Life-Support Measures

Before any specific treatment starts, there must be a rapid assessment of the patient s airway, ventilatory and circulatory status. Immediate life-support measures are required for patients presenting in respiratory failure or arrest and for circulatory collapse. Patients may also present with both toxic and physical trauma which may compound the situation. Box 8.1 summarises actions of toxic agents causing respiratory failure. 

Peripheral neuromuscular paralysis (depolarising as part of the cholinergic syndrome) 

There is type 2 respiratory failure in the case of nerve agent-induced ventilatory failure with build up of CO2 and the production of hypoxia Other actions of nerve agents on the airways lead to the exacerbation of respiratory problems  

Airway blockage from secretions Bronchospasm leading to increased airway resistance Cyanide agents 

Mitochondrial respiratory failure Lung-damaging agents 

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Given the severity of acute pancreatitis, patients are monitored closely in the intensive care setting. Patients with mild disease can be managed more conservatively with observation and supportive care. Critically ill patients may require surgery and aggressive life support measures.16,28... 

Erythrodermic psoriasis is a generalized, life-threatening condition that presents with erythema, desquamation, and edema, and may require life support measures as well as systemic therapy. 

Basic and advanced life-support measures should be utilized as required by the condition of the patient. 

Minimal local pain may be present initially however, systemic toxicity may be delayed for several hours. Nausea, vomiting, weakness, dizziness, and numbness have been reported. Drowsiness or euphoria may occur. Central and peripheral nervous system effects and paralysis may be quite serious, but do not always occur. Life support measures should be instituted, as necessary, with stabilization of vital signs, and evaluation of pulmonary and neurological symptoms. Antivenin may be given to a patient, based on history and circumstances of the bite. Skin testing for sensitivity to horse serum is performed when that decision is made. Patients who are treated with the antivenin need to be monitored for serum sickness. 

Basic and advanced life support measures should be utilized as necessary for atropine exposure. Gastric decontamination procedures should be employed based on the patient s history and current symptomatology. Activated charcoal can be given to adsorb atropine. The mainstay of treatment is supportive care. Physostigmine, a cholinesterase inhibitor, can be given to patients to reverse signs and symptoms of... 

Basic and advanced life-support measures should be implemented as necessary. Gastrointestinal decontamination procedures should be used as appropriate based on the patient s level of consciousness and history of ingestion. Activated charcoal can be used to adsorb the benzodiazepines. The patient s level of consciousness and vital signs should be monitored closely. Obtunded patients with reduced gag reflex should be intubated to prevent pulmonary aspiration. Respiratory support, including oxygen and ventilation, should be provided as needed. If hypotension occurs it should be treated with standard... 

Basic life-support measures for respiratory and cardiovascular functions should be utilized. Dermal decontamination should be accomplished by repeated washing with soap. Exposed eyes should be irrigated with copious amounts of room-temperature water for at least 15 min. 

Basic and advanced life-support measures should be utilized as necessary. Treatment is generally symptomatic and supportive. Gastrointestinal evacuation procedures are generally unnecessary. If the patient is alert and able to swallow, milk or water should be immediately offered, stopping if vomiting occurs during administration. Administration of an acidic substance to neutralize sodium hypochlorite is contraindicated. 

Basic and advanced life-support measures should be utilized. Activated charcoal without a cathartic may be used in early decontamination. Most ingestions are self-limiting. Treatment after decontamination is symptomatic and supportive. Monitoring of fluids and electrolytes is recommended for symptomatic patients. If a significant ingestion of anthraquinones does occur, Borntrager s reaction may occur (red color is seen in alkaline urine and a yellow-brown color in acid urine). No other specific laboratory tests are available to assist in diagnosis and treatment. 

In case of contact, the eyes and skin should be flushed with water for 15-20 min. For inhalation exposure, the victim should be moved to fresh air. Oxygen and artificial respiration should be administered, if necessary. If the patient is in cardiac arrest, cardiopulmonary resuscitation should be given. Life-support measures should be continued until medical assistance has arrived. In the case of an unconscious or convulsing person, liquids should not be administered and vomiting should not be induced. 

All basic and advanced life-support measures should be implemented. Gastric decontamination should be performed. Butyrophenones are readily absorbed by activated charcoal. Aggressive supportive care should be instituted. Dystonic reactions respond well to intravenous benztropine or diphenhydramine. Oral therapy with diphenhydramine or benztropine should be continued for 2 days to prevent recurrence of the dystonic reaction. For patients suffering from neuroleptic malignant syndrome, a potentially fatal condition associated with the administration of antipsychotic drugs, dantrolene sodium, and bromocriptine have been used in conjunction with cooling and other supportive measures. Arrhythmias should be treated with lidocaine or phenytoin. Diazepam is the drug of choice for seizures phenytoin is used to prevent recurrence. Hemodialysis and hemoperfu-sion have not been shown to be effective. 

Basic and advanced life-support measures should be implemented as necessary. In patients presenting within Ih of ingestion, activated charcoal should be administered. In the event of depressed consciousness or seizures, airway protection should first be secured. Sodium bicarbonate, epinephrine, and high-dose diazepam should be used to treat cardiotoxicity. Diazepam is recommended for the treatment of seizures. Methods of extracorporeal drug removal, such as hemoperfusion and hemodialysis, are ineffective. 

Though the clinical need for such measures would be expected to be rare, basic and advanced life-support measures as well as aggressive decontamination may be instituted as clinically necessary. Gastric decontamination with a single dose of activated charcoal will effectively adsorb ingested cimetidine. 

Basic and advanced life-support measures should be performed as necessary. Gastrointestinal decontamination procedures should be considered for substantial recent ingestions. Activated charcoal will adsorb codeine. Patients with respiratory or CNS depression can be treated with intravenous boluses of naloxone. A continuous naloxone infusion may be necessary if the toxic effects of codeine persist longer than the duration of action of naloxone. 

Basic and advanced life-support measures should be utilized as necessary. Treatment of colchicine toxicity is largely supportive. Activated charcoal effectively adsorbs colchicines and should be administered for substantial recent ingestions. Aggressive early gastrointestinal decontamination may be life saving. Severe anemia may require packed red blood... 

Treatment is based on the patient s clinical presentation. Basic and advanced life support measures should be performed as needed. Activated charcoal may be utilized to adsorb orally administered fentanyl, such as the ingestion of a fentanyl patch. Whole bowel irrigation should be considered to speed the... 

Basic and advanced life support measures should be initiated immediately. Activated charcoal may be utilized to adsorb illicit fentanyl derivatives following ingestion. Naloxone is the specific pharmacologic antagonist for fentanyl derivatives. Naloxone displaces these agents at the opioid receptor and reverses their clinical effects however, higher than customary doses may be needed to successfully overcome the opioid receptor. 

There is no antidote for fenvalerate. Treatment is primarily supportive. The victim should be monitored for the development of respiratory distress, seizures, and hypersensitivity reactions. Convulsions are often treated with diazepam. Prevention of absorption may be accomplished by gastric lavage followed by activated charcoal. Some formulations include solvents so care should be taken to protect against pulmonary effects during lavage. Basic and advanced life-support measures should be used as necessary. 

All basic and advanced life-support measures should be implemented. Gastric decontamination should be performed. Fluoxetine is readily adsorbed by activated charcoal and charcoal should be considered for substantial recent ingestions. Aggressive supportive care should be instituted. There is no specific antidote for fluoxetine overdose. Hemoperfusion and hemodialysis are ineffective. 

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