Emergency medicine clinics of North America
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Over the last decade, the use of novel psychoactive substances (NPS) has increased. Some substances are derived from plants but an increasing number are synthetically produced. ⋯ These substances have a wide variety of effects due to the varied potency with which they bind their targeted receptors. Routine immunoassay urine drug screens do not detect these substances and it is, therefore, important for clinicians to be aware of these substances to make accurate clinical diagnoses.
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Taking care of patients with agitated toxidromes can be challenging. While many will be able to be discharged from the emergency department or transferred to psychiatry following brief and simple interventions others will have life-threatening toxicity. Health care providers must develop an organized approach to the assessment and management of these patients that includes foremost the protection of the patient and staff from physical harm, prompt pharmacologic control to allow rapid assessment for life-threatening abnormalities such as hypoglycemia and hyperthermia and optimal cooling of patients with extreme temperature elevations.
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Carbon monoxide accounts for thousands of deaths worldwide each year. Clinical effects can be diverse and include headache, dizziness, nausea, vomiting, syncope, seizures, coma, dysrhythmias, and cardiac ischemia, and severe toxicity generally affects the nervous and cardiovascular systems. ⋯ Even when the diagnosis is certain, appropriate therapy is widely debated. Normobaric oxygen is the standard therapy, and the efficacy of hyperbaric oxygen is unclear.
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Emerg. Med. Clin. North Am. · May 2022
ReviewUtilizing the Toxicology Laboratory in the Poisoned Patient.
When evaluating a potentially poisoned patient, there is no substitute for a thorough history and physical examination. Clues from the examination are generally more likely to be helpful than a "shotgun" laboratory approach that involves indiscriminate testing of blood or urine for multiple agents. ⋯ When a specific toxin or even class of toxins is suspected, requesting qualitative or quantitative levels may be appropriate. The purpose of this review is to examine the role of common diagnostic tests in the evaluation of the poisoned patient.
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The most common chemicals used in riot control agents are chlorobenzylidene malononitrile, chloroacetophenone, dibenz[b,f]-[1,4]-oxazepine, and oleoresin capsicum. They cause ocular, respiratory, and dermal effects usually within seconds to minutes of exposure, but delayed effects have been reported. ⋯ Although most effects are mild, some may be serious, especially in those with preexisting respiratory disease. Treatment consists of removing the patient from the source of exposure, removing contaminated clothes, and copiously irrigating the affected areas with water.