Critical care clinics
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Critical care clinics · Jul 2021
ReviewManagement of Organophosphorus Poisoning: Standard Treatment and Beyond.
Organophosphorus (OP) compounds remain a leading cause of self-poisoning and mortality, especially in South East Asia, China, and Africa. Organophosphorus causes an acute cholinergic syndrome by inhibiting acetylcholinesterase. ⋯ Magnesium sulfate, calcium channel blockers (nimodipine), plasma alkalinizing agents, β-2 agonists, nicotinic receptor antagonists, clonidine, and lipid emulsions are promising treatment alternatives. However, large phase III trials are required to establish their efficacy.
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Managing unstable poisoned patients is often associated with clinician cognitive overload. This article summarizes the mechanisms of toxicity; clinical presentations; and the current evidence available for the treatment of cardiovascular drug toxicity due to calcium channel blockers, beta-blockers, cardiac glycosides, and sodium channel blockers. In addition, management approaches are proposed.
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As the cancer population increases and immunotherapy becomes widely utilized, severe toxicities from these treatments will become more prevalent. In cancer patients, the most common immunotherapies that lead to critical illness are chimeric antigen receptor T cells, monoclonal antibodies, and immune checkpoint inhibitors. ⋯ A multidisciplinary approach for diagnosis and treatment is recommended. This article reviews the most common toxicities from immunotherapy and offers a therapy-specific and system-based approach for affected patients.
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A trend in the increasing use of prescription psychoactive drugs (PADs), including antidepressants, antipsychotics, and mood stabilizers, has been reported in the United States and globally. In addition, there has been an increase in the production and usage of illicit PADs and emergence of new psychoactive substances (NPSs) all over the world. PADs pose unique challenges for critical care providers who may encounter toxicology issues due to drug interactions, side effects, or drug overdoses. This article provides a summary of the toxicologic features of commonly used and abused PADs: antidepressants, antipsychotics, mood stabilizers, hallucinogens, NPSs, caffeine, nicotine, and cannabis.
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Sympathomimetic drugs comprise a broad category of substances including both illicit and prescribed drugs that have deleterious effects when ingested or abused. The clinical syndromes that result from overstimulation of the sympathetic nervous system by reuptake inhibition of biogenic amines, such as norepinephrine and dopamine, carry significant morbidity. Recognition and awareness of the appropriate supportive measures are required to mitigate life-threatening complications of multiple organ systems. The sympathomimetic toxidrome is recognized by a constellation of symptoms including agitation, hyperthermia, tachycardia, and hypertension, and the primary treatment involves supportive care, including the liberal use of benzodiazepines.