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Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 47-54

High-yield toxicology: Essential facts for the critical care boards

1 The Reading Hospital Trauma Center, University of Pennsylvania Trauma Network, Reading, PA, USA
2 OPUS 12 Foundation, Bethlehem, PA, USA

Correspondence Address:
Stanislaw P Stawicki
OPUS 12 Foundation, 304, Monroe Boulevard, King of Prussia, PA 19406 SA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_3_17

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Key points: (a) It is imperative that critical care practitioners are familiar with the most commonly encountered types of poisoning and toxicity– early recognition and appropriate intervention are crucial when approaching patients affected by toxins and poisons; (b) Acetaminophen toxicity has four distinct stages, predictable toxicity within 4-24 h of exposure, and can be treated with N-acetylcysteine administration; (c) Anticholinergic toxicity is associated with characteristic signs and symptoms, including hyperthermia, dry skin, flushing, mydriasis and delirium; (d) Cyanide poisoning can be rapidly fatal– early recognition and treatment with thiosulfate, hydroxycobalamin, or amyl nitrate are essential; (e) Digitalis toxicity is associated with either increased drug level or increased sensitivity to the drug, and can produce a variety of symptoms (mostly non-specific)– cardiac arrhythmias constitute the most common cause of mortality; (f) Lithium toxicity can result in severe neurologic and cardiovascular symptoms– dialysis may be indicated in cases of severe toxicity or concurrent renal failure; (g) Organophosphate poisoning is characterized by muscarinic side effects, nicotinic side effects and central nervous system toxicity– muscarinic symptoms seen in acute organophosphate poisoning can be remembered by the use of the mnemonic DUMBELS (defecation, urination, miosis, bronchorrhea, bronchospasm, bradycardia, emesis, lacrimation, and salivation). The following core competencies are addressed in this article: Medical knowledge, Patient care. Republished with permission from: Reilly EF, Stawicki SP. High-yield toxicology: Essential facts for the critical care boards. OPUS 12 Scientist 2008;2(1):33-38.

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