Master the board step 3

Emergency Medicine/Toxicology
Treatment
Treatment is as follows:
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Alkalinize the urine to increase excretion.
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Use charcoal to block absorption.
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Dialysis is used in severe cases.
CCS Tip: Alkalinize the urine with D5W with 3 amps of bicarbonate. Alkalinization
of the urine facilitates excretion of the following:
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Salicylates (ASA)
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Tricyclic antidepressants (This will show up on the urine tox you ordered.)
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Phenobarbital
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Chlorpropamide
Benzodiazepines
Benzodiazepine overdose (by itself) is not fatal. Let the patient sleep! Move the
clock forward on CCS, and the overdose will pass.
Do not administer flumazenil for benzodiazepine overdoses to patients in the
emergency department. You do not know who has chronic dependency, and
flumazenil can induce benzodiazepine withdrawal and seizures.
On CCS, remember
to order an aspirin,
acetaminophen, and
alcohol (ETOH) level on all
overdose patients. There
is a very high frequency of
co-ingestion.
Carbon Monoxide
The most common cause of death in fires is carbon monoxide (CO) poisoning;
60 percent of deaths in the first 24 hours after a fire are due to carbon
monoxide poisoning.
Carboxyhemoglobin (COHg) does not release oxygen to tissues. Hence, CO
poisoning is the same as anemia and asphyxiation. CO poisoning presents
with the following:
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Shortness of breath
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Lightheadedness and headaches
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Disorientation
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Severe disease causes metabolic acidosis from tissue hypoxia.
CO poisoning also commonly presents in families that are “snowed in” and
can’t leave their house with a wood-burning stove. Everyone is fatigued and has
a headache. Look for the phrase “He feels better when he is shoveling snow.”
Treatment
If CO poisoning is suspected, call an ambulance. Give 100 percent oxygen to
all survivors from a fire until you have their CO levels.
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