Drugs for pulmonary edema pulmonar,survivalist communities idaho,best sales book in the world summary,male enhancement last longer 9gag - Downloads 2016

Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. The accumulation of fluid within the air gaps of lungs and parenchyma is called Pulmonary Edema. Diagnostic TestingElectrocardiogramFrequent or continuous cardiac monitoring along with a 12- lead electrocardiogram is indicated following exposure to any potential cardiotoxin. If the patient has ingested methanol, ethylene glycol, or isopropanol, a modification of this formula can be used to estimate serum levels of these toxic alcohols. Congestive heart, poor heart function, abnormal condition of the valves in heart or heart attacks lead to high accumulation of blood in the blood vessel of the lungs which in turn results to the fluid to be pushed out from the blood vessels to the alveoli. Cardiac monitoring may be especially useful in poisoning due to sympathomimetic agents, cyclic antidepressants, digitalis, ?-blockers, calciumchannel antagonists, antihypertensive agents, arsenic, cyanide, and carbon monoxide.The ECG may demonstrate conduction abnormalities such as blocks associated with digitalis or other cardioactive drugs and is essentially diagnostic for serious TCA overdose. When a patient presents with an elevated anion gap (greater than 12), the mnemonic METALACID GAP can assist in identifying the toxic cause. Other causes that are responsible are lung infection, cocaine smoking, radiation and lung injury. Furthermore, depending on the extent of metabolism, and the time of ingestion, little parent compound may be present when a patient presents to the ED.61,62Toxicology ScreensToxicology screens come in two flavors?qualitative screens, which test for the presence of multiple drugs, and quantitative screens, which measure the level of a particular drug. In many cases kidney failure, brain surgery or bleeding in the brain may increase the fluid level in the blood vessels. A number of other toxins may produce this finding, including cocaine, propoxyphene, antiarrhythmics, thioridazine (Mellaril), and quinine.While conduction abnormalities are the most important toxin-related ECG findings, the cardiogram may demonstrate other significant findings as well. In general, qualitative toxicology screens are less important than the patient history and clinical status, but quantitative levels of suspected substances, such as acetaminophen or aspirin, may be valuable in certain circumstances. Cocaine or carbon monoxide may cause myocardial ischemia or infarction, detectable on the ECG.58Because the ECG is so valuable in cases of tricyclic ingestion, some authorities recommend its routine use in the management of any known or suspected overdose.
Conversely, if the delta gap is more negative than -6, suspect a concomitant hyperchloremic acidosis because the rise in the anion gap is less than the fall in HCO3.52 The clinical utility of routinely measuring adelta gap is unknown.



The utility and cost-effectiveness of this suggestion remain unknown.Laboratory TestsRoutine TestsSeveral simple, readily available laboratory tests may provide important diagnostic clues in the symptomatic overdose patient. This is because most mixed acid-base disorders in toxicology are clinically obvious (as when a patient ingests an acid-inducing toxin such as iron or aspirin and then begins to vomit).Osmolar GapWhen a patient presents with an unexplained metabolic acidosis, measurement of the osmolar gap may be helpful. These include measurements of electrolytes, blood urea nitrogen and creatinine, serum glucose, a measured bicarbonate level, and arterial blood gases.
The drugs tested are by necessity restricted, as hospitals cannot support the cost of maintaining the procedures, instruments, training, and specialized labor needed to analyze every toxin on a 24-hour basis.63 While most immunoassays are capable of detecting commonly abused drugs such as marijuana and cocaine, many common and dangerous substances are not routinely included, such as isoniazid, digitalis glycosides, calcium antagonists, ?-blockers, heavy metals, and pesticides.
If the patient is a female of childbearing age, a pregnancy test is useful since these patients often overdose for suicidal or abortifacient reasons.59Anion GapThe finding of a wide gap metabolic acidosis can significantly narrow the differential diagnosis in an unknown overdose, as well as determine necessary therapy.
On the other hand, the screen may detect some drugs that present in therapeutic amounts, such as opioids and benzodiazepines, even though they are not responsible for the presenting symptoms. Finally, technical limitations of the assay can cause either false-positive or false-negative results (although improvements over the past decade have rendered the tests increasingly more sensitive and specific).63-66The toxicology screen may have little medical value if the specimens are collected too early or late for detection. In general, metabolites in the urine can be detected as long as 2-3 days (or longer) after exposure, compared with 6-12 hours in the blood. The analysis of gastric contents is not clinically useful and is usually reserved for forensic cases.A comprehensive urine toxicology screen is laborintensive and is intended to detect as many drugs as possible using common techniques. Usually included on the panel are the alcohols, sedative-hypnotics, barbiturates, benzodiazepines, anticonvulsants, antihistamines, antidepressants, antipsychotics, stimulants, opioids, cardiovascular drugs, oral hypoglycemics, and methylxanthines (caffeine, theophylline).
In a study of 209 patients, unexpected toxicology findings led to changes in therapy in only three cases, and none of these changes appeared to have a major impact on outcome.64Similar findings occur in children. In addition to the victim of smoke inhalation or intentional CO poisoning, consider a CO level in patients who have headaches and use stoves for heat or who live with someone who is similarly symptomatic.73 Acetaminophen LevelsA recurring issue regards the need for a routine acetaminophen (APAP) level in the overdose patient. Acetaminophen toxicity is the one common poisoning where the patient may be asymptomatic at this time despite a potentially lethal ingestion. For this reason, some authorities suggest a routine quantitative serum acetaminophen level in the overdosed patient.


One review looked at over 1800 patients with a history of suicidal ingestion or an altered mental status with a strong suspicion of ingestion.
Another retrospective study from Hong Kong examined the clinical value of screening for acetaminophen in 294 Chinese patients with acute poisoning. Of the 208 patients with no suspected acetaminophen ingestion, four were found to have elevated but non-toxic plasma levels.
In this population, the authors felt that routine screening of all patients with acute poisoning for toxic plasma acetaminophen concentrations was not indicated.74This said, it still seems prudent to measure an acetaminophen level in patients who take an overdose during a suicide attempt. In one study, a negative urine screen for acetaminophen obviated the need for a four-hour serum level.75Urine Analysis A urine ferric chloride test is one of the most useful urine tests in the poisoned patient. A darkening of the solution (often purple) indicates the presence of salicylates76 or phenothiazines. This suggests either myoglobinuria from muscle breakdown or hemolysis possibly due to a toxin.Urine color may also provide a diagnostic clue. These professional ?mules? differ from body stuffers, who quickly ?swallow the evidence.? Plain films of the abdomen are usually negative in stuffers80 and should not be routine. For many slightly radiodense drugs such as neuroleptics and salicylates, visibility will be dependent on the time of ingestion. When a patient presents several hours after the ingestion, the radiograph is rarely useful. Chest FilmsPatients with tachypnea, coma, or obtundation should have radiographs to search for potential causes of hypoxemia, including chemical or aspiration pneumonitis, cardiogenic or non-cardiogenic pulmonary edema, and atelectasis.




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