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The Gist of Emergency Medicine - part 4

Thuốc quá liều, ví dụ: tricyclics (bicarb prn), digoxin (bicarb prn, MgSO4 prn, Dilantin ® prn, digibind ® prn), thuốc chẹn canxi (calcium gluconate prn, glucagon prn), các thuốc chẹn beta (glucagon prn). 2. Hít phải khói / carbon monoxide và / hoặc nhiễm độc cyanide / từ đốt cháy các vật liệu nội thất tổng hợp | The Gist of Emergency Medicine 58 1. Drug overdoses e.g. tricyclics bicarb prn digoxin bicarb prn MgSO4 prn dilantin prn digibind prn calcium blockers calcium gluconate prn glucagon prn beta blockers glucagon prn . 2. Smoke inhalation carbon monoxide and or cyanide poisoning from burning synthetic furniture materials 100 O2 sodium thiosulfate 25 1mL kg to 50mL prn converts cyanide to nontoxic thiocyanate early presumptive therapy Hyperbaric O2 chamber prn. 3. Hypothermia core rewarming prn bretylium prn . 4. Tension pneumothorax cardiac tamponade needle decompression prn . 5. Others e.g. shock ringers prn anoxia ventilate prn acidosis bicarb prn hyperkalemia bicarb prn pulmonary embolism 100 O2 heparin thrombolytics surgery trauma thoracotomy . A Ventricular fibrillation or pulseless ventricular tachycardia L Precordial thump BCLS ACLS defibrillate immediately with 200J and repeat X 2 prn 200J 360J then prn . Epinephrine prn lidocaine prn consider bicarbonate bretylium prn procainamide prn amiodarone prn consider MgSO4. hypothermic cardiac arrest see also 2 p.156. B Ventricular tachycardia with a pulse L Precordial thump BCLS ACLS lidocaine prn procainamide prn consider bretylium cardioversion prn usually synchronized 50 J sedation prn cardiovert unstable patients prn e.g. ischemic chest pain CHF hypotension decreased cerebral status . Accelerated idioventricular rhythm slow ventricular tachycardia usually requires no treatment. Beware of iatrogenic ventricular tachycardia secondary to for example quinidine hyperkalemia or type 1C antiarrhythmics e.g. rythmol . See also 12 p.69. C Asystolic cardiac arrest L precordial thump BCLS ACLS epinephrine prn atropine prn if in doubt defibrillate prn fine ventricular fibrillation consider bicarbonate consider immediate transcutaneous pacing. Hypothermic cardiac arrest see also 2 p.156. D Electromechanical dissociation EMD also referred to as pulseless electrical activity PEA . CPR - Electrolytes - Acid - Base The Gist of .