tailieunhanh - Manual of the intensive care unit (Second edition): Part 2

(BQ) Continued part 1, part 2 of the document Manual of the intensive care unit (Second edition) has contents: Community-Acquired pneumonia, acute neuromuscular weakness, brain death and management of potential organ donors, neurologic assessment and prognosis after cardiopulmonary arrest, status epilepticus, and other contents. Invite you to refer. | CHAPTER Drug Overdoses and Toxic Ingestions Pia Chatterjee Jeanmarie Perrone Successful management of patients after a life-threatening drug overdose depends on emergency medical system EMS and emergency department ED personnel 1 initiating the critical interventions of airway management and cardiovascular stabilization 2 simultaneously obtaining a thorough history and 3 targeting specific therapies based on the suspected exposure. Communication between the ED and the intensive care unit ICU will be paramount for continuing successful resuscitations in the ICU. Not all drug overdoses are intentional. Toxic ingestions may be accidental or result from the ingestion of products stored inappropriately for example lye stored in a soda bottle. Iatrogenic dosing errors and excess self-medication of drugs with narrow therapeutic toxic ratios salicylates lithium digoxin also occur. Occasionally chronic medications precipitate acute toxicity caused by a drug interaction or a change in drug metabolism. Acute management of poisoned patients will depend on the ingestion however disposition of patients following ICU care depends on whether or not the overdose was intentional. Although deep sedation and coma in patients admitted to the ICU may be attributed to a drug ingestion patients with unclear histories should undergo evaluation for other causes of altered mental status. Intracranial pathologic conditions should be excluded by computed tomographic CT scan of the head and lumbar puncture should be considered in febrile patients. The regional poison center is an additional important resource in the management of any suspected poisoning including those resulting from new recreational drugs with serious toxic side effects such as bath salts or synthetic cannabinoids K2 Spice and new therapies including use of lipid therapy for hemodynamically significant poisonings. Mechanisms of Injury DIRECT DRUG EFFECTS Nearly all drugs produce harmful effects if taken in excessive amounts. .