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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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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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.