Management of the critically poisoned patient

Boyle, Jennifer S undefined; Bechtel, Laura K.; Holstege, Christopher P.

doi:10.1186/1757-7241-17-29

Cited by 60 publications

(58 citation statements)

References 62 publications

(54 reference statements)

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“…These included all resources required for airway support (endotracheal tubes, oxygen masks, laryngeal masks, nasal catheters and cannulas, and mechanical ventilator), volume expanders (colloids and crystalloids), and cardiac support (electrical defibrillation); breathing support resources were not as common. A review of the published studies indicate that supportive measures including the ''ABC'' (airway, breathing, circulation) are frequently necessary before proof of intoxication [7,10,28]. Intubation is indicated in acute respiratory failure [7,10].…”

Section: Availability Of Stabilization Resourcesmentioning

confidence: 99%

“…inducing vomiting for patients poisoned by hydrocarbons can cause aspiration pneumonitis, or providing oxygen to patients with paraquat intoxication might hasten and worsen pulmonary fibrosis) [5,6]. Current recommendations indicate that inducing emesis should not be used routinely after poisoning exposures due to the lack of evidence of improved outcomes and risks including delayed administration of oral antidotes or the reduced effectiveness of activated charcoal, aspiration pneumonitis, and complications from retching and prolonged emesis [7][8][9]. Also, if a poisoning case receives an appropriate treatment but significantly late, the treatment would be ineffective (e.g.…”

Section: Introductionmentioning

confidence: 98%

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Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

et al. 2011

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Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

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Section: Availability Of Stabilization Resourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

et al. 2011

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“…82,80 If the calculated gap is greater than expected, this is taken as evidence of presence of unmeasured negatively charged molecules. Again, there is a wide differential for the possible causes of a raised anion gap acidosis and the clinician must consider them all.…”

Section: -4952-57mentioning

confidence: 99%

“…Again, there is a wide differential for the possible causes of a raised anion gap acidosis and the clinician must consider them all. 1,2,82 A common tool clinicians use to remember the list of causes of a raised anion is the pneumonic MUDPILES which stands for Methanol, Uraemia, Diabetic ketoacidosis, Paraldehyde, Propylene glycol, Iron, Inhalants (carbon monoxide, toluene), Isoniazid, Ibuprofen, Lactic acidosis, Ethylene glycol, Ethanol ketoacidosis, Salicylates, Starvation ketoacidosis, Sympathomimetics.…”

Section: -4952-57mentioning

confidence: 99%

Challenges in the diagnosis of ethylene glycol poisoning

McQuade

Dargan

2013

Ann Clin Biochem

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Ethylene glycol poisoning, while uncommon, is clinically significant due to the associated risk of severe morbidity or lethality and it continues to occur in many countries around the world. The clinical presentation of ethylene glycol toxicity, while classically described in three phases, varies widely and when combined with the range of differential diagnoses that must be considered makes diagnosis challenging. Early and accurate detection is important in these patients, however, as there is a need to start antidotal treatment early to prevent serious harm. In this article, we will review the literature and provide guidance regarding the diagnosis of ethylene glycol poisoning. While gas chromatography is the gold standard, the usefulness of this test is hampered by delays in access due to availability. Consequently, there are several surrogate markers that can give an indication of ethylene glycol exposure but these must be interpreted with caution and within the clinical context. An in-depth review of these tests, particularly the detection of a raised osmolar gap or an raised anion gap acidosis, will form the main focus of this article.

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“…The use of GL for patients with oral poisons presenting altered mental status was a standard approach until the 1990s [4]. Now, the guidelines suggest that GL should only be considered in a potentially life-threatening ingestion and then only if it can be undertaken within 60 min of ingestion [5,6].…”

mentioning

confidence: 99%

More Reasons to Reduce Indications of Gastric Lavage in Self Poisoning

Rita¹

2012

Emergency Medicine

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Management of the critically poisoned patient

Cited by 60 publications

References 62 publications

Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Challenges in the diagnosis of ethylene glycol poisoning

More Reasons to Reduce Indications of Gastric Lavage in Self Poisoning

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