Management Of Common Toxicological Emergencies Flashcards
(35 cards)
What are the common toxicological emergencies?
- Coma and ACL
- Respiratory failure
- Pulmonary edema
- Shock
- Convulsions and seizures
- Acid-base disturbance
- Rhabdomyolysis
What are the causes of coma?
- Toxins that cause direct CNS depression (alcohols, opiates, barbiturates, benzodiazepines, antidepressants)
- Secondary to metabolic disorders,
- hypoxia - toxic gases (CO, H2S, HCN)
- toxin-induced metabolic acidosis
- hypoglycemia (insulin, toxic alcohol)
How to grade a comatose patient?
Using scales such as
1. REED’s classification
2. GCS scale
What is the score of the comatose patient according to the GCS scale?
<8 score
How to manage a comatose patient?
- Stabilization using the ABCD approach, investigations (ABG, glucose, urea, electrolytes)
- give coma cocktail for undiagnosed patients
What is coma cocktail?
- IV glucose (Dextrose) for hypoglycemia
- Oxygen as an antidote for CO
- Naloxone as an antidote for opioids
- Thiamine (Vit B1) to correct Wernicke’s encephalopathy in alcohol toxicity
What is the ICU care of the comatose patient?
- Eyes: Protect with ointment to prevent corneal ulcers.
- Mouth: Provide regular oral care to maintain hygiene and prevent infections.
- Skin: Perform frequent repositioning and skin care to avoid bed sores, especially on bony prominences.
- Chest:
- Monitor oxygen levels with pulse oximetry.
- Perform physiotherapy to prevent respiratory complications like pneumonia. - Cardiovascular System: Continuously monitor heart rate and blood pressure.
- Stomach: Administer H2-blockers (e.g., ranitidine) to prevent stress ulcers.
- Fluid Balance: Use a urinary catheter and fluid chart to monitor input and output.
- Deep Veins (Legs): Administer SC heparin (5000 U/12h) to prevent deep venous thrombosis (DVT).
- Muscles and Joints: Perform physiotherapy to prevent stiffness and contractures.
- Mobilization: Gradually mobilize the patient once conscious to restore physical function.
- General Care:
- Provide proper nutrition and hydration (enteral or parenteral).
- Monitor daily lab values (electrolytes, glucose, hematocrit, urea).
- Conduct daily clinical exams and assess consciousness levels
The conscious level is maintained by?
Brain stem reticular activating system and its bilateral projections to the thalamus and cerebral hemisphere
How to diagnose respiratory failure?
Arterial oxygen tension (PaO2) < 60 mmHg, Arterial carbon dioxide tension (PaCO2) > 45 mmHg
What are the causes of respiratory failure?
Depression of brain controlling centers of respiration, respiratory muscle paralysis, failure of the exchange of oxygen and carbon dioxide within alveoli, damage to respiratory airways (corrosives)
What are the causes of respiratory muscle paralysis?
Botulism, Cobra snake envenomation, Anticholinesterase poisoning
What are the clinical signs of respiratory failure?
Cyanosis - hypoxia, confusion, sweating and drowsiness - high CO2, deteriorating consciousness and dysrhythmias
How to manage a respiratory failure patient?
Ensure upper airway patency, administer oxygen, treat the causes, use antibiotics to fight infection, administer bronchodilators, consider mechanical ventilation
Why should the amount of O2 be properly adjusted in COPD patients?
As high O2 flow can precipitate hypoventilation with a rise in PCO2
How to ensure airway patency?
Assess responses, breathing sounds, and obstruction signs; position with head-tilt chin-lift; suction to clear secretions; use oropharyngeal airway (OPA) for unconscious patients; perform bronchial toilet for lower airway secretions
What bronchodilator is used with OP poisoning?
Atropine
What bronchodilator is contraindicated with OP poisoning?
Theophylline
As it may reduce the acetylcholinesterase (AChE)
What are the indications for mechanical ventilation?
Hypoxia not responding to high O2 flow rate, altered consciousness level interfering with normal breathing, respiratory muscle paralysis, peripheral toxic lung injury
What is the definition of pulmonary edema?
Accumulation of exudate in alveolar lumen
What are the types of pulmonary edema?
Cardiogenic pulmonary edema (CPE): left ventricular dysfunction, Non-Cardiogenic pulmonary edema (NCPE): results from disruption of alveolar capillary membrane
What are the toxicological causes of CPE?
Poisoning with calcium channel blockers, beta-blockers, TCA, poison-induced dysrhythmias, scorpion-induced myocarditis
What causes disruption of the alveolar capillary membrane?
Destruction of type II pneumocytes that synthesize surfactant
What are the toxicological causes of NCPE?
Direct toxic effect on the pulmonary capillary membrane as in corrosive fumes, heroin, barbiturates, salicylates, OP compounds
What are the clinical signs of a patient with pulmonary edema?
Severe dyspnea, rapid respiration, cyanosis, coughing of pink frothy sputum, anxiety, clammy skin, pulmonary crepitations. The patient of CPE shows manifestations of underlying cardiac problems, while NCPE shows manifestations of underlying lung problems.
