Emergency medicine clinics of North America
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Over the last decade, the use of novel psychoactive substances (NPS) has increased. Some substances are derived from plants but an increasing number are synthetically produced. ⋯ These substances have a wide variety of effects due to the varied potency with which they bind their targeted receptors. Routine immunoassay urine drug screens do not detect these substances and it is, therefore, important for clinicians to be aware of these substances to make accurate clinical diagnoses.
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Emerg. Med. Clin. North Am. · May 2022
ReviewUpdates on the Evaluation and Management of Caustic Exposures.
In the 2019 annual report by the American Association of Poison Control Centers, there were more than 180,000 single substance exposures involving household cleaners, making these products the second most common exposure reported to poison control centers. Little controversy exists in the general management following dermal or ocular caustic exposure. ⋯ This article provides a thorough review of diagnosis, management and prevention of gastrointestinal caustic exposures and their sequelae. Hydrofluoric acid, which requires special consideration compared to other acids, is also explored.
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Management of the acutely poisoned patient requires supportive care and timely administration of antidotes to minimize ongoing toxicity and mortality. New applications for old antidotes include utilization of methylene blue and hydroxocobalamin in vasoplegia. ⋯ Additional antidote considerations include administration of lipid emulsion in lipophilic xenobiotic exposure not responsive to standard resuscitative modalities. These expert recommendations provide guidance for providers caring for the acutely poisoned patient.
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Taking care of patients with agitated toxidromes can be challenging. While many will be able to be discharged from the emergency department or transferred to psychiatry following brief and simple interventions others will have life-threatening toxicity. Health care providers must develop an organized approach to the assessment and management of these patients that includes foremost the protection of the patient and staff from physical harm, prompt pharmacologic control to allow rapid assessment for life-threatening abnormalities such as hypoglycemia and hyperthermia and optimal cooling of patients with extreme temperature elevations.
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The most common chemicals used in riot control agents are chlorobenzylidene malononitrile, chloroacetophenone, dibenz[b,f]-[1,4]-oxazepine, and oleoresin capsicum. They cause ocular, respiratory, and dermal effects usually within seconds to minutes of exposure, but delayed effects have been reported. ⋯ Although most effects are mild, some may be serious, especially in those with preexisting respiratory disease. Treatment consists of removing the patient from the source of exposure, removing contaminated clothes, and copiously irrigating the affected areas with water.