertinent terms, physics, radiobiology, and medical management of radiation injuries and illnesses that may confront the emergency practitioner.
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This article describes the epidemiology and presentation of human envenomation from marine organisms. Venom pathophysiology, envenomation presentation, and treatment options are discussed for sea snake, stingray, spiny fish, jellyfish, octopus, cone snail, sea urchin, and sponge envenomation. The authors describe the management of common exposures that cause morbidity as well as the keys to recognition and treatment of life-threatening exposures.
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Adverse cardiovascular events comprise a large portion of the morbidity and mortality in drug overdose emergencies. Adverse cardiovascular events encountered by emergency physicians treating poisoned patients include myocardial injury, hemodynamic compromise with shock, tachydysrhythmias, and cardiac arrest. ⋯ Treatment of toxicologic bradycardia consists of the use of isotonic fluids, atropine, calcium salts, and glucagon. High-dose insulin euglycemia should be used early in the course of suspected severe poisoning and intravenous lipid emulsion given to patients who suffer cardiac arrest.
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Many new emerging drugs of abuse are marketed as legal highs despite being labeled "not for human consumption" to avoid regulation. The availability of these substances over the Internet and in "head shops" has lead to a multitude of emergency department visits with severe complications including deaths worldwide. Despite recent media attention, many of the newer drugs of abuse are still largely unknown by health care providers. ⋯ Additionally, prescription medications, performance enhancing medications, and herbal supplements are also becoming more commonly abused. Most new drugs of abuse have no specific antidote and management largely involves symptom based goal directed supportive care with benzodiazepines as a useful adjunct. This paper will focus on the history, epidemiology, clinical effects, laboratory analysis, and management strategy for many of these emerging drugs of abuse.