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concept_intro_to_toxicology_patient [2025/05/12 20:18] – [7.2 Decontamination] jkohtsconcept_intro_to_toxicology_patient [2025/05/13 09:49] (current) – ↷ Links adapted because of a move operation 3.230.224.6
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 ===== - Investigations ===== ===== - Investigations =====
  
-The following investigations may be useful to perform:+The following investigations may be useful.
  
 +
 +**Laboratory tests**
   * **Blood gas**  analysis to assess gas exchange and metabolic disturbance particularly in patients with altered level of consciousness.   * **Blood gas**  analysis to assess gas exchange and metabolic disturbance particularly in patients with altered level of consciousness.
   * **Blood glucose **especially important in those with an altered level of consciousness.   * **Blood glucose **especially important in those with an altered level of consciousness.
-  * **Paracetamol concentration**  is often tested routinely when a patient is not alert enough to give a reliable risk assessment. 
-  * **ECG**  assessing for QT prolongation or evidence of sodium channel blockade. 
   * **Electrolytes, renal function, liver function tests**.   * **Electrolytes, renal function, liver function tests**.
   * **CK**  if rhabdomyolysis is suspected on risk assessment, particularly following long lie.   * **CK**  if rhabdomyolysis is suspected on risk assessment, particularly following long lie.
 +
 +**Toxicology tests**
 +  * **Paracetamol concentration**  is often tested routinely when a patient is not alert enough to give a reliable risk assessment.
   * Specific **drug concentrations**  (e.g. valproate, carbamazepine, lithium) may be helpful if results are available in a clinically useful timeframe.   * Specific **drug concentrations**  (e.g. valproate, carbamazepine, lithium) may be helpful if results are available in a clinically useful timeframe.
   * **Urinary drug screens**  have limited utility in a toxicology patient, they confirm the presence of some drug classes which are commonly misused, however false positives and negatives occur.   * **Urinary drug screens**  have limited utility in a toxicology patient, they confirm the presence of some drug classes which are commonly misused, however false positives and negatives occur.
-  * **CXR**  if evidence of aspiration.+ 
 + 
 +**Cardiac investigations** 
 +  * **ECG**  assessing for QT prolongation or evidence of sodium channel blockade.
   * **Bedside echocardiography**  in patients with haemodynamic instability to determine the contribution of negative inotropy versus vasodilation.   * **Bedside echocardiography**  in patients with haemodynamic instability to determine the contribution of negative inotropy versus vasodilation.
 +
 +**Radiology studies**
 +  * **CXR**  if evidence of aspiration.
   * **CT head**  if concerns for concurrent trauma or hypoxic brain injury.   * **CT head**  if concerns for concurrent trauma or hypoxic brain injury.
-More in depth description of some investigations can be found in appropriate sections ([[:wikitox:arterial_blood_gases|Bloods Gases]] , [[:wikitox:ecg_changes|ECG]]) or in specific drug monographs.+ 
 +More in depth description of some investigations can be found in appropriate sections ([[concept_blood_gas_analysis|Bloods Gas Analysis]] , [[concept_ecg_changes|ECG]]) or in specific drug monographs.
  
  
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 Antidotes for poisonings have existed for thousands of years and the term refers to a wide range of substances that ameliorate poisonings. Broad mechanisms of action of antidotes include reducing absorption, restoring function, or treating effects of poisoning. Examples of antidotes used currently are supplied in the following table (click to enlarge). Antidotes for poisonings have existed for thousands of years and the term refers to a wide range of substances that ameliorate poisonings. Broad mechanisms of action of antidotes include reducing absorption, restoring function, or treating effects of poisoning. Examples of antidotes used currently are supplied in the following table (click to enlarge).
  
-{{  :wikitox:antidotes.png?direct&400  }}+{{  antidotes_list_buckley_2016.png?direct&400  }}
  
 ==== - Supportive Treatment ==== ==== - Supportive Treatment ====
  
-Good supportive care is the mainstay of managing the poisoned patient. It involves;+Good supportive care is the mainstay of managing the poisoned patient. It involves but is not limited to the following.
  
   * Maintaining hydration with IV fluids   * Maintaining hydration with IV fluids
   * Placing a urinary catheter if there is urinary retention   * Placing a urinary catheter if there is urinary retention
-  * Treating agitation with sedation (eg benzodiazepines)+  * Treating agitation with sedation (e.g. benzodiazepines)
   * Adequate thromboprophylaxis   * Adequate thromboprophylaxis
-  * Prevent of pressure areas+  * Prevent of pressure area damage
   * Treating nausea with antiemetics   * Treating nausea with antiemetics