toxicology: what not to do
TRANSCRIPT
TOXICOLOGY…WHAT NOT TO DO
Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
Financial Conflicts of Interest NO !
http://litfl.org/CONCEPTOS
ResusRSI DEAD
ResuscitationRisk AssessmentSupportive care & monitoringInvestigationsDecontaminationEnhanced eliminationAntidotesDisposition
RESUSCITATION
(WHAT NOT TO DO)
Do not get distracted… resuscitation comes first!
RES
USC
ITIA
TIO
N
Do not intubate based on !risk assessment alone when!there are no signs of toxicity!
RES
USC
ITIA
TIO
N
Do not rush to intubate a salicylate overdose patient lightly or allow respiratory
acidosis to develop!
RES
USC
ITIA
TIO
N
Do not use phenytoin for toxin-induced seizures!
RES
USC
ITIA
TIO
N
Do not give up too early! in cardiac arrest !
RES
USC
ITIA
TIO
N
RISK ASSESSMENT
(WHAT NOT TO DO)
Do not be lazy…! seek more information
RIS
K A
SSES
SMEN
T
Do not be reassured by!the apparently well patient
RIS
K A
SSES
SMEN
T
Do not expect toxidromes !to “fit” in a mixed overdose
RIS
K A
SSES
SMEN
T
Do not get your !calculations wrong
RIS
K A
SSES
SMEN
T
Do not ignore phone advice, but do not forget you are !
the one at the bedside!
RIS
K A
SSES
SMEN
T
SUPPORTIVE CARE & MONITORING
(WHAT NOT TO DO)
Do not forget to !observe and monitor !
in an appropriately !staffed and equipped
environmentSUPP
OR
TIVE
CA
RE
INVESTIGATIONS
(WHAT NOT TO DO)
Do not ever forget glucose
INVE
STIG
ATIO
NS
Do not rely on “gaps”! to diagnose !
toxic alcohol poisoning
INVE
STIG
ATIO
NS
Osmolar gap Anion gap
Do not order! drug levels unless you !
can interpret them and they will change management
INVE
STIG
ATIO
NS
Do not perform !urine drug screens
INVE
STIG
ATIO
NS
DECONTAMINATION
(WHAT NOT TO DO)
Do not perform !gastric lavage
DEC
ON
TAM
INAT
ION
Eddleston et al (2007), PMCID: PMC1941903!
Do not administer!activated charcoal
‘within 1 hour’ as a routine
DEC
ON
TAM
INAT
ION
Do not ‘freak out’ about organophosphate poisoning!
DEC
ON
TAM
INAT
ION
ENHANCED ELIMINATION
(WHAT NOT TO DO)
Do not hesitate to call in the renal team when
hemodialysis is indicated!
ENH
AN
CED
ELI
MIN
ATIO
N
ANTIDOTES
(WHAT NOT TO DO)
Do not overdose your !patients with naloxone
unless they are !apneic or peri-arrest!
RES
USC
ITIA
TIO
N
Do not forget octreotide for sulfonylurea-induced
hypoglycemia
AN
TID
OTE
S
Do not give flumazenil
AN
TID
OTE
S
Do not give glucagon
AN
TID
OTE
S
Do not be afraid of physostigmine for
anticholinergic delirium
AN
TID
OTE
S
Do not stop !N-acetylcysteine for
anaphylactoid reactions
AN
TID
OTE
S
Do not forget transporting!the antidote to the patient !
is an option
AN
TID
OTE
S
DISPOSITION
(WHAT NOT TO DO)
Do not forget!self-poisoning is a “snapshot” of a psychosocial disorder
DIS
POSI
TIO
N
ResuscitationRisk AssessmentSupportive care & monitoringInvestigationsDecontaminationEnhanced eliminationAntidotesDisposition
http://litfl.org/CONCEPTOS