Emergency medicine clinics of North America
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This article reviews the background, metabolism, clinical effects, and treatment of toxic alcohols, specifically ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropyl alcohol. This article also reviews the importance of an anion gap metabolic acidosis in relation to toxic alcohols and explores both the utility and the limitations of the osmol gap in patient management.
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Pediatric poisonings comprise the majority of the toxic exposures reported to U. S. poison centers. ⋯ These toxins include such substances as specific prescription medications, over-the-counter medications, essential oils, and common household items. With such a vast array of potential toxic exposures that can affect children, it is imperative that health care practitioners who work with children understand the general management of the poisoned pediatric patient.
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Emerg. Med. Clin. North Am. · May 2022
ReviewFound Down: Approach to the Patient with an Unknown Poisoning.
Approximately 30% of poison exposures reported to centers each year are either referred to or initiated within a health care facility. Among these exposures, undifferentiated poisoned patients are among the most challenging cases faced in the emergency department. ⋯ This includes considering key additional history, a possible toxidrome, and data in the form of vital signs, physical examination, laboratory analysis, ECG, and imaging. After which a tailored approach to supportive care, decontamination, possible antidotes, and enhanced elimination techniques will improve outcomes.
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Beta-blockers and calcium channel blockers result in a disproportionate number of fatalities from cardiac medication overdoses, and share similar characteristics. High-dose insulin is a superior therapy for both overdoses, but is likely synergistic with vasopressors; therefore we recommend starting vasopressors and high-dose insulin simultaneously. Digoxin remains an important cardiac poison and can likely be safely treated with smaller doses of fab fragments than in the past, except for patients in extremis. Extracorporeal membrane oxygenation is an invasive but promising nonspecific therapy for refractory shock from cardiotoxic overdose and should be considered primarily in cases of refractory cardiogenic shock.
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This review discusses the distinct envenomation syndromes produced by North American species of snakes and arthropods, specifically the Crotalinae subfamily of snakes, which includes cottonmouths, copperheads, and rattlesnakes; coral snakes; Latrodectus and Loxosceles species of arachnid; and Centruroides sculpturatus, the only species of North American scorpion capable of producing an envenomation syndrome. The authors discuss the epidemiology, pathophysiology, and presentation of these syndromes and emphasize the varying degrees to which these syndromes can manifest clinically. Finally, the management of each envenomation syndrome is addressed. Special attention is paid to available antivenoms, their indications for use, and their side effects.