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The Gist of Emergency Medicine - part 9

tham khảo tài liệu tham khảo, ví dụ: chì, thạch tín, thủy ngân. → Tất cả các can thiệp với hoạt động của enzyme bằng cách gắn các nhóm sulfhydryl, dẫn đến biểu hiện thần kinh, tim mạch, tiêu hóa, huyết học, và thận ± những người khác. → Chẩn đoán → Ví dụ: đường dẫn hơi xanh nướu và xương dài | The Gist of Emergency Medicine 153 L ABC s and supportive care for example ringers prn bicarb prn blood products prn 50 dextrose prn gastric lavage prn whole bowel irrigation prn x-rays will demonstrate the iron tablets deferoxamine mesylate 15mg kg hr I.V. prn to 6 grams day until the urine is no longer pink no free plasma iron give the deferoxamine on clinical impression before the serum iron level is back maintain an adequate urine output continue the deferoxamine if the patient is put on charcoal hemoperfusion dialysis gastrotomy prn. B Heavy metal poisoning consult references e.g. lead arsenic mercury. All interfere with enzyme activity by attaching to the sulfhydryl groups resulting in neurological cardiovascular gastrointestinal hematological and renal manifestations others. Diagnosis e.g. bluish gingival and long bone lead lines metallic flecks on abdominal. x-rays basophilic stippling of RBC s elevated blood lead levels elevated 24 hour urine arsenic or mercury levels. Arsenic poisoning may result from naturally occurring contaminated well water. L ABC s treat for example seizures arrhythmias hypotension renal failure decontaminate prn e.g. gastric lavage prn charcoal prn whole bowel irrigation prn chelation therapy prn for example BAL CaNa2 - EDTA D-penicillamine 2 3-DMSA dialysis prn. Prevent reoccurrence. Evaluate family significant others and coworkers prn. 20 Tar and asphalt burns L ACBC s cool with H2O prn use neosporin polysporin ung to dislodge from skin burn care. 21 TWENTY-ONE A Hydrocarbon poisoning epinephrine contraindicated. remember to decontaminate the skin prn. 1 Liquid petroleum distillates e.g. kerosene gastric lavage only if it contains a toxic substance e.g. pesticide look for chemical pneumonitis delayed 24hrs . Poisoning The Gist of Emergency Medicine 154 L ABC s 100 O2 prn and supportive care. 2 Gases e.g. propane asphyxia intoxication arrhythmias. L ABC s 100 O2 prn and supportive care. Hyperbaric O2 3 Solvents e.g. benzene epoxy .