Emergency medicine clinics of North America
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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.
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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.
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Emerg. Med. Clin. North Am. · May 2022
ReviewToxin-Induced Seizures ∗Adapted from "Toxin-Induced Seizures" in Neurologic Clinics, November 2020.
New toxins are constantly emerging within society. We review common toxins that cause seizure, their mechanisms, associated toxidromes, and treatments. Stimulants, cholinergic agents, gamma-aminobutyric acid (GABA) antagonists, glutamate agonists, histamine and adenosine antagonists, and withdrawal states are highlighted. Understanding current mechanisms for common toxin-induced seizures can promote understanding of future toxins and predicting if seizure may occur as a result of toxicity.
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Management of the acutely poisoned patient requires supportive care and timely administration of antidotes to minimize ongoing toxicity and mortality. New applications for old antidotes include utilization of methylene blue and hydroxocobalamin in vasoplegia. ⋯ Additional antidote considerations include administration of lipid emulsion in lipophilic xenobiotic exposure not responsive to standard resuscitative modalities. These expert recommendations provide guidance for providers caring for the acutely poisoned patient.
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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.