Emergency medicine clinics of North America
-
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.
-
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.
-
Pediatric poisonings comprise the majority of the toxic exposures reported to U. S. poison centers. ⋯ These toxins include such substances as specific prescription medications, over-the-counter medications, essential oils, and common household items. With such a vast array of potential toxic exposures that can affect children, it is imperative that health care practitioners who work with children understand the general management of the poisoned pediatric patient.
-
This review discusses the distinct envenomation syndromes produced by North American species of snakes and arthropods, specifically the Crotalinae subfamily of snakes, which includes cottonmouths, copperheads, and rattlesnakes; coral snakes; Latrodectus and Loxosceles species of arachnid; and Centruroides sculpturatus, the only species of North American scorpion capable of producing an envenomation syndrome. The authors discuss the epidemiology, pathophysiology, and presentation of these syndromes and emphasize the varying degrees to which these syndromes can manifest clinically. Finally, the management of each envenomation syndrome is addressed. Special attention is paid to available antivenoms, their indications for use, and their side effects.
-
Emerg. Med. Clin. North Am. · May 2022
ReviewUpdates on the Evaluation and Management of Caustic Exposures.
In the 2019 annual report by the American Association of Poison Control Centers, there were more than 180,000 single substance exposures involving household cleaners, making these products the second most common exposure reported to poison control centers. Little controversy exists in the general management following dermal or ocular caustic exposure. ⋯ This article provides a thorough review of diagnosis, management and prevention of gastrointestinal caustic exposures and their sequelae. Hydrofluoric acid, which requires special consideration compared to other acids, is also explored.