Goldfrank’s
MANUAL OF
TOXICOLOGIC
EMERGENCIES
EDITORS
Robert S. Hoffman, MD, FAACT, FACMT
Director, New York City Poison Center
Attending Physician, Department of Emerg...
Goldfrank’s
MANUAL OF
TOXICOLOGIC
EMERGENCIES
Robert S. Hoffman, MD, FAACT, FACMT
Lewis S. Nelson, MD, FAACT, FACEP, FACMT...
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Manufactured in the United States of America. Exc...
DEDICATED TO . . .
The staffs of our hospital emergency departments who have worked with
remarkable courage, concern, comp...
Notice
Medicine is an ever-changing science. As new research and clinical experience
broaden our knowledge, changes in tre...
vii
Contributors
Judith C. Ahronheim, MD, Chief, Division of Geriatrics, Visiting Professor of
Medicine, State University ...
viii CONTRIBUTORS
Keith K. Burkhart, MD, Professor of Clinical Emergency Medicine, Pennsylvania
State University College o...
CONTRIBUTORS ix
Kathleen A. Delaney, MD, Professor and Vice Chair, Division of Emergency
Medicine, University of Texas Sou...
x CONTRIBUTORS
Martin Griffel, MD, Director, Cardiovascular ICU, Department of Anesthesiology,
New York University Medical...
CONTRIBUTORS xi
School of Public Health, Director, Toxikon Consortium, Chief of Clinical
Toxicology, Cook County Hospital,...
xii CONTRIBUTORS
Michael McGuigan, MD, CM, MBA, Professor of Clinical Emergency Medicine,
State University of New York, St...
CONTRIBUTORS xiii
Babies and Children’s Hospital, University Hospitals of Cleveland, Cleveland,
Ohio, Chapter 78, “γ Hydro...
xiv CONTRIBUTORS
VA Medical Center, Research Professor, Department of Chemistry, Portland State
University, Portland, Oreg...
CONTRIBUTORS xv
Lisa E. Vivero, PharmD, Teaching Fellow, Trinity College, School of Pharmacy
(Pharmacology), Dublin, Irela...
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xvii
Table of Antidotes in Brief
Readers of Goldfrank’s Toxicologic Emergencies are undoubtedly aware that the ed-
itors h...
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xix
Contents
Contributors vii
Table of Antidotes in Brief xvii
Contents xix
Preface xxiii
Acknowledgments xxiv
1 Historica...
xx CONTENTS
33 Postmortem Toxicology 281
SC-1 Special Considerations: Organ Procurement from Poisoned Patients 286
PART C
...
CONTENTS xxi
F Anesthetics and Related Medications 560
64 Local Anesthetics 560
65 Inhalational Anesthetics 566
66 Neuromu...
xxii CONTENTS
105 Barium 825
106 Sodium Monofluoroacetate and Fluoroacetamide 828
107 Phosphorus 830
108 Strychnine 834
109...
xxiii
Preface
The eighth edition of Goldfrank’s Toxicologic Emergencies, published in 2006, con-
tinues to offer readers a...
xxiv
Acknowledgments
We are grateful to Joan Demas, with her commitment to detail and exceptional rigor,
who not only help...
1
1 Historical Principles
and Perspectives
The term poison first appeared in the English literature around the year 1230
A....
2 1 HISTORICAL PRINCIPLES AND PERSPECTIVES
RECENT POISONINGS AND POISONERS
Although accounting for just a tiny fraction of...
3
TABLE 1–1. Important Early Figures in the History of Toxicology
Person Date Importance
Homer ca. 850 B.C. Wrote how Ulys...
4 1 HISTORICAL PRINCIPLES AND PERSPECTIVES
full circle. Government-sanctioned execution in the United States again fa-
vor...
5 TABLE 1–2. Notable Poisoners from Antiquity to the Present
Poisoner Date Victim(s) Poison(s)
Locusta A.D. 54–55 Claudius...
6
TABLE 1–3. Protecting Our Health: Important US Regulatory Initiatives Pertaining to Xenobiotics Since 1900
Date Federal ...
7
1976 Resource Conservation and Recovery Act
(RCRA)
Authorized EPA to control hazardous waste from its generation to its ...
8
Antiquated Antidotes
Although the judicious use of some antidotes (eg, N-acetylcysteine, nalox-
one, pyridoxine) is crit...
ANTIQUATED ANTIDOTES 9
proach was associated with problems related to opioid toxicity in these un-
monitored patients. Adj...
10 ANTIQUATED ANTIDOTES
Because of the extremely rapid onset of action of caustics, concerns arose
over whether it was alr...
11
2 Toxicologic Plagues and
Disasters in History
Throughout history, mass poisonings have caused suffering and misfortune...
12 2 TOXICOLOGIC PLAGUES AND DISASTERS IN HISTORY
TABLE 2–1. Gas Disasters
Toxin Location Date Significance
Smog (SO2) Lond...
2 TOXICOLOGIC PLAGUES AND DISASTERS IN HISTORY 13
FOOD DISASTERS
Unintentional contamination of food and drink has led to ...
14 2 TOXICOLOGIC PLAGUES AND DISASTERS IN HISTORY
MEDICINAL DRUG DISASTERS
Illness and death as a consequence of therapeut...
2 TOXICOLOGIC PLAGUES AND DISASTERS IN HISTORY 15
TABLE 2–5. Alcohol and Illicit Drug Disasters
Toxin Location Date Signifi...
16 2 TOXICOLOGIC PLAGUES AND DISASTERS IN HISTORY
RADIATION DISASTERS
A discussion of mass poisonings is incomplete withou...
PART A THE GENERAL APPROACH
TO MEDICAL TOXICOLOGY
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms...
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19
3 Initial Evaluation of the
Patient: Vital Signs and
Toxic Syndromes
For more than 200 years the American medical commu...
20 PART A THE GENERAL APPROACH TO MEDICAL TOXICOLOGY
TABLE 3–1. Normal Vital Signs by Age
Age
Systolic BP
(mm Hg)
Diastoli...
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