ravilya internal - toxycology

Management. The initial evaluation of a patient who has been poisoned involves attempting to
find out the nature of the toxin ingested. At the same time, history and physical examination
can give clues to the nature of the toxin. In this patient, the key issue is the short time between
the ingestion and his arrival in the emergency department. He is awake and alert, and there is a
short time interval since the ingestion.

Toxidromes
Associated Physical Findings in Specific Toxidromes
• Miosis: clonidine, barbiturates, opiates, cholinergics, pontine stroke
• Mydriasis: sympathomimetics, anticholinergics
• Dry skin: anticholinergics
• Wet skin: cholinergics, sympathomimetics
• Blisters: barbiturates, carbon monoxide poisoning

Gastric emptying is rarely, if ever, utilized. In ingestions of an unknown type, a urine or blood
toxicology screen should be performed, but this should not delay the administration of antidotes,
charcoal, or gastric emptying in the rare circumstances in which emptying is indicated.
Induced vomiting. Ipecac only can be used within 1-2 hours after ingestion; therefore,
ipecac has extremely limited usein the hospital. This is because very few people arrive
within the first hour. In addition, ipecac can delay the use of oral antidotes such as charcoal
or N-acetyl cysteine because of the vomiting it induces. Ipecac is more useful for
ingestions in the home, in which the time period since ingestion is short and there are