הרעלות - האיגוד הישראלי לרפואה דחופה

הרעלות - האיגוד הישראלי לרפואה דחופה

By הרעלות – האיגוד הישראלי לרפואה דחופהMedicineHealth & Fitness
Download on the App Store

הרעלות - האיגוד הישראלי לרפואה דחופה episodes

  • PODCAST: Smoke Inhalation Injury
    Table of Contents

    00:37 – Overview of Smoke Inhalation Injury

    00:55 – Three Key Pathophysiologic Processes

    01:41 – Physical Exam Findings to Watch For

    02:12 – Airway Management and Early Intervention

    03:23 – Carbon Monoxide Toxicity

    04:24 – Workup and Initial Treatment of CO Poisoning

    06:14 – Cyanide Toxicity

    07:19 – Treatment Options for Cyanide Poisoning

    09:12 – Take-Home Points and Clinical Pearls

    Physiological Effects of Smoke Inhalation:
    • Thermal Injury:
      • Direct upper airway damage from heated air or steam.
      • Leads to swelling, inflammation, and possible airway obstruction.
      • Chemical Irritation:
        • Causes bronchospasm, mucus plugging, and inflammation in the lower airways.
        • Increases capillary permeability, potentially causing pulmonary edema.
        • Systemic Toxicity:
          • Primarily involves carbon monoxide and cyanide poisoning.
            • Clinical Signs and Symptoms:
            • Physical Exam:
              • Facial burns, singed nasal hairs
              • Hoarseness, stridor (upper airway swelling)
              • Carbonaceous sputum (lower airway edema)
              • Systemic Symptoms:
                • Headache, dizziness, nausea
                • Syncope, seizures, altered mental status
                  • Airway Management Considerations:
                  • Not every patient requires immediate intubation.
                  • Intubation should be performed early if airway compromise is suspected, as swelling can rapidly progress.
                  • Close airway monitoring recommended for all patients.
                    • Carbon Monoxide Poisoning:
                    • Common cause of death post-smoke inhalation (50–75% of fire-related injuries).
                    • Hemoglobin affinity 250 times greater for CO than oxygen, impairing tissue oxygenation.
                    • Diagnosis:
                      • Carboxyhemoglobin level via VBG (ensure proper lab ordering).
                      • Pulse oximetry unreliable; falsely high readings.
                      • Treatment:
                        • Immediate high-flow oxygen administration.
                        • Consider hyperbaric oxygen therapy for severe cases to reduce delayed neurocognitive sequelae.
                          • Cyanide Poisoning:
                          • Blocks cytochrome oxidase in electron transport chain, halting aerobic ATP production.
                          • Patients present critically ill; notable features include:
                            • Elevated lactate levels (>8–10 mmol/L)
                            • Arterialization of venous blood
                            • Treatment:
                              • First-line therapy: hydroxocobalamin (Cyanokit) binds cyanide forming vitamin B12 for renal excretion.
                              • Alternative: Cyanide antidote kit (amyl nitrite, sodium nitrite, sodium thiosulfate); induces methemoglobinemia and requires monitoring.
                              • Important note: hydroxocobalamin turns blood and urine bright red; draw labs beforehand.
                                • Key Takeaways:
                                • Assess for airway compromise and signs of inhalation injury early.
                                • Maintain a high index of suspicion for CO and cyanide poisoning in smoke inhalation victims.
                                • Immediate, aggressive oxygen therapy and early antidote administration can significantly impact outcomes.

                                  • The post PODCAST: Smoke Inhalation Injury first appeared on האיגוד הישראלי לרפואה דחופה.

                                  11 min
                                • PODCAST: Pediatric Toxic Ingestions

                                  Pediatric Toxic Ingestions
                                  Dec 1 2023

                                  In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2023 Pediatric Emergency Medicine Practice article, Management of Pediatric Toxic Ingestions in the Emergency Department.

                                  Need help now? Call the Poison Help Line at: 1‑800‑222‑1222 

                                  Epidemiology

                                   

                                  Prehospital Care

                                   

                                  ED History and Physical Exam

                                   

                                  Diagnostic Studies

                                  • Labs
                                  • EKG
                                  • Imaging
                                  • Urine Toxicology Testing

                                    •  

                                    Treatment

                                    • Hemodialysis
                                    • Activated Charcoal
                                    • Whole Bowel Irrigation
                                    • Gastric Lavage
                                    • Ipecac

                                      •  

                                      Drug Specific Therapies

                                      • Acetaminophen
                                      • Alcohols
                                      • Anticholinergics
                                      • Beta Blockers
                                      • Calcium Channel Blockers
                                      • Cholinergic Agents
                                      • Digoxin
                                      • Iron
                                      • Opioids
                                      • Salicylates
                                      • Sedative Hypnotics
                                      • Sulfonylureas
                                      • Laundry Pods

                                        • The post PODCAST: Pediatric Toxic Ingestions first appeared on האיגוד הישראלי לרפואה דחופה.

                                        1 hr 7 min
                                      • PODCAST: Substance Use in Adolescents

                                        In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the October 2023 Pediatric Emergency Medicine Practice article, Substance Use in Adolescents: Recognition and Management in the Emergency Department and the October 2023 Emergency Medicine Practice article, Evidence-Based Emergency Department Management of Migraine and Other Primary Headaches

                                        Substance Use In Adolescents

                                        Epidemiology

                                        Risk Factors

                                        Differential Diagnosis

                                        Prehospital Care

                                        ED History and Physical Exam

                                        Urine Drug Screen

                                        Treatment

                                        • Marijuana
                                        • Alcohol
                                        • Methaphetamines
                                        • MDMA
                                        • Cocaine
                                        • Opioids

                                          • Disposition

                                          Migraine and Other Primary Headaches

                                          Epidemiology

                                          Cluster Headaches

                                          Medication Overuse Headache

                                          Nerve Blocks

                                          • Greater Occipital
                                          • Sphenopalatine Ganglion

                                            • Pregnant Patients

                                            Disposition

                                            Check out the clinical pathway at https://clinicalpathways.ebmedicine.net

                                            The post PODCAST: Substance Use in Adolescents first appeared on האיגוד הישראלי לרפואה דחופה.

                                            53 min
                                          • PODCAST: Organophosphate Poisoning

                                            Introduction

                                            • Used as pesticides
                                            • Used as weapons (nerve agents)
                                              • Sarin Gas, VX Gas, Novichok
                                              • Transdermal, Inhalation, Ingestion

                                                • Clinical Presentation

                                                • Muscarinic Activation (Dumbels Mnemonic)
                                                  • Defication
                                                  • Urination
                                                  • Myosis
                                                  • Bradycardia, Bronchospasm, and Bronchorrhea
                                                    • “The Killer B’s”
                                                    • Emesis
                                                    • Lacrimation
                                                    • Salivation and Sweating
                                                    • Nicotinic Activation
                                                      • Muscle weakness and paralysis
                                                      • CNS Activation
                                                        • Respiratory Depression
                                                        • Altered Mental Status
                                                        • Seizures

                                                          • Treatment

                                                          • Atropine
                                                            • Reverses Dumbels
                                                            • Keep giving and doubling the dose until brochorrhea and bradycardia resolve
                                                            • Pralidoxime
                                                              • Only works before ‘aging’ occurs
                                                              • Diazepam
                                                                • Stops the seizures

                                                                  • The post PODCAST: Organophosphate Poisoning first appeared on האיגוד הישראלי לרפואה דחופה.

                                                                  17 min

                                                                About הרעלות - האיגוד הישראלי לרפואה דחופה

                                                                From the publisher's feed

                                                                The Israel Association for Emergency Medicine