Emergency medicine clinics of North America
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Almost all of the drugs of abuse can be identified in bodily fluids, and attempts should be made to do so. These specific drug assays help to document intoxication but do not aid in the emergency management of an acutely intoxicated patient. There are no specific antidotes for the drugs of abuse; symptomatic, detailed medical care is the cornerstone to the successful management of the patient.
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Emerg. Med. Clin. North Am. · Feb 1984
Gastrointestinal decontamination in the management of the poisoned patient.
Ipecac syrup is the agent of choice to promote emesis in awake, alert, and cooperative patients who have ingested poison. Lavage is a reasonable alternative when ipecac fails or emesis is contraindicated. Activated charcoal is effective in minimizing absorption of ingested toxins, and saline cathartics may be useful to hasten the elimination of activated charcoal and possibly of enteric-coated or sustained release medications.
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Every pediatric patient should be resuscitated unless there is rigidity, body decay, known terminal illness, or irreparable damage. The techniques for pediatric CPR are described in detail.
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Submersion accidents are an important public health problem in this country and worldwide, and they present a special challenge to emergency personnel. Submersion injury affects multiple systems but most notably involves the lungs, where ventilation-perfusion mismatching and intrapulmonary shunting result in hypoxemia, acidosis, and generalized anoxic injury. Resuscitation of the victims of submersion casualties should be directed at restoring respiration, improving oxygenation, correcting acidosis, and treating concomitant problems such as hypothermia, drug and alcohol intoxication, or cervical spinal trauma. With expeditious and proper treatment, most submersion victims have a good prognosis.
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The introduction of closed chest massage in 1960 initiated a widespread interest in cardiopulmonary resuscitation. Until that time, open chest cardiac massage was the standard for CPR. Initial explanations for blood flow during closed chest CPR were based upon direct compression of the heart. ⋯ Cardiac output with open chest massage is approximately double that obtained by closed chest massage. Cerebral blood flow during open chest massage approaches physiologic values. The use of drugs possessing alpha adrenergic activity and maneuvers that augment intrathoracic pressure improve vital organ perfusion.