Emergency Medicine Residency Program



Take Home Points –Toxicology

Approach to Poisoned Patients

| |

|Cardiac Arrest – What Treatments May Be Useful? Causative Agents/Antidotes |

|Oxygenation - CN (Cyanide Kit), Methemoglobinemia (Methylene Blue) |

|Bradycardia - CCB/BB (High Dose Insulin/Glucagon/Lipid Emulsion), Organophosphate/Cholinergics (Atropine, Pacing) |

|Arrhythmia - Digoxin (Digi Fab), TCA (Na Bicarb), Local Anesthetics (Lipid Emulsion) |

|Also Consider: Snake/Spider Bites (Antivenom), Balloon Pump, ECMO |

| |

|Modified Resuscitation for Suspected Overdose |

|Airway – Clear obstructed airway, but comatosed/encephalopathy may be reversible |

|( Antidotes |

|Breathing – Provide oxygen, positive pressure as needed |

|Circulation – Most hypotensive patients are not volume depleted but 10-20mg/kg may stabilize blood pressure; if not consider ionotropes (if pump failure) |

|or vasopressor (if vasodilatory shock) depending on offending agent |

|Disability/Dextrose – Consider neurogenic (CVA, ICH, meningitis, Stat Ep) vs metabolic (hypoglycemia, thyroid, uremia, hepatic encephalopathy) as |

|alterative causes of altered mental status |

|( Decontamination |

|Exposure – Treat hypo/hyperthermia (consider NMS, SS, environmental) |

|( Enhanced Elimination |

|Antidotes |

|See Board Review materials for list of antidotes |

|Coma cocktail - DONT (Dextrose, Oxygen, Naloxone, Thiamine), avoid empiric Flumazenil |

|Seizures - Benzodiazepines, consider pyridoxine for isoniazid poisoning |

|Agitation - Benzodiazepines (antipsychotics may cause anti-cholinergic, extra pyramidal, QT prolong effects) |

|Lipid Emulsion – Lipophilic Agents: Local Anestehics, Haldol, TCA, BB, CCB |

|Decontamination |

|GI |

|OG Lavage – only if ................
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