Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · Feb 2015
ReviewResources for Toxicologic and Radiologic Information and Assistance.
Most approaches toward chemical and radiological/nuclear (CRN) incidents focus on the clinical skills of the first receiver. These skills are certainly important and are addressed throughout this article. ⋯ The following are basic competencies in information management for the emergency medicine physician to handle large-scale CRN incidents: planning information; incident management information; toxicant management; disposition/definitive care management; and recovery management. Information management and synthesis are crucial throughout the phases of the disaster cycle: planning, response, mitigation, and recovery.
-
Organophosphates (OPs) and carbamates have a wide variety of applications, most commonly as pesticides used to eradicate agricultural pests or control populations of disease-carrying vectors. Some OP and carbamates have therapeutic indications such as physostigmine. Certain organophosphorus compounds, known as nerve agents, have been employed in chemical warfare and terrorism incidents. ⋯ In the setting of toxicity from either agent class, clinical syndromes result from excessive nicotinic and muscarinic neurostimulation. The toxic effects from OPs and carbamates differ with respect to reversibility, subacute, and chronic effects. Decontamination, meticulous supportive care, aggressive antimuscarinic therapy, seizure control, and administration of oximes are cornerstones of management.
-
Emerg. Med. Clin. North Am. · Feb 2015
ReviewToxic Industrial Chemicals and Chemical Weapons: Exposure, Identification, and Management by Syndrome.
Toxidromes aid emergency care providers in the context of the patient presenting with suspected poisoning, unexplained altered mental status, unknown hazardous materials or chemical weapons exposure, or the unknown overdose. The ability to capture an adequate chemical exposure history and to recognize toxidromes may reduce dependence on laboratory tests, speed time to delivery of specific antidote therapy, and improve selection of supportive care practices tailored to the etiologic agent. This article highlights elements of the exposure history and presents selected toxidromes that may be caused by toxic industrial chemicals and chemical weapons. Specific antidotes for toxidromes and points regarding their use, and special supportive measures, are presented.
-
Emerg. Med. Clin. North Am. · Feb 2015
ReviewIntentional and Inadvertent Chemical Contamination of Food, Water, and Medication.
Numerous examples of chemical contamination of food, water, or medication have led to steps by regulatory agencies to maintain the safety of this critical social infrastructure and supply chain. Identification of contaminant site is important. ⋯ Clinical diagnosis should be based on toxidrome recognition and assessment of public health implications. There are several resources available to assist and these can be accessed through regional poison control centers or local/state public health departments.