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EM (incl accidents/ poisoning) - Coggle Diagram
EM (incl accidents/ poisoning)
https://www.youtube.com/watch?v=hi1JyrMYs-A&list=PLD3UNdKzloDQ1r7qW2mELPvwUSFbg_Ohg&index=19&pp=iAQB
https://www.youtube.com/watch?v=o51Jtydr2YA
https://www.youtube.com/watch?v=FoX_v9XROhA
General Approach -- usually accidental/ curiosity. Calculate Toxic Dose= dose at which most ppl experience toxicity. Not a toxic dose? You don't need to do anything!
Multi drug urine dipsticks (drugs of abuse) , Benzos for toxic seizures ( AVOID phenytoin) .
*
Clod and flu meds have pseudoephedrine -- which will come up + for amphetamines
Urine mass spectrometry - looks at all sorts by molecular weight - limited use in acute care..
Wash !!!!
Global burden of disease- Poisoning: 0.14% off ALL deaths. Looking at kids under 5, 0.21% . Poisoning 130x more likely in Eastern Cape than Ireland...
In South Africa -- 44% Pharmacueticals , 24% Household/handyman, 12% Pesticides (Orhanophosphates, formamidine)
TOXIDROMES
ANTICHOLINERGICS ( antihistamines atropine Amanita pantherina) "Hot as a hare, blind as a bat, dry as a bone, mad as a hatter" Agitation, hallucination, dilated pupils, fever, flushing dry mouth/skin, urinary retention
SYMPATHOMIMETICS (cocaine, amphetamine nasal decongestants) Agitation, hallucination, dilated pupils, sweating, tremor, seizures tachycardia, hypertension
O
PIATES C
o
ma, pin-p
o
int pupils, hyp
o
thermia, hyp
o
tension
SEDATIVES (benzos, alcohol) COma, dilated pupils, hypothermia, hypotension
CHOLINERGICS (organophosphates, carbamates) Pin point pupils, bradycardia, fasciculations salivation, wheezing, incontinence
COMMON POISONS
Isoniazide overdose
Pyridoxine for seizures
PARACETAMOL
you don't always need NAC -- calculate. IV Toxic dose 60mg/kg.
2-bag 20 hr Regimen
. First bag NAC - 200mg/kg over 4 hrs, 100 mg/kg over 16 hrs. Safer, easier, less anaphylaxis.
COLD/FLU meds
PSYCH Meds
Parrafin
pneumonitis --> oxygen and supportive care.
Batteries
corrosive damage
Pesticides
Organophosphates/ Carbamates (cholinergic poisoning)
30 mins into 50 min lecture
ANTIDOTES
Iron --> Desferrioxamine
Organophosphates - atropine (+oximes)
Paracetamol --> N-Acetylcysteine
Dystonia --> biperiden (Akineton)
Benzos --> FLumazenil
Opioids --> Naloxone
Heavy metals --> Chelating agents
ELIMINATION TECHNIQUES
Urine alkalisation (e.g. salicylate toxicity)
MDAC - Multiple dose activated charcoal (carbamazepine theophylline -- substances that undergo intrahepatic circ )
Haemodialysis ( lithium)
https://www.youtube.com/watch?v=RmfdmLZYQFM
https://www.youtube.com/watch?v=eS30IGOe1IM&t=5s
https://www.youtube.com/watch?v=D8UyVm0DJzU
POISONING