یکی دوتا نکته بگم‌ و تمام!

▫️عکس‌ها زیادن ولی خب ذات مطلب همین بود، چون اپروچ کلی به یه بیمار مسموم به ماده‌ی نامشخصه. ممکنه یه سریاش تکراری باشن ولی سعی شده از چندتا رفرنس(آپتودیت/هریسون/گلدفرانک/تینتینالی) جداول مهمش آورده بشه‌‌ و مرج بشن.

▫️این کتاب استاد صناعی‌زاده هم درباره‌ی مسمومیت خیلی کتاب خوبیه.

▫️همه‌ی تصاویر مهم هستند ولی اگه وقت نداشتید، عکس‌هایی که اهمیت بیشتری دارند رو با "✅" مشخص کردیم. و متن اولیه هم فراموش نشه!

▫️و مورد آخر هم یه جمله کلیدی از آپتودیت:
Supportive care is the cornerstone of the treatment of the poisoned patient, and the adage "treat the
patient, not the poison" is the guiding principle of medical toxicology.


تمام؛ امیدوارم که مفید بوده باشه. اگه نظر/مطلب تکمیلی دارین بفرمایید.❤️

📝اوردر کلی:
#Order

▪️︎Imp: Toxicity
▪️︎Cond: Urgency
▪️︎Diet: Npo
▪️︎Activity: CBR- Bed sides up

▪️︎Check V/S

▪️︎CM & POM

▪️︎Oxygenation if indicated (sat<90, distress, etc)

▪️︎IV line fix(IV fluid therapy if needed)

▪️︎ECG

▪️︎CBC, BMP, U/A, b-HCG(if appropriate), serum alcohol concentration, urine toxicology, BUN, Cr

▪️︎ABG/VBG
*calculate the Serum osmolality and AG

▪️︎BS glocumetery

▪️︎Consider specific antidotes and treatment if indicated:
e.g.
▫️naloxone 0.4-2 mg IV/IM/SC; repeat q2-3min PRN; not to exceed 10 mg (0.01 mg/kg)
☝️🏻When there is unexplained respiratory arrest or depression(manifested as slow, shallow, or absent breathing).
✌️🏻Avoid when the patient is breathing normally, regardless of their level of consciousness. as naloxone does not improve outcomes in patients without respiratory compromise and may precipitate withdrawal or other adverse effects in opioid-dependent individuals.

▫️administration benzodiazepine if seizure occur.
▫️administration benzodiazepine in agitated patient with HTN

▪️︎Consider ICU/intubation/ hemodialysis etc if indicated

▪️︎Consider Activated Charcoal(50g or 1g/kg) if indicated.
▫️indications:
Ingestion within the previous (1to 2)hours of a toxic substance known to be adsorbed by activated charcoal, where the benefits of administration are judged to outweigh the risks.
▫️Contraindications:
•Toxins poorly adsorbed by AC (eg, metals including iron and lithium, alkali, mineral acids, alcohols).
•Presence of intestinal obstruction (absolute contraindication) or concern for decreased peristalsis (relative contraindication).
•Late presentation (ie, no toxin is likely to remain in the stomach).
•Increased risk and severity of aspiration associated with AC use (eg, hydrocarbon ingestion)
•Need for endoscopy
•Depressed mental status without airway protection (risk of aspiration)

🔺️نکته‌ی مهم: تحریک بیمار برای استفراغ در منجمنت مسمومیت جایگاهی ندارد.
🔺️ دو مورد
Whole bowel irrigation (PEG-ES) and
Gastric lavage (stomach pumping)
هم تقریبا منسوخ شدن (مخصوصا لاواژ) و استفاده نمیشن مگر در موارد خیلی خاص.

🔹️Appendix:

▪️︎ICU admission criteria:
Any of eight clinical criteria:

•Partial pressure of carbon dioxide (PaCO2) >45 mmHg
•Need for emergency intubation •Post-ingestion seizures •Unresponsiveness to verbal stimuli
•Non-sinus cardiac rhythm
•Second- or third-degree atrioventricular block
•Systolic blood pressure <80 mmHg
•QRS duration ≥0.12 seconds

📝 فهرست مطالب آپتودیت
#Episode_45