emergency management of coma
A-airway B- Breathing C- circulation D- Drugs -Dextrose for low bs - naloxone for opioids - flumazenil (unless coingested anticonvulsant, high dose benzouser, or has seizure DO)
Emergency treatment of Hypotension
in general give 1-2L ns
monitor CVP
dopamin or norepi if not responding to nS
determine cause treat specific cases
over dose trycyclic antidepressant
sodium bicarb
overdose betablocker
glucagon
calcium channel blocker overdose
calcium chloride
Bupropion and Verapamil overdoses can be treated with
lipid emulsion
Treatment of emergent hypertensionf diastolic greater than 105-110mmHg and no prior history
Lorasepam for anxiety
phentolamine or nitroprusside hypertension
esmolol or labetalol for tachycardia
-no betablockers alone
emergent treatment of arrhythmias ( general, tricyclic, digoxin, Torsades, chlorinated)
amiodarone
- if tricyclic then sodium bicarb
- if digoxin then digi-bind
- if Torsades de point Mg
- propranolol
Emergency treatment of seizures
lorazepam or diazepam
-phenobarbitol if refractory
Emergent treatement of hYperthermia (general, muscle rigidity, neruomalignant syndrome, serotonin syndrome)
clothes off, water on body,fanning
- Muscle rigidity =neromuscular blocker (intubation, ventilation, EEG) followed by dantrolene
- Neromalignant syndrome = bromocriptine
- Serotonin syndrome= Cyproheptitdine or chlorpromazine
antidote for antichlinergics
physostigmine
antidote for anticholinesterases (organophosphate pesticide)
atropine and pralidoxime
antidote for benzodiazepines
flumazenil
antidote for carbon monoxide
O2 hyperbaric
antidote for cyanide
sodium nitrate or hydroxycobalamine (b12)
antidote for isoniazid
pyridoxine (b6)
antidote for methylene or ethylene glycol
ethanol or fomepizole
antidote for sulfonylurea or hypoglycemic drug
glucose or octreotide
When is gastric lavage contraindicated
stuporus or comatose patients; only use if endotracheal tube is in place
Gastric lavage technique
drop the lubricated tube
aspirated stomach contents
wash stomach with tepped water until clear
Contraindications of activated charcoal
comatose or convulsin patients unless airway is inplace and gastric tube is available in place
- do not give to ppl with ileus or intestinal obstruction
- do not give for corosives
Sorbitol Catharsis should be monitored for
hypotension and dehydration intestinal cramping and vomiting, also third spacing
Whole Bowel irrgation (polyehtlene glycol electrolyte) can be used for
massive iron ingestion or lithium, or sustained release tablets
Poisoning labs to order
serum osmolality and osmol gap, electrolytes and anion gap, glucose, creatinine, blood urea nitrogen, creatine kinase, urinalysis, and EKG
Osmol gap increases in presence of
alcohol and ketoacidosis
Anion Gap elevation in presence of
accumulation of lactic acid including carbon monoxide, cyanide, ethylene glycol, medicinal iron, INH, methanol, metformin, ibu, and salicylates
treatment of acid ingestion
glass of water place tube remove stomach contents symptomatic endoscopy ct possible surgery
Treatment of alkalies
glass of water small tube to remove agent symptomatic enodscopy ct
Treatment of amphetamine
treat seizures> benzo (phenobarbital)
lower body temp
give fluids
treat hypertention > nitroprusside
treatment of anticoagulant
stop medication acute overdose give charcoal get PT/INR - pt increase in 12-24(36-48 peak) - --> newer anticoags have no peak pt but with normal inr will be considered safe with no toxicity
Treatment of warfarin overdose
Donot treat prophylactically with VitK (wait for pt/inr) get labs pt/inr give fresh frozen plasma prothrombin complex concentrate activated factor VII
Treatment of chronic warfarin user overdose
fresh frozen plasma and vit k
Treatement of superwarfarin user
monitor over several weeks using vitK at large doses
Direct acting anticoagulants like dabigatran treated with
idarucizumab
treatment of anticonvulsants overdose
activated charcole and gastric wash
patient using valproic acid comes in with hypernatremia, metabolic acidosis, hypocalcemia, elevated amino transferase and serum ammonia you suspect and order
valproic acid toxicity
order bowel irrigation
referral for dialysis if severe
treatement for antipsychotic medication
activated charcol
fluid and vasopressors for hypotension
Treatment for arsenic poison
perform gastric lavage and give fluids
patient comes in feeling bad urine screen finds high levels of arsenic what is next
ask paitent if they have eatten seafood
treatment of atropine and anticholinergics
activated charcoal
external cooling for high temperatures
treatment for calcium channel blocker
charcoal and bowel irrigation
treatment of carbonmonoxid
100% o2 with high flow reservor face mask
treament of clonidine overdose
charcoal,
airway
fluids
dopamine or atropine for bradycardi
treatment of cyanid poisoning
charcoal cyanide kit sodium nitrite or sodium thiosulfate or Hydroxocobalamin (may casue red skin)
treatment of digitalis poisoning
digifab (immune specific antibodies)
digibind (based on calculation)
Treament of ethanol
charcoal
Flumazenil may cause seizures in patients with
seizure disorder, benzoaddiction, using tricyclic, or other anticonvulsant overdose
treatment of iron poisoning
fluids
whole bowel irrigation
Deferoximine (chelation) ( for short time or ARDS)
Treatment of isoniazid poisoning
active charcoal
B6 (pyridoxine)
benzo is seizures
Treatment of lead poisoning
ABD radiograph
whole bowel irrigation
endoscopy or surgery (maybe)
edetate calcium dysodium
Treatment of lithium poisoning
gastric lavage or whole bowel irrigation
lithium levels
fluids
hemodialysis (maybe)
treatment of Lsd and hallucinogin
physostigmine
benzo or haldol for psychosis
betablockers for dysrhythmias
treatment of Methanol and Ethylene glycol
nasogastric aspiration hemodialysis folic acid, thiamine, and pyridoxine may enhance breakdown Fomepizole (ethylene glycol) ethanol block metabolism
treatment of pesticide toxicity
nasogastric aspiration
then give activiated charcoal
wash skin
Atropin (muscarini stimultion reverse)
Pralidoxime (oranophosphate binding reversal)
Treatment for salicilate toxicity
gastric lavage charcoal glucose Sodium bicarb (metabolic acidosis) Hemodialysis ( server acidosis) Specific alkalinization of urine
Treatment of theophyllin or caffeine poison
charcoal Whole bowel irrigation Hemodialysis benzodiazepine for seizure beta blocker (low dose for hypotension and tachycardia)
Treatment of trycyclic antidepressants
charcoal and gastric lavage sodium bicarb (help sodium channels)
