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TOXICOLOGY APPROACH IN ED

Learn about risk assessment, supportive care, and interventions in toxicology emergencies. Explore resuscitation protocols, investigations, decontamination, enhanced elimination methods, antidotes, and patient disposition.

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TOXICOLOGY APPROACH IN ED

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  1. TOXICOLOGY APPROACH IN ED Y A MAMOOJEE

  2. RESUSCITATION – A, B, C • RISK ASSESSMENT • SUPPORTIVE CARE • INVESTIGATIONS • DECONTAMINATION • DELAYED ABSORPTION • ENHANCED ELIMINATION • ANTIDOTE • DISPOSITION

  3. RESUSCITATION • A – aspiration risk • B – decreased LOC (GCS <12) • C – hypotension • DEFG – treat if <4 (agents?) • HYPERTHERMIA – treat if >38.5 • CONTROL SEIZURES – usually generalised, Midazolam first choice • CONSIDER SPECIFIC ANTIDOTES

  4. RISK ASSESSMENT • AGENT • DOSE • TOI • CLINICAL FEATURES • PATIENT FACTORS • Ask family members, paramedics, count tabs, check medical records • Usually a worst case scenario

  5. POISON CENTRE - 131126

  6. SUPPORTIVE CARE • Airway – Intubation • Breathing – oxygen and ventilation • Circulation – fluids, inotropes, control HTN, defib, antiarrhythmics • Sedation • Seizure control • Metabolic – bsl, pH • Fluids and electrolytes • Renal function – adequate hydration and fluid balance • General – nutrition, resp toilet, bladder care, pressure care, TE prophylaxis, mobilisation

  7. INVESTIGATIONS • ECG • PARACETAMOL • OTHER SPECIFIC – COHB, MetHb, ABG • Drug levels – Li, Fe, dig, CBMZP, toxic alcohols, salicylates

  8. BOWEL DECONTAMINATION • EMESIS • GASTRIC LAVAGE • ACTIVATED CHARCOAL • WHOLE BOWEL IRRIGATION

  9. ENHANCED ELIMINATION • SEVERE TOXICITY • POOR OUTCOME DESPITE GOOD SUPPORTIVE CARE AND ANTIDOTE ADMINISTRATION • SLOW ENDOGENOUS ELIMINATION RATES • SUITABLE PHARMACOKINETIC PROPERTIES

  10. ENHANCED ELIMINATION • MULTIPLE DOSE ACTIVATED CHARCOAL – CBMZP, DAPSONE, PHENOBARB, QUININE, THEOPHYLLINE • URINARY ALKALINIZATION – PHENOBARB, SALICYLATE • HAEMODIALYSIS – Li, Metformin lactic acidosis, K, salicylates, toxic alcohols

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